Relationship between Random Blood Glucose, Fasting Blood Glucose, and Gensini Score in Patients with Acute Myocardial Infarction

Objective. To examine the relationship between admission random blood glucose (RBG), fasting blood glucose (FBG), and Gensini score in patients with acute myocardial infarction (AMI) to clarify the effects of RBG and FBG on the severity of coronary artery disease. Method. A total of 958 consecutive AMI patients who underwent emergency coronary angiography at the Cardiology Department of Zhongda Hospital (affiliated with Southeast University) were enrolled in this study from January 1, 2016, to December 31, 2018. The Gensini score of each patient was calculated according to the results of coronary angiography. The RBG, FBG, baseline data, hematological indexes, echocardiography parameters, coronary angiography data, and the use of intra-aortic balloon pump (IABP) were recorded. Patients with an RBG level >11.1 mmol/L were classified into the stress hyperglycemia group, and those with an FBG level >7.0 mmol/L were classified into the elevated FBG group. The Gensini scores in the stress hyperglycemia and elevated FBG groups were compared to those in the control group, and correlations between the RBG and FBG levels and the Gensini scores of AMI patients were evaluated. Independent risk factors for the Gensini score were analyzed by multiple linear and multiple logistic regression analyses. Results. The Gensini scores of the stress hyperglycemia group and the elevated FBG group were higher than those of the control group. RBG and FBG were positively correlated with the Gensini score, and there were significant differences between RBG and FBG in different Gensini score groups. After adjusting for confounding factors, multiple linear regression analysis showed that sex, diabetes, estimated glomerular filtration rate (eGFR), and FBG were independent risk factors for the Gensini score. Multiple logistic regression analysis showed that age and FBG were independent risk factors in group 2 compared to group 1, eGFR and FBG were independent risk factors in group 3, and eGFR and FBG were independent risk factors in group 4. Diabetes and RBG were not independent risk factors for the Gensini score. Conclusion. The Gensini scores of patients in the stress hyperglycemia group and the elevated FBG group were significantly higher than those in the control group. RBG and FBG were positively correlated with the Gensini score in AMI patients, and FBG was an independent risk factor for the Gensini score in AMI patients.

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Prevalence of chronic renal insufficiency in the Chinese population: A cross-sectional study

10.21203/rs.3.rs-17894/v1 ◽

2020 ◽

Author(s):

Lingling Xu ◽

Jin Liu ◽

Dongling Li ◽

Hua Yang ◽

Kechuan Shi ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Heart Rate ◽

Blood Glucose ◽

Renal Insufficiency ◽

Chronic Renal Insufficiency ◽

Central Obesity ◽

Fasting Blood Glucose ◽

Female Sex ◽

Independent Risk Factors

Abstract Background: The prevalence of chronic kidney disease (CKD) is increasing worldwide, and it has become a global health issue with a high economic burden. Chronic renal insufficiency (CRI), the most severe form of CKD, is associated with increased risks of cardiovascular disease, premature mortality, and decreased quality of life. However, epidemiological information on Chinese patients with CRI is still lacking. This study aimed to investigate the prevalence and epidemiological features of CRI in China. Methods: A total of 395,541 individuals aged ≥ 18 years residing in Binhai county, China were enrolled. e estimated the prevalence of CRI adjusting for age and sex. Associations of age, sex, blood pressure, body mass index, heart rate, and fasting blood glucose and triglyceride levels with CRI were examined. Odds ratios were calculated using a binary logistic regression model. Data were obtained from the records of universal health examinations of Binhai county residents conducted from January to December 2018. Results: The overall adjusted prevalence of CRI was 1.10% (95% confidence interval [CI], 1.07%-1.13%) in this Chinese adult population. The prevalence was 0.86% among men (95% CI, 0.82%-0.90%) and 1.34% among women (95% CI, 1.29%-1.39%). Female sex, age (per 10-year increase), central obesity, triglyceride levels (per 118-mg/dl increase), systolic blood pressure (per 10-mmHg increase), heart rate (per 10-beats/min increase) and fasting blood glucose ≥ 100 mg/dl were found to be independent risk factors for CRI. Conclusions: The overall prevalence of CRI in Chinese adults was 1.10%. Age, female sex, central obesity, higher triglycerides, SBP, heart rate and elevated fasting glucose levels were all independent risk factors associated with decreased eGFR. Health policies to prevent CRI are urgent among this population.

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Association of Risk Factors and Glycemic Status in Hospital Patients of Different Types of Myocardial Infarction in a Tertiary Care Hospital

Bangladesh Critical Care Journal ◽

10.3329/bccj.v5i1.32534 ◽

2017 ◽

Vol 5 (1) ◽

pp. 3-6

Author(s):

Aparna Rahman ◽

Md Babul Miah ◽

Shabnam Jahan Hoque ◽

Md Zahid Alam ◽

SM Rezaul Irfan ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Blood Glucose ◽

Hba1c Level ◽

Fasting Blood Glucose ◽

Care Hospital ◽

Glycemic Status ◽

Significant Difference ◽

Different Types ◽

St Elevation

Background: Glycometabolic state at hospital admission is an important risk marker for long-term mortality in patients with acute myocardial infarction. Our aim was to ascertain the associated risk factors and glycemic status in patients with different types of myocardial infarction, and to assess whether such abnormalities can be identified in the early course of myocardial infarction.Methodology: This cross sectional observational study was carried out enrolling 100 subjects with ST elevation (42 subjects) and non ST elevation (58 subjects) myocardial infarction, in the Department of Cardiology, BIRDEM General Hospital, Shahbagh, Dhaka, over a period of six months from January 2012 to June 2012. We did fasting blood glucose and glycatedhaemoglobinA1C (HbA1C) level next day following admission with or without history ofdiabetes mellitus and observed the difference between two types of myocardial infarction (ST elevation and non ST elevation ).Results: Mean age and gender difference was significant between ST elevation and non ST elevationmyocardial infarction. Significant differences in pre-existing risk factors such as Diabetes (95.2%,vs 86.2% ), Dyslipidemia (72.91%, vs 44.82%), Hypertension (79.16%, vs 36.2%) and family history of Ischemic Heart Disease(75%, vs 29.31%) were observed between ST elevation and non ST elevation groups. It was revealed that mean fasting blood glucose (FBG) in ST elevation and non ST elevation was 10.23 mmol/l and 8.42 mmol/l respectively. Mean HbA1C level was 9.2% and 8.9% in ST elevation and non ST elevation. Significant difference in fasting blood glucose and HbA1C was observed between ST elevation and non ST elevation group.Conclusion: Glycemic status is relatively more uncontrolled in ST elevated MI and must be managed with all possible therapeutic modules to minimize further complications.Bangladesh Crit Care J March 2017; 5(1): 3-6

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Low Expression of FFAR2 in Peripheral White Blood Cells May Be a Genetic Marker for Early Diagnosis of Acute Myocardial Infarction

Cardiology Research and Practice ◽

10.1155/2020/3108124 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8 ◽

Cited By ~ 2

Author(s):

Jianjun Ruan ◽

Heyu Meng ◽

Xue Wang ◽

Weiwei Chen ◽

Xiaomin Tian ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Risk Factor ◽

Blood Glucose ◽

Peripheral Blood ◽

Fasting Blood Glucose ◽

Control Group ◽

Fasting Blood Glucose Level ◽

The Relationship ◽

Low Expression

Objective. To find molecular markers for the diagnosis of acute myocardial infarction (AMI), this research further verified the relationship between the expression level of FFAR2 gene and AMI by expanding the sample size based on the previous gene chip results. Methods. Peripheral venous leukocytes were collected from 113 patients with AMI and 94 patients with noncoronary artery disease as the experimental group and the control group, respectively. Real-time fluorescence quantitative polymerase chain reaction was used to detect the expression of the FFAR2 gene. Western blot analysis was applied to detect the relative expression of the FFAR2 gene at the level of protein. Furthermore, the relationship between gene expression and clinical data was also analyzed and compared. Results. The level of expression of FFAR2 gene in peripheral blood of patients with AMI was significantly lower than that of the control group (0.33 [0.04–1.08], 0.62 [0.07–1.86], respectively; p<0.05), which was 0.53 times that of the control group. Western blot results presented that the FFAR2 protein level in the peripheral blood of the AMI group was lower than that of the control group (0.114; p=0.004). Analyzing clinical data of the subjects indicated that the average age of the AMI group was significantly higher than the age of control group (p<0.01). Also, the fasting blood glucose level was higher (p<0.01), and the high-density lipoprotein cholesterol (HDL-C) level was lower (p=0.03). The FFAR2 mRNA level correlated positively with the HDL-C level (p<0.01). Logistic regression analysis suggested that the low expression of the FFAR2 gene in peripheral blood may be a risk factor for AMI independent of age, family history of diabetes, fasting blood glucose level, and HDL-C level (p=0.025). Compared with the high FFAR2 expression group, the risk of AMI in the low FFAR2 expression group was 6.308 times higher. Conclusion. The expression level of the FFAR2 gene in peripheral blood of patients with AMI was significantly lower than that in the control group. Low expression of the FFAR2 gene in peripheral blood is an independent risk factor for AMI. Hence, it may also be a potential biomarker to predict AMI.

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Effect of Regular Physical Activity and Lifestyle Changes on Insulin Resistance in Patients after Kidney Transplantation

10.21203/rs.3.rs-549736/v1 ◽

2021 ◽

Author(s):

Graňák Karol ◽

Vnučák Matej ◽

Skálová Petra ◽

Pytliaková Margaréta ◽

Laca Ľudovít ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Insulin Resistance ◽

Blood Glucose ◽

Waist Circumference ◽

Fasting Blood Glucose ◽

Lifestyle Changes ◽

Regular Physical Activity ◽

Moderate Intensity ◽

Control Group

Abstract Introduction: Insulin resistance (IR) at the time of kidney transplant (KT) is the most significant risk factor for the development of post-transplant diabetes mellitus (PTDM) and is a strong predictor of cardiovascular morbidity and mortality in patients after KT. It is possible to improve long-term survival of grafts and patients by influencing just modifiable risk factors, including obesity and the associated IR. The aim of this work is to determine the effect of regular physical activity and lifestyle changes on IR and other risk factors for PTDM in patients after KT.Material and methods: The primary goal was to complete at least 150 minutes of moderate intensity physical exertion per week. Study group (n = 22) performed an aerobic or combined (aerobic + anaerobic) type of sports activity. Monitoring was provided by a sports tracker (Xiaomi Mi Band 4 compatible with Mi Fit mobile application). Control group was consisted of 22 stable patients after KT. Patients in both groups have the same immunosuppressive protocol. The duration of follow-up was 6 months.Results: There were significantly lower waist circumference (P = 0.0437, P = 0.0372), better graft function (P = 0.0036, P = 0.0137), lower value of fasting blood glucose (P = 0.0016, P = 0.0003), C-peptide (P = 0.0447, P = 0014) in the 3rd and 6th month of monitoring and lower low-density lipoprotein at 6 months (P = 0.0444) in the observed group compared to the control group. IR was statistically significantly lower at 6 months (P = 0.0202) and fasting blood glucose at 3 and 6 months (P = 0.0227) in the observed group. In the monitored group, the subgroup performing intensive training achieved a significant additional effect on the reduction of waist circumference (P = 0.0173). Conclusion: In our study, we confirmed a significant effect of regular physical activity in preventing the development of IR and impaired fasting glucose in patients after KT. It is necessary to perform at least 150 minutes of medium-intensity aerobic or combined sport effort per week to achieve this goal.

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MO933EFFECT OF PHYSICAL ACTIVITY AND LIFESTYLE CHANGES ON INSULIN RESISTANCE IN PATIENTS AFTER KIDNEY TRANSPLANTATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab110.0012 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Karol Graňák ◽

Vnucak Matej ◽

Petra Skálová ◽

Margaréta Pytliaková ◽

Ľudovít Laca ◽

...

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Risk Factors ◽

Insulin Resistance ◽

Kidney Transplantation ◽

Blood Glucose ◽

Fasting Blood Glucose ◽

Lifestyle Changes ◽

Control Group

Abstract Background and Aims The incidence of post-transplant diabetes mellitus (PTDM) after kidney transplantation (KT) is high and ranges from 15-30%. Insulin resistance (IR) at the time of KT is the most significant risk factor for the development of PTDM in patients after KT, as demonstrated by several analyzes. It is possible to reduce the high incidence of PTDM by influencing just modifiable risk factors, including obesity and the associated IR. The aim of this work is to determine the effect of precisely determined physical activity and lifestyle changes on IR and other risk factors for PTDM in patients after KT. Method This is a prospective controlled analysis, which included 44 patients after primary KT in the Martin Transplant Center. Half consisted of a study group (n = 22) whose patients were assigned to perform regular physical activity. The primary goal was to complete at least 150 minutes of moderate intensity physical exertion per week. They performed an aerobic or combined (aerobic + anaerobic) type of sports activity. Monitoring was provided by a sports tracker (Xiaomi Mi Band 3 compatible with Mi Fit mobile application). The other half was made up of a control group. The exclusion criterion at that time was already diagnosed with diabetes mellitus or a pre-diabetic condition. IR was assessed using the HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) index from fasting blood glucose and insulinemia values. Each patient underwent an oral glucose tolerance test (oGTT) at the end of follow-up. Patients in both groups have the same immunosuppressive protocol. The duration of follow-up was 6 months. Results In the observed group we univariately found in the 3rd and 6th month of monitoring significantly lower waist circumference (P = 0.0437, P = 0.0372), better graft function (P = 0.0036, P = 0.0137), lower value glycemia (P = 0.0016, P = 0.0003), C-peptide (P = 0.0447, P = 0014) and lower low-density lipoprotein (LDL) at 6 months (P = 0.0444) compared to the control group. We confirmed a statistically significantly lower IR at 6 months (P = 0.0202) and fasting blood glucose at 3 and 6 months (P = 0.0227) by multivariate analysis in the observed group. After the end of the follow-up, we identified statistically significantly fewer patients with a negative oGTT result in the control group (P < 0.0001), significantly more patients with impaired glucose tolerance, fasting hyperglycemia (P = 0.0078) and diagnosed with PTDM (P = 0.0212). In the control group, we found a statistically significant increase in glycemia at 30 (P = 0.0034) as well as at 120 minutes (P = 0.0011) during oGTT compared to the observed group. Conclusion In our study, we confirmed a significant effect of regular physical activity in preventing the development of IR and associated pre-diabetic conditions and PTDM.

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Anti-diabetic activity of diphenhydramine in diabetic rats

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i4.3102 ◽

2020 ◽

Vol 11 (4) ◽

pp. 5067-5070

Author(s):

Pang Jyh Chayng ◽

Nurul Ain ◽

Kaswandi Md Ambia ◽

Rahim Md Noah

Keyword(s):

Blood Glucose ◽

Blood Glucose Level ◽

Glucose Level ◽

Fasting Blood Glucose ◽

Insulin Level ◽

Diabetic Rats ◽

Group Iv ◽

Diabetic Rat ◽

Control Group ◽

Group I

The purpose of this project is to study the anti-diabetic effect of on a diabetic rat model. A total of Twenty male Sprague rats were used and it randomly distributed into four groups which are Group I: , Group II: negative control, Group III: and Group IV: and . In diabetic model were induced with via injection at the dosage of 65mg/kg. and FBG (Fasting Blood Glucose) level of diabetic rats were assessed every three days. Blood was collected via cardiac puncture at day 21 after the induction of treatment. Insulin level of the rats was assessed with the Mercodia Rat Insulin ELISA kit. FBG level of group I (12.16 ±3.96, p<0.05) and group IV (11.34 ±3.67, p<0.05) were significantly decreased. Meanwhile, the for all rats did not show any significant increase. However, the insulin level was escalated in group IV (0.74+0.25, p<0.05) significantly. The present study shows that the and the combination of and lowered blood glucose level and enhanced insulin secretion.

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CARDIOVASCULAR RISK FACTORS PECULIARITIES IN MEN UNDER 60 YEARS OLD WITH MYOCARDIAL INFARCTION AND CHRONIC INFLAMMATORY LUNG DISEASES

"Medical & pharmaceutical journal "Pulse" ◽

10.26787/nydha-2686-6838-2020-22-9-21-25 ◽

2020 ◽

pp. 21-25

Author(s):

Tupitsyn V.V. ◽

Bataev Kh.M. ◽

Men’shikova A.N. ◽

Godina Z.N.

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Heart Disease ◽

Cardiovascular Risk ◽

Digestive System ◽

Control Group ◽

Study Group ◽

Type I ◽

Internal Organs ◽

History Of

Relevance. Information about the cardiovascular diseases risk factors (CVD RF) for in men with chronic lung inflam-matory pathology (CLID) is contradictory and requires clarification. Aim. To evaluate the peculiarities of CVD RF in men under 60 years of age with CLID in myocardial infarction (MI) to improve prevention. Material and methods. The study included men aged 19-60 years old with type I myocardial infarction. Patients are divided into two age-comparable groups: I - the study group, with CLID - 142 patients; II - control, without it - 424 patients. A comparative analysis of the frequency of observation of the main and additional cardiovascular risk fac-tors in groups was performed. Results. In patients of the study group, more often than in the control group we observed: hereditary burden of is-chemic heart disease (40.8 and 31.6%, respectively; p = 0.0461) and arterial hypertension (54.2 and 44.6%; p = 0.0461), frequent colds (24.6 and 12.0%; p = 0.0003), a history of extrasystoles (19.7 and 12.7%; p = 0.04); chronic foci of infections of internal organs (75.4 and 29.5%; p˂0.0001), non-ulcer lesions of the digestive system (26.1 and 14.6%; p = 0.007), smoking (95.1 and 66.3%; p˂0.0001), MI in winter (40.8 and 25.9%; p = 0.006). Less commonly were observed: oral cavity infections (9.2 and 23.6%; p˂0.0001); hypodynamia (74.5 and 82.5%; p = 0.0358), over-weight (44.4 and 55.2%; p = 0.0136), a subjective relationship between the worsening of the course of coronary heart disease and the season of the year (43.7 and 55.2%; p = 0.0173) and MI - in the autumn (14.1 and 21.9%; p = 0.006) period. Conclusions. The structure of CVD RF in men under 60 years of age with CLID with MI is characterized by the pre-dominance of smoking, non-ulcer pathology of the digestive system, frequent pro-student diseases, meteorological dependence, a history of cardiac arrhythmias and foci of internal organ infections. It is advisable to use the listed factors when planning preventive measures in such patients.

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IDENTIFICATION AND ASSESSMENT OF RISK FACTORS ROLE IN MYOCARDIAL INFARCTION DEVELOPMENT

Wiadomości Lekarskie ◽

10.36740/wlek201905111 ◽

2019 ◽

Vol 72 (5) ◽

pp. 779-783

Author(s):

Victor A. Ognev ◽

Anna A. Podpriadova ◽

Anna V. Lisova

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Cardiovascular Disease ◽

Cardiovascular System ◽

Control Group ◽

Biological Factors ◽

Prevention And Treatment ◽

High Level ◽

Social Importance ◽

The Impact

Introduction:The high level of morbidity and mortality from cardiovascular disease is largely due toinsufficient influence on the main risk factors that contribute to the development of myocardial infarction.Therefore, a detailed study and assessment of risk factors is among the most important problems of medical and social importance. The aim: To study and evaluate the impact of biological, social and hygienic, social and economic, psychological, natural and climatic risk factors on the development of myocardial infarction. Materials and methods: A sociological survey was conducted in 500 people aged 34 to 85. They were divided into two groups. The main group consisted of 310 patients with myocardial infarction. The control group consisted of 190 practically healthy people, identical by age, gender and other parameters, without diseases of the cardiovascular system. Results: It was defined that 30 factors have a significant impact on the development of myocardial infarction.Data analysis revealed that the leading risk factors for myocardial infarction were biological and socio-hygienic. The main biological factors were: hypertension and hypercholesterolemia. The man socio-hygienic factor was smoking. Conclusions: Identification of risk factors provides new opportunities for the development of more effective approaches for the prevention and treatment of myocardial infarction.

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Effect of Dapagliflozin on Intestinal Flora in MafA-deficient Mice

Current Pharmaceutical Design ◽

10.2174/1381612824666180912143434 ◽

2018 ◽

Vol 24 (27) ◽

pp. 3223-3231 ◽

Cited By ~ 3

Author(s):

Luyao Li ◽

Shiyao Xu ◽

Tingting Guo ◽

Shouliang Gong ◽

Chuan Zhang

Keyword(s):

Blood Glucose ◽

High Throughput Sequencing ◽

Fatty Acid Content ◽

Fasting Blood Glucose ◽

Intestinal Flora ◽

Short Chain Fatty Acids ◽

The Body ◽

Short Chain ◽

Control Group ◽

Deficient Mice

Objective: To investigate the effect of dapagliflozin on intestinal microflora in MafA-deficient mice using an animal model of diabetes. Methods: Male MafA-deficient mice were administered dapagliflozin (1.0 mg/kg/d) intragastrically for 6 weeks. Mouse body weights and fasting blood glucose levels were measured, and intestinal short-chain fatty acids were measured by gas chromatography. A series of methods was used to analyse the number of primary harmful bacteria in the faeces, and high-throughput sequencing was used to sequence the changes in intestinal flora. Results: The weight of the mice decreased after dapagliflozin gavage, and fasting blood glucose was significantly lower than that in the control group (P < 0.001). Acetic acid and butyric acid contents in the intestinal tracts of the mice increased, and the growth of harmful microorganisms, such as Clostridium perfringens, enterococci, Enterobacteriaceae, and intestinal enterococci, was inhibited. Blautia is a species found in the experimental group and was significantly different from the control and blank groups as determined by the LDA score from highthroughput sequencing. Conclusion: Dapagliflozin can reduce fasting blood glucose, decrease body weight, increase short-chain fatty acid content, regulate the intestinal microecological balance of the body and promote blood glucose and energy homeostasis.

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Epidemiology, Risk Factors, and Outcomes of Opportunistic Infections after Kidney Allograft Transplantation in the Era of Modern Immunosuppression: A Monocentric Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm8050594 ◽

2019 ◽

Vol 8 (5) ◽

pp. 594 ◽

Cited By ~ 4

Author(s):

Philippe Attias ◽

Giovanna Melica ◽

David Boutboul ◽

Nathalie De Castro ◽

Vincent Audard ◽

...

Keyword(s):

Risk Factors ◽

Protective Factor ◽

Opportunistic Infections ◽

Control Group ◽

Kidney Allograft ◽

Extended Criteria Donor ◽

Allograft Transplantation ◽

Kidney Recipients ◽

Independent Risk Factors ◽

Kidney Transplantations

Epidemiology of opportunistic infections (OI) after kidney allograft transplantation in the modern era of immunosuppression and the use of OI prevention strategies are poorly described. We retrospectively analyzed a single-center cohort on kidney allograft adult recipients transplanted between January 2008 and December 2013. The control group included all kidney recipients transplanted in the same period, but with no OI. We analyzed 538 kidney transplantations (538 patients). The proportion of OI was 15% (80 and 72 patients). OI occurred 12.8 (6.0–31.2) months after transplantation. Viruses were the leading cause (n = 54, (10%)), followed by fungal (n = 15 (3%)), parasitic (n = 6 (1%)), and bacterial (n = 5 (0.9%)) infections. Independent risk factors for OI were extended criteria donor (2.53 (1.48–4.31), p = 0.0007) and BK viremia (6.38 (3.62–11.23), p < 0.0001). High blood lymphocyte count at the time of transplantation was an independent protective factor (0.60 (0.38–0.94), p = 0.026). OI was an independent risk factor for allograft loss (2.53 (1.29–4.95), p = 0.007) but not for patient survival. Post-kidney transplantation OIs were mostly viral and occurred beyond one year after transplantation. Pre-transplantation lymphopenia and extended criteria donor are independent risk factors for OI, unlike induction therapy, hence the need to adjust immunosuppressive regimens to such transplant candidates.

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