scholarly journals CURRENT ASPECTS OF DIAGNOSTICS AND TREATMENT OF ACUTE BILLARIAN PANCREATITIS

2018 ◽  
Vol 14 (3-4) ◽  
pp. 74-79
Author(s):  
I.V. Kolosovych ◽  
B.H. Bezrodnyi ◽  
I.V. Hanol
Keyword(s):  
Acute Pancreatitis ◽  
Length Of Stay ◽  
Comparison Group ◽  
Abdominal Cavity ◽  
Main Group ◽  
Duct System ◽  
Results Of Treatment ◽  
Positive Clinical Effect ◽  
Number Of Patients ◽  
Comparative Group

Relevance. The article is devoted to the problem of diagnosis and treatment of acute biliary pancreatitis, which remains one of the most common surgical diseases of the abdominal cavity and accounts for 33.2% of the total number of patients with acute pancreatitis. Objective of the work is to improve the diagnosis and results of surgical treatment of patients with acute pancreatitis of biliary etiology. Materials and methods. The results of treatment of 264 patients with acute pancreatitis of biliary etiology are analyzed. Operative treatment was applied in 92 (34,8 %) patients: endoscopic operations were performed in 44 patients (16,7 %). Thus, in 10 (3,8 %) patients, endoscopic papilloprotectomy was performed with the auditory of the duct system and the extraction of concrements. In other cases, organo-preserving intervention was performed without disturbing the morphofunctional integrity of the sphincter apparatus of the duct system: the cannulation in 6 (2,3%) patients, mechanical (balloon) in 5 (1,9 %) cases, pharmacological (myogenic antispasmodic) dilatation of distal duct and a large duodenal papilla in 11 (4,2 %) patients. In residual choledocholithiasis, a technique of papillotomy under the control of choledochoscopy was proposed – 12 (4,54 %) patients. A comparative analysis of the effectiveness of the treatment of patients who used the "open" (comparative group) and noninvasive endoscopic interventions in the early disease (the main group) was performed. Results. So in the main group the length of stay in the hospital was 12±3,2 days, respectively, in the comparison group – 26±4,3 days. In 42 (95,4 %) patients who had undergone endoscopic surgery, a positive clinical effect, a rapid regress of the symptoms of acute pancreatitis was achieved. In two (4,5 %) patients in the main group, the course was complicated by the development of the abscess of the stuffing box, and puncture under ultrasound control was performed. In patients of the comparison group complications arose in 5 (41,6 %) patients, it is noteworthy that all of them had undergone operative interventions, which were limited only to the rehabilitation and drainage of the abdominal cavity, a stuffing box bag. The mortality rate among unopposed was 1,2 % (2 patients), and among the operated – 11,9 % (11 patients). Among prooperated patients who died, 81,8 % (9 people) were elderly patients. Conclusions. The use of minimally invasive endoscopic interventions in the early phase of the disease reduces the length of stay of patients in the hospital from 26±4,3 days (comparison group) to 12 3,2 days (main group) and the number of complications occurring by 37,1 % (P <0, 05). Application of the proposed method of papillotomy under the control of choledochoscopy makes it possible to reduce the risk of perforation of the wall of the duodenum with the development of peritonitis or retroperitoneal phlegmon by 1,2 % (P <0,05).

scholarly journals Вплив лікувально-профілактичних заходів на показники ротової рідини та клінічний стан тканин пародонта у дітей 6–7 років, хворих на гінгівіт

2017 ◽  
Author(s):  
O. V. Avdeev ◽  
Y. K. Zmarko ◽  
A. B. Boykiv ◽  
R. O. Drevnitska
Keyword(s):  
Clinical Supervision ◽  
Oral Fluid ◽  
Urease Activity ◽  
Comparison Group ◽  
Local Therapy ◽  
Main Group ◽  
Control Group ◽  
Results Of Treatment ◽  
Comparative Group ◽  
Anti Inflammatory

The high prevalence of inflammatory processes in the periodontitis of children, the ineffective effectiveness of preventive and curative measures can contribute to the development of generalized periodontitis, therefore it remains urgent to develop pathogenetic effects in the treatment of chronic catarrhal gingivitis.The aim of the study – a comparative assessment of the traditional treatment of chronic catarrhal gingivitis in children aged 6–7 years with therapy using an anti-inflammatory gel with neovitin.Materials and Methods. 61 children aged 6–7 years, suffering from chronic catarrhal gingivitis, were taken under clinical supervision and divided into groups: the main (30 children) and the comparative (31 children). All children underwent conventional therapy in accordance with the protocols for the provision of medical care – basic therapy. In the main group, for a month, pathogenetic agents were used: an anti-inflammatory gel with neovitin, hygiene products were recommended. In the comparative group, 3 % hydrogen peroxide solution was used for local therapy, for rinsing of the mouth (during the first week of treatment) – Rotokan, a therapeutic and prophylactic toothpaste.Examination and control examinations were carried out with the hygienic state of the mouth determined by the hygienic index of Yu. A. Fedorov and V. V. Volodkina, prevalence and intensity of the inflammatory process in the gums with the help of the Schiller-Pisarev test and the PMA index, oral fluid index (lysozyme content, formation of oxydradicals, urease activity, degree of dysbiosis, pH and viscosity).Results and Discussion. After the treatment, elimination of gum inflammation in patients of the main group was accompanied by a decrease in the PMA index by 3.8 times; formation of oxyradicals decreased in children of the main group by 6.35 %; in the comparative group – by 6.15 %. Urease activity decreased in children of the main group by 16.37 % (p<0.05), the viscosity of the oral fluid of children decreased in 2.65 times in the main group and in 2.13 times in the comparative group (p<0.05). The lysozyme content increased in children of the main group by 15.61 % (p<0.05) in the comparison group – by 9.63% (p<0.05). The treatment after 0.5 years caused an increase in the lysozyme content in the oral fluid of the children of the main group to the level of the control group. The degree of dysbiosis decreased in the main group, in the comparison group tended to increase.Conclusions. The use of the proposed therapy with gel with neovitin contributed to the best results of treatment: reducing the degree of inflammation of the gums, the number of visits to the doctor, improving the indices of nonspecific protection in the oral fluid of 6-7 years-old children and, to a greater extent, six months after the treatment.

scholarly journals The methods of prophylaxis of the morbidity occurrence after pancreatico-duodenal resection

2019 ◽  
Vol 86 (5) ◽  
pp. 3-7
Author(s):  
V. М. Коpchak ◽  
L. О. Pererva ◽  
О. V. Duvalko ◽  
V. V. Khanenko ◽  
S. V. Аndronik ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Pancreatic Fistula ◽  
Comparison Group ◽  
Main Group ◽  
Postoperative Pancreatic Fistula ◽  
Occurrence Rate ◽  
Results Of Treatment ◽  
Comparative Group ◽  
Clinically Significant ◽  
Duodenal Resection

Objective. To elaborate the system of measures with objective of lowering of the occurrence rate for pancreatic fistula and severe complications after pancreaticoduodenal resection (PDR). Маterials and methods. Results of treatment was analyzed for 143 patients, to whom pancreaticoduodenal resection performed. In accordance to the scheme proposed, using elaborated scale of the risk for occurrence of postoperative pancreatic fistula, were operated 56 patients in 2017 - 2018 yrs (the main group). Comparative group consisted of 87 patients, operated in the clinic in 2015 - 2016 yrs without estimation of the risk for postoperative pancreatic fistula occurrence and sarcopenia presence, and formation of pancreaticojejunoanastomosis have depended upon decision of a surgeon-operator. Results. The rate of occurrence of the postoperative complications was trustworthily higher in the comparison group (c2 = 5.8, p=0.01). In the main group a clinically significant pancreatic fistula of Grade В was observed in 1 of 7 patients with postoperative complications. In the comparison group pancreatic fistulas of Grades В or С were diagnosed in 15 of 26 patients with postoperative complications, which are trustworthily higher, than in the main group (c2 = 4.16, p=0.04). Conclusion. The system of measures elaborated gave the possibility to reduce the occurrence rate for pancreatic fistula significantly - from 17.2 tо 1.8% and severe postoperative morbidity - from 29.9 tо 12.5%.

scholarly journals Results of using L-ornitin-L-aspartate in the treatment of hepatic encephalopathy in liver transplantation

2021 ◽  
Vol 13 (3) ◽  
pp. 235-247
Author(s):  
S. E. Voskanyan ◽  
E. V. Naydenov ◽  
A. I. Artemev ◽  
D. A. Zabezhinskiy ◽  
K. K. Gubarev ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Hepatic Encephalopathy ◽  
Length Of Stay ◽  
Cognitive Functions ◽  
Comparison Group ◽  
Hospital Length ◽  
Main Group ◽  
Stage Ii ◽  
Hospital Length Of Stay ◽  
Preoperative Period

The aim was to study the results of using various treatment regimens for hepatic encephalopathy for patients with liver cirrhosis before and after liver transplantation and the effect on the incidence and severity of hepatic encephalopathy in the perioperative period, and on the posttransplantation course.Material and methods. Fifty four patients with cirrhosis of various etiologies and the presence of significant hepatic encephalopathy undergoing living donor liver transplantation were included in the study. In the comparison group, patients took lactulose and rifaximin. In the main group, patients took lactulose and rifaximin in combination with L-ornithine-L-aspartate in the preoperative period, and L-ornithine-L-aspartate after liver transplantation for 5 days.Results. The use of L-ornithine-L-aspartate in the complex therapy of hepatic encephalopathy led to significantly reduced time of performing the Number Connection Test, the improvement of cognitive functions in patients by the Montreal Cognitive Assessment, a decreased incidence of stage II–III hepatic encephalopathy and an increased incidence of stage 0-I hepatic encephalopathy in the preoperative period. In the postoperative period, patients of the main group showed a rapid decrease in the severe stages of hepatic encephalopathy (stage II–III) towards less severe forms (stage 0–I) on the 3rd, 5th and 7th days after liver transplantation, and also a faster recovery of cognitive functions, an earlier adequate recovery of consciousness, muscle tone, an earlier possibility of extubation, a shorter length of stay in the intensive care unit, and a decreased postoperative hospital length of stay relatively to the patients of the comparison group.Conclusion. The use of L-ornithine-L-aspartate in the combination therapy for hepatic encephalopathy in the peritransplantation period leads to a significant decrease of the incidence and severity of hepatic encephalopathy, accelerates rehabilitation of patients, reduces postoperative hospital length of stay.

scholarly journals PREVALENCE OF THE GENERALIZED PERIODONTITIS IN PATIENTS WITH DIFFERENT GROUPS BLOOD IN DEPENDING ON AGE AND PERIODONTAL BIOTYPE

2020 ◽  
Vol 73 (1) ◽  
pp. 119-122
Author(s):  
Yurii L. Bandrivsky ◽  
Orysia O. Bandrivska ◽  
Roksolana Yu. Shkrebnyuk ◽  
Volodimira T. Dyryk
Keyword(s):  
Periodontal Disease ◽  
Blood Group ◽  
Comparison Group ◽  
Main Group ◽  
Number Of Patients ◽  
Periodontal Biotype ◽  
Initial Forms

The aim of the study was to investigate the prevalence of generalized periodontitis depending on age and biotype of periodontium. Materials and methods: We examined 855 males aged 20-55 years, who were divided into 2 groups: the main group – 570 surveyed with a generalized periodontitis, the comparison group – 285 dental healthy individuals.The diagnosis of generalized periodontitis was established by the classification Danilevsky M.F. (1994) and refined by using paraclinical indices. The periodontal biotype was determined using Hu-Friedy Colourvue Biotype Probe. Results: As a result of the conducted researches was establish, in the carriers of blood group O (I) and A (II), developed forms of generalized periodontitis were found, on average, 2.7 times more often than the initial forms of the disease. Instead, at the representatives of B (III) and AB (IV) groups blood the frequency of initial GP – I degree was on average, 1.2 times greater than the prevalence of developed forms of generalized periodontitis. Also as a result of our researches, we found that the cluster A1 had 39.30% patients, cluster A2 was found at 28, 77%, and cluster B – 31.93% of the total number of patients with generalized periodontitis. Conclusions: As a result of our research, it was found that in the carriers of the blood group O (I) and A (II), more advanced forms of generalized periodontitis were observed, which was confirmed by the presence of the biotype of the periodontal disease in the cluster A1 and A2.

scholarly journals The Results of Duodenum-Preserving Resections of the Pancreas in Chronic Pancreatitis Using the Technology of Sealing the Pancreatic-Intestinal Anastomosis

2019 ◽  
Vol 4 (2) ◽  
pp. 122-126
Author(s):  
V. G. Lubyanskiy ◽  
V. V. Seroshtanov
Keyword(s):  
Chronic Pancreatitis ◽  
Intestinal Anastomosis ◽  
Abdominal Cavity ◽  
Main Group ◽  
Control Group ◽  
Cervical Anastomosis ◽  
Pancreatic Anastomosis ◽  
Drainage Fluid ◽  
Results Of Treatment ◽  
Cause Of Deaths

Background. The problem of chronic pancreatitis in recent years is acute, primarily due to the occurrence of complications and pain that forces you to turn to a surgeon. The main cause of deaths is the failure of the pancreatic anastomosis and the occurrence of bleeding into the cavity of the pancreatic intestinal anastomosis (40 %).Aims: to improve the results of duodenum-preserving resections by introducing the technology of sealing the pancreaticintestinal anastomosis.Materials and methods. The clinic operated 225 patients with chronic pancreatitis. All patients before the operation and in the postoperative period were carried out clinical and biochemical studies, the Frey operation was performed. Patients were divided into two groups. The first group, the group of comparison, included 184 (81.8 %) patients with pancreatoenteroanastomosis formed without additional sealing methods. The second group – the main one – consisted of 41 (18.2 %)patients in which the suture of the pancreatic anastomosis was strengthened with an adhesive composite or with the loop of the small intestine.Results. After the surgery, complications in the control group were recorded in 19 (8.4 %) patients: failure – in 6 (3 %), bleeding into the lumen of pancreatoenteroanastomosis – in 9 (4 %), mortality was 1.8 % (4 persons). There were no complications in the main group. The analysis of the amylase content in the drainage fluid revealed high values in the control group on the 3rd day – 916 ± 15 U/l, in comparison with the main group – 437 ± 16 U/l (p < 0.05). The data obtained indicate that the cause of insolvency of the pancreatic-intestinal anastomosis is the penetration of enzymes through the pancreatic-cervical anastomosis zone into the abdominal cavity. When analyzing the results, it turned out that the failure of the pancreatic-intestinal anastomosis was not detected in any case in patients with sealing.Conclusion. The escape of enzymes destroys the tightness of the superimposed fistula and is characterized by an increase in the level of amylase in the drainage fluid. The proposed sealing technologies decrease the number of postoperative complications and improve the results of treatment.

scholarly journals Surgical tactics for victims of gunshot wounds of the diaphragm specialized stage of medical care in conditions of a modern armed conflict

2019 ◽  
Keyword(s):  
Surgical Treatment ◽  
Medical Care ◽  
Comparison Group ◽  
Care Delivery ◽  
Abdominal Cavity ◽  
Surgical Care ◽  
Gunshot Wounds ◽  
Main Group ◽  
Lung Capacity ◽  
Combat Injuries

Introduction. The diaphragm gunshot wounds are serious combat injuries. The main functions of the diaphragm are to change the intra-abdominal pressure and the outflow of lymph and blood from the abdominal cavity due to the constant contraction and relaxation. Therefore, when it is injured at the same time with a powerful painful impulse, cardiopulmonary disorders quickly arise. Purpose: To improve the results of surgical treatment of patients with gunshot wounds through the introduction of new video endoscopic technologies at the stage of specialized surgical care. Materials and methods. The article analyzes the features of specialized surgical care in 64 patients with gunshot wounds who were treated at the surgical clinic of the Military Medical Clinical Center of the Northern Region (III level of medical care). New minimally invasive methods are proposed to improve the outcomes of surgical treatment of victims with diaphragm gunshot wounds at level III of health care delivery. Results. Thus, the use of video thoracoscopic technique in the surgical treatment of the diaphragm wound and its suturing in the proposed method allowed to improve the results of treatment by increasing the average value of diaphragmatic excursion in deep breath in the main group to 3.73 ± 0.31 cm, whereas in the comparison group 2.21 ± 0.38 cm. The severity of the pain syndrome on the of Visual Аnalogue Scale 5 days after surgical treatment was 5.2 ± 2.3 points in the injured main group, 6.7 ± 2.1 points in the comparison group. The ratio of vital lung capacity to the required vital lung capacity in the main group was 75.3 ± 2.2%, in the comparison group 64.1 ± 1.7%. Conclusions. The use of video thoracoscopy increases the efficiency of the diagnosis of gunshot wounds of the diaphragm. The use of laser imaging and fluorescence diagnosis of diaphragm wounds ensure the adequacy of the removal of paravulary necrotic tissues. The suturing of the wounds in accordance with the anatomical and functional structure of the diaphragm with the use of plaques improves the immediate postoperative results of surgical treatment.

scholarly journals SPEAKING OF PREVENTION OF ACUTE PANCREATITIS AFTER ENDOSCOPIC CHOLANGIOPANCREATO-GRAPHY

2020 ◽  
pp. 45-48
Author(s):  
V. I. Lupaltsov ◽  
N. N. Skalii ◽  
A. I. Yagnyuk ◽  
V. S. Kotovshchіkov
Keyword(s):  
Acute Pancreatitis ◽  
Clinical Practice ◽  
Pancreatic Necrosis ◽  
Preventive Measures ◽  
Comparison Group ◽  
Main Group ◽  
Pancreatic Ducts ◽  
Terminal Part ◽  
Highly Effective ◽  
The Common

Summary. Purpose. To study the manometric control of pressure in the pancreatic ducts when performing ERCP and to determine its capabilities in the early diagnosis of postmanipulative pancreatitis. Materials and methods. The study was conducted to identify postmanipulative pancreatitis in 122 patients with impaired patency of the terminal part of the common bile duct who underwent ERCP. Patients were divided into two groups: the main – 58 patients and the comparison group – 64 patients. In 58 patients of the main group, the pressure in the pancreatic duct was studied by the device we developed. One makes it possible to register early signs of acute postmanipulative pancreatitis with conducting timely preventive measures for its development. Results. Using the proposed device that records the pressure in the pancreatic ducts, acute postmanipulative pancreatitis was diagnosed in 6.9 % of patients in the main group, while in the comparison group it developed in 21.9 % of cases. Mild forms of APMP in the comparison group were noted in 11 patients and in 4 patients in the main group. Severe APMP caused by focal pancreatic necrosis occurred in three cases of the comparison group. Conclusions. 1. ERCP is a highly effective method for diagnosing diseases of the pancreatobiliary zone, at the same time, sometimes fraught with the danger of developing serious complications, one of which is acute postmanipulative pancreatitis. 2. Monometric control during ERCP is a highly effective method for the diagnosis of early forms of acute postmanipulative pancreatitis, which can be recommended in the clinical practice of endoscopic surgeries.

scholarly journals Peculiarities of early diagnosis and tactics of treatment in an acute pancreatitis in pregnant women

2018 ◽  
Vol 85 (6) ◽  
pp. 13-17
Author(s):  
Ya. P. Feleshtynskyi ◽  
О. V. Golyanovskyi ◽  
Т. P. Pavliv
Keyword(s):  
Acute Pancreatitis ◽  
Early Diagnosis ◽  
Pregnant Women ◽  
Comparison Group ◽  
Early Stage ◽  
Treatment Algorithm ◽  
Main Group ◽  
Diagnosis And Treatment ◽  
Treatment Results ◽  
Standard Methods

Objective. Improvement of the treatment results of an acute pancreatitis in pregnant women, using enhanced early diagnosis and tactics of treatment. Маterials and methods. Analysis of the diagnosis and treatment results was conducted in 123 pregnant women, suffering an acute pancreatitis. In the main group (61 pregnant women) the elaborated algorithm of diagnosis and treatment for an acute pancreatitis in the period 2012 - 2018 yrs was applied, while in a comparison group (62 pregnant women) - the standard methods of diagnosis and treatment in an acute pancreatitis for the period of 2006 - 2012 yrs. Results. In the main group in 100% of the patients an acute pancreatitis was revealed on early stage. This have had guaranteed the effect obtaining from the conservative therapy in 27 (44.3%) pregnant women, using miniinvasive surgical interventions - in 31 (50.8%) and to prevent postoperative lethality. In a comparison group in 26 (41.9%) patients an acute pancreatitis diagnosis was established in (8 ± 2.1) days after the disease beginning. In a comparison group the conservative treatment effect was observed in 21 (33.9%) patients only. Two (3.2%) pregnant women died. Conclusion. Application of the diagnostic-treatment algorithm, comparing with standard methods, permits to diagnose an acute pancreatitis in pregnant women on early stage, to reduce the complications and lethality rate.

scholarly journals The choice of surgical treatment method of patients with bacterial liver abscesses

2012 ◽  
Vol 93 (2) ◽  
pp. 265-269 ◽  
Author(s):  
A P Tolstikov
Keyword(s):  
Postoperative Complications ◽  
Ultrasound Guidance ◽  
Comparison Group ◽  
Average Duration ◽  
Abdominal Cavity ◽  
Bile Leakage ◽  
Main Group ◽  
Early Postoperative Complications ◽  
Liver Abscesses ◽  
Bed Days

Aim. To improve the results of surgical treatment of patients with bacterial abscesses of the liver. Methods. During the period from 2000 to 2010 treated were 118 patients with bacterial liver abscesses, 75 men and 43 women aged from 18 to 80 years (mean age 52.1 years). Management of the patients was based on the developed algorithm of diagnosis and treatment of liver abscesses. Two groups of patients were formed: the main group (treatment consisted of percutaneous puncture and drainage of the abscesses under ultrasound guidance) - 94 patients, the comparison group - 24 patients. In the comparison group surgical interventions were performed using the transabdominal access: laparotomy, opening and drainage of the abscess (18 patients), hepatic resection (3 patients), left-sided hemihepatectomy (2 patients), right-sided hemihepatectomy (1 patient). Results. In the patients of the comparison group the following early postoperative complications developed: wound infection - 4, intra-abdominal hemorrhage - 1, bile leakage - 1, abscesses of the abdominal cavity - 2, exudative pleuritis - 2, pneumonia - 3 cases. The average duration of patient hospitalization was 19.5±1.6 bed-days. In the main group the average duration of patient hospitalization was 9.2±±0.6 bed-days. Early postoperative complications in patients of the main group included: intra-abdominal hemorrhage - 1, bile leakage - 1, abscesses of the abdominal cavity - 1, exudative pleuritis - 2, pneumonia - 2 cases. There were no deaths in either of the groups. Conclusion. Puncture and drainage of bacterial liver abscesses under ultrasound guidance is an effective method of treatment that makes it possible to reduce the number of abdominal operations, reduce the number of postoperative complications and shorten the hospital stay.

scholarly journals Surgical treatment of patients with osteoarthritis of the ankle joint

2012 ◽  
Vol 93 (1) ◽  
pp. 38-43
Author(s):  
Yu A Plakseychuk ◽  
R Z Salikhov ◽  
V V Soloviev
Keyword(s):  
Surgical Treatment ◽  
Ankle Joint ◽  
Bone Grafting ◽  
Comparison Group ◽  
Functional Results ◽  
Main Group ◽  
Radiographic Evaluation ◽  
Results Of Treatment ◽  
Ilizarov Apparatus

Aim. To evaluate the results of treatment using the authors’ proposed method of arthrodesis of the ankle and subtalar joints, based on the combination of bone grafting with compression in the Ilizarov apparatus. Methods. Conducted was a clinical and radiographic evaluation of the results of arthrodesis in the Ilizarov apparatus in 286 patients with osteoarthritis of the ankle and subtalar joints (during the last 15 years). 36 (12.6%) patients (the main group) were operated on using the authors’ proposed technique. Results. Bone adhesion as a result of arthrodesis was achieved in all patients of the main group. Excellent functional results were achieved in 11 out of 36 patients (30.5%), good results - in 22 (61.1%) patients, satisfactory results - in 3 (8.4%) patients. Bone adhesion as a result of arthrodesis in 250 patients of the comparison group was achieved in 243 patients (97.2%). In this group excellent functional results were achieved in 76 out of 250 patients (30.4%), good results - in 145 (58%) patients, satisfactory results - in 21 (8.4%) patients, poor results - in 8 (3.2%) patients. Conclusion. The proposed method of biarticular arthrodesis makes it possible to improve the trophism of the arthrodesis zone, to conduct the correction of posttraumatic deformities in the region of the ankle and subtalar joints, provides a durable and solid bone ankylosis of the ankle and subtalar joints, and makes it possible to achieve adhesion even in severe forms of osteoarthritis of the ankle and subtalar joints.

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