scholarly journals Detection of Salivary miRNAs Reflecting Chronic Periodontitis: A Pilot Study

Molecules ◽  
2019 ◽  
Vol 24 (6) ◽  
pp. 1034 ◽  
Author(s):  
Kohei Fujimori ◽  
Toshiki Yoneda ◽  
Takaaki Tomofuji ◽  
Daisuke Ekuni ◽  
Tetsuji Azuma ◽  
...  
Keyword(s):  
Pilot Study ◽  
Chronic Periodontitis ◽  
Pocket Depth ◽  
Cross Sectional ◽  
Relative Expression ◽  
Reverse Transcription Pcr ◽  
Probing Pocket Depth ◽  
Severe Periodontitis ◽  
Whole Saliva ◽  
Unstimulated Whole Saliva

The purpose of this cross-sectional pilot study was to find salivary microRNAs (miRNAs) reflecting periodontal condition in chronic periodontitis. One hundred and twenty chronic periodontitis patients (mean age, 68.4 years) participated in the study, from whom unstimulated whole saliva was collected. A multiphase study was conducted to explore salivary miRNAs as biomarkers of periodontitis. At first, a polymerase chain reaction (PCR) array was performed to compare salivary miRNAs profiles in no and mild (no/mild) and severe periodontitis patients. Next, the relative expression of salivary miRNAs on individual samples was assessed by real-time reverse transcription-PCR. The numbers (%) of patients were 26 (21.6%, no/mild), 58 (48.3%, moderate) and 36 (30.0%, severe), respectively. Among 84 miRNAs, only the relative expression of hsa-miR-381-3p in the severe periodontitis group was significantly higher than that of the no/mild periodontitis group (p < 0.05). Among the 120 patients, there was also a significant correlation between the relative expression of hsa-miR-381-3p and the mean probing pocket depth (PPD) (r = 0.181, p < 0.05). Salivary hsa-miR-381-3p was correlated with periodontitis condition in chronic periodontitis patients.

scholarly journals Investigation of Salivary RANKL and OPG Levels in Periodontitis Patients at Hospital Universiti Sains Malaysia

2021 ◽  
Author(s):  
Saba Asif ◽  
Basaruddin Ahmad ◽  
Syed Ameer Hamza ◽  
Haslina Taib ◽  
Nur Karyatee Kassim ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Periodontal Pocket ◽  
Pocket Depth ◽  
Cross Sectional ◽  
Plaque Score ◽  
Mean Values ◽  
Severe Periodontitis ◽  
Whole Saliva ◽  
Elisa Technique ◽  
Unstimulated Whole Saliva

Abstract Background This study was aimed to determine the levels of salivary receptor activator of NF-κB ligand (RANKL) and osteoprotegerin (OPG) and its association with periodontal status among periodontitis patients. Patients and Methods A cross-sectional study was designed and performed at the Dental Clinic, Hospital Universiti Sains Malaysia (HUSM). Random sampling was employed to identify 88 participants into three groups: 30 mild periodontitis, 30 moderate to severe periodontitis, and 28 healthy (nonperiodontitis) patients. Periodontal parameters: periodontal pocket depth (PPD), clinical attachment level (CAL), plaque score (PS), and gingival bleeding index (GBI) were recorded. In total, 4 mL of unstimulated whole saliva was collected to determine the levels of salivary RANKL and OPG proteins by using ELISA technique. Data were analyzed by using SPSS software version 24.0. Results Mean values for PPD (5.3 ± 0.5) and CAL (5.6 ± 0.5) were observed higher for moderate to severe periodontitis as compared with values (4.4 ± 0.2) (4.5 ± 0.2) in mild periodontitis patients. The mean salivary RANKL and OPG was 0.23 ± 0.07 ng/mL and 1.78 ± 0.70 ng/mL respectively in moderate to severe periodontitis. Only salivary RANKL levels were significantly and positively correlated with all the clinical periodontal parameters. Conclusion The levels of salivary RANKL were higher as opposed to lower OPG levels in periodontitis patients in contrast to healthy (nonperiodontitis) patients. RANKL levels were significantly associated with the periodontal parameters. Therefore, we can conclude that RANKL can potentially aid as an adjunctive diagnostic protein in evaluating periodontal disease.

scholarly journals Validating gingival surface temperature as an alternative tool in the diagnosis of periodontal disease activity: An observational clinical trial

2019 ◽  
Vol 13 (2) ◽  
pp. 123-127
Author(s):  
Sumanth Gunupati ◽  
Hasya Sappiti ◽  
Sreenivas Nagarakanti ◽  
BV Ramesh Reddy ◽  
Vijay Kumar Chava
Keyword(s):  
Pilot Study ◽  
Periodontal Disease ◽  
Surface Temperature ◽  
Disease Activity ◽  
Diagnostic Tool ◽  
Pocket Depth ◽  
Clinical Attachment Loss ◽  
Cross Sectional ◽  
Probing Pocket Depth ◽  
Pilot Clinical Study

Background. Elevated temperature has been recognized as an inflammatory sign. It is the only indication that can be both objectively and quantitatively evaluated and is considered as a potential indicator of periodontal disease. Assessing gingival surface temperature (GST) could be a diagnostic parameter to determine periodontal health. This pilot clinical study aimed to validate gingival surface temperature (GST) as a clinical diagnostic tool to measure periodontal disease activity by correlating with the periodontal inflamed surface area (PISA). Methods. A cross-sectional mono-center pilot study was conducted with a convenient sample of 50 participants with a mean age of 34.14±13.7 years. Clinical parameters such as probing pocket depth (PPD) clinical attachment loss (CAL) and bleeding on probing (BOP) were measured. GST was recorded with a single lead of the bedside patient monitor and correlated with PISA. Results. The results showed a positive correlation between PISA and GST (P=0.46). Conclusion. This study showed a rise in GST of inflamed sites, but the results did not support the hypothesis that increased GST is an indicator of periodontal disease. As this is a pilot study, further studies with more larger sample sizes need to be undertaken to confirm its use as a diagnostic tool in clinical trials.

scholarly journals Detection of Salivary miRNAs That Predict Chronic Periodontitis Progression: A Cohort Study

2021 ◽  
Vol 18 (15) ◽  
pp. 8010
Author(s):  
Kohei Fujimori ◽  
Toshiki Yoneda ◽  
Takaaki Tomofuji ◽  
Daisuke Ekuni ◽  
Tetsuji Azuma ◽  
...  
Keyword(s):  
Cohort Study ◽  
Chronic Periodontitis ◽  
Characteristic Curve ◽  
Control Group ◽  
Discrimination Power ◽  
Whole Saliva ◽  
Supportive Periodontal Therapy ◽  
New Biomarkers ◽  
Unstimulated Whole Saliva ◽  
Attachment Level

The aim of this two-year cohort study was to investigate salivary microRNAs (miRNAs) that predict periodontitis progression. A total of 120 patients who underwent supportive periodontal therapy were recruited. Unstimulated whole saliva was collected at baseline. Two years later, 44 patients were followed up (median age, 67.1 years) and divided into two groups: progression group (n = 22), with one or more sites with clinical attachment level (CAL) progression (>3 mm compared with baseline) or tooth extraction due to periodontitis progression; and the control group (n = 22), which did not exhibit CAL progression. In the microarray analysis of salivary miRNAs, hsa-miR-5571-5p, hsa-miR-17-3p, hsa-let-7f-5p, hsa-miR-4724-3p, hsa-miR-99a-5p, hsa-miR-200a-3p, hsa-miR-28-5p, hsa-miR-320d, and hsa-miR-31-5p showed fold change values <0.5 or ≥2.0 in the progression group compared with the control group (p < 0.05). On receiver operating characteristic curve analysis, areas under the curves of hsa-miR-5571-5p, hsa-let-7f-5p, hsa-miR-99a-5p, hsa-miR-28-5p, and hsa-miR-320d were >0.7, indicating fair discrimination power. The expressions of salivary hsa-miR-5571-5p, hsa-let-7f-5p, hsa-miR-99a-5p, hsa-miR-28-5p, and hsa-miR-320d were associated with periodontitis progression in patients with chronic periodontitis. These salivary miRNAs may be new biomarkers for progression of periodontitis, and monitoring them may contribute to new diagnostics and precision medicine for periodontitis.

scholarly journals Origin of MMP-8 and Lactoferrin levels from gingival crevicular fluid, salivary glands and whole saliva

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Liza L. Ramenzoni ◽  
Deborah Hofer ◽  
Alex Solderer ◽  
Daniel Wiedemeier ◽  
Thomas Attin ◽  
...  
Keyword(s):  
Matrix Metalloproteinase ◽  
Salivary Glands ◽  
Gingival Crevicular Fluid ◽  
Clinical Parameters ◽  
Pocket Depth ◽  
Active Matrix ◽  
Probing Pocket Depth ◽  
Whole Saliva ◽  
Biomarker Testing ◽  
Crevicular Fluid

Abstract Background Pathologically elevated levels of matrix metalloproteinase-8 (MMP-8) and Lactoferrin in oral fluids have been associated with the presence of gingivitis/periodontitis. This study aimed to assess the origin of MMP-8 and Lactoferrin in periodontitis patients and to identify the degree to which conventional clinical parameters correlate with their presence. Methods A total of ten periodontitis and ten healthy patients were included in this study. Whole saliva (stimulated and unstimulated), parotid/sublingual glandular fluid and gingival crevicular fluid from pockets and sulci were tested for MMP-8 and Lactoferrin and protein concentrations were quantified using an ELISA assay. Clinical parameters were checked for potential associations with MMP-8 and Lactoferrin levels. Results Periodontal patients presented higher concentrations of MMP-8 and Lactoferrin in pockets than other sources (P = 0.03). Lactoferrin measurement was higher in the parotid compared to sublingual glandular fluid in periodontitis patients (P = 0.03). Increased probing pocket depth was positively correlated with high MMP-8 and Lactoferrin levels. Conclusions Periodontal pockets appear to be the major source of active matrix metalloproteinase and Lactoferrin, which also may also enter the oral cavity through the salivary glands. Since clinically healthy sites in periodontitis patients also had elevated biomarker levels, gingival crevicular fluid biomarker testing may be more predictive of future tissue breakdown than conventional clinical parameters.

scholarly journals A COMPARATIVE STUDY TO ASSES THE EFFICACY OF NANOBIO FUSION GEL AS AN ADJUNCT TO SCALING AND POLISHING IN CHRONIC PERIODONTITIS. - A CLINICAL STUDY

2020 ◽  
pp. 1-3
Author(s):  
Patil A. Veena ◽  
Ansari T. Sobia ◽  
Agarwal Priyanka ◽  
Ayesha Ayesha ◽  
Sultana Shahnaaz
Keyword(s):  
Periodontal Disease ◽  
Chronic Periodontitis ◽  
Antimicrobial Agents ◽  
Test Group ◽  
Controlled Clinical Trial ◽  
Pocket Depth ◽  
Antioxidant Power ◽  
Probing Pocket Depth ◽  
Significant Difference ◽  
And Control

Introduction: Various chemical agents such as nonsteroidal, anti-inflammatory drugs and antimicrobial agents has gained popularity in treatment of periodontal disease but simultaneously lead to condition such as drug resistance and drug allergy. Hence , the topical application of herbal agents such as propolis, aloevera, green tea extracts, Neem reduces the potency and effectiveness to prevent progression of periodontal disease. NanoBioFusion(NBF)gel contains the natural antioxidant power of propolis,vit C,vit E which allows the ultrafine antioxidant to surpase the moist intraoral environment to enter the cells and rejuvenate,revitalize,support,protect and optimize gum and soft oral tissue.Hence the present study is aimed to evaluate the clinical effect of locally delivered NBF gel as an adjunctive therapy to scaling and polishing in the treatment of Periodontitis. Materials and Methods: Chronic Periodontitis patients with 40 sites and probing pocket depth (PD) between 5 and 7 mm were selected in a randomized controlled clinical trial. SRP was performed in both control and test group followed by NBF gel application in 40 sites. The plaque index, gingival index and probing Pocket depth,were recorded at baseline, 6 weeks, and 3 months.The statistical analysis with paired t‑test was used to compare the test and control sites. Results: From baseline to a period of 3 months, a statistically significant difference was seen between both groups for Pocket probing depth and from baseline to 6 weeks the mean GI and PI score have a statistically significant result was obtained(P=0.01& 0.00). Conclusions: Locally delivered NBF gel exhibited a significant improvement compared with SRP alone in chronic periodontitis.

scholarly journals Fusobacterium Nucleatum : Bakteri Anaerob pada Lingkungan Kaya Oksigen (Dihubungkan dengan Staterin Saliva)

2018 ◽  
Vol 1 (1) ◽  
pp. 181-188
Author(s):  
Yumi Lindawati ◽  
Ameta Primasari ◽  
Dwi Suryanto
Keyword(s):  
Bacterial Colonization ◽  
Anaerobic Bacteria ◽  
Fusobacterium Nucleatum ◽  
Cross Sectional ◽  
Obligate Anaerobic ◽  
Supragingival Plaque ◽  
Whole Saliva ◽  
Dental Plaques ◽  
Cross Sectional Design ◽  
Unstimulated Whole Saliva

Fusobacterium nucleatum pada plak gigi berperan penting sebagai jembatan peralihan antara kolonisasi bakteri awal plak gigi dengan kolonisasi bakteri berikutnya, khususnya bakteri anaerob obligat. Fusobacterium nucleatum merupakan bakteri anaerob obligat, namun membran terluar F. nucleatum secara spesifik mengikat asam amino ke-21 dan 26 dari molekul staterin yang berasal dari saliva sehingga memungkinkan bakteri ini dapat tumbuh pada saliva dan plak supragingiva. Penelitian ini bertujuan untuk mengetahui keberadaan dan jumlah koloni F. nucleatum, konsentrasi staterin, korelasi keduanya pada saliva dan plak supragingiva. Penelitian observasional ini menggunakan desain cross- sectional pada 28 sampel Unstimulated whole saliva menggunakan metode spitting dan plak supragingiva matang dilekatkan pada paper point nomor 60 dari pasien di Instalasi Periodonsia RSGMP FKG USU. Konsentrasi staterin dihitung menggunakan ELISA, jumlah koloni F. nucleatum dengan mengkultur sampel pada media Crystal Violet Erythromicyn, dilakukan perhitungan manual pada piring petri. Penelitian ini menemukan pertumbuhan koloni F. nucleatum dari sampel saliva dan plak supragingiva dalam jumlah sedikit. Median konsentrasi staterin diperoleh pada saliva 1,5 µg/ml (x=2,35±2,71 µg/ml) pada plak supragingiva 223 µg/ml (x=332±242 µg/ml). Secara teoritis bakteri ini berhubungan dengan staterin, akan tetapi pada penelitian ini secara statistik tidak dapat dikorelasikan pertumbuhannya dengan staterin. Simpulan penelitian ini membuktikan bahwa F. nucleatum dapat diperoleh dari lingkungan yang mengandung oksigen seperti pada saliva dan plak supragingiva, akan tetapi keterkaitannya dengan staterin saliva pada lingkungan tersebut memerlukan penjelasan lebih lanjut. Fusobacteriumnucleatum on dental plaque plays an important role as a transitional bridge between early bacterial colonization of dental plaques and subsequent bacterial colonization, especially obligate anaerobes. Fusobacteriumnucleatum is an obligate anaerobic bacteria, but the outer nucleatum membrane specifically binds to the 21st and 26th amino acids from the statherin molecule which comes from saliva, allowing this bacteria to grow in saliva and supragingival plaque. The objective of this study was to determine the presence and the number of fusobacteriumnucleatum colonies, statherine concentrations, their correlation to saliva and supragingival plaque. This observational study used a cross-sectional design in 28 unstimulated whole saliva samples using spitting and mature supragingival plaque methods attached to number 60 paper points from patients at Installation Periodonsia RGGMP FKG USU. The concentration of statherin was calculated using ELISA, the number of F. nucleatum colonies by culturing samples on the Violet Erythromicyn Crystal media. Manual calculations were made on petri dishes. This study found small amounts of F. nucleatum colonies from saliva and supragingival plaque samples. The median statherine concentration was found at saliva 1.5 µg / ml (x = 2.35 ± 2.71 µg / ml) and at supragingival plaques 223 µg / ml (x = 332 ± 242 µg / ml). Theoretically, this bacteria is related to statherine, but its growth can not be statistically correlated with statherine in this study. The conclusion of this study proved that F. nucleatumcould be obtained from oxygen rich environment such as saliva and supragingival plaque, but its association with saliva in the temperature required further explanation.

scholarly journals COMPARATIVE EVALUATION OF EFFICACY OF SCALING AND ROOT PLANING WITH AND WITHOUT CHLORHEXIDINE CHIP AND DIODE LASER IN CHRONIC PERIODONTITIS PATIENTS

2021 ◽  
Vol 5 (11) ◽  
Author(s):  
Reya Shree ◽  
Varun Dahiya ◽  
Pradeep Shukla ◽  
Prerna Kataria ◽  
Mona Dagar
Keyword(s):  
Diode Laser ◽  
Chronic Periodontitis ◽  
Control Group ◽  
Clinical Parameters ◽  
Scaling And Root Planing ◽  
Pocket Depth ◽  
Probing Pocket Depth ◽  
Root Planing ◽  
Before And After ◽  
Laser Group

Introduction: The motive of the present study is to comparatively measure the competence and effectiveness of diode laser and chlorhexidine chip as adjuncts to the scaling and root planing procedure, in patients with chronic periodontitis. Aim: To evaluate the efficacy of diode laser and chlorhexidine chip before and after scaling and root planing in the management of chronic periodontitis. The objective is to compare the efficacy of chlorhexidine chip and diode laser before and after scaling and root planning on clinical parameters. Study and design: Randomized clinical trial with split mouth design done in the Department of Periodontics and Implantology. Materials and methods: Twenty chronic periodontitis patients having a probing pocket depth of 5mm-7mm on at least one interproximal site in each quadrant of the mouth were selected in the study. After initial treatment, four sites in each patient were randomly subjected to scaling and root planing (control), chlorhexidine chip application (CHX chip group), diode laser (810 nm) decontamination (Diode laser group) or combination of both (Diode laser and chip group). All subjects received a clinical periodontal examination by single examiner who recorded all the variables by manual procedure. Clinical parameters namely Plaque index (PI), Gingival Index (GI), probing pocket depth (PPD) and clinical attachment level (CAL) were assessed at baseline, one month and three months. Results were statistically analysed using one-way ANOVA followed by Post Hoc Analysis. Results: The differences in PPD reduction and CAL gain between control group and CHX chip and combination groups were statistically significant (p<0.05) at three months, whereas, the diode laser group did not show any significant difference from the control group. Conclusion: Within the limitations in the present study, the following conclusions were derived, i.e., chlorhexidine local delivery alone or in combination with diode laser decontamination is effective in improving oral hygiene, reducing gingival inflammation, reducing probing pocket depth and improving clinical attachment levels when used as adjuncts to scaling and root planing in non-surgical periodontal therapy of patients with chronic periodontitis. Keywords: Diode laser decontamination, Local drug delivery, Scaling and root planing.

scholarly journals Prevalence of Aggregatibacter actinomycetemcomitans and Periodontal Findings among 14 to 15-Year Old Danish Adolescents: A Descriptive Cross-Sectional Study

Pathogens ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 1054
Author(s):  
Anne Birkeholm Jensen ◽  
Flemming Isidor ◽  
Marianne Lund ◽  
Michael Væth ◽  
Anders Johansson ◽  
...  
Keyword(s):  
Aggregatibacter Actinomycetemcomitans ◽  
Cross Sectional Study ◽  
Northern Europe ◽  
Subgingival Plaque ◽  
Sectional Study ◽  
Pocket Depth ◽  
Clinical Attachment Loss ◽  
Cross Sectional ◽  
Plaque Score ◽  
Probing Pocket Depth

Aggregatibacter actinomycetemcomitans (Aa) is a keystone pathogen associated with periodontitis in adolescents. The knowledge on the prevalence of Aa and periodontitis among adolescents in Northern Europe is sparse. A total of 525 14- to 15-year-old adolescents from the municipality of Aarhus, Denmark, underwent a full-mouth clinical examination. Plaque score (PS), bleeding on probing (BOP), probing pocket depth (PPD), and clinical attachment loss (CAL) were recorded. Subgingival plaque samples (SPS) and stimulated saliva samples (SSS) were collected and analyzed for the presence of JP2 and non-JP2 genotypes of Aa using real-time PCR. A total of 70 (13.3%) individuals were positive for Aa, with 17 found in SPS, 19 in SSS, and 35 in both. The highly leukotoxic JP2 genotype of Aa was not detected. The individuals positive for Aa in both SPS and SSS had poorer periodontal outcomes (PPD and CAL) than individuals without Aa and individuals carrying Aa in either SPS or SSS only. In conclusion, 13% of 14- to 15-year-old Danish adolescents were positive for Aa, and the presence of Aa in both SPS and SSS was associated with poorer periodontal outcomes.

scholarly journals Clinical Evaluation of Topical Metronidazole and Chlorhexidine Gel following Scaling and Root Planing in Patients with Chronic Periodontitis

2019 ◽  
Vol 15 (1) ◽  
pp. 10-17
Author(s):  
Pujan Acharya ◽  
Manoj Kumar ◽  
CS Saimbi
Keyword(s):  
Chronic Periodontitis ◽  
Etiologic Agent ◽  
Etiologic Factor ◽  
Clinical Parameters ◽  
Scaling And Root Planing ◽  
Antimicrobial Drugs ◽  
Pocket Depth ◽  
Probing Pocket Depth ◽  
Root Planing ◽  
Topical Metronidazole

Background: Chronic periodontitis is the most prevalent form of periodontitis with a multifactorial  etiology, dental plaque being the primary etiologic agent. The removal of such etiologic factor through scaling and root planing builds the foundation of treatment. In addition, the use of an antimicrobial adjunct augments elimination of microbes leading to subsequent control of the disease. Chlorhexidine and Metronidazole have been found to be active against several periodontopathogens. In this study, the use of these antimicrobial gels has been made. To evaluate and compare the clinical efficacy of subgingival application of 1% Metronidazole, 1% Chlorhexidine and Combination gel when used as an adjunct to non-surgical therapy. Methods: A total of 120 patients, age group 30-60 years with chronic generalized periodontitis were included in the randomized, controlled, double blinded study. The patients were randomly divided into four groups and treated with scaling and root planing along with antimicrobial adjunct. The antimicrobials used were Chlorhexidine, Metronidazole, Combination of Chlorhexidine and Metronidazole, and Placebo. Clinical parameters (plaque index, gingival index, probing pocket depth and clinical attachment level) were recorded at baseline, 1 month and 3 months. Results: In all the groups, there was a statistically significant reduction in all the clinical parameters at different time intervals. Inter-group comparison with respect to clinical changes showed that Combination gel was the best. Conclusions: Long term, controlled randomized trials with more samples are suggested to further validate the efficacy of these antimicrobial drugs.  

scholarly journals Association between Chronic Periodontitis and Oral/Oropharyngeal Cancer

2016 ◽  
Vol 27 (3) ◽  
pp. 261-266 ◽  
Author(s):  
Renata Costa de Moraes ◽  
Fernando Luiz Dias ◽  
Carlos Marcelo da Silva Figueredo ◽  
Ricardo Guimarães Fischer
Keyword(s):  
Oral Cavity ◽  
Chronic Periodontitis ◽  
Oropharyngeal Cancer ◽  
Risk Indicators ◽  
Control Group ◽  
Case Group ◽  
Pocket Depth ◽  
Clinical Attachment Loss ◽  
Probing Pocket Depth ◽  
Significant Difference

Abstract The aim of this case control study was to assess the association between the extent and severity of chronic periodontitis and oral cavity and/or oropharyngeal cancer. The case group comprised 35 patients (mean age 56.1±8.4), diagnosed for oral and/or oropharyngeal cancer. The control group comprised 40 individuals (mean age 55.4±9.4) without diagnostic of cancer. All individuals were subjected to a periodontal examination, including bleeding on probing, plaque index, gingival index, probing pocket depth (PPD), clinical attachment loss (CAL), and decayed, extracted and filled teeth index (DMFT). The case group had significantly more sites with plaque. GI and BOP had similar values in both groups. The median PPD and CAL values were significantly higher for the case group. Chronic generalized periodontitis was predominant in 80% of patients with oral and/or oropharyngeal cancer. Eighty nine percent of the patients in the case group presented severe chronic periodontitis. There was no significant difference between groups for median values of DMFT. The extent and severity of chronic periodontitis remained as risk indicators for oral cavity and/or oropharyngeal cancer even after the adjustments for traditional confound factors, i.e. smoking and alcohol consumption.

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