1.Chronic prostatitis/chronic pelvic pain syndrome induces metabolomic changes in expressed prostatic secretions and plasma.
Fang-Xing ZHANG ; Xi CHEN ; De-Cao NIU ; Lang CHENG ; Cai-Sheng HUANG ; Ming LIAO ; Yu XUE ; Xiao-Lei SHI ; Zeng-Nan MO
Asian Journal of Andrology 2025;27(1):101-112
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a complex disease that is often accompanied by mental health disorders. However, the potential mechanisms underlying the heterogeneous clinical presentation of CP/CPPS remain uncertain. This study analyzed widely targeted metabolomic data of expressed prostatic secretions (EPS) and plasma to reveal the underlying pathological mechanisms of CP/CPPS. A total of 24 CP/CPPS patients from The Second Nanning People's Hospital (Nanning, China), and 35 asymptomatic control individuals from First Affiliated Hospital of Guangxi Medical University (Nanning, China) were enrolled. The indicators related to CP/CPPS and psychiatric symptoms were recorded. Differential analysis, coexpression network analysis, and correlation analysis were performed to identify metabolites that were specifically altered in patients and associated with various phenotypes of CP/CPPS. The crucial links between EPS and plasma were further investigated. The metabolomic data of EPS from CP/CPPS patients were significantly different from those from control individuals. Pathway analysis revealed dysregulation of amino acid metabolism, lipid metabolism, and the citrate cycle in EPS. The tryptophan metabolic pathway was found to be the most significantly altered pathway associated with distinct CP/CPPS phenotypes. Moreover, the dysregulation of tryptophan and tyrosine metabolism and elevation of oxidative stress-related metabolites in plasma were found to effectively elucidate the development of depression in CP/CPPS. Overall, metabolomic alterations in the EPS and plasma of patients were primarily associated with oxidative damage, energy metabolism abnormalities, neurological impairment, and immune dysregulation. These alterations may be associated with chronic pain, voiding symptoms, reduced fertility, and depression in CP/CPPS. This study provides a local-global perspective for understanding the pathological mechanisms of CP/CPPS and offers potential diagnostic and therapeutic targets.
Humans
;
Male
;
Prostatitis/blood*
;
Adult
;
Pelvic Pain/blood*
;
Metabolomics
;
Prostate/metabolism*
;
Middle Aged
;
Chronic Pain/blood*
;
Metabolome
;
Case-Control Studies
;
Tryptophan/blood*
;
Depression/blood*
;
Oxidative Stress/physiology*
;
Chronic Disease
;
Lipid Metabolism/physiology*
2.Different Radiological Indices of Patellar Height Predict Patients’ Diverse Outcomes Following Total Knee Arthroplasty
Zhiguo BI ; Yimeng CAI ; Chao SUN ; Xiaotong SHI ; Shiyu LIAO ; Jianguo LIU
Clinics in Orthopedic Surgery 2024;16(5):741-750
Background:
Total knee arthroplasty (TKA) is a common surgical procedure for patients with knee osteoarthritis. The patellar component plays a crucial role in knee biomechanics and can influence postoperative outcomes. This study aimed to investigate the relationship between radiological indices of patellar height and patient outcomes following TKA.
Methods:
A retrospective analysis was conducted on patients who underwent TKA for osteoarthritis. Radiographic measurements of patellar height, including the Insall-Salvati (IS) ratio, modified Blackburne-Peel (mBP) ratio, Caton-Deschamps ratio, and plateaupatellar angle (PPA), were obtained. Clinical outcomes were assessed using the Knee Society Score (KSS) and the Forgotten Joint Score-12 (FJS-12). Patient satisfaction and postoperative complications were also evaluated. Statistical analyses, including correlation analysis and multiple regression models, were performed to determine the association between radiological indices and patient outcomes.
Results:
The study included 330 cases that met the inclusion criteria. The analysis revealed significant correlations between different radiological indices of patellar height and patient outcomes. Lower postoperative PPA was correlated with worse KSS and range of motion scores. A decreased mBP ratio was associated with poorer FJS-12 responses and higher risks of dissatisfaction and patellar clunk or crepitus. Increased IS ratio was linked to a lower likelihood of incidental giving way of the knee. Advanced age was associated with reduced dissatisfaction and incidental giving way probabilities.
Conclusions
The findings of this study demonstrate that radiological indices of patellar height can predict patient outcomes following TKA. Assessing patellar height using various radiographic measurements provides valuable information for surgical planning and prognostic evaluation. Understanding the impact of patellar height on clinical outcomes can aid in optimizing TKA procedures and improving patient satisfaction. These findings emphasize the importance of considering patellar height as a predictive factor in TKA and highlight its potential role in guiding postoperative management and rehabilitation strategies.
3.Safety of minimally invasive liver resection for resectable hepatocellular carcinoma complica-ted with portal hypertension: a multicenter study
Junhao ZHENG ; Guangchao YANG ; Zhanzhi MENG ; Wei CAI ; Li CAO ; Xukun WU ; Yedong LIU ; Mingheng LIAO ; Jieyi SHI ; Xin WANG ; Yao LI ; Qifan ZHANG ; Qiang GAO ; Jiwei HUANG ; Zhibo ZHANG ; Jianwei LI ; Dalong YIN ; Yong MA ; Xiao LIANG
Chinese Journal of Digestive Surgery 2023;22(4):481-488
Objective:To investigate the safety of minimally invasive liver resection for resectable hepatocellular carcinoma (HCC) complicated with portal hypertension.Methods:The propensity score matching and retrospective cohort study was conducted. The clinicopathological data of 807 patients with resectable HCC who underwent minimally invasive liver resection in 8 medical centers, including Sir Run Run Shaw Hospital, Affiliated with the Zhejiang University School of Medicine et al, from June 2011 to November 2022 were collected. There were 670 males and 137 females, aged 58(50,66)years. Of the 807 patients, 173 cases with portal hypertension were divided into the portal hypertension group, and 634 cases without portal hypertension were divided into the non-portal hypertension group. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and post-operative situations; (3) subgroup analysis. Propensity score matching was done by the 1:1 nearest neighbor matching method, with the caliper setting as 0.001. Measurement data with skewed distribution were represented as M( Q1, Q3), and comparison between groups was conducted using the rank sum test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was constructed using the non-parameter rank sun test. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of the 807 patients, 268 cases were successfully matched, including 134 cases in the portal hypertension group and 134 cases in the non-portal hypertension group. The elimination of the tumor diameter and robot-assisted surgery confounding bias ensured comparability between the two groups after propensity score matching. (2) Intraoperative and postoperative situations. The occlusion time of porta hepatis, cases with intraoperative blood transfusion, cases with postoperative complication, cases with complication >Ⅱ grade of Clavien-Dindo classification, cases of Clavien-Dindo classification as Ⅰ grade, Ⅱ grade, Ⅲ grade, Ⅳ grade, cases with liver related complication were 27.0(15.0,43.0)minutes, 33, 55, 15, 13, 29, 14, 1, 37 in the portal hypertension group, versus 35.0(22.0,60.0)minutes, 17, 25, 5, 14, 9, 4, 1, 13 in the non-portal hypertension group, showing significant differences in the above indicators between the two groups ( Z=-2.15, χ2=6.30, 16.39, 4.38, 20.72, 14.16, P<0.05). (3) Subgroup analysis. Results of subgroups analysis showed that in cases with major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 243.5(174.6,296.3)minutes, 200.0(150.0,600.0)mL, 7.5(6.0,13.0)days in the portal hypertension group, versus 270.0(180.0,314.5)minutes, 200.0 (75.0,450.0)mL, 7.0(5.5,10.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.54, -1.73, -0.92, P>0.05). In cases with non-major live resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 8.0(5.0,10.0)days in the portal hypertension group, versus 170.0(120.0,227.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.5,9.0)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-1.39, -0.10, 1.05, P>0.05). In cases with anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 210.0(150.0,285.0)minutes, 150.0(50.0,200.0)mL, 8.0(6.0,9.3)days in the portal hypertension group, versus 225.5(146.3,306.8)minutes, 100.0(50.0,250.0)mL, 7.0(6.0,9.0)days in the non-portal hypertension group, showing no significant difference in the above indica-tors between the two groups ( Z=-0.75, -0.26, -0.91, P>0.05). In cases with non-anatomical liver resection, the operation time, volume of intraoperative blood loss, duration of postoperative hospital stay were 173.5(120.0,231.5)minutes, 175.0(50.0,300.0)mL, 7.0(5.0,11.0)days in the portal hyper-tension group, versus 186.0(123.0,262.5)minutes, 100.0(50.0,200.0)mL, 7.0(5.0,9.5)days in the non-portal hypertension group, showing no significant difference in the above indicators between the two groups ( Z=-0.97, -1.12, -0.98, P>0.05). Conclusion:Minimally invasive liver resection or even major liver resection is safe and feasible for screened HCC patients complicated with portal hyper-tension, but attention should be paid to the prevention and treatment of postoperative complications.
4.Varieties systematization and standards status analysis of fermented Chinese medicine.
Ting-Ting FU ; Xing-Bin YIN ; Meng-Ru CAI ; Rong-Yue ZHU ; Hua-Ting HUANG ; Shi-Lang LIAO ; Chang-Hai QU ; Xiao-Xu DONG ; Yue-Hua ZHOU ; Jian NI
China Journal of Chinese Materia Medica 2023;48(10):2699-2712
Fermented Chinese medicine has long been used. Amid the advance for preservation of experience, the connotation of fermented Chinese medicine has been enriched and improved. However, fermented Chinese medicine prescriptions generally contain a lot of medicinals. The fermentation process is complicated and the conventional fermentation conditions fail to be strictly controlled. In addition, the judgment of the fermentation end point is highly subjective. As a result, quality of fermented Chinese medicine is of great difference among regions and unstable. At the moment, the quality standards of fermented Chinese medicine are generally outdated and different among regions, with simple quality control methods and lacking objective safe fermentation-specific evaluation indictors. It is difficult to comprehensively evaluate and control the quality of fermented medicine. These problems have aroused concern in the industry and also affected the clinical application of fermented Chinese medicine. This article summarized and analyzed the application, quality standards, and the modernization of fermentation technology and quality control methods of fermented Chinese medicine and proposed suggestions for improving the quality standards of the medicine, with a view to improving the overall quality of it.
Medicine, Chinese Traditional
;
Reference Standards
;
Quality Control
;
Fermentation
5.Effects of booster vaccination with tetanus toxoid, reduced diphtheria and acellular pertussis combined vaccine (Tdap) after vaccination of rats with DTacP-sIPV or DTacP-IPV/Hib
Lukui CAI ; Jingyan LI ; Qin GU ; Yan MA ; Na GAO ; Qiuyan JI ; Jiana WEN ; Hongwei LIAO ; Xiaoyu WANG ; Guang JI ; Wenzhu HU ; Li SHI ; Mingbo SUN ; Jiangli LIANG
Chinese Journal of Microbiology and Immunology 2021;41(9):704-710
Objective:To evaluate the effects of a booster immunization with a candidate tetanus toxoid, reduced diphtheria toxoid and acellular pertussis combined vaccine (Tdap) in a rat model after primary vaccination with diphtheria, tetanus, acellular pertussis and Sabin strain inactivated poliovirus combined vaccine (DTacP-sIPV) or diphtheria, tetanus, acellular pertussis, inactivated poliovirus and haemophilus type b combined vaccine (DTacP-IPV/Hib) for further preclinical study.Methods:Wistar rats were randomly divided into three groups and respectively immunized with a self-developed DTacP-sIPV, a marketed DTacP-IPV/Hib and normal saline at 0, 1, and 2 months of age. Serum levels of antibody against each component in each group were detected before immunization and after each dose. A booster dose of the candidate Tdap was given 10 months after primary immunization. Serum levels of antibody against each component in each group were detected before, 1 month and 6 months after the booster immunization.Results:One month after three doses of primary immunization, the geometric mean titers (GMT, Log2) of antibodies against diphtheria toxoid (DT), tetanus toxoid (TT), pertussis toxin (PT), filamentous hemagglutinin (FHA) and pertactin (PRN) in the DTacP-sIPV group were 17.41, 18.34, 18.11, 19.93 and 13.91, respectively, and the seroconversion rates of these components all reached 100%. Ten months after primary immunization, the GMTs of antibodies against DT, TT, PT, FHA and PRN decreased to 15.17, 14.26, 13.60, 14.51 and 10.39, respectively, and the seroconversion rates remained above 89%. One month after booster immunization, the GMTs of antibodies against DT, TT, PT and FHA in the DTacP-sIPV and DTacP-IPV/Hib groups were 16.49/17.26, 16.80/17.63, 16.70/17.74 and 18.48/19.26, respectively, and the seroconversion rates of these components all reached 100% with no significant difference between the two groups ( P>0.05). The GMTs of anti-PRN antibody in the DTacP-sIPV and DTacP-IPV/Hib groups were 13.07 and 11.00, and the seroconversion rates were 100% and 88%, which were higher in the DTacP-sIPV group than in the DTacP-IPV/Hib group ( P<0.05). Six months after booster immunization, the GMTs of antibodies against DT, TT, PT, FHA and PRN in the DTacP-sIPV and DTacP-IPV/Hib groups decreased to 15.74/14.87, 15.07/15.14, 14.84/15.73, 16.62/16.37 and 11.44/9.96, respectively, and the seroconversion rates remained above 88%. Conclusions:Booster vaccination with the candidate Tdap vaccine induces humoral immune response following primary immunization with DTacP-sIPV or DTacP-IPV/Hib in the Wistar rat model, while the antibody titer decreases with time.
6.Association between
Ming-Xuan CAI ; Bing WEI ; Shi-E LIAO ; Jin-Yue FU ; Ya-Jun LIU ; Ling-Xue LI
Chinese Journal of Contemporary Pediatrics 2021;23(11):1132-1140
OBJECTIVES:
To study the association of β2-drenergic receptor (
METHODS:
A total of 143 children with asthma who attended the hospital from October 2016 to October 2020 were enrolled as the asthma group, among whom 61 children had mild symptoms (mild group) and 82 children had moderate-to-severe symptoms (moderate-to-severe group). A total of 137 healthy children were enrolled as the control group. Peripheral venous blood samples were collected from the two groups. The SNaPshot SNP technique was used to analyze the SNP and haplotypes of the
RESULTS:
Polymorphisms were observed in the
CONCLUSIONS
SNP/haplotype of the
Asthma/genetics*
;
Case-Control Studies
;
Child
;
Genetic Predisposition to Disease
;
Genotype
;
Haplotypes
;
Humans
;
Polymorphism, Single Nucleotide
;
Receptors, Adrenergic, beta-2/genetics*
;
Regulatory Sequences, Nucleic Acid
7. Study on the health literacy and related factors of the cancer prevention consciousness among urban residents in China from 2015 to 2017
Chengcheng LIU ; Chunlei SHI ; Jufang SHI ; Ayan MAO ; Huiyao HUANG ; Pei DONG ; Fangzhou BAI ; Yunsi CHEN ; Debin WANG ; Guoxiang LIU ; Xianzhen LIAO ; Yana BAI ; Xiaojie SUN ; Jiansong REN ; Li YANG ; Donghua WEI ; Bingbing SONG ; Haike LEI ; Yuqin LIU ; Yongzhen ZHANG ; Siying REN ; Jinyi ZHOU ; Jialin WANG ; Jiyong GONG ; Lianzheng YU ; Yunyong LIU ; Lin ZHU ; Lanwei GUO ; Youging WANG ; Yutong HE ; Peian LOU ; Bo CAI ; Xiaohua SUN ; Shouling WU ; Xiao QI ; Kai ZHANG ; Ni LI ; Wanghong XU ; Wuqi QIU ; Min DAI ; Wanqing CHEN
Chinese Journal of Preventive Medicine 2020;54(1):47-53
Objective:
To understand the health literacy and relevant factors of cancer prevention consciousness in Chinese urban residents from 2015 to 2017.
Methods:
A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The self-designed questionnaire was used to collect the information of demographic characteristics and cancer prevention consciousness focusing on nine common risk factors, including smoking, alcohol, fiber food, food in hot temperature or pickled food, chewing betel nut, helicobacter pylori, moldy food, hepatitis B infection, estrogen, and exercise. The logistic regression model was adopted to identify the influencing factors.
Results:
The overall health literacy of the cancer prevention consciousness was 77.4% (24 980 participants), with 77.4% (12 018 participants), 79.9% (6 406 participants), 77.2% (1 766 participants) and 74.5% (4 709 participants) in each group (
8. Analysis on the consciousness of the cancer early detection and its influencing factors among urban residents in China from 2015 to 2017
Ayan MAO ; Jufang SHI ; Wuqi QIU ; Chengcheng LIU ; Pei DONG ; Huiyao HUANG ; Kun WANG ; Debin WANG ; Guoxiang LIU ; Xianzhen LIAO ; Yana BAI ; Xiaojie SUN ; Jiansong REN ; Li YANG ; Donghua WEI ; Bingbing SONG ; Haike LEI ; Yuqin LIU ; Yongzhen ZHANG ; Siying REN ; Jinyi ZHOU ; Jialin WANG ; Jiyong GONG ; Lianzheng YU ; Yunyong LIU ; Lin ZHU ; Lanwei GUO ; Youqing WANG ; Yutong HE ; Peian LOU ; Bo CAI ; Xiaohua SUN ; Shouling WU ; Xiao QI ; Kai ZHANG ; Ni LI ; Min DAI ; Wanqing CHEN
Chinese Journal of Preventive Medicine 2020;54(1):54-61
Objective:
To understand the consciousness of the cancer early detection among urban residents and identify the influencing factors from 2015 to 2017.
Methods:
A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. Self-designed questionnaires were used to collect population, socioeconomic indicators, self-cancer risk assessment, regular participation in physical examination and other information. The multivariate logistic regression model was used to identify the factors of people who had not regularly participated in the regular physical examination in the past five years.
Results:
The self-assessment results of 32 357 residents showed that there were 27.54% (8 882) of total study population with self-reported cancer risk, 45.48% (14 671) without cancer risk and 26.98% (8 704) with unclear judgement on their own cancer risk. Among population with cancer risk, 79.84% (7 091) considered physical examination accounted. In the past five years, there were 21 105 (65.43%) residents participated in regular physical examination and 11 148 (34.56%) participated in non-scheduled one, respectively. The multivariate logistic regression analysis showed that compared with unmarried and western region residents, divorced, middle and eastern region residents had a stronger consciousness to participate in the regular physical examination (
9. Analysis on the consciousness of the early cancer diagnosis and its related factors among urban residents in China from 2015 to 2017
Xuan CHENG ; Pei DONG ; Jufang SHI ; Wuqi QIU ; Chengcheng LIU ; Kun WANG ; Huiyao HUANG ; Yana BAI ; Xiaojie SUN ; Debin WANG ; Guoxiang LIU ; Xianzhen LIAO ; Li YANG ; Donghua WEI ; Bingbing SONG ; Haike LEI ; Yuqin LIU ; Yongzhen ZHANG ; Siying REN ; Jinyi ZHOU ; Jialin WANG ; Jiyong GONG ; Lianzheng YU ; Yunyong LIU ; Lin ZHU ; Lanwei GUO ; Youqing WANG ; Yutong HE ; Peian LOU ; Bo CAI ; Xiaohua SUN ; Shouling WU ; Xiao QI ; Kai ZHANG ; Ni LI ; Jiansong REN ; Wanqing CHEN ; Min DAI ; Ayan MAO
Chinese Journal of Preventive Medicine 2020;54(1):62-68
Objective:
To understand the consciousness of the cancer early diagnosis among urban residents and identify the related factors from 2015 to 2017.
Methods:
A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The general demographic characteristics, the consciousness of the cancer early diagnosis (whether people would have a willingness or encourage their relatives/friends to confirm the abnormal results once which were detected from the physical examination) and other information were collected by using the self-designed questionnaire. The non-conditional logistic regression model was used to identify the relateol factors related to the consciousness of the cancer early diagnosis.
Results:
As for residents with abnormal result from the physical examination, 89.29% (28 802) of residents would choose to seek medical treatment for further diagnosis. If their relatives/friends had abnormal results from the physical examination, 89.55% (28 886) of residents would encourage their relatives/friends to confirm the diagnosis in time. The non-conditional logistic regression model analysis showed that compared with the public institution staff/civil servants, annual household income less than 20 000 CNY, the western region and the cancer risk assessment/screening intervention population, the company staff, annual household income about 40 000 CNY and more, and the residents from the middle and eastern region had a stronger consciousness to seek further diagnosis; while the unemployed residents and community residents were less likely to seek further diagnosis (
10. Analysis on the consciousness of the early cancer treatment and its influencing factors among urban residents in China from 2015 to 2017
Huichao LI ; Kun WANG ; Yannan YUAN ; Ayan MAO ; Chengcheng LIU ; Shuo LIU ; Lei YANG ; Huiyao HUANG ; Pei DONG ; Debin WANG ; Guoxiang LIU ; Xianzhen LIAO ; Yana BAI ; Xiaojie SUN ; Jiansong REN ; Li YANG ; Donghua WEI ; Bingbing SONG ; Haike LEI ; Yuqin LIU ; Yongzhen ZHANG ; Siying REN ; Jinyi ZHOU ; Jialin WANG ; Jiyong GONG ; Lianzheng YU ; Yunyong LIU ; Lin ZHU ; Lanwei GUO ; Youqing WANG ; Yutong HE ; Peian LOU ; Bo CAI ; Xiaohua SUN ; Shouling WU ; Xiao QI ; Kai ZHANG ; Ni LI ; Min DAI ; Wanqing CHEN ; Ning WANG ; Wuqi QIU ; Jufang SHI
Chinese Journal of Preventive Medicine 2020;54(1):69-75
Objective:
To understand the consciousness of the cancer early treatment and its demographic and socioeconomic factors.
Methods:
A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China (CanSPUC) from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The questionnaire collected personal information, the consciousness of the cancer early treatment and relevant factors. The Chi square test was used to compare the difference between the consciousness of the cancer early treatment and relevant factors among the four groups. The logistic regression model was used to analyze the influencing factors related to the consciousness of the cancer early treatment.
Results:
With the assumption of being diagnosed as precancer or cancer, 89.97% of community residents, 91.84% of cancer risk assessment/screening population, 93.00% of cancer patients and 91.52% of occupational population would accept active treatments (

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