1.Effect of moxibustion on inflammatory factors and oxidative stress factors in patients with knee osteoarthritis: a randomized controlled trial.
Yu CHEN ; Rui-Qing WANG ; Jing-Xuan LIU ; Zi-di ZHANG ; Ye-Juan JIA ; Jiu-Heng LV ; Jing SHI ; Jing XU ; Chun-Sheng JIA
Chinese Acupuncture & Moxibustion 2020;40(9):913-917
		                        		
		                        			OBJECTIVE:
		                        			To compare the clinical efficacy between moxibustion and acupuncture for knee osteoarthritis (KOA), and to observe the effect on serum tumor necrosis factor-α(TNF-α), interleukin-1β(IL-1β), superoxide dismutase (SOD) and malondialdehyde (MDA).
		                        		
		                        			METHODS:
		                        			A total of 60 patients with KOA were randomized into a moxibustion group (30 cases, 2 cases dropped off) and an acupuncture group (30 cases, 2 cases dropped off). In the aucpuncture group, acupuncture was applied at Neixiyan (EX-LE 4), Dubi (ST 35), Heding (EX-LE 2), Xuehai (SP 10), Liangqiu (ST 34), Zusanli (ST 36) and point on the affected side for 30 min.In the moxibustion group, moxibustion was adopted at knee for 60 min. The treatment was given once every two days for 4 weeks, totally 14 times. Before and after treatment, the western ontario and McMaster universities osteoarthritis index (WOMAC) score was compared, and the therapeutic effect was evaluated in the two groups. The contents of serum TNF-αand IL-1β, the activity of serum SOD and the serum level of MDA were detected in the two groups.
		                        		
		                        			RESULTS:
		                        			Compared before treatment, the WOMAC scores and the contents of serum TNF-α, IL-1β and MDA after treatment were reduced (<0.05), the activity of serum SOD was increased (<0.05) in the two groups. In the moxibustion group, the WOMAC score and the contents of serum TNF-α, IL-1β and MDA after treatment were lower than the acupuncture group (<0.05), the activity of serum SOD was higher than the acupuncture group (<0.05). The total effective rate was 89.3% (25/28) in the moxibustion group, which was superior to 42.9% (12/28) in the acupuncture group (<0.05).
		                        		
		                        			CONCLUSION
		                        			Moxibustion and acupuncture can relieve KOA symptoms, and the therapeutic effect of moxibustion is superior to acupuncture. The mechanism may be related to the reduction of serum inflammatory factor and oxidative stress factor.
		                        		
		                        		
		                        		
		                        	
2.Clinical application and optimization of HEAD-US quantitative ultrasound assessment scale for hemophilic arthropathy.
Jun LI ; Xin Juan GUO ; Xiao Ling DING ; Bing Mei LV ; Jing XIAO ; Qing Li SUN ; Dong Shuang LI ; Wen Feng ZHANG ; Jin Chong ZHOU ; Chang Ping LI ; Ren Chi YANG
Chinese Journal of Hematology 2018;39(2):132-136
		                        		
		                        			
		                        			Objective: To assess the feasibility of HEAD-US scale in the clinical application of hemophilic arthropathy (HA) and propose an optimized ultrasound scoring system. Methods: From July 2015 to August 2017, 1 035 joints ultrasonographic examinations were performed in 91 patients. Melchiorre, HEAD-US (Hemophilic Early Arthropathy Detection with UltraSound) and HEAD-US-C (HEAD-US in China) scale scores were used respectively to analyze the results. The correlations between three ultrasound scales and Hemophilia Joint Health Scores (HJHS) were evaluated. The sensitivity differences of the above Ultrasonic scoring systems in evaluation of HA were compared. Results: All the 91 patients were male, with median age of 16 (4-55) years old, including 86 cases of hemophilia A and 5 cases hemophilia B. The median (P25, P75) of Melchiorre, HEAD-US and HEAD-US-C scores of 1 035 joints were 2(0,6), 1(0,5) and 2(0,6), respectively, and the correlation coefficients compared with HJHS was 0.747, 0.762 and 0.765 respectively, with statistical significance (P<0.001). The positive rates of Melchiorre, HEAD-US-C and HEAD-US scale score were 63.0% (95%CI 59.7%-65.9%), 59.5% (95%CI 56.5%-62.4%) and 56.6% (95%CI 53.6%-59.6%) respectively, and the difference was statistically significant (P<0.001). Even for 336 cases of asymptomatic joints, the positive rates of Melchiorre, HEAD-US-C and HEAD-US scale score were 25.0% (95%CI 20.6%-29.6%), 17.0% (95%CI 12.6%-21.1%) and 11.9% (95%CI 8.4%-15.7%) respectively, and the difference was statistically significant (P<0.001). There were significant changes (P<0.05) in the ultrasonographic score of HA before and after onset of hemorrhage in 107 joints of 40 patients. The difference in variation amplitude of HEAD-US-C scores and HEAD-US scores before and after joint bleeding was statistically significant (P<0.001). Conclusion: Compared with Melchiorre, there were similar good correlations between HEAD-US, HEAD-US-C and HJHS. HEAD-US ultrasound scoring system is quick, convenient and simple to use. The optimized HEAD-US-C scale score is more sensitive than HEAD-US, especially for patients with HA who have subclinical state, which make up for insufficiency of sensitivity in HEAD-US scoring system.
		                        		
		                        		
		                        		
		                        			Adolescent
		                        			;
		                        		
		                        			Adult
		                        			;
		                        		
		                        			Child
		                        			;
		                        		
		                        			Child, Preschool
		                        			;
		                        		
		                        			China
		                        			;
		                        		
		                        			Hemarthrosis
		                        			;
		                        		
		                        			Hemophilia A
		                        			;
		                        		
		                        			Hemophilia B
		                        			;
		                        		
		                        			Humans
		                        			;
		                        		
		                        			Male
		                        			;
		                        		
		                        			Middle Aged
		                        			;
		                        		
		                        			Ultrasonography
		                        			;
		                        		
		                        			Young Adult
		                        			
		                        		
		                        	
3.Impact of premature rupture of membranes on neonatal complications in preterm infants with gestational age <37 weeks.
Shun-Yan DUAN ; Xiang-Yong KONG ; Feng-Dan XU ; Hong-Yan LV ; Rong JU ; Zhan-Kui LI ; Shu-Juan ZENG ; Hui WU ; Xue-Feng ZHANG ; Wei-Peng LIU ; Fang LIU ; Hong-Bin CHENG ; Yan-Jie DING ; Tie-Qiang CHEN ; Ping XU ; Li-Hong YANG ; Su-Jing WU ; Jin WANG ; Li PENG ; Xiao-Lin ZHAO ; Hui-Xian QIU ; Wei-Xi WEN ; Ying LI ; Lan LI ; Zheng WEN ; Guo GUO ; Feng WANG ; Gai-Mei LI ; Wei LI ; Xiao-Ying ZHAO ; Yun-Bo XU ; Wen-Chao CHEN ; Huan YIN ; Xiao-Liang WANG ; Rui-Yan SHAN ; Mei-Ying HAN ; Chun-Yan YANG ; Zhi-Chun FENG
Journal of Southern Medical University 2016;36(7):887-891
OBJECTIVETo investigate the effect of premature rupture of the membrane (PROM) on neonatal complications in premature infants.
METHODSThe registration information of 7684 preterm infants with gestational age <37 weeks were collected from the cooperative units in the task group between January 1, 2014 to December 31, 2014. Specially trained personnel from each cooperative units filled in the unified form in a standardized format to record the gender, gestational age, birth weight, PROM, placental abruption, antenatal corticosteroid, Apgar score, amniotic fluid pollution, and complications of the infants. The data were analyzed comparatively between the cases with PROM and those without (control).
RESULTSThe preterm mortality rate was significantly lower but the incidences of ICH, NEC, ROP and BPD were significantly higher in PROM group than in the control group (P<0.05). The 95% confidence interval of the OR value was <1 for mortality, and was >1 for ICH, NEC, ROP and BPD. After adjustment for gestational age, birth weight, gender, mode of delivery, placental abruption, placenta previa, prenatal hormones, gestational diabetes mellitus (GDM), gestational period hypertension and 5-min Apgar score <7, the incidences of NEC, ROP and BPD were significantly different between the two groups (P<0.05) with 95% confidence interval of OR value >1, but the mortality rate and incidence of ICH were not significantly different between the two groups (P>0.05).
CONCLUSIONPROM is a risk factor for NEC, ROP and BPD in preterm infants, and adequate intervention of PROM can reduce the incidences of such complications as NEC, ROP and BPD in the infants.
Apgar Score ; Birth Weight ; Female ; Fetal Membranes, Premature Rupture ; pathology ; Gestational Age ; Humans ; Incidence ; Infant, Newborn ; Infant, Newborn, Diseases ; etiology ; Infant, Premature ; Pregnancy ; Risk Factors
4.Laser-induced interstitial thermotherapy via a single-needle delivery system: Optimal conditions of ablation, pathological and ultrasonic changes.
Yan-Rong ZHANG ; Ling-Yun FANG ; Cheng YU ; Zhen-Xing SUN ; Yan HUANG ; Juan CHEN ; Tao GUO ; Fei-Xiang XIANG ; Jing WANG ; Cheng-Fa LU ; Tian-Wei YAN ; Qing LV ; Ming-Xing XIE
Journal of Huazhong University of Science and Technology (Medical Sciences) 2015;35(4):579-584
		                        		
		                        			
		                        			This study aimed to examine the optimal conditions of laser-induced interstitial thermotherapy (LITT) via a single-needle delivery system, and the ablation-related pathological and ultrasonic changes. Ultrasound (US)-guided LITT (EchoLaser system) was performed at the output power of 2-4 Wattage (W) for 1-10 min in ex vivo bovine liver. Based on the results of the ex vivo study, the output power of 3 and 4 W with different durations was applied to in vivo rabbit livers (n=24), and VX2 tumors implanted in the hind limbs of rabbits (n=24). The ablation area was histologically determined by hematoxylin-eosin (HE) staining. Traditional US and contrast enhanced ultrasound (CEUS) were used to evaluate the treatment outcomes. The results showed: (1) In the bovine liver, ablation disruption was grossly seen, including a strip-like ablation crater, a carbonization zone anteriorly along the fiber tip, and a surrounding gray-white coagulation zone. The coagulation area, 1.2 cm in length and 1.0 cm in width, was formed in the bovine liver subjected to the ablation at 3 W for 5 min and 4 W for 4 min, and it extended slightly with the ablation time. (2) In the rabbit liver, after LITT at 3 W for 3 min and more, the coagulation area with length greater than or equal to 1.2 cm, and width greater than or equal to 1.0 cm, was found. Similar coagulation area was seen in the implanted VX2 carcinoma at 3 W for 5 min. (3) Gross examination of the liver and carcinoma showed three distinct regions: ablation crater/carbonization, coagulation and congestion distributed from the center outwards. (4) Microscopy revealed four zones after LITT, including ablation crater/carbonization, coagulation, edema and congestion from the center outwards. A large area with coagulative necrosis was observed around a vessel in the peripheral area with edema and hyperemia. (5) The size of coagulation was consistent well to the CEUS findings. It was concluded that EchoLaser system at low power can produce a coagulation area larger than 1.0 cm×1.0 cm during a short time period. The real-time US imaging can be used to effectively guide and assess the treatment.
		                        		
		                        		
		                        		
		                        			Animals
		                        			;
		                        		
		                        			Bone Neoplasms
		                        			;
		                        		
		                        			diagnostic imaging
		                        			;
		                        		
		                        			pathology
		                        			;
		                        		
		                        			therapy
		                        			;
		                        		
		                        			Cattle
		                        			;
		                        		
		                        			Hindlimb
		                        			;
		                        		
		                        			pathology
		                        			;
		                        		
		                        			Laser Therapy
		                        			;
		                        		
		                        			instrumentation
		                        			;
		                        		
		                        			methods
		                        			;
		                        		
		                        			Liver Diseases
		                        			;
		                        		
		                        			diagnostic imaging
		                        			;
		                        		
		                        			therapy
		                        			;
		                        		
		                        			Rabbits
		                        			;
		                        		
		                        			Treatment Outcome
		                        			;
		                        		
		                        			Ultrasonic Therapy
		                        			;
		                        		
		                        			instrumentation
		                        			;
		                        		
		                        			methods
		                        			;
		                        		
		                        			Ultrasonography
		                        			
		                        		
		                        	
5.Expansion of new type cytokine induced killer cells in vitro with peripheral blood mononuclearcells in ad-vanced breast cancer in PBMC
Xiangshi LU ; Chuanjian SONG ; Jing CUI ; Li QIN ; Fen MEI ; Yanqiao ZHANG ; Juan ZHAO ; Huimin LV ; Benning ZHANG
Practical Oncology Journal 2014;(5):391-395
		                        		
		                        			
		                        			Objective To investigate new type cytokine induced killer cells expansion using advanced breast cancer′s peripheral blood .Methods peripheral blood mononuclear cells were isolated from 8 advanced breast cancer volunteers and co -cultured with Cytokine induced killer cells .These cells were placed in plastic flasks containing CIK-MediumTM supplemented with 10% auto-plasma in the presence of IL -2 ( 1 000 IU/mL) .The cultures were fed with CIK-MediumTM supplemented with IL -2 following the proliferation capacity . Cell proliferation was measured by cell counting during the cultivation .Fourteen days after cultivation ,cell mark-ers CD3/CD16/CD56 were examined by flow cytometry .51Cr and MTT assays were employed in cytotoxicity as-says.Cytokines were assayed by ELISA method .Results CD16+,CD16+CD56+,CD56+CIK cells were 5.8~11.6%in 2 ×107 fresh PBMCs and 95.2~97.6%in co-cultured cells after 18 days cultivation .The in vitro ex-pansion rate of new type cytokine induced killer cells was up to more than 8.2 ×108 in total,the cytotoxicity are ef-fective killing cells against MCF 7 and BT20 breast cancer cell lines .New type cytokine induced killer cells expand-ed from all PBMCs and secreted cytokines IFN -and TNF-.Conclusion The present culture could be useful to clarify the mechanisms of CIK cells expansion in vitro and feasible for breast cancer immmuno cell therapy .
		                        		
		                        		
		                        		
		                        	
6.Left ventricle geometry remolding after heart transplantation: a two-dimensional ultrasound study.
Xiao-juan QIN ; He LI ; Jun YOU ; Qing LV ; Jing ZHANG ; Han-jing GAO ; Ming-xing XIE
Journal of Huazhong University of Science and Technology (Medical Sciences) 2013;33(6):892-896
		                        		
		                        			
		                        			The function of the transplanted heart will be affected by acute allograft rejection, chronic rejection, high blood pressure and so on, which may induce the reconstruction of the left ventricle and the increase of left ventricular mass (LVM), and eventually lead to left ventricular hypertrophy that will significantly affect the prognosis of heart transplantation (HT). The purpose of this study was to dynamically monitor the changes of left ventricular geometric patterns after HT using two-dimensional echocardiography and to understand the remodeling process and its possible influencing factors. The left ventricular internal diameter, interventricular septal wall thickness, posterior wall thickness at end diastole were measured and the relative wall thickness (RWT), left ventricular mass, left ventricular mass index were calculated respectively in 34 HT patients and 34 healthy volunteers by two-dimensional echocardiography. The type of left ventricular geometry was identified based on the echocardiographic determination of LVM index (LVMI) and RWT. The HT patients were divided into three groups according to the time length after surgery: A (3 months postoperatively), B (6 months postoperatively) and C (12 months postoperatively). We compared the parameters of left ventricle between HT group and normal control group, and explored the risk factors causing the increase of LVM. The results showed that 4 patients (16%) in group A had concentric remodeling. Nine patients (34.62%) in group B had reconstruction, including 5 cases of concentric remodeling, 2 cases of concentric hypertrophy and 2 cases of eccentric hypertrophy. The hypertrophy incidence rate was 15.4% in group B. 15 patients (62.5%) had reconstruction in group C, including 9 cases of concentric remodeling, 5 cases of concentric hypertrophy, and 1 case of eccentric hypertrophy. The prevalence of hypertrophy was 25%. Multivariate analysis showed that hypertension and acute rejection history were the risk factors that resulted in left ventricular hypertrophy. It is concluded that the left ventricular remodeling occurs following cardiac transplantation at an early stage and the incidence of left ventricular hypertrophy increases with survival time. In this study, the one-year prevalence of left ventricular hypertrophy was 25% after surgery. Hypertension and acute rejection history are risk factors that can predict the left ventricular hypertrophy.
		                        		
		                        		
		                        		
		                        			Adult
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		                        			Cardiomegaly
		                        			;
		                        		
		                        			diagnostic imaging
		                        			;
		                        		
		                        			etiology
		                        			;
		                        		
		                        			Case-Control Studies
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		                        			Echocardiography
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		                        			Female
		                        			;
		                        		
		                        			Heart Transplantation
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		                        			adverse effects
		                        			;
		                        		
		                        			Heart Ventricles
		                        			;
		                        		
		                        			diagnostic imaging
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		                        			Humans
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		                        			Male
		                        			;
		                        		
		                        			Middle Aged
		                        			;
		                        		
		                        			Postoperative Period
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		                        			Ventricular Remodeling
		                        			
		                        		
		                        	
7.Sero-epidemiological investigation on Rickettsia typhi,Bartonella henselae and Orientia tsutsugamushi in farmers from rural areas of Tianjin,2007-2009
Ying ZHANG ; Zhi-Lun ZHANG ; Jie-Ying YIN ; Jie LV ; Hui-Lan YU ; Chang-Wei LIANG ; Shi-Wen WANG ; Jing-Bo ZHAO ; Li-Juan ZHANG
Chinese Journal of Epidemiology 2011;32(3):256-259
		                        		
		                        			
		                        			Objective To study the sero-epidemiological starus regarding Rickettsia (R.) typhi,Bartonella (B.) henselae and Orientia (O.) tsutsugamushi in farmers from rural areas of Tianjin.Methods Field epidemiological surveys were performed in 8 districts (county) of Tianjin city from 2007 to 2009.886 farmers were randomly recruited and their serum samples collected to detect the specific antibodies of R.typhi,B.henselae and O.tsutsugamushi by micro-indirect immunoflorescence (IFA).Results The total antibody positive rates of R.typhi increased from 5.0% to 58.2% while B.heaselae had an increase from 2.6% to 14.5% and O.tsutsugamushi increased from 1.8% to 39.8%.Geographic distribution showed that farmers living in the central and southeast areas were higher than that in other areas.Conclusion Infections of both R.typhi,B.henselae and O.tsutsugamushi in farmers from Tianjin areas were popular and the antibody positive rates ofR.typhi,B.henselae and O.tsutsugamushi had an annual increase.
		                        		
		                        		
		                        		
		                        	
8.Familial aggregation of metabolic syndrome in adolescents with paternal metabolic syndrome
Hui-Ying ZHANG ; Yu-Ye SUN ; Su-Fen CHEN ; Jing-Juan LV ; Liu YANG ; Wei XIA ; Cai-Hong SUN ; Yi-Jun WANG
Chinese Journal of Epidemiology 2010;31(2):126-128
		                        		
		                        			
		                        			Objective To analyze the impact of parental Metabolic Syndrome(MS)on adolescents,and to explore the familial aggregation of MS with its components.Methods Using a 1:3 case-control familial study design to choose 26 MS male patients as proband and 78 healthy men as controls.Data regarding phenotype of their adolescence offspring were collected.Height,weight,waist circumference(WC),blood pressure,body mass index(BMI),waist-to-hip ratio(WHR)and waist-to-height ratio(WHtR)were measured or calculated.FPG,TC,TG,HDL-C and LDL-C were detected by automatic biochemical analyzer and hs-CRP was detected.Results WC,WHtR,WHR,DBP and hs-CRP of those adolescents with paternal MS were significantly higher than in controls(P<0.05).Rates of MS,Obesity depend WC,low level of HDL-C of adolescent with paternal MS were significantly higher than in controls(P<0.05).The rate of number on MS was significantly higher in case group than in control(r=0.231,P<0.05).Conclusion The phenotypes of MS were different between adolescents with or without parental MS,indicating that the familial aggregation of MS had been existed in their adolescent offspring,and mainly presented in central obesity,increased blood pressure and inflammation.
		                        		
		                        		
		                        		
		                        	
9.Etiological characteristics of influenza A (H1N1) 2009 virus in Beijing
Fang HUANG ; Jing GUO ; Shu-Juan CUI ; Yan-Ning LV ; Zhi-Yong GAO ; Wei-Hong LI ; Han-Qiu YAN ; Mei QU ; Wei-Xian SHI ; Gui-Lan LU ; Xin ZHANG ; Dai-Tao ZHANG ; Li-Li TIAN ; Hai-Kun QIAN ; Peng YANG ; Xing-Huo PANG ; Quan-Yi WANG
Chinese Journal of Epidemiology 2010;31(5):494-496
		                        		
		                        			
		                        			Objective To analyze the results of detection on influenza A (H1N1) 2009 virus in Beijing from May 2009 to December 2009 and to understand the epidemiologic characteristics during the pandemic period. Methods The study was conducted from the May 1 to December 27,2009. A total of 101 852 throat swab samples were detected with the real-time RT-PCR assay by the Beijing Network Laboratory. Data was statistically analyzed. Results 9843 samples showed influenza A (H1N1) 2009 positive, with an overall positive rate as 9.66%. In terms of the positive rates, they were 2.85% from May to June, 3.32% from July to August and 8.35% from September to October. The peak month fell in November (29.67%) and December (24.33%). The positive rates among the following subpopulations were: 8.40% among the suspected cases, 4.75% among close contact cases, 11.46% among the influenza-like illness cases and 7.33% among the cluster cases with fever. Positive cases mainly fell in age groups 5-14 and 15-24. The ratio of male to female was 1.5:1.Conclusion During the pandemic period of influenza A (H1N1) 2009, positive cases gradually increased during May to November but slowly decreasing in December.
		                        		
		                        		
		                        		
		                        	
10.IGFBP7 plays a potential tumor suppressor role against colorectal carcinogenesis with its expression associated with DNA hypomethylation of exon 1.
Wen-jing RUAN ; Jie LIN ; En-ping XU ; Fang-ying XU ; Yu MA ; Hong DENG ; Qiong HUANG ; Bing-jian LV ; Hu HU ; Jing CUI ; Mei-juan DI ; Jian-kang DONG ; Mao-de LAI
Journal of Zhejiang University. Science. B 2006;7(11):929-932
		                        		
		                        			
		                        			Insulin-like growth factor binding-protein-7 (IGFBP7) was obtained from our previous colonic adenocarcinoma (CRC) and normal mucosa suppression subtraction hybridization (SSH) cDNA libraries. By RT-PCR and immunohistochemistry, we found that IGFBP7 was overexpressed in CRC tissue compared to normal tissue. However, our in vitro experiments performed in 10 CRC cell lines showed that IGFBP7 expressed only in SW480 and Caco2 cell lines, which implied an underlying reversible regulatory mechanism. Using methylation-specific PCR (MSP) and bisulfite sodium PCR (BSP), we found that its expression was associated with DNA hypomethylation of exon1. This was further supported by the in vitro study which showed restored IGFBP7 expression after demethylation agent 5-aza-2'-deoxycytidine treatment. Correlation analysis between IGFBP7 expression and prognosis indicated that overexpression of IGFBP7 in CRC tissue correlated with favourable survival. Investigation of the functional role of IGFBP7 through transfection studies showed that IGFBP7 protein could inhibit growth rate, decrease colony formation activity, and induce apoptosis in RKO and SW620 cells, suggesting it a potential tumor suppressor protein in colorectal carcinogenesis. In conclusion, our study clearly demonstrated that IGFBP7 plays a potential tumor suppressor role against colorectal carcinogenesis and its expression is associated with DNA hypomethylation of exon 1.
		                        		
		                        		
		                        		
		                        			Adenocarcinoma
		                        			;
		                        		
		                        			genetics
		                        			;
		                        		
		                        			metabolism
		                        			;
		                        		
		                        			Apoptosis
		                        			;
		                        		
		                        			genetics
		                        			;
		                        		
		                        			Cell Line, Tumor
		                        			;
		                        		
		                        			Colorectal Neoplasms
		                        			;
		                        		
		                        			genetics
		                        			;
		                        		
		                        			metabolism
		                        			;
		                        		
		                        			DNA Methylation
		                        			;
		                        		
		                        			Exons
		                        			;
		                        		
		                        			Gene Expression Regulation, Neoplastic
		                        			;
		                        		
		                        			genetics
		                        			;
		                        		
		                        			Humans
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		                        			Insulin-Like Growth Factor Binding Proteins
		                        			;
		                        		
		                        			genetics
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		                        			metabolism
		                        			;
		                        		
		                        			Transfection
		                        			;
		                        		
		                        			Tumor Suppressor Proteins
		                        			;
		                        		
		                        			genetics
		                        			;
		                        		
		                        			metabolism
		                        			
		                        		
		                        	
            
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