1.Effects of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criteria Changes for Schizophrenia on Diagnoses of First-Episode Schizophrenia Spectrum Disorders
WooRi CHO ; Sung-Wan KIM ; Seung-Hee WON ; Bong-Ju LEE ; Naohisa TSUJINO ; Youji TAKUBO ; Taiju YAMAGUCHI ; Takahiro NEMOTO ; Ling LI ; Thi-Hung LE ; Fatima Zahra RAMI ; Young-Chul CHUNG
Psychiatry Investigation 2025;22(2):212-217
Objective:
Impact of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) changes on the criteria for schizophrenia (SZ) has been reported to be minimal in previous studies. However, this could be different in first-episode schizophrenia spectrum disorders (FE-SSDs). We investigated what proportion of patients with FE-SSDs was diagnosed based on the sole presence of bizarre delusions (BDs) or first rank auditory hallucinations (FRAHs). Their alternative diagnosis by the DSM-5 was established and diagnostic stability over 1-year was identified.
Methods:
This was a retrospective review study on the medical records, case report forms for the subjects with FE-SSDs (n=404) participated in the Korea Early Psychosis Study. The two Japanese sites reviewed retrospectively only medical records of the subjects with FE-SSDs (n=103). We used three different definitions of BDs (strict, narrow, and broad) and specified subtypes of Other Specified Schizophrenia spectrum and Other psychotic disorders (OSSOs). To ensure inter-rater reliability between the hospitals, regular zoom meetings were held.
Results:
Forty (7.89%) subjects out of 507 were found to be diagnosed as SSDs based on the sole presence of BDs or FRAHs. All these patients met the criteria of OSSOs and were classified as having pure delusion (n=22), delusion with attenuated auditory hallucinations (AHs) (n=5), pure AHs (n=3) and AHs with attenuated delusion (n=10). The patients with first and second subtypes (n=27) were found to have BDs. The BDs fulfilled mostly strict definitions or satisfied the next broadest definition. The diagnostic stability of FE-OSSOs and its subgroups (first and second subtypes) over 1-year was substantially high (70.27% and 84% respectively).
Conclusion
These findings suggest that more rigorous diagnostic assessment should be performed especially to differentiate OSSOs from SZ in patients with FE-SSDs and more refined classification of the subtypes for OSSOs considered in the next DSM revision.
2.Effects of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criteria Changes for Schizophrenia on Diagnoses of First-Episode Schizophrenia Spectrum Disorders
WooRi CHO ; Sung-Wan KIM ; Seung-Hee WON ; Bong-Ju LEE ; Naohisa TSUJINO ; Youji TAKUBO ; Taiju YAMAGUCHI ; Takahiro NEMOTO ; Ling LI ; Thi-Hung LE ; Fatima Zahra RAMI ; Young-Chul CHUNG
Psychiatry Investigation 2025;22(2):212-217
Objective:
Impact of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) changes on the criteria for schizophrenia (SZ) has been reported to be minimal in previous studies. However, this could be different in first-episode schizophrenia spectrum disorders (FE-SSDs). We investigated what proportion of patients with FE-SSDs was diagnosed based on the sole presence of bizarre delusions (BDs) or first rank auditory hallucinations (FRAHs). Their alternative diagnosis by the DSM-5 was established and diagnostic stability over 1-year was identified.
Methods:
This was a retrospective review study on the medical records, case report forms for the subjects with FE-SSDs (n=404) participated in the Korea Early Psychosis Study. The two Japanese sites reviewed retrospectively only medical records of the subjects with FE-SSDs (n=103). We used three different definitions of BDs (strict, narrow, and broad) and specified subtypes of Other Specified Schizophrenia spectrum and Other psychotic disorders (OSSOs). To ensure inter-rater reliability between the hospitals, regular zoom meetings were held.
Results:
Forty (7.89%) subjects out of 507 were found to be diagnosed as SSDs based on the sole presence of BDs or FRAHs. All these patients met the criteria of OSSOs and were classified as having pure delusion (n=22), delusion with attenuated auditory hallucinations (AHs) (n=5), pure AHs (n=3) and AHs with attenuated delusion (n=10). The patients with first and second subtypes (n=27) were found to have BDs. The BDs fulfilled mostly strict definitions or satisfied the next broadest definition. The diagnostic stability of FE-OSSOs and its subgroups (first and second subtypes) over 1-year was substantially high (70.27% and 84% respectively).
Conclusion
These findings suggest that more rigorous diagnostic assessment should be performed especially to differentiate OSSOs from SZ in patients with FE-SSDs and more refined classification of the subtypes for OSSOs considered in the next DSM revision.
3.Effects of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criteria Changes for Schizophrenia on Diagnoses of First-Episode Schizophrenia Spectrum Disorders
WooRi CHO ; Sung-Wan KIM ; Seung-Hee WON ; Bong-Ju LEE ; Naohisa TSUJINO ; Youji TAKUBO ; Taiju YAMAGUCHI ; Takahiro NEMOTO ; Ling LI ; Thi-Hung LE ; Fatima Zahra RAMI ; Young-Chul CHUNG
Psychiatry Investigation 2025;22(2):212-217
Objective:
Impact of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) changes on the criteria for schizophrenia (SZ) has been reported to be minimal in previous studies. However, this could be different in first-episode schizophrenia spectrum disorders (FE-SSDs). We investigated what proportion of patients with FE-SSDs was diagnosed based on the sole presence of bizarre delusions (BDs) or first rank auditory hallucinations (FRAHs). Their alternative diagnosis by the DSM-5 was established and diagnostic stability over 1-year was identified.
Methods:
This was a retrospective review study on the medical records, case report forms for the subjects with FE-SSDs (n=404) participated in the Korea Early Psychosis Study. The two Japanese sites reviewed retrospectively only medical records of the subjects with FE-SSDs (n=103). We used three different definitions of BDs (strict, narrow, and broad) and specified subtypes of Other Specified Schizophrenia spectrum and Other psychotic disorders (OSSOs). To ensure inter-rater reliability between the hospitals, regular zoom meetings were held.
Results:
Forty (7.89%) subjects out of 507 were found to be diagnosed as SSDs based on the sole presence of BDs or FRAHs. All these patients met the criteria of OSSOs and were classified as having pure delusion (n=22), delusion with attenuated auditory hallucinations (AHs) (n=5), pure AHs (n=3) and AHs with attenuated delusion (n=10). The patients with first and second subtypes (n=27) were found to have BDs. The BDs fulfilled mostly strict definitions or satisfied the next broadest definition. The diagnostic stability of FE-OSSOs and its subgroups (first and second subtypes) over 1-year was substantially high (70.27% and 84% respectively).
Conclusion
These findings suggest that more rigorous diagnostic assessment should be performed especially to differentiate OSSOs from SZ in patients with FE-SSDs and more refined classification of the subtypes for OSSOs considered in the next DSM revision.
4.Effects of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criteria Changes for Schizophrenia on Diagnoses of First-Episode Schizophrenia Spectrum Disorders
WooRi CHO ; Sung-Wan KIM ; Seung-Hee WON ; Bong-Ju LEE ; Naohisa TSUJINO ; Youji TAKUBO ; Taiju YAMAGUCHI ; Takahiro NEMOTO ; Ling LI ; Thi-Hung LE ; Fatima Zahra RAMI ; Young-Chul CHUNG
Psychiatry Investigation 2025;22(2):212-217
Objective:
Impact of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) changes on the criteria for schizophrenia (SZ) has been reported to be minimal in previous studies. However, this could be different in first-episode schizophrenia spectrum disorders (FE-SSDs). We investigated what proportion of patients with FE-SSDs was diagnosed based on the sole presence of bizarre delusions (BDs) or first rank auditory hallucinations (FRAHs). Their alternative diagnosis by the DSM-5 was established and diagnostic stability over 1-year was identified.
Methods:
This was a retrospective review study on the medical records, case report forms for the subjects with FE-SSDs (n=404) participated in the Korea Early Psychosis Study. The two Japanese sites reviewed retrospectively only medical records of the subjects with FE-SSDs (n=103). We used three different definitions of BDs (strict, narrow, and broad) and specified subtypes of Other Specified Schizophrenia spectrum and Other psychotic disorders (OSSOs). To ensure inter-rater reliability between the hospitals, regular zoom meetings were held.
Results:
Forty (7.89%) subjects out of 507 were found to be diagnosed as SSDs based on the sole presence of BDs or FRAHs. All these patients met the criteria of OSSOs and were classified as having pure delusion (n=22), delusion with attenuated auditory hallucinations (AHs) (n=5), pure AHs (n=3) and AHs with attenuated delusion (n=10). The patients with first and second subtypes (n=27) were found to have BDs. The BDs fulfilled mostly strict definitions or satisfied the next broadest definition. The diagnostic stability of FE-OSSOs and its subgroups (first and second subtypes) over 1-year was substantially high (70.27% and 84% respectively).
Conclusion
These findings suggest that more rigorous diagnostic assessment should be performed especially to differentiate OSSOs from SZ in patients with FE-SSDs and more refined classification of the subtypes for OSSOs considered in the next DSM revision.
5.Effects of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Criteria Changes for Schizophrenia on Diagnoses of First-Episode Schizophrenia Spectrum Disorders
WooRi CHO ; Sung-Wan KIM ; Seung-Hee WON ; Bong-Ju LEE ; Naohisa TSUJINO ; Youji TAKUBO ; Taiju YAMAGUCHI ; Takahiro NEMOTO ; Ling LI ; Thi-Hung LE ; Fatima Zahra RAMI ; Young-Chul CHUNG
Psychiatry Investigation 2025;22(2):212-217
Objective:
Impact of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) changes on the criteria for schizophrenia (SZ) has been reported to be minimal in previous studies. However, this could be different in first-episode schizophrenia spectrum disorders (FE-SSDs). We investigated what proportion of patients with FE-SSDs was diagnosed based on the sole presence of bizarre delusions (BDs) or first rank auditory hallucinations (FRAHs). Their alternative diagnosis by the DSM-5 was established and diagnostic stability over 1-year was identified.
Methods:
This was a retrospective review study on the medical records, case report forms for the subjects with FE-SSDs (n=404) participated in the Korea Early Psychosis Study. The two Japanese sites reviewed retrospectively only medical records of the subjects with FE-SSDs (n=103). We used three different definitions of BDs (strict, narrow, and broad) and specified subtypes of Other Specified Schizophrenia spectrum and Other psychotic disorders (OSSOs). To ensure inter-rater reliability between the hospitals, regular zoom meetings were held.
Results:
Forty (7.89%) subjects out of 507 were found to be diagnosed as SSDs based on the sole presence of BDs or FRAHs. All these patients met the criteria of OSSOs and were classified as having pure delusion (n=22), delusion with attenuated auditory hallucinations (AHs) (n=5), pure AHs (n=3) and AHs with attenuated delusion (n=10). The patients with first and second subtypes (n=27) were found to have BDs. The BDs fulfilled mostly strict definitions or satisfied the next broadest definition. The diagnostic stability of FE-OSSOs and its subgroups (first and second subtypes) over 1-year was substantially high (70.27% and 84% respectively).
Conclusion
These findings suggest that more rigorous diagnostic assessment should be performed especially to differentiate OSSOs from SZ in patients with FE-SSDs and more refined classification of the subtypes for OSSOs considered in the next DSM revision.
6.Effectiveness evaluation of the construction of "mosquito-free village" in Fuling District
WANG Ling ; JU Denghui ; XIANG Yu ; YU Shan ; LI Jiwen
Journal of Preventive Medicine 2025;37(7):714-717,721
Objective:
To evaluate the effectiveness for the construction of the "mosquito-free village" in Jinzishan Village, Fuling District, Chongqing Municipality, so as to provide references for improving mosquito control practices in hilly and mountainous rural areas.
Methods:
The "mosquito-free village" initiative in Fuling District was launched in April 2023. Mosquito density monitoring was conducted annually from April to October. Larval mosquito density was monitored using the path method and scoop-catch method, and adult mosquito density was monitored using human-baited landing catch. One hundred and fifty-two villagers were randomly conducted before the "mosquito-free village" construction (April 2023) and one hundred and sixty-seven villagers were randomly conducted after the construction (November 2024). Knowledge awareness rate and correct behavioral practices regarding mosquito control among villagers were assessed. The satisfaction among villagers were evaluated in November 2024. The effectiveness of the initiative was evaluated based on mosquito density data, health education outcomes from 2023 to 2024, and satisfaction.
Results:
The average larval mosquitoes path index in Jinshanzi Village decreased from 1.50 spots/km in 2023 to 0.07 spots/km in 2024 (P<0.05). The average sampling spoon index of larval mosquitoes decreased from 3.43% in 2023 to 0 in 2024. The average landing rate index of adult mosquitoes decreased from 3.90 mosquitoes/(person·time) in 2023 to 0.38 mosquitoes/(person·time) in 2024 (P<0.05). The awareness rate of mosquito control knowledge and the formation rate of correct behaviors among villagers increased from 59.87% and 57.24% in 2023 to 92.22% and 90.42% in 2024, respectively (both P<0.05). In 2024, the satisfaction of villagers was 92.81%.
Conclusion
The mosquito density, health education effectiveness, and satisfaction of villagers in Jinzishan Village have all met the evaluation criteria for a "mosquito-free village", providing a replicable model for promotion in hilly and mountainous rural areas.
7.Effect of Temperature Cycle Preservation on Platelet Aggregation Rate and Routine Parameters.
Ju-Ling LIANG ; Zhi-Hao DENG ; Chuang-Jin ZHUO ; Lu HUANG ; Jing XU ; Wei-Jian WU
Journal of Experimental Hematology 2025;33(1):236-240
OBJECTIVE:
To compare and analyze the changes of aggregation rate and routine parameters of platelets stored in temperature cycle, cold storage at 4 ℃ and oscillating storage at 22 ℃, so as to provide more experimental data for platelet preservation methods.
METHODS:
Blood samples were collected at 5 time points on the 1st, 2nd, 3rd, 4th and 6th day after platelet cycling preservation at temperature, cold storage at 4 ℃, and oscillating storage at 22 ℃. Platelet maximum aggregation rate (MAR) and routine parameters including platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW) and platelet-larger cell ratio (P-LCR) were detected.
RESULTS:
The platelet MAR of three groups showed a significant decrease trend with the preservation time, the fastest decrease was in the 22 ℃ group, the slowest was in the 4 ℃ group, and the temperature cycle group was between the two groups. On the 3rd day of preservation, the platelet MAR in 4 ℃ group was still in the normal range (MAR>60%), while in temperature cycle group was about 50%, and in 22 ℃ group was the lowest. On the 4th day of preservation, platelet MAR in all the three groups was lower than 50%, and that in temperature cycle group was significantly lower than in 4 ℃ group but higher than in 22 ℃ group (both P < 0.05). On the 6th day of preservation, platelet MAR in the temperature cycle group was significantly lower than that in the 4 ℃ group ( P <0.05), but there was no statistically significant difference compared to 22 ℃ group (P >0.05). PLT values in the three groups were all significantly decreased with the preservation time extension, and were significantly lower than those in the early stage of preservation within 6 days (all P < 0.05). PDW in temperature cycle group had no significant change within 6 days of preservation, but MPV and P-LCR were significantly increased. MPV, PDW and P-LCR all decreased significantly in 4 ℃ group within 6 days of preservation but increased in 22 ℃ group. Under the same storage days, PLT value of temperature cycle group had no significant difference with that of 4 ℃ group and 22 ℃ group, while MPV, PDW and P-LCR values were significantly higher than 4 ℃ group but lower than 22 ℃ group (all P < 0.05).
CONCLUSION
The aggregation function and routine parameters changes of temperature circulating preserved platelets are between 4 and 22 ℃.
Humans
;
Platelet Aggregation
;
Blood Preservation/methods*
;
Temperature
;
Blood Platelets
;
Platelet Count
;
Mean Platelet Volume
;
Cryopreservation/methods*
;
Cold Temperature
8.Qingda Granule Attenuates Hypertension-Induced Cardiac Damage via Regulating Renin-Angiotensin System Pathway.
Lin-Zi LONG ; Ling TAN ; Feng-Qin XU ; Wen-Wen YANG ; Hong-Zheng LI ; Jian-Gang LIU ; Ke WANG ; Zhi-Ru ZHAO ; Yue-Qi WANG ; Chao-Ju WANG ; Yi-Chao WEN ; Ming-Yan HUANG ; Hua QU ; Chang-Geng FU ; Ke-Ji CHEN
Chinese journal of integrative medicine 2025;31(5):402-411
OBJECTIVE:
To assess the efficacy of Qingda Granule (QDG) in ameliorating hypertension-induced cardiac damage and investigate the underlying mechanisms involved.
METHODS:
Twenty spontaneously hypertensive rats (SHRs) were used to develope a hypertension-induced cardiac damage model. Another 10 Wistar Kyoto (WKY) rats were used as normotension group. Rats were administrated intragastrically QDG [0.9 g/(kg•d)] or an equivalent volume of pure water for 8 weeks. Blood pressure, histopathological changes, cardiac function, levels of oxidative stress and inflammatory response markers were measured. Furthermore, to gain insights into the potential mechanisms underlying the protective effects of QDG against hypertension-induced cardiac injury, a network pharmacology study was conducted. Predicted results were validated by Western blot, radioimmunoassay immunohistochemistry and quantitative polymerase chain reaction, respectively.
RESULTS:
The administration of QDG resulted in a significant decrease in blood pressure levels in SHRs (P<0.01). Histological examinations, including hematoxylin-eosin staining and Masson trichrome staining revealed that QDG effectively attenuated hypertension-induced cardiac damage. Furthermore, echocardiography demonstrated that QDG improved hypertension-associated cardiac dysfunction. Enzyme-linked immunosorbent assay and colorimetric method indicated that QDG significantly reduced oxidative stress and inflammatory response levels in both myocardial tissue and serum (P<0.01).
CONCLUSIONS
Both network pharmacology and experimental investigations confirmed that QDG exerted its beneficial effects in decreasing hypertension-induced cardiac damage by regulating the angiotensin converting enzyme (ACE)/angiotensin II (Ang II)/Ang II receptor type 1 axis and ACE/Ang II/Ang II receptor type 2 axis.
Animals
;
Drugs, Chinese Herbal/therapeutic use*
;
Hypertension/pathology*
;
Renin-Angiotensin System/drug effects*
;
Rats, Inbred SHR
;
Oxidative Stress/drug effects*
;
Male
;
Rats, Inbred WKY
;
Blood Pressure/drug effects*
;
Myocardium/pathology*
;
Rats
;
Inflammation/pathology*
9.Repair effect of resveratrol combined with Schwann cell-like cells on sciatic nerve injury in rats
Xing LIU ; Ling ZHENG ; Yu LIU ; Liming YI ; Libing RAO ; Xiaojun JU
Chinese Journal of Neuroanatomy 2024;40(4):485-491
Objective:To explore the repair effect of resveratrol combined with Schwann cell-like cells(SCLCs)dif-ferentiated from adipose-derived stem cells(ADSCs)on sciatic nerve injury in rats.Methods:ADSCs were primarily cultured and induced to differentiate into SCLCs.Cell morphology was observed by scanning electron microscopy.West-ern Blot method was used to detect the expressions of S100 calcium-binding protein β(S100β),p75 neurotrophin receptor(p75NTR),and glial fibrillary acidic protein(GFAP).Rats were randomly divided into Control group(Con-trol),Schwann cell-like cell group(SCLCs),resveratrol group(Res),and resveratrol+Schwann cell-like cell group(Res+SCLCs).Eight weeks after the successful establishment of the sciatic nerve injury model,the sciatic nerve func-tion index(SFI)of each group was detected by footprint experiment;the mechanical withdrawal threshold(MWT)was measured by von Frey filament stimulation needle;The wet weight ratio(WR)of the tibialis anterior muscle was deter-mined by weighing method;Western Blot and RT-qPCR methods were used to detect the expressions of neurotrophin-3(NT-3),nerve growth factor(NGF),insulin-like growth factor-1(IGF-1),and brain-derived neurotrophic factor(BDNF)at the injury site.Results:After 8 days of induction of ADSCs,the cells had elongated poles and increased extracellular components;S100β,p75NTR,and GFAP proteins were highly expressed.After treatment with SCLCs,Res,and Res+SCLCs,the SFI and WR of the treatment groups were significantly better than those of the Control group(P<0.05);the MWT of rats in the Res+SCLCs group and SCLCs group was reduced(P<0.05).Western Blot re-sults showed that the expressions of NT-3,IGF-1,NGF,and BDNF proteins in rats in the Res+SCLCs group were higher than those in other groups(P<0.05);The expressions of NT-3,NGF,and BDNF proteins in rats in the SCLCs group were higher than those in the Control group(P<0.05);the expressions of NT-3 and NGF proteins in rats in the Res group were higher than those in the Control group(P<0.05).RT-qPCR results showed that the expressions of NT-3,IGF-1,NGF,and BDNF mRNA in rats in the Res+SCLCs group were highly expressed;the expressions of NT-3,IGF-1,NGF,and BDNF mRNA in rats in the SCLCs group were higher than those in the Control group(P<0.05);The expressions of IGF-1 and NGF mRNA in rats in the Res group were higher than those in the Control group(P<0.05).Conclusion:Res combined with SCLCs differentiated from ADSCs has a good repair effect on sciatic nerve inju-ry in rats.
10.Effect of Huangqi Xuming Decoction on Norepinephrine,Hypersensitive C-reactive Protein,Superoxide Dismutase and Activities of Daily Living of Patients with Alzheimer's Disease of Spleen and Kidney Deficiency Type
Yan YUAN ; Lu-Ling TAO ; Ju-Kong ZHANG
Journal of Guangzhou University of Traditional Chinese Medicine 2024;41(6):1416-1422
Objective To investigate the therapeutic effect of Huangqi Xuming Decoction for Alzheimer's disease(AD)patients with spleen and kidney deficiency syndrome and to explore its possible mechanism.Methods A total of 134 patients with AD of spleen and kidney deficiency type were randomly divided into observation group and control group,with 67 cases in each group.The control group was treated with routine western medicine,and the observation group was treated with Huangqi Xuming Decoction on the basis of treatment for the control group.The course of treatment for the two groups covered 12 weeks.The changes of traditional Chinese medicine(TCM)syndrome score,Mini-Mental State Examination(MMSE)score,Alzheimer's Disease Assessment Scale-Cognitive Subscale(ADAS-Cog)score and serum levels of 5-hydroxytryptamine(5-HT),norepinephrine(NE),brain-derived neurotrophic factor(BDNF),superoxide dismutase(SOD),interleukin-6(IL-6)and hypersensitive C-reactive protein(Hs-CRP)in the two groups before and after treatment were observed.After treatment,the clinical efficacy of the two groups was evaluated.Results(1)After 12 weeks of treatment,the total effective rate of the observation group was 89.55%(60/67)and that of the control group was 71.64%(48/67),and the intergroup comparison(tested by chi-square test)showed that the efficacy of the observation group was significantly superior to that of the control group(P<0.05).(2)After treatment,the MMSE scores of the patients in the two groups were higher(P<0.05)and the TCM syndrome scores and ADAS-Cog scores were lower than those before treatment(P<0.05).The intergroup comparison showed that the increase of the MMSE scores and the decrease of the TCM syndrome scores and ADAS-Cog scores in the observation group were significantly superior to those in the control group(P<0.05).(3)After treatment,the serum 5-HT,NE,BDNF,and SOD levels of the two groups were higher(P<0.05)and serum IL-6 and Hs-CRP levels were lower than those before treatment(P<0.05).The intergroup comparison showed that the increase of serum 5-HT,NE,BDNF,and SOD levels and the decrease of serum IL-6 and Hs-CRP levels in the observation group were significantly superior to those in the control group(P<0.05).Conclusion For patients with AD of spleen and kidney deficiency type,the application of Huangqi Xuming Decoction based on the conventional western medicine treatment is helpful to relieving the inflammatory response,regulating the imbalance of oxidative stress,promoting the improvement of the patients'abilities of daily living,and enhancing the clinical efficacy.


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