BACKGROUND Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity.AIM To...BACKGROUND Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity.AIM To analyze the effect of a stellate ganglion block combined with total diploma intravenous anesthesia on postoperative pain and immune function in patients undergoing laparoscopic radical gastric cancer(GC)surgery to provide a refe-rence basis for the formulation of anesthesia protocols for radical GC surgery.METHODS This study included 112 patients who underwent laparoscopic radical surgery for GC between January 2022 and March 2024.There was no restriction on sex.The patient grouping method used was a digital random table method,and the num-ber of cases in each group was 56.The control group was administered total intravenous anesthesia,and the observation group compounded the stellate gan-glion block according to the total intravenous anesthesia protocol.Postoperative hemodynamics,pain levels,and immune indices were compared between the groups.RESULTS The heart rate and mean arterial pressure in the observation group after in-tubation were lower than those in the control group(P<0.05).Pain levels were compared between the two groups at 2 hours,12 hours,24 hours,and 48 hours after surgery(P>0.05).The number of CD3+,CD4+,and CD4+/CD8+cells at the end of surgery was higher in the observation group than in the control group,and the number of CD8+cells was lower in the observation group than in the control group(P<0.05).There were no significant differences between the two groups in terms of propofol dosage,awakening time,extubation time,or postoperative adverse reactions(P>0.05).CONCLUSION The application of a stellate ganglion block combined with total intravenous anesthesia had no significant effect on postoperative pain levels in patients undergoing laparoscopic radical GC surgery.However,it can safely reduce the effect of surgery on the immune function of patients and is worth applying in clinical practice.展开更多
Objective: To compare the effects of total intravenous anesthesia and static aspiration combined general anesthesia on postoperative cognitive function and psychological state of elderly esophageal cancer patients. Me...Objective: To compare the effects of total intravenous anesthesia and static aspiration combined general anesthesia on postoperative cognitive function and psychological state of elderly esophageal cancer patients. Methods: From July 2020 to April 2021, 180 elderly patients who underwent radical esophageal cancer surgery in our hospital were randomly divided into 90 cases in the control group and 90 in the observation group. The control group used static aspiration compound general anesthesia, and the patients in the observation group used intravenous anesthesia to compare the cognitive function and psychological state of the two groups of patients. Results: There was no statistical difference in the cognitive function score of patients in the observation group 30 minutes before anesthesia, 1 h and 24 hours after anesthesia compared with that in the control group, P > 0.05;there was no statistical difference between the Hamilton Anxiety Scale (HAMA) scores 30 minutes before and 24 hours after anesthesia in the observation group compared with the control group, P > 0.05;the cognitive function score of patients in the observation group of 4 h after surgery and 12 h after operation was significantly higher than that of the control group;the HAMA scores of patients in the observation group of 1 h, 4 h and 12 h after surgery were significantly lower than that of the control group, P Conclusion: The application of total intravenous anesthesia in elderly patients with esophageal cancer surgery can reduce the impact of anesthesia on their cognitive function and psychological state, which is worth popularizing and applying in clinical practice.展开更多
The effects of propofol and midazolam as an intravenous anesthetic were compared in 40 ASA Ⅰ-Ⅱ patients undergoing gynecological surgery during total intravenous anesthesia (TIVA). They were divided into propofol gr...The effects of propofol and midazolam as an intravenous anesthetic were compared in 40 ASA Ⅰ-Ⅱ patients undergoing gynecological surgery during total intravenous anesthesia (TIVA). They were divided into propofol group (Pn= 20) and midazolam group (Mn= 20) randomly. The anesthesia was designed for each group respectively. Here, we discuss the experimental method and the results, which indicate that propofol is not only an effective anesthetic but also has more rapid and head-clear recovery properties than midazolam.展开更多
Objective: to analyze and study the effects of total intravenous anesthesia and inhalation anesthesia on anesthesia effect and postoperative cognitive function in elderly patients. Methods: 70 elderly patients undergo...Objective: to analyze and study the effects of total intravenous anesthesia and inhalation anesthesia on anesthesia effect and postoperative cognitive function in elderly patients. Methods: 70 elderly patients undergoing surgical treatment in our hospital were selected as the research object. From September 2020 to September 2021, all patients were divided into reference group (inhalation anesthesia) and study group (total intravenous anesthesia) by coin tossing method. There were 35 cases in each group. The anesthetic effect, quality of life and cognitive function of the two groups were compared. Results: the effective rate of anesthesia in the study group was significantly higher than that in the reference group (P < 0.05), and the scores of quality of life and MMES were significantly better than those in the reference group (P < 0.05). Conclusion the clinical effect of total intravenous anesthesia is more significant, the anesthetic effect is better, and the quality of life and cognitive function of patients have been significantly improved. It has popularization value.展开更多
Objective: analyze the specific curative effect of ordinary gastroscopy and intravenous anesthesia gastroscopy in the treatment of upper gastrointestinal foreign body. Methods: from July 2017 to July 2019, 84 patients...Objective: analyze the specific curative effect of ordinary gastroscopy and intravenous anesthesia gastroscopy in the treatment of upper gastrointestinal foreign body. Methods: from July 2017 to July 2019, 84 patients with foreign body in upper digestive tract were randomly divided into two groups according to the nature of treatment. Among them, 42 cases were treated with ordinary gastroscopy (control group), and the remaining 42 cases were treated with anesthesia gastroscopy (study Group). The related indexes of foreign body removal and vital signs before and after operation were compared between the two groups. Result: There was no significant difference in vital signs between the two groups before operation, P > 0.05. After operation, the heart rate HR, map and SpO2 of the study group were in a stable state compared with the control group, there were differences, P < 0.05. Conclusion: the time of foreign body removal in the study group was shorter than that in the control group, the success rate of foreign body removal was higher than that of the control group, but the incidence of postoperative complications was lower, but the success rate of gastroscopy and gastroscopy in the treatment of foreign body is better than that in the control group.展开更多
Objective:To compare the effects of adding rocuronium and nitroglycerin to ropivacaine in intravenous regional anesthesia(IVRA)on pain and hemodynamic parameters.Methods:This randomized controlled trial was done in 20...Objective:To compare the effects of adding rocuronium and nitroglycerin to ropivacaine in intravenous regional anesthesia(IVRA)on pain and hemodynamic parameters.Methods:This randomized controlled trial was done in 2023.Participants were 177 candidates for forearm operation surgery under IVRA selected from Valiasr Hospital,Arak,Iran.They were allocated by block randomization to three different groups,namely nitroglycerin group,rocuronium group and control group.Hemodynamic parameters were recorded before tourniquet application up to postoperative recovery time.Sensory block and motor block onset and duration and pain were also evaluated.The data analysis was carried out by IMB SPSS software 20.0.Results:177 Eligible patients were included in study,with 59 in each group.Time to sensory and motor block onset in the nitroglycerin group was significantly less than the other groups and the time of motor block in the rocuronium group was statistically higher than the control and the nitroglycerin groups(P<0.001).Seven participants in the nitroglycerin group experienced headache and three from the rocuronium group experienced dizziness.The side effects occurrence in the nitroglycerin group was more prevalent than in the control and rocuronium groups(P=0.009).Conclusions:Nitroglycerin significantly reduces the time to sensory and motor block onset,while rocuronium is more effective in prolonging the time of motor block.Although there is no difference between nitroglycerin and rocuronium respecting the pain score and opioid need administration,nitroglycerin is associated with a higher prevalence of medication side effects.Therefore,both nitroglycerin and rocuronium can be used as adjuvant for IVRA.The final choice relies on patients’conditions and anesthesiologists’judgment.展开更多
BACKGROUND Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function,challenges in fluid balance,and the complexities of anesthetic ...BACKGROUND Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function,challenges in fluid balance,and the complexities of anesthetic management.Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes.Total intravenous anesthesia(TIVA)and goal-directed fluid therapy(GDT)have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy.However,evidence supporting their efficacy in patients with uremia remains limited.AIM To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.METHODS This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024.Patients received either inhalational anesthesia or TIVA,combined with either standard fluid therapy or GDT.The primary outcome measure was the incidence of postoperative complications.Secondary outcomes included length of hospital stay,major complications,and 30-day mortality.RESULTS Postoperative complications occurred in 23.3%(28/120)of patients.TIVA was associated with a lower complication rate than that of inhalational anesthesia(20.0%vs 26.7%,P=0.045).GDT resulted in significantly reduced fluid administration(2400 mL vs 3100 mL,P<0.001)and lower complication rates(19.5%vs 28.2%,P=0.030)compared with those of standard management.Independent risk factors for complications included age over 75 years(OR:2.40,95%CI:1.60-3.60),stage 5 uremia(OR:1.85,95%CI:1.20-2.85),and cumulative fluid balance exceeding 2000 mL(OR:1.70,95%CI:1.10-2.65).Patients with complications had longer hospital stays(median,15 days vs 11 days;P<0.001)and higher rates of major complications(27.8%vs 13.5%;P=0.003).CONCLUSION In patients with uremia undergoing colorectal cancer surgery,TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management.Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.展开更多
BACKGROUND Patients with Becker muscular dystrophy(BMD)have a high risk of developing hyperkalemia,rhabdomyolysis,and malignant hyperthermia when exposed to volatile anesthetics and depolarizing muscle relaxants.Patie...BACKGROUND Patients with Becker muscular dystrophy(BMD)have a high risk of developing hyperkalemia,rhabdomyolysis,and malignant hyperthermia when exposed to volatile anesthetics and depolarizing muscle relaxants.Patients with BMD are also prone to respiratory depression after general anesthesia.Thus,it is extremely challenging for anesthesiologists to manage anesthesia in BMD patients,particularly in pediatric BMD patients.Here,we present successful anesthesia management using transversus abdominis plane block(TAPB)combined with total intravenous anesthesia(TIVA)in a pediatric BMD patient undergoing laparoscopic inguinal hernia repair.CASE SUMMARY A 2-year-old boy,weighing 15 kg,with BMD,was scheduled for laparoscopic inguinal hernia repair.TIVA was used for induction,and continuous infusions of short-acting intravenous anesthetics combined with TAPB were performed for anesthesia maintenance.Moreover,TAPB provided good postoperative analgesia.The patient underwent uneventful surgery and anesthesia,and over the 17 mo follow-up period showed no anesthesia-induced complications.CONCLUSION TAPB combined with TIVA,using short-acting intravenous anesthetic agents,can provide safe and effective anesthesia management in pediatric BMD patients undergoing short-term abdominal surgery.展开更多
BACKGROUND Congenital cataract,facial dysmorphism,and neuropathy(CCFDN)syndrome is an extremely rare multiorgan disorder.Characteristics include congenital cataracts,facial deformation,extremity deformities,and demyel...BACKGROUND Congenital cataract,facial dysmorphism,and neuropathy(CCFDN)syndrome is an extremely rare multiorgan disorder.Characteristics include congenital cataracts,facial deformation,extremity deformities,and demyelinating neuropathy.CCFDN syndrome is associated with increased risk during anesthesia including rhabdomyolysis or epileptic seizures.There is a lack of published information about difficult airways in these patients.Difficult airways during intubation represent one of the most dreaded anesthesia complications:A"can not intubate,can not oxygenate"scenario.Presented herein is the first described successful endotracheal intubation of a CCFDN syndrome patient.CASE SUMMARY We report the anesthetic management of a 13-year-old girl with CCFDN syndrome scheduled for posterior neuromuscular scoliosis correction surgery.The patient suffered from extensive progressive neuromuscular scoliosis with a Cobb angle of 83°.Her limitations included neuropathy and a scoliotic curve.This condition negatively impacted her quality of life.This case reflects the potential anesthetic complications for posterior scoliosis correction and CCFDN syndrome.The challenge for our anesthetic team was the limited amount of data about anesthetic management of this condition.In total,one case report without any data about endotracheal intubation of patients with this condition was available.Endotracheal intubation in our case was uncomplicated.Another focus of our case was the prevention of possible complications associated with this syndrome,including rhabdomyolysis and seizures.Rhabdomyolysis can be triggered by some types of anesthetic agents like suxamethonium or volatile anesthetics,especially in patients with certain types of myopathies.CONCLUSION Adequate understanding of the anesthetic management of CCFDN syndrome can reduce perioperative complications and improve patient outcome after surgery.展开更多
基金The Kunshan Social Development Science and Technology Special Project,No.KS2241.
文摘BACKGROUND Stellate ganglion block is a commonly used sympathetic nerve block technique that restores the balance of the sympathetic and vagal nervous systems of the body and inhibits sympathetic nerve activity.AIM To analyze the effect of a stellate ganglion block combined with total diploma intravenous anesthesia on postoperative pain and immune function in patients undergoing laparoscopic radical gastric cancer(GC)surgery to provide a refe-rence basis for the formulation of anesthesia protocols for radical GC surgery.METHODS This study included 112 patients who underwent laparoscopic radical surgery for GC between January 2022 and March 2024.There was no restriction on sex.The patient grouping method used was a digital random table method,and the num-ber of cases in each group was 56.The control group was administered total intravenous anesthesia,and the observation group compounded the stellate gan-glion block according to the total intravenous anesthesia protocol.Postoperative hemodynamics,pain levels,and immune indices were compared between the groups.RESULTS The heart rate and mean arterial pressure in the observation group after in-tubation were lower than those in the control group(P<0.05).Pain levels were compared between the two groups at 2 hours,12 hours,24 hours,and 48 hours after surgery(P>0.05).The number of CD3+,CD4+,and CD4+/CD8+cells at the end of surgery was higher in the observation group than in the control group,and the number of CD8+cells was lower in the observation group than in the control group(P<0.05).There were no significant differences between the two groups in terms of propofol dosage,awakening time,extubation time,or postoperative adverse reactions(P>0.05).CONCLUSION The application of a stellate ganglion block combined with total intravenous anesthesia had no significant effect on postoperative pain levels in patients undergoing laparoscopic radical GC surgery.However,it can safely reduce the effect of surgery on the immune function of patients and is worth applying in clinical practice.
文摘Objective: To compare the effects of total intravenous anesthesia and static aspiration combined general anesthesia on postoperative cognitive function and psychological state of elderly esophageal cancer patients. Methods: From July 2020 to April 2021, 180 elderly patients who underwent radical esophageal cancer surgery in our hospital were randomly divided into 90 cases in the control group and 90 in the observation group. The control group used static aspiration compound general anesthesia, and the patients in the observation group used intravenous anesthesia to compare the cognitive function and psychological state of the two groups of patients. Results: There was no statistical difference in the cognitive function score of patients in the observation group 30 minutes before anesthesia, 1 h and 24 hours after anesthesia compared with that in the control group, P > 0.05;there was no statistical difference between the Hamilton Anxiety Scale (HAMA) scores 30 minutes before and 24 hours after anesthesia in the observation group compared with the control group, P > 0.05;the cognitive function score of patients in the observation group of 4 h after surgery and 12 h after operation was significantly higher than that of the control group;the HAMA scores of patients in the observation group of 1 h, 4 h and 12 h after surgery were significantly lower than that of the control group, P Conclusion: The application of total intravenous anesthesia in elderly patients with esophageal cancer surgery can reduce the impact of anesthesia on their cognitive function and psychological state, which is worth popularizing and applying in clinical practice.
文摘The effects of propofol and midazolam as an intravenous anesthetic were compared in 40 ASA Ⅰ-Ⅱ patients undergoing gynecological surgery during total intravenous anesthesia (TIVA). They were divided into propofol group (Pn= 20) and midazolam group (Mn= 20) randomly. The anesthesia was designed for each group respectively. Here, we discuss the experimental method and the results, which indicate that propofol is not only an effective anesthetic but also has more rapid and head-clear recovery properties than midazolam.
文摘Objective: to analyze and study the effects of total intravenous anesthesia and inhalation anesthesia on anesthesia effect and postoperative cognitive function in elderly patients. Methods: 70 elderly patients undergoing surgical treatment in our hospital were selected as the research object. From September 2020 to September 2021, all patients were divided into reference group (inhalation anesthesia) and study group (total intravenous anesthesia) by coin tossing method. There were 35 cases in each group. The anesthetic effect, quality of life and cognitive function of the two groups were compared. Results: the effective rate of anesthesia in the study group was significantly higher than that in the reference group (P < 0.05), and the scores of quality of life and MMES were significantly better than those in the reference group (P < 0.05). Conclusion the clinical effect of total intravenous anesthesia is more significant, the anesthetic effect is better, and the quality of life and cognitive function of patients have been significantly improved. It has popularization value.
文摘Objective: analyze the specific curative effect of ordinary gastroscopy and intravenous anesthesia gastroscopy in the treatment of upper gastrointestinal foreign body. Methods: from July 2017 to July 2019, 84 patients with foreign body in upper digestive tract were randomly divided into two groups according to the nature of treatment. Among them, 42 cases were treated with ordinary gastroscopy (control group), and the remaining 42 cases were treated with anesthesia gastroscopy (study Group). The related indexes of foreign body removal and vital signs before and after operation were compared between the two groups. Result: There was no significant difference in vital signs between the two groups before operation, P > 0.05. After operation, the heart rate HR, map and SpO2 of the study group were in a stable state compared with the control group, there were differences, P < 0.05. Conclusion: the time of foreign body removal in the study group was shorter than that in the control group, the success rate of foreign body removal was higher than that of the control group, but the incidence of postoperative complications was lower, but the success rate of gastroscopy and gastroscopy in the treatment of foreign body is better than that in the control group.
基金approved by the Ethics Committee of Arak University of Medical Sciences,Arak,Iran(No.IR.ARAKMU.REC.1402.033)registered in the Iranian Registry of Clinical Trials(No.IRCT20141209020258N183).
文摘Objective:To compare the effects of adding rocuronium and nitroglycerin to ropivacaine in intravenous regional anesthesia(IVRA)on pain and hemodynamic parameters.Methods:This randomized controlled trial was done in 2023.Participants were 177 candidates for forearm operation surgery under IVRA selected from Valiasr Hospital,Arak,Iran.They were allocated by block randomization to three different groups,namely nitroglycerin group,rocuronium group and control group.Hemodynamic parameters were recorded before tourniquet application up to postoperative recovery time.Sensory block and motor block onset and duration and pain were also evaluated.The data analysis was carried out by IMB SPSS software 20.0.Results:177 Eligible patients were included in study,with 59 in each group.Time to sensory and motor block onset in the nitroglycerin group was significantly less than the other groups and the time of motor block in the rocuronium group was statistically higher than the control and the nitroglycerin groups(P<0.001).Seven participants in the nitroglycerin group experienced headache and three from the rocuronium group experienced dizziness.The side effects occurrence in the nitroglycerin group was more prevalent than in the control and rocuronium groups(P=0.009).Conclusions:Nitroglycerin significantly reduces the time to sensory and motor block onset,while rocuronium is more effective in prolonging the time of motor block.Although there is no difference between nitroglycerin and rocuronium respecting the pain score and opioid need administration,nitroglycerin is associated with a higher prevalence of medication side effects.Therefore,both nitroglycerin and rocuronium can be used as adjuvant for IVRA.The final choice relies on patients’conditions and anesthesiologists’judgment.
文摘BACKGROUND Patients with uremia undergoing colorectal cancer surgery face an increased risk of postoperative complications due to impaired renal function,challenges in fluid balance,and the complexities of anesthetic management.Effective anesthesia and fluid strategies are critical to reducing complications and improving outcomes.Total intravenous anesthesia(TIVA)and goal-directed fluid therapy(GDT)have been suggested to enhance perioperative stability compared with inhalational anesthesia and standard fluid therapy.However,evidence supporting their efficacy in patients with uremia remains limited.AIM To evaluate the effects of different anesthetic techniques on postoperative complications in patients with uremia undergoing colorectal cancer surgery.METHODS This retrospective cohort study included 120 patients with stage 3-5 uremia who underwent elective colorectal cancer surgery between January 2022 and December 2024.Patients received either inhalational anesthesia or TIVA,combined with either standard fluid therapy or GDT.The primary outcome measure was the incidence of postoperative complications.Secondary outcomes included length of hospital stay,major complications,and 30-day mortality.RESULTS Postoperative complications occurred in 23.3%(28/120)of patients.TIVA was associated with a lower complication rate than that of inhalational anesthesia(20.0%vs 26.7%,P=0.045).GDT resulted in significantly reduced fluid administration(2400 mL vs 3100 mL,P<0.001)and lower complication rates(19.5%vs 28.2%,P=0.030)compared with those of standard management.Independent risk factors for complications included age over 75 years(OR:2.40,95%CI:1.60-3.60),stage 5 uremia(OR:1.85,95%CI:1.20-2.85),and cumulative fluid balance exceeding 2000 mL(OR:1.70,95%CI:1.10-2.65).Patients with complications had longer hospital stays(median,15 days vs 11 days;P<0.001)and higher rates of major complications(27.8%vs 13.5%;P=0.003).CONCLUSION In patients with uremia undergoing colorectal cancer surgery,TIVA and GDT are associated with a lower incidence of postoperative complications compared with that of inhalational anesthesia and standard fluid management.Optimizing anesthetic techniques and fluid management may improve postoperative outcomes in this high-risk population.
文摘BACKGROUND Patients with Becker muscular dystrophy(BMD)have a high risk of developing hyperkalemia,rhabdomyolysis,and malignant hyperthermia when exposed to volatile anesthetics and depolarizing muscle relaxants.Patients with BMD are also prone to respiratory depression after general anesthesia.Thus,it is extremely challenging for anesthesiologists to manage anesthesia in BMD patients,particularly in pediatric BMD patients.Here,we present successful anesthesia management using transversus abdominis plane block(TAPB)combined with total intravenous anesthesia(TIVA)in a pediatric BMD patient undergoing laparoscopic inguinal hernia repair.CASE SUMMARY A 2-year-old boy,weighing 15 kg,with BMD,was scheduled for laparoscopic inguinal hernia repair.TIVA was used for induction,and continuous infusions of short-acting intravenous anesthetics combined with TAPB were performed for anesthesia maintenance.Moreover,TAPB provided good postoperative analgesia.The patient underwent uneventful surgery and anesthesia,and over the 17 mo follow-up period showed no anesthesia-induced complications.CONCLUSION TAPB combined with TIVA,using short-acting intravenous anesthetic agents,can provide safe and effective anesthesia management in pediatric BMD patients undergoing short-term abdominal surgery.
文摘BACKGROUND Congenital cataract,facial dysmorphism,and neuropathy(CCFDN)syndrome is an extremely rare multiorgan disorder.Characteristics include congenital cataracts,facial deformation,extremity deformities,and demyelinating neuropathy.CCFDN syndrome is associated with increased risk during anesthesia including rhabdomyolysis or epileptic seizures.There is a lack of published information about difficult airways in these patients.Difficult airways during intubation represent one of the most dreaded anesthesia complications:A"can not intubate,can not oxygenate"scenario.Presented herein is the first described successful endotracheal intubation of a CCFDN syndrome patient.CASE SUMMARY We report the anesthetic management of a 13-year-old girl with CCFDN syndrome scheduled for posterior neuromuscular scoliosis correction surgery.The patient suffered from extensive progressive neuromuscular scoliosis with a Cobb angle of 83°.Her limitations included neuropathy and a scoliotic curve.This condition negatively impacted her quality of life.This case reflects the potential anesthetic complications for posterior scoliosis correction and CCFDN syndrome.The challenge for our anesthetic team was the limited amount of data about anesthetic management of this condition.In total,one case report without any data about endotracheal intubation of patients with this condition was available.Endotracheal intubation in our case was uncomplicated.Another focus of our case was the prevention of possible complications associated with this syndrome,including rhabdomyolysis and seizures.Rhabdomyolysis can be triggered by some types of anesthetic agents like suxamethonium or volatile anesthetics,especially in patients with certain types of myopathies.CONCLUSION Adequate understanding of the anesthetic management of CCFDN syndrome can reduce perioperative complications and improve patient outcome after surgery.
