The Experts below are selected from a list of 81 Experts worldwide ranked by ideXlab platform
Lorenzo Genitori - One of the best experts on this subject based on the ideXlab platform.
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Vagus Nerve stimulation surgical technique of implantation and revision and related morbidity
Epilepsia, 2017Co-Authors: Flavio Giordano, Anna Zicca, Carmen Barba, Renzo Guerrini, Lorenzo GenitoriAbstract:Summary Indications for Vagus Nerve stimulation (VNS) therapy include focal, multifocal epilepsy, drop attacks (tonic/atonic seizures), Lennox-Gastaut syndrome, tuberous sclerosis complex (TSC)–related multifocal epilepsy, and unsuccessful resective surgery. Surgical outcome is about 50–60% for seizures control, and may also improve mood, cognition, and memory. On this basis, VNS has also been proposed for the treatment of major depression and Alzheimer's' disease. The Vagus Nerve stimulator must be implanted with blunt technique on the left side to avoid cardiac side effects through the classic approach for anterior cervical discectomy. The actual device is composed of a wire with three helical contacts (two active contacts, one anchoring) and a one-pin battery. VNS is usually started 2 weeks after implantation with recommended settings of stimulation (1.0–2.0 mA; 500 μs pulse width; 20–30 Hz; 30 s ON, 5 min OFF). The complications of VNS therapy are early (related to surgery) and late (related to the device and to stimulation of the Vagus Nerve). Early complications include the following: intraoperative bradycardia and asystole during lead impedance testing, peritracheal hematoma, infections (3–8%), and Vagus Nerve Injury followed by hoarseness, dyspnea, and dysphagia because of left vocal cord paralysis. Delayed morbidity due to the device includes late infections or problems in wound healing; other more rare events are due to late Injury of the Nerve. Late complications due to Nerve stimulation include delayed arrhythmias, laryngopharyngeal dysfunction (hoarseness, dyspnea, and coughing), obstructive sleep apnea, stimulation of phrenic Nerve, tonsillar pain mimicking glossopharyngeal neuralgia, and vocal cord damage during prolonged endotracheal intubation. The laryngopharyngeal dysfunction occurs in about 66% of patients and is usually transitory and due to the stimulation of the inferior (recurrent) laryngeal Nerve. A true late paralysis of the left vocal cord is often partial and rare (1–2.7%), and usually transitory, and may be caused by previous surgical trauma (i.e., damage of Nerve fibers and/or of their blood supply) or to a supposed chronic denervation during stimulation. Surgery for complete removal or revision and replacement of the device is to be considered in cases of device malfunction (4–16.8%), failure of VNS therapy, intolerable side effects, or because of patient's specific request. As described in the literature, the surgical techniques of lead revision and replacement are two: sharp and blunt dissection of helical electrodes and replacement; and blunt dissection combined with ultrasharp low-voltage cautery dissection. The incidence of left vocal cord palsy after Vagus Nerve stimulator replacement/revision is slightly higher than that of first implantation (4.9% vs. 3.8%). A de novo implantation in a naive segment of the left or right Vagus Nerve may be considered in specific cases; the use of the right Vagus Nerve is a rare exception that may be chosen with an acceptable result.
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Vagus Nerve stimulation surgical technique of implantation and revision and related morbidity
Epilepsia, 2017Co-Authors: Flavio Giordano, Anna Zicca, Carmen Barba, Renzo Guerrini, Lorenzo GenitoriAbstract:Summary Indications for Vagus Nerve stimulation (VNS) therapy include focal, multifocal epilepsy, drop attacks (tonic/atonic seizures), Lennox-Gastaut syndrome, tuberous sclerosis complex (TSC)–related multifocal epilepsy, and unsuccessful resective surgery. Surgical outcome is about 50–60% for seizures control, and may also improve mood, cognition, and memory. On this basis, VNS has also been proposed for the treatment of major depression and Alzheimer's' disease. The Vagus Nerve stimulator must be implanted with blunt technique on the left side to avoid cardiac side effects through the classic approach for anterior cervical discectomy. The actual device is composed of a wire with three helical contacts (two active contacts, one anchoring) and a one-pin battery. VNS is usually started 2 weeks after implantation with recommended settings of stimulation (1.0–2.0 mA; 500 μs pulse width; 20–30 Hz; 30 s ON, 5 min OFF). The complications of VNS therapy are early (related to surgery) and late (related to the device and to stimulation of the Vagus Nerve). Early complications include the following: intraoperative bradycardia and asystole during lead impedance testing, peritracheal hematoma, infections (3–8%), and Vagus Nerve Injury followed by hoarseness, dyspnea, and dysphagia because of left vocal cord paralysis. Delayed morbidity due to the device includes late infections or problems in wound healing; other more rare events are due to late Injury of the Nerve. Late complications due to Nerve stimulation include delayed arrhythmias, laryngopharyngeal dysfunction (hoarseness, dyspnea, and coughing), obstructive sleep apnea, stimulation of phrenic Nerve, tonsillar pain mimicking glossopharyngeal neuralgia, and vocal cord damage during prolonged endotracheal intubation. The laryngopharyngeal dysfunction occurs in about 66% of patients and is usually transitory and due to the stimulation of the inferior (recurrent) laryngeal Nerve. A true late paralysis of the left vocal cord is often partial and rare (1–2.7%), and usually transitory, and may be caused by previous surgical trauma (i.e., damage of Nerve fibers and/or of their blood supply) or to a supposed chronic denervation during stimulation. Surgery for complete removal or revision and replacement of the device is to be considered in cases of device malfunction (4–16.8%), failure of VNS therapy, intolerable side effects, or because of patient's specific request. As described in the literature, the surgical techniques of lead revision and replacement are two: sharp and blunt dissection of helical electrodes and replacement; and blunt dissection combined with ultrasharp low-voltage cautery dissection. The incidence of left vocal cord palsy after Vagus Nerve stimulator replacement/revision is slightly higher than that of first implantation (4.9% vs. 3.8%). A de novo implantation in a naive segment of the left or right Vagus Nerve may be considered in specific cases; the use of the right Vagus Nerve is a rare exception that may be chosen with an acceptable result.
Flavio Giordano - One of the best experts on this subject based on the ideXlab platform.
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Vagus Nerve stimulation surgical technique of implantation and revision and related morbidity
Epilepsia, 2017Co-Authors: Flavio Giordano, Anna Zicca, Carmen Barba, Renzo Guerrini, Lorenzo GenitoriAbstract:Summary Indications for Vagus Nerve stimulation (VNS) therapy include focal, multifocal epilepsy, drop attacks (tonic/atonic seizures), Lennox-Gastaut syndrome, tuberous sclerosis complex (TSC)–related multifocal epilepsy, and unsuccessful resective surgery. Surgical outcome is about 50–60% for seizures control, and may also improve mood, cognition, and memory. On this basis, VNS has also been proposed for the treatment of major depression and Alzheimer's' disease. The Vagus Nerve stimulator must be implanted with blunt technique on the left side to avoid cardiac side effects through the classic approach for anterior cervical discectomy. The actual device is composed of a wire with three helical contacts (two active contacts, one anchoring) and a one-pin battery. VNS is usually started 2 weeks after implantation with recommended settings of stimulation (1.0–2.0 mA; 500 μs pulse width; 20–30 Hz; 30 s ON, 5 min OFF). The complications of VNS therapy are early (related to surgery) and late (related to the device and to stimulation of the Vagus Nerve). Early complications include the following: intraoperative bradycardia and asystole during lead impedance testing, peritracheal hematoma, infections (3–8%), and Vagus Nerve Injury followed by hoarseness, dyspnea, and dysphagia because of left vocal cord paralysis. Delayed morbidity due to the device includes late infections or problems in wound healing; other more rare events are due to late Injury of the Nerve. Late complications due to Nerve stimulation include delayed arrhythmias, laryngopharyngeal dysfunction (hoarseness, dyspnea, and coughing), obstructive sleep apnea, stimulation of phrenic Nerve, tonsillar pain mimicking glossopharyngeal neuralgia, and vocal cord damage during prolonged endotracheal intubation. The laryngopharyngeal dysfunction occurs in about 66% of patients and is usually transitory and due to the stimulation of the inferior (recurrent) laryngeal Nerve. A true late paralysis of the left vocal cord is often partial and rare (1–2.7%), and usually transitory, and may be caused by previous surgical trauma (i.e., damage of Nerve fibers and/or of their blood supply) or to a supposed chronic denervation during stimulation. Surgery for complete removal or revision and replacement of the device is to be considered in cases of device malfunction (4–16.8%), failure of VNS therapy, intolerable side effects, or because of patient's specific request. As described in the literature, the surgical techniques of lead revision and replacement are two: sharp and blunt dissection of helical electrodes and replacement; and blunt dissection combined with ultrasharp low-voltage cautery dissection. The incidence of left vocal cord palsy after Vagus Nerve stimulator replacement/revision is slightly higher than that of first implantation (4.9% vs. 3.8%). A de novo implantation in a naive segment of the left or right Vagus Nerve may be considered in specific cases; the use of the right Vagus Nerve is a rare exception that may be chosen with an acceptable result.
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Vagus Nerve stimulation surgical technique of implantation and revision and related morbidity
Epilepsia, 2017Co-Authors: Flavio Giordano, Anna Zicca, Carmen Barba, Renzo Guerrini, Lorenzo GenitoriAbstract:Summary Indications for Vagus Nerve stimulation (VNS) therapy include focal, multifocal epilepsy, drop attacks (tonic/atonic seizures), Lennox-Gastaut syndrome, tuberous sclerosis complex (TSC)–related multifocal epilepsy, and unsuccessful resective surgery. Surgical outcome is about 50–60% for seizures control, and may also improve mood, cognition, and memory. On this basis, VNS has also been proposed for the treatment of major depression and Alzheimer's' disease. The Vagus Nerve stimulator must be implanted with blunt technique on the left side to avoid cardiac side effects through the classic approach for anterior cervical discectomy. The actual device is composed of a wire with three helical contacts (two active contacts, one anchoring) and a one-pin battery. VNS is usually started 2 weeks after implantation with recommended settings of stimulation (1.0–2.0 mA; 500 μs pulse width; 20–30 Hz; 30 s ON, 5 min OFF). The complications of VNS therapy are early (related to surgery) and late (related to the device and to stimulation of the Vagus Nerve). Early complications include the following: intraoperative bradycardia and asystole during lead impedance testing, peritracheal hematoma, infections (3–8%), and Vagus Nerve Injury followed by hoarseness, dyspnea, and dysphagia because of left vocal cord paralysis. Delayed morbidity due to the device includes late infections or problems in wound healing; other more rare events are due to late Injury of the Nerve. Late complications due to Nerve stimulation include delayed arrhythmias, laryngopharyngeal dysfunction (hoarseness, dyspnea, and coughing), obstructive sleep apnea, stimulation of phrenic Nerve, tonsillar pain mimicking glossopharyngeal neuralgia, and vocal cord damage during prolonged endotracheal intubation. The laryngopharyngeal dysfunction occurs in about 66% of patients and is usually transitory and due to the stimulation of the inferior (recurrent) laryngeal Nerve. A true late paralysis of the left vocal cord is often partial and rare (1–2.7%), and usually transitory, and may be caused by previous surgical trauma (i.e., damage of Nerve fibers and/or of their blood supply) or to a supposed chronic denervation during stimulation. Surgery for complete removal or revision and replacement of the device is to be considered in cases of device malfunction (4–16.8%), failure of VNS therapy, intolerable side effects, or because of patient's specific request. As described in the literature, the surgical techniques of lead revision and replacement are two: sharp and blunt dissection of helical electrodes and replacement; and blunt dissection combined with ultrasharp low-voltage cautery dissection. The incidence of left vocal cord palsy after Vagus Nerve stimulator replacement/revision is slightly higher than that of first implantation (4.9% vs. 3.8%). A de novo implantation in a naive segment of the left or right Vagus Nerve may be considered in specific cases; the use of the right Vagus Nerve is a rare exception that may be chosen with an acceptable result.
Christine G Gourin - One of the best experts on this subject based on the ideXlab platform.
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national prevalence and impact of perioperative Vagus Nerve Injury in vestibular schwannoma
Laryngoscope, 2012Co-Authors: Bryan K Ward, Howard W Francis, Simon R Best, Heather M Starmer, Lee M Akst, Christine G GourinAbstract:Objectives/hypothesis Lower cranial Nerve Injury may be an under-reported complication of vestibular schwannoma surgery. This study aims to characterize the prevalence of complications associated with Vagus Nerve Injury following vestibular schwannoma surgery and the impact of these complications on patient care. Study design Retrospective cross-sectional study. Methods Discharge data from the Nationwide Inpatient Sample for 17,281 patients with vestibular schwannoma who underwent surgery in 2003-2008 were analyzed using cross-tabulations and multivariate regression modeling. Results Dysphagia was reported in 443 cases (2.6%) and unilateral vocal fold paralysis in 115 cases (0.7%). The mean length of hospitalization was 5.3 days (95% confidence interval [CI], 4.9-5.7) and was prolonged in patients with dysphagia (mean, 11.7 days; 95% CI, 8.9-14.4) and in those with unilateral vocal fold paralysis (mean, 12.1 days; 95% CI, 7.3-16.9). Compared to patients without dysphagia, a diagnosis of dysphagia was associated with advanced comorbidity status (37.0% vs. 18.8%), central nervous system complications (39.3% vs. 15.3%), aspiration pneumonia (7.1% vs. 0.4%), and greater likelihood of requiring medical care at another facility or at home after discharge (48.5% vs. 6.6%, P Conclusions Although infrequently reported in this national inpatient sample, Vagus Nerve Injury-related symptoms are associated with significantly increased length of hospitalization and costs of care.
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national prevalence and impact of perioperative Vagus Nerve Injury in vestibular schwannoma
Laryngoscope, 2012Co-Authors: Bryan K Ward, Howard W Francis, Simon R Best, Heather M Starmer, Lee M Akst, Christine G GourinAbstract:Objectives/Hypothesis: Lower cranial Nerve Injury may be an under-reported complication of vestibular schwannoma surgery. This study aims to characterize the prevalence of complications associated with Vagus Nerve Injury following vestibular schwannoma surgery and the impact of these complications on patient care. Study Design: Retrospective cross-sectional study. Methods: Discharge data from the Nationwide Inpatient Sample for 17,281 patients with vestibular schwannoma who underwent surgery in 2003–2008 were analyzed using cross-tabulations and multivariate regression modeling. Results: Dysphagia was reported in 443 cases (2.6%) and unilateral vocal fold paralysis in 115 cases (0.7%). The mean length of hospitalization was 5.3 days (95% confidence interval [CI], 4.9-5.7) and was prolonged in patients with dysphagia (mean, 11.7 days; 95% CI, 8.9-14.4) and in those with unilateral vocal fold paralysis (mean, 12.1 days; 95% CI, 7.3-16.9). Compared to patients without dysphagia, a diagnosis of dysphagia was associated with advanced comorbidity status (37.0% vs. 18.8%), central nervous system complications (39.3% vs. 15.3%), aspiration pneumonia (7.1% vs. 0.4%), and greater likelihood of requiring medical care at another facility or at home after discharge (48.5% vs. 6.6%, P < .001). Tracheostomy (3.4% vs. 0.8%) and gastrostomy tube placement (20.9% vs. 0.5%) were significantly more likely in patients with dysphagia (P < .0001). After adjusting for other variables, dysphagia, aspiration pneumonia, and tracheostomy were significantly associated with increased length of hospitalization and hospital-related costs. Conclusions: Although infrequently reported in this national inpatient sample, Vagus Nerve Injury-related symptoms are associated with significantly increased length of hospitalization and costs of care.
Piyush Jani - One of the best experts on this subject based on the ideXlab platform.
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management of tumors arising from the parapharyngeal space a systematic review of 1 293 cases reported over 25 years
Laryngoscope, 2015Co-Authors: Mongloon Kuet, A V Kasbekar, Liam Masterson, Piyush JaniAbstract:Objectives We present a systematic review of 1,252 lesions published in the past 25 years, the largest to date. We also include our own experience of 41 cases. Data Sources Our data sources were MEDLINE and Embase databases. Review Methods A systematic review of the literature (1988–2014) was performed and data on histological diagnosis, presentation, surgical approach, and postoperative complications were reviewed. Results In total, 22 studies (including our own institution) revealed 82% of lesions were benign. The most common presentation was an intraoral mass (52%) followed by a cervical mass (48%), and the most common primary lesion was a pleomorphic adenoma (29%). Ninety-six percent of patients underwent surgery. The cervical approach was most frequently used (46%), and the most common complication was Vagus Nerve Injury (13%). Within our institution, 5-year progression-free survival for benign and malignant disease was 93% and 61%, respectively (P = .196). Conclusions A parapharyngeal space mass is an uncommon tumor and requires careful preoperative assessment. Definitive treatment is usually surgery, and these patients should be counseled appropriately about the potential for permanent cranial Nerve deficits. Level of Evidence NA Laryngoscope, 125:1372–1381, 2015
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a systematic review of 1143 parapharyngeal space tumors reported over 20 years
Oral Oncology, 2014Co-Authors: Faruque Riffat, Raghav C Dwivedi, Carsten E Palme, Brian Fish, Piyush JaniAbstract:Parapharyngeal space tumours are rare and most clinicians will only see a small number during their career. We performed a systematic review of 1143 parapharyngeal space tumors published in the past 20 years to increase cumulative experience. A systematic literature review was performed and data on histological diagnosis, presentation, surgical approach and postoperative complications of cases published between 1989 and 2009 were compiled and reviewed. The systematic review identified a total of 1143 parapharyngeal space tumors presented in 17 studies. A majority (82%) were benign and 18% were malignant. The most common presentation was a cervical mass (50%) or an intraoral mass (47%). Approximately 70 different histologic subtypes of parapharyngeal space tumors were reported in the cumulative series. The most common primary lesion was a pleomorphic adenoma (34%). Ninety-five percent of patients underwent surgery. The most frequent approach and used to excise the lesions was the cervical approach (48%) and the commonest complication was the Vagus Nerve Injury seen in 14% of the cases.
Renzo Guerrini - One of the best experts on this subject based on the ideXlab platform.
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Vagus Nerve stimulation surgical technique of implantation and revision and related morbidity
Epilepsia, 2017Co-Authors: Flavio Giordano, Anna Zicca, Carmen Barba, Renzo Guerrini, Lorenzo GenitoriAbstract:Summary Indications for Vagus Nerve stimulation (VNS) therapy include focal, multifocal epilepsy, drop attacks (tonic/atonic seizures), Lennox-Gastaut syndrome, tuberous sclerosis complex (TSC)–related multifocal epilepsy, and unsuccessful resective surgery. Surgical outcome is about 50–60% for seizures control, and may also improve mood, cognition, and memory. On this basis, VNS has also been proposed for the treatment of major depression and Alzheimer's' disease. The Vagus Nerve stimulator must be implanted with blunt technique on the left side to avoid cardiac side effects through the classic approach for anterior cervical discectomy. The actual device is composed of a wire with three helical contacts (two active contacts, one anchoring) and a one-pin battery. VNS is usually started 2 weeks after implantation with recommended settings of stimulation (1.0–2.0 mA; 500 μs pulse width; 20–30 Hz; 30 s ON, 5 min OFF). The complications of VNS therapy are early (related to surgery) and late (related to the device and to stimulation of the Vagus Nerve). Early complications include the following: intraoperative bradycardia and asystole during lead impedance testing, peritracheal hematoma, infections (3–8%), and Vagus Nerve Injury followed by hoarseness, dyspnea, and dysphagia because of left vocal cord paralysis. Delayed morbidity due to the device includes late infections or problems in wound healing; other more rare events are due to late Injury of the Nerve. Late complications due to Nerve stimulation include delayed arrhythmias, laryngopharyngeal dysfunction (hoarseness, dyspnea, and coughing), obstructive sleep apnea, stimulation of phrenic Nerve, tonsillar pain mimicking glossopharyngeal neuralgia, and vocal cord damage during prolonged endotracheal intubation. The laryngopharyngeal dysfunction occurs in about 66% of patients and is usually transitory and due to the stimulation of the inferior (recurrent) laryngeal Nerve. A true late paralysis of the left vocal cord is often partial and rare (1–2.7%), and usually transitory, and may be caused by previous surgical trauma (i.e., damage of Nerve fibers and/or of their blood supply) or to a supposed chronic denervation during stimulation. Surgery for complete removal or revision and replacement of the device is to be considered in cases of device malfunction (4–16.8%), failure of VNS therapy, intolerable side effects, or because of patient's specific request. As described in the literature, the surgical techniques of lead revision and replacement are two: sharp and blunt dissection of helical electrodes and replacement; and blunt dissection combined with ultrasharp low-voltage cautery dissection. The incidence of left vocal cord palsy after Vagus Nerve stimulator replacement/revision is slightly higher than that of first implantation (4.9% vs. 3.8%). A de novo implantation in a naive segment of the left or right Vagus Nerve may be considered in specific cases; the use of the right Vagus Nerve is a rare exception that may be chosen with an acceptable result.
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Vagus Nerve stimulation surgical technique of implantation and revision and related morbidity
Epilepsia, 2017Co-Authors: Flavio Giordano, Anna Zicca, Carmen Barba, Renzo Guerrini, Lorenzo GenitoriAbstract:Summary Indications for Vagus Nerve stimulation (VNS) therapy include focal, multifocal epilepsy, drop attacks (tonic/atonic seizures), Lennox-Gastaut syndrome, tuberous sclerosis complex (TSC)–related multifocal epilepsy, and unsuccessful resective surgery. Surgical outcome is about 50–60% for seizures control, and may also improve mood, cognition, and memory. On this basis, VNS has also been proposed for the treatment of major depression and Alzheimer's' disease. The Vagus Nerve stimulator must be implanted with blunt technique on the left side to avoid cardiac side effects through the classic approach for anterior cervical discectomy. The actual device is composed of a wire with three helical contacts (two active contacts, one anchoring) and a one-pin battery. VNS is usually started 2 weeks after implantation with recommended settings of stimulation (1.0–2.0 mA; 500 μs pulse width; 20–30 Hz; 30 s ON, 5 min OFF). The complications of VNS therapy are early (related to surgery) and late (related to the device and to stimulation of the Vagus Nerve). Early complications include the following: intraoperative bradycardia and asystole during lead impedance testing, peritracheal hematoma, infections (3–8%), and Vagus Nerve Injury followed by hoarseness, dyspnea, and dysphagia because of left vocal cord paralysis. Delayed morbidity due to the device includes late infections or problems in wound healing; other more rare events are due to late Injury of the Nerve. Late complications due to Nerve stimulation include delayed arrhythmias, laryngopharyngeal dysfunction (hoarseness, dyspnea, and coughing), obstructive sleep apnea, stimulation of phrenic Nerve, tonsillar pain mimicking glossopharyngeal neuralgia, and vocal cord damage during prolonged endotracheal intubation. The laryngopharyngeal dysfunction occurs in about 66% of patients and is usually transitory and due to the stimulation of the inferior (recurrent) laryngeal Nerve. A true late paralysis of the left vocal cord is often partial and rare (1–2.7%), and usually transitory, and may be caused by previous surgical trauma (i.e., damage of Nerve fibers and/or of their blood supply) or to a supposed chronic denervation during stimulation. Surgery for complete removal or revision and replacement of the device is to be considered in cases of device malfunction (4–16.8%), failure of VNS therapy, intolerable side effects, or because of patient's specific request. As described in the literature, the surgical techniques of lead revision and replacement are two: sharp and blunt dissection of helical electrodes and replacement; and blunt dissection combined with ultrasharp low-voltage cautery dissection. The incidence of left vocal cord palsy after Vagus Nerve stimulator replacement/revision is slightly higher than that of first implantation (4.9% vs. 3.8%). A de novo implantation in a naive segment of the left or right Vagus Nerve may be considered in specific cases; the use of the right Vagus Nerve is a rare exception that may be chosen with an acceptable result.
