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1.
Chinese Journal of Contemporary Pediatrics ; (12): 492-499, 2022.
Artículo en Chino | WPRIM | ID: wpr-928634

RESUMEN

OBJECTIVES@#To study the influence of umbilical cord milking versus delayed cord clamping on the early prognosis of preterm infants with a gestational age of <34 weeks.@*METHODS@#PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wanfang Data, Weipu Database, and SinoMed were searched for randomized controlled trials on umbilical cord milking versus delayed cord clamping in preterm infants with a gestational age of <34 weeks published up to November 2021. According to the inclusion and exclusion criteria, two researchers independently performed literature screening, quality evaluation, and data extraction. Review Manger 5.4 was used for Meta analysis.@*RESULTS@#A total of 11 articles were included in the analysis, with 1 621 preterm infants in total, among whom there were 809 infants in the umbilical cord milking group and 812 in the delayed cord clamping group. The Meta analysis showed that compared with delayed cord clamping, umbilical cord milking increased the mean blood pressure after birth (weighted mean difference=3.61, 95%CI: 0.73-6.50, P=0.01), but it also increased the incidence rate of severe intraventricular hemorrhage (RR=1.83, 95%CI: 1.08-3.09, P=0.02). There were no significant differences between the two groups in hemoglobin, hematocrit, blood transfusion rate, proportion of infants undergoing phototherapy, bilirubin peak, and incidence rates of complications such as periventricular leukomalacia and necrotizing enterocolitis (P>0.05).@*CONCLUSIONS@#Compared with delayed cord clamping, umbilical cord milking may increase the risk of severe intraventricular hemorrhage in preterm infants with a gestational age of <34 weeks; however, more high-quality large-sample randomized controlled trials are needed for further confirmation.


Asunto(s)
Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Hemorragia Cerebral , Constricción , Edad Gestacional , Recien Nacido Prematuro , Pronóstico , Cordón Umbilical/fisiología , Clampeo del Cordón Umbilical
2.
Journal of Forensic Medicine ; (6): 749-754, 2020.
Artículo en Chino | WPRIM | ID: wpr-985170

RESUMEN

Objective To identify the species of common necrophagous flies in Fujian Province by gene fragment sequences of mitochondrial cytochrome c oxidase subunit Ⅰ (COⅠ) and 16S ribosomal deoxyribonucleic acid (16S rDNA), and to explore the identification efficacy of these two molecular markers. Methods In total 22 common necrophagous flies were collected from the death scenes in 9 different regions in Fujian Province and DNA was extracted from the flies after morphological identification. The gene fragments of COⅠ and 16S rDNA were amplified and sequenced. All the sequences were uploaded to GeneBank and BLAST and MEGA 10.0 software were used to perform sequence alignment, homology analysis and intraspecific and interspecific genetic distance analysis. The phylogenetic trees of DNA fragment sequences of COⅠ and 16S rDNA of common necrophagous flies in Fujian Province were established by unweighted pair-group method with arithmetic means (UPGMA), respectively. Results The flies were classified into 6 species, 5 genera and 3 families by morphological identification. The results of gene sequence analysis showed that the average number of interspecific and intraspecific genetic distance of 16S rDNA ranged from 1.8% to 8.9% and 0.0% to 2.4%, respectively. The average number of interspecific and intraspecific genetic distance of COⅠ ranged from 7.2% to 13.6% and 0.0% to 6.3%, respectively. Conclusion The gene sequences of COⅠ and 16S rDNA can accurately identify the species of different necrophagous flies, and 16S rDNA showed higher value in species identification of common calliphoridae necrophagous flies in Fujian Province.


Asunto(s)
Animales , Humanos , ADN Ribosómico/genética , Dípteros/genética , Filogenia , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADN , Especificidad de la Especie
3.
Chinese Medical Equipment Journal ; (6): 135-138, 2017.
Artículo en Chino | WPRIM | ID: wpr-662509

RESUMEN

Objective To reform the management mode for medical consumables.Methods The problems and countermeasures in medical consumables management were explored from the aspects of variety introduction,consumables naming,secondary warehouse management,charging management,qualification management,logistics delivery,supervision and professional level.Results Medical consumables management had to emphasize on demonstration management,warehouse management,information management,safety management and personnel management.Conclusion Standardization of medical consumables management can be promoted by optimizing the management methods and strengthening the quality control management strategy.

4.
Chinese Medical Equipment Journal ; (6): 135-138, 2017.
Artículo en Chino | WPRIM | ID: wpr-660183

RESUMEN

Objective To reform the management mode for medical consumables.Methods The problems and countermeasures in medical consumables management were explored from the aspects of variety introduction,consumables naming,secondary warehouse management,charging management,qualification management,logistics delivery,supervision and professional level.Results Medical consumables management had to emphasize on demonstration management,warehouse management,information management,safety management and personnel management.Conclusion Standardization of medical consumables management can be promoted by optimizing the management methods and strengthening the quality control management strategy.

5.
Journal of Medical Biomechanics ; (6): E467-E475, 2016.
Artículo en Chino | WPRIM | ID: wpr-804085

RESUMEN

Biomechanics, one important sub-discipline of mechanics, is an interdisciplinary subject involved in mechanics, biology and medical science, and it is closely associated with life health and clinic medicine. In this paper, applications and grants of normal projects and youth science foundation projects of National Natural Science Foundation of China (NSFC) on biomechanics from year 2012 to 2016 are introduced. Research directions and research teams of biomechanics are mainly discussed, and some suggestions are given for the development of biomechanics in China.

6.
Chinese Pharmacological Bulletin ; (12): 1107-1112, 2014.
Artículo en Chino | WPRIM | ID: wpr-454254

RESUMEN

Aim Toresearchthemolecularmecha-nisms of DADS-induced apoptosis in human leukemia K562cells.Methods Cellviabilitywasmeasuredby MTT. Levels of DADS-induced ROS were measured by 2ˊ, 7ˊ-dichlorofluorescein diacetate ( DCFH-DA) fluo-rescence. DADS-induced mRNA levels of components of the NADPH oxidase were detected by Real-time PCR. The combination of protein Rac2 and p67phox was measured by immunoprecipitation assays. Flow cy-tometry methods were used to determine the percentage of apoptosis cells. DADS-induced Rac2 levels were measuredbyWesternblot.Results TheDADS-trea-ted K562 cells showed a dose-and time-dependent de-crease in cell viability and proliferation. There was sig-nificant up-regulation of the mRNA level of components of the NADPH oxidase complex in K562 cells after treatment with 6 mg·L-1 DADS for 6 h. Western blot results revealed that, compared with the control group, there was a significant up-regulation of Rac2 protein in K562 cells treated with 5. 0 and 10. 0 mg·L-1 DADS for 24h. And Rac2 combined with p67phox in DADS-induced apoptosis in K562 cells. PMA markedly in-creased the percentage of apoptotic cells, and DPI re-duced the percentage of apoptotic cells in DADS-in-duced K562 cells. Levels of DADS-induced ROS, also showed enhancement when exposed in PMA, but there was no DADS-induced ROS production evident when exposed in DPI in DADS induced K562 cells. Conclu-sions TheseresultsindicatethatNADPHoxidaseis the main source of DADS-induced ROS production. Diallyl disulfide induces apoptosis in human leukemia K562 cells through activation of NADPH oxidase.

7.
China Journal of Chinese Materia Medica ; (24): 1618-1620, 2013.
Artículo en Chino | WPRIM | ID: wpr-294056

RESUMEN

To investigated Shui nationality folk medicine's awareness to orthopedics & traumatology, the history of orthopedics & traumatology treatment, Shui nationality folk doctors' practicing medicine, heritage, diagnosis and treatment methods and tools, etc, through investigated drug resources category and distribution characteristics of Shui nationality medicine to orthopedics & traumatology treatment, explored and finished Shui nationality medicine orthopedics & traumatology treatment theoretical system. After more than 5 years' exploration and finishing, preliminarily formed the theoretical system framework and medicine application characteristics of Shui nationality medicine treating orthopedics & traumatology. Shui nationality medicine treatment orthopedics & traumatology has distinctive national style, and worthy to further exploration and research.


Asunto(s)
Humanos , Enfermedades Óseas , Etnología , Historia , Terapéutica , China , Etnología , Historia del Siglo XX , Historia del Siglo XXI , Ortopedia , Historia , Métodos , Religión y Medicina , Traumatología , Historia , Métodos
8.
National Journal of Andrology ; (12): 606-610, 2012.
Artículo en Chino | WPRIM | ID: wpr-286438

RESUMEN

<p><b>OBJECTIVE</b>To investigate the value and clinical application of the Three-Step Sperm Retrieval method in improving the sperm retrieval rate for non-obstructive azoospermia (NOA) patients.</p><p><b>METHODS</b>Seventy-three NOA patients underwent Three-Step Sperm Retrieval in the following order of procedures: testicular fine needle aspiration (TFNA), testicular sperm extraction (TSE), and microdissection testicular sperm extraction (MD-TSE). The testicular tissue obtained from each step was observed for spermatozoa under the 400-fold inverted microscope. If spermatozoa were found in one step, the operation would be stopped; otherwise, the next step would be carried out. The testicular tissue was subjected to pathological examination.</p><p><b>RESULTS</b>Spermatozoa was found in the testicular tissue in 38.4% of the cases (28/73) at TFNA as the first step, in 52.1% (38/73) at TFNA and TSE, and in 64.4% (47/73) at TFNA, TSE and MD-TSE. Pathological examination showed 25 of the cases to be Sertoli cell-only syndrome, 21 to be sperm maturation arrest and the other 27 to be hypospermatogenesis, in which spermatozoa were found in 10, 14 and 23 cases, respectively.</p><p><b>CONCLUSION</b>The Three-Step Sperm Retrieval method can significantly improve the sperm retrieval rate for NOA patients. And the sperm retrieval rate is associated with the pathological type of the testicular tissue, a higher rate with hypospermatogenesis.</p>


Asunto(s)
Adulto , Humanos , Masculino , Azoospermia , Recuperación de la Esperma , Testículo , Patología , Cirugía General
9.
Chinese Journal of Endemiology ; (6): 190-192, 2010.
Artículo en Chino | WPRIM | ID: wpr-643356

RESUMEN

Objective To investigate the distribution status of coal-burning fluorosis (endemic fluorosis) areas in Luoyang and to provide scientifc evidence for making strategies in prevention and control. Methods In 2006, a household per village was chosen to carry the general survey so as of disease condition, living habits and housing structure among 941 coal-burning pollution fluorine sickness natural villages in Yanshi, Mengjin, Xin'an, Luanchuan counties and Geely area which were under the jurisdiction of Luoyang. In the general survey, the sampled village having a population of more than 500 person was considered as a major survey village, and water fluoride, 8 - 12 year-old child fluorine spot on tooth and the urinary fluoride were surveyed. Water fluoride and the child urinary fluoride determination used the fluoride ion selective electrode method, and the children's dental fluorosis used Dean method. Results The endemic fluorosis of Luoyang existed 742 in endemic fluomsis villages, compared with history, a decrease of 199 in number. Ninety-six point seven per cent( 142 543/147 419) of the households were consuming smoke-free coal. Households using intact kitchens accounted for 93.6%( 137 919/147 419). Of which 63.0%(86 889/137 919) of kitchens were mixed up with bedrooms. Total 125 060 people were using coal- fired furnace for heating, of which 87.8%(109 802/125 060) had smoke-free facilities, 12.2%(15 258/125 060) had none. Among 52 endemic villages with population of more than 500 people surveyed, a total of 183 water samples were collected, 2 had water fluoride exceeding 1.0 rag/L, the highest water fluoride being 1.04 rag/L, averaging 0.39 mg/L Sixteen villages had a prevalence rate of dental fluorosis for children less than 30.00%, accounting for 30.8% (16/52), 36 endemic villages the prevalence of dental fluorosis detection rate of more than 30.00%, accounting for 69.2%(36/52). Twenty-thrce villages had a dental fluorosis index greater than 0.6, severe dental fluorosis was not found. Real-time measurement of 1408 urine samples of children aged 8 - 12 showed that urine fluoride highest value 6.88 nag/L, the minimum value of 0.10 mg/L, geometric mean 1.10 mg/L. The prevalence rate of dental fluorosis for children was 36.06%. Conclusions In Luoyang city, numbers of coal-burning endemic fluorosis villages are less than before, children's dental fluorosis has significantly declined, however some people still use kitchens connecting with bedrooms and lack smoke-free facilities, they need to be educated to change lifestyle and improve furnace to reduce soot fluoride pollution.

10.
Chinese Journal of Endemiology ; (6): 191-193, 2009.
Artículo en Chino | WPRIM | ID: wpr-643395

RESUMEN

Objective To understand the prevailing status of coal-burning endemic fluorosis in Henan, and to provide scientific grounds for endemic fluorosis prevention. Methods Undertook general surveillance on factors such as coal using, living habit, main foods, the structure of the houses and the fluoride content in drinking-water among 1832 historical coal-burning endemic fluorosis villages within 13 counties in 2006 and 2007, and conducted focal point sampling survey on 216 villages which still using local high-fluoride. For all children aged 8-12 years of each village, conducted dental fluorosis examination and collected 30 immediate urinary samples for fluoride content determination. Results The fluoride content in drinking-water of all historical fluorosis villages was below 1.0 mg/L. Households having individual kitchens accounted for 93.7%(241 281/257 393), those with stoves having smoke evacuation devices accounted for 41.9% (107 917/257 393), those using local high-fluoride coal for cooking accounted for 28.6%(73 686/257 393), those using local high-fluoride coal for heating accounted for 24.1%(61 924/257 393). Villages with serf-supply of main foods accounted for 95.7%(1753/1832) of all fluorosis villages. Solar drying food was used in all households. Villages with dental fluorosis detection rate for children aged 8 to 12 years above 30.0% accounted for 16.2%(35/216), which axe all in Luoyang City. Among 77.8%(168/216) of fluorosis villages, children' s urinary fluoride concentrations were no higher than 1.50 mg/L. Conclusions Coal-burning endemic fluorosis areas in Henan Province were decreased greatly and the extent of the health hazard was becoming slightly. The detection rate of dental fluorosis for children aged 8 to 12 years of 8 counties had reached the standard for fluorosis control, whereas the other 5 counties had not yet, all located in Luoyang City.

11.
International Journal of Biomedical Engineering ; (6): 88-91, 2009.
Artículo en Chino | WPRIM | ID: wpr-394963

RESUMEN

Objective To improve the hardware of a medical radioisotope dose calibration system base on LabVIEW platform.Methods Hiish performance voltage-frequency-converter VFC32 was applied to realize hardware circuit design of medical radioisotope dose calibrator,and the function of the circuit wag analyzed.The output voltage signal from the calibrator ionization chamber was processed by the designed circuit.The output frequency signal from the circuit was obtained by USB-6009 DAQ and was then processed by virtual instrument designed using LabVIEW 8.0.Results Experimental data graphs indicated that the improved system had a better linearity in the low and medium frequency band.Conclusion The redesigned radioisotope dose calibrator has advantages in improving measuring accuracy,measuring range,feeble-minded detection limit and so on.

12.
National Journal of Andrology ; (12): 918-920, 2007.
Artículo en Chino | WPRIM | ID: wpr-232038

RESUMEN

<p><b>OBJECTIVE</b>To investigate the clinical and pathological features of paratesticular desmoplastic small round cell tumor (DSRCT), and to improve the diagnosis and treatment of the disease.</p><p><b>METHODS</b>One case of paratesticular DSRCT was studied retrospectively and a considerable amount of related literature from Medline and Chinese journals reviewed. The patient was a 27-year-old man presenting with a painless testicular mass in the left hemiscrotum. On physical examination, a cystic mass was palpable while the testis was not in the left hemiscrotum.</p><p><b>RESULTS</b>During the operation the paratesticular area was found full of multiple nodular tumor masses of various sizes ranging from 0.5 cm to 1.5 cm in diameter. Pathological examination showed the characteristic histological pattern of nests of small undifferentiated cells embedded in a dense fibrous stroma. The tumor presented an immunohistochemical feature of epithelial, mesenchymal as well as neural multidirectional differentiation. Following testicular tumor orchiectomy, chemotherapy was performed with DDP, VP16, ifosfamide and EPI. Three years follow-up found no tumor recurrence.</p><p><b>CONCLUSION</b>Desmoplastic small round cell tumor has a specific clinicopathologic stigmata, usually occurring in young males, for which surgical resection with chemotherapy is the treatment of choice. DSRCT located in the paratesticular region may have a better prognosis than its more frequently abdominal counterpart.</p>


Asunto(s)
Adulto , Humanos , Masculino , Carcinoma de Células Pequeñas , Diagnóstico , Quimioterapia , Cirugía General , Terapia Combinada , Fibroma Desmoplásico , Diagnóstico , Quimioterapia , Cirugía General , Neoplasias Testiculares , Diagnóstico , Quimioterapia , Cirugía General , Resultado del Tratamiento
13.
China Journal of Chinese Materia Medica ; (24): 1450-1453, 2006.
Artículo en Chino | WPRIM | ID: wpr-316025

RESUMEN

<p><b>OBJECTIVE</b>To investigate the effects of novel triterpene (12-oleanene-3beta, 6alpha-diol) from Celastrus hypoleucus on the proliferation and apoptosis of human colorectal cancer cell line RKO.</p><p><b>METHOD</b>The inhibitory effect of the novel triterpene on RKO cell proliferation was assayed by MTT dye reduction. The morphology of apoptotic cells was observed with AO/EB double fluorescence staining and HE staining, DNA fragment with electrophoresis on agarose gels, sub-diploid peak and cell cycle with flow cytometer (FCM).</p><p><b>RESULT</b>Novel triterpene (12-oleanene-3beta, 6alpha-diol) from C. hypoleucus significantly inhibited proliferation of RKO cells in dose-dependent and time-dependent manner, the IC50 was (12.20 +/- 0.79) microg x mL(-1) at 48 h. Typical apoptotic changes were observed in RKO cells under the fluorescence microscope and the light microscope. DNA ladder was detected on agarose gels at concentrations from 10 microg x mL(-1) to 20 microg x mL(-1) at 48 h. With FCM methods, dose-dependent apoptosis-induced effect was observed in RKO cell line after treatment of triterpene for 48 h, and the apoptotic rates were increased from(2.93 +/- 0.84) % to (50.79 +/- 6.61) % at concentrations from 2.5 microg x mL(-1) to 20 microg x mL(-1). DNA histograms data from FCM analysis showed that the number of cells was obviously reduced during G0-G1 phase and G2-M phase, but not during S phase for RKO cell line after treatment with various concentrations of the triterpene for 48 hours.</p><p><b>CONCLUSION</b>Novel triterpene (12-oleanene-3beta, 6alpha-diol) from C. hypoleucus can induce apoptosis and has inhibition effect on the proliferation in RKO cell line.</p>


Asunto(s)
Humanos , Antineoplásicos Fitogénicos , Farmacología , Apoptosis , Celastrus , Química , Ciclo Celular , Línea Celular Tumoral , Proliferación Celular , Neoplasias Colorrectales , Patología , Relación Dosis-Respuesta a Droga , Concentración 50 Inhibidora , Ácido Oleanólico , Farmacología , Tallos de la Planta , Química , Plantas Medicinales , Química
14.
China Biotechnology ; (12)2006.
Artículo en Chino | WPRIM | ID: wpr-684953

RESUMEN

Objective: To facilitate the functional analysis of chromosomal genes and their products, the recombineering technique to epitope tagging of chromosomal genes of Y. pestis was adapted. Methods: The epitope tag was generated by primer annealing and then fused with resistance gene by fusion PCR. The epitope-resistance cassette was inserted into pBluecript, resulted in the template plasmid, pBS-MH. The tagging cassette for rpoS was obtained by PCR amplification from pBS-MH with primers containing homology specific to the target gene. PCR products were transformed into recombination competent cells and recombinants were selected. PCR and DNA sequencing were used to confirm the correct tagging event. The expression of the tagged protein was detected with Western blot by using monoclonal antibody to the epitope. Results: The template plasmid containing fusion of epitope and resistance gene was successfully constructed. The sigma factor gene, rpoS, was tagged with a myc-his tag at the COOH terminus. Expression of the tagged rpoS was successfully detected indirectly by the antibody against His tag. Conclusion: The chromosomal gene tagging by recombineering technique represents a powerful tool in the functional study of bacterial genes and their products.

15.
Journal of Shanghai Jiaotong University(Medical Science) ; (6)2006.
Artículo en Chino | WPRIM | ID: wpr-640547

RESUMEN

Objective To investigate the pathological features and differential diagnosis of mixed epithelial and stromal tumor of the kidney(MESTK). Methods Three patients with MESTK were studied by light microscopy and immunohistochemistry,and related literatures were reviewed. Results In the three patients,two were females and one was male,with the mean age of 20 years old.Examined grossly,the tumors were well circumscribed and typically composed of multiple cysts and solid areas.Microscopically,the tumors were composed of epithelial and spindle cells,both of the which were well differentiated with no atypia and mitosis of the nuclei.The immunohistochemical staining showed positive for the cytokeratin in the epithelial cells,and Vimentin,SMA,actin,PgR or ER and WT-1 in the spindle cells.No tumor recurrence and metastasis was found in all the three patients by 25 to 29 months of follow up. ConclusionMESTK is an uncommon mixed renal neoplasm with a favorable prognosis.

16.
Journal of Shanghai Jiaotong University(Medical Science) ; (6)2006.
Artículo en Chino | WPRIM | ID: wpr-640438

RESUMEN

Objective To detect the genome-wide genetic alterations in central neurocytoma,and to study the pathogensis of central neurocytoma. Methods Comparative genomic hybridization(CGH) analysis was performed in 10 central neurocytomas. Results Chromosomal imbalances were demonstrated in 6 cases.Overrepresentation of genetic material was detected in 4 cases on Chromosome 2p and 10q,and 3 cases on Chromosome 18q. Conclusion(Genetic abnormalities) on Chromosome 2p,10q and 18q may be associated with the pathogenesis of central neurocytoma.

17.
Journal of Applied Clinical Pediatrics ; (24)2004.
Artículo en Chino | WPRIM | ID: wpr-638434

RESUMEN

Objective To investigate the prognostic sequelae in neontes with hypoxic-ischemic encephalopathy (HIE) and ven-tricnlar dilatation.Methods Seventy-six full term newborns infants with HIE were followed up at the age from 3 to 19 months after therapy. Twenty-five infants among them were followed up by telephone in the epidemic period of SARS.Results Among 76 infants of 88 newborn infants with HIE(84.6%), 73 infants were normal (96.1% ). 1 infant had cerebral palsy (1.3%), 2 infants died (2.6 %).Among 39 cases with mild HIE, none of them had cerebral sequelae; among moderate HIE. 1 infant had cerebral palsy (2.9%) 1 infant died (2. 9 %), interlenkin-4 among severe HIE 50 % died (P00.5 The poor outcome of HIE in those infants were related to intrauterine growth retardation,severe birth asphyxia;and inadequate treatment.Cranial ultra-sonography of 49 infants were done on follow-up,and 12 of them (24.5 % ) had ventricular dilatations, which appeared after birth with 6 infants. Others occurred on follow-up with 1 infant had cerobral palsy,all ventricular dilatations recovered to normal at 12- 19 months except the cerebral palsy.Conclusions The poor outcome of HIE depends on the infants with intranterine growth relarda-tion,severe birth asphyxia and inadequate treatment.The prognosis of transient ventrealar ddatation are good except cerebral palsy.J Appl Clin pediatr,2004,19(12) : 1045- 1047

18.
Chinese Journal of Pathophysiology ; (12)1986.
Artículo en Chino | WPRIM | ID: wpr-517637

RESUMEN

AIM: To investigate the effects of pretreatment of captopril on the infarct size and myocardial cell apoptosis in rabbits. METHODS: Rabbits were randomly divided into sham-operated control group (SO), acute infarct group (AI) and captopril pretreatment group (CP). The rabbits of CP group were treated with captopril (25 mg?kg -1 .d -1 ) for 1 week before harvest. The left circumflex branch of coronary (LCX) was ligated to develop acute ischemic model. The systolic and diastolic function of left ventricle(LV) was measured before and at 15, 30, 60 min after ligating LCX, and the blood viscosity and hematocrit before and at 60 min after ligating LCX were measured also. 6 hours later LCX ligation, the hearts were harvested for determining the infarction size, which was expressed as the ratio of infarct area to the total ischemic area, and evaluating apoptosis index expressed as the percentage of myocardial cells with TUNEL positive staining. RESULTS: 1.Compared with AI group, captopril pretreatment significantly reduced the infarction size (16 60%?0.94% vs 36.24%?1.94%, P

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