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1.
Chinese Journal of Experimental Traditional Medical Formulae ; (24): 187-195, 2024.
Artigo em Chinês | WPRIM | ID: wpr-1016478

RESUMO

The term ''panvascular'' refers to the human vascular system, which is a complex network of arteries, veins, and lymphatic vessels. Panvascular diseases refer to a group of vascular system diseases, with vascular atherosclerosis as the common pathological feature. The panvascular diseases in target organs such as the heart, brain, kidney, and limbs are caused by ischemia or bleeding, including arterial system diseases, venous system diseases, microcirculation system diseases, and Zangfu organ-blood vessel diseases. The concept of panvascular diseases integrates vascular lesions and target organ damage. In clinical practice, blood vessels in multiple regions are regarded as a large vascular unit system, and vascular lesions and the induced target organ damage are considered as a whole. Based on the holistic concept and the Zangxiang theory in traditional Chinese medicine (TCM), the ''blood vessel-Zangfu organ-syndrome differentiation and treatment'' network is built, on the basis of which a pattern of vascular disease-Zangfu organ dysfunction-syndrome differentiation and treatment is applied to the TCM diagnosis and treatment of panvascular diseases. The theory of treating arterial system diseases from the heart, venous system diseases from the kidneys, and microvascular system diseases from the liver is proposed. According to the causes identified based on syndrome differentiation, this paper summarizes the methods of reinforcing Yang and activating blood (including warming Yang and activating blood, replenishing Qi and activating blood, replenishing Qi, nourishing Yin and activating blood, activating Yang and blood, dispersing cold and activating blood), cooling blood and resolving stasis, tonifying kidney and promoting urination coupled with activating blood and dredging vessels, nourishing Yin and tonifying kidney coupled with activating blood and dredging vessels, and soothing liver and regulating Qi coupled with activating blood and dredging collaterals, as well as wind-extinguishing medicines, applied to the treatment of panvascular diseases, aiming to provide methods and ideas for the treatment of vascular diseases with TCM.

2.
Chinese Journal of Ocular Fundus Diseases ; (6): 17-21, 2023.
Artigo em Chinês | WPRIM | ID: wpr-995589

RESUMO

Objective:To investigate the etiology, clinical features and treatment of familial exudative vitreoretinopathy (FEVR) secondary glaucoma.Methods:A retrospective clinical study. From January 1, 2016 to January 1, 2022, 15 patients (17 eyes) were diagnosed with FEVR secondary glaucoma in Beijing Tongren Hospital, Capital Medical University were included in the study. All patients underwent systematic ophthalmological evaluation. According to the patient's age, visual acuity, intraocular pressure, anterior segment, vitreous body and retina condition, the choice of translimbal lensectomy combined with vitrectomy, goniectomy, cyclophotocoagulation, intravitreal injection of anti-vascular endothelial growth factor (VEGF) treatment were chosen. The follow-up time was 3 to 37 months. The clinical characteristics of the affected eye, and the changes of intraocular pressure, anterior chamber depth and complications after surgery were observed.Results:Among the 15 patients, there were 11 males with 13 eyes, and 4 females with 4 eyes. Age was 6.14±7.37 years old. FEVR stages 2B, 3B, 4A, 4B, 5A, and 5B were 1, 1, 5, 6, 3, and 1 eye, respectively. The intraocular pressure of the affected eye was 42.74±9.06 mm Hg (1 mm Hg=0.133 kPa). All eyes had shallow anterior chamber and angle closure, anterior or posterior iris adhesions, lens opacity, retinal detachment, iris neovascularization in 4 eyes, and vitreous hemorrhage in 2 eyes. Sixteen eyes were treated with translimbal lensectomy combined with vitrectomy and goniotomy, of which 8 eyes were treated with anti-VEGF treatment; 1 eye was treated with cyclophotocoagulation combined with anti-VEGF treatment. After operation, the intraocular pressure of 16 eyes returned to normal range, and the depth of anterior chamber of 16 eyes returned to normal, and no obvious complications occurred.Conclusions:The main etiology of secondary glaucoma in FEVR is the structural and functional abnormalities of the anterior chamber and angle, which are found in the 2B and above stages of FEVR. The lensectomy and vitrectomy via limbal approach can effectively control the intraocular pressure and restore the anterior chamber, with no serious complications.

3.
International Eye Science ; (12): 1967-1972, 2023.
Artigo em Chinês | WPRIM | ID: wpr-998473

RESUMO

AIM: To analyze the current status, hotspots and trends of studies on the treatments of diabetic retinopathy.METHODS: Relevant literatures on diabetic retinopathy in Chinese National Knowledge Infrastructure(CNKI)and Web of Science core collection database were retrieved from creation to June 15, 2023, and CiteSpace 6.2.R2 and VOSviewer were used to conduct visualized analysis with the country/issuing institution, research author and keywords.RESULTS: A total of 5 919 Chinese literatures and 11 475 English literatures were included. The top three countries with global publications are the United States, China and the United Kingdom, respectively. The top three institutions for issuing articles at abroad are Harvard Medical School, Harvard University and Johns Hopkins University, while the top three institutions for issuing articles in China are the Eye Hospital of China Academy of Chinese Medical Science, Hunan University of Chinese Medicine, and Zhongshan Ophthalmic Center of Sun Yat-sen University. The research results of high-frequency keywords in both Chinese and English show that the laser photocoagulation, vitrectomy, traditional Chinese medicine therapy, vascular endothelial growth factor and ranibizumab are research hotspots.CONCLUSIONS: In recent years, the research hotspots of diabetic retinopathy mainly focus on surgery, vascular protective agents, traditional Chinese medicine therapy, anti-vascular endothelial growth factor, etc., and the research trend mainly focuses on anti-vascular endothelial growth factor drugs.

4.
Rev. bras. ortop ; 57(4): 619-628, Jul.-Aug. 2022. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1394868

RESUMO

Abstract Objective The treatment of Colles fracture can deform the wrist. Some studies claim the resulting deformity rarely hinders daily activities, whereas others report the opposite; thus, anatomical reduction is desirable. Our objective was to analyze the anatomical and functional results of Colles fracture to find out the values of individual parameters corresponding to the best functional outcome. Methods The present prospective study included 70 elderly patients with Colles fracture. All patients were managed conservatively. The anatomical parameters were evaluated by measuring dorsal angulation, radial inclination, and radial height, and they were assessed as per Stewart et al. The functional result was assessed by the Mayo wrist score. The results were analyzed using the chi-squared test of association, and a p-value < 0.001 was considered statistically significant and to examine strengths of associations; we computed odds ratios (ORs) with 95% confidence intervals (CI). Results Excellent and good results were obtained in 68.5% of the cases anatomically and 78.5% functionally, which was statistically significant (p= 0.0009). Out of the three anatomical parameter dorsal angulation < 10° and loss of radial inclination < 9° showed statistically significant association with functional results (p= 0.0006), but loss of radial height < 6 mm did not (p= 0.0568), which became significant when loss of radial height was kept < 4 mm (p= 0.00062). Conclusion Fractures with anatomical reduction have better functional results. The acceptable borderline anatomical parameters for obtaining excellent or good functional results are dorsal angulation < 10°, loss of radial inclination < 9°, and loss of radial height < 4 mm.


Resumo Objetivo O tratamento da fratura de Colles pode deformar o pulso. Alguns estudos afirmam que essa deformidade raramente dificulta as atividades diárias, enquanto outros relatam o contrário; assim, a redução anatômica é desejável. Nosso objetivo foi analisar os resultados anatômicos e funcionais da fratura de Colles para descobrir os valores de parâmetros individuais correspondentes ao melhor desfecho funcional. Métodos Este estudo prospectivo incluiu 70 pacientes idosos com fratura de Colles. Todos os pacientes foram tratados de forma conservativa. Os parâmetros anatômicos foram a angulação dorsal, a inclinação radial e a altura radial, avaliados de acordo com Stewart et al. O resultado funcional foi avaliado segundo a tabela de pontuação de pulso Mayo. Os resultados foram analisados por meio do teste de associação do qui-quadrado, considerando o valor de p< 0,001 estatisticamente significativo. A força das associações foi analisada por razões de possibilidades com intervalos de confiança de 95%. Resultados Excelentes e bons resultados anatômicos e funcionais foram obtidos em 68,5% e 78,5% dos casos, respectivamente, com diferença estatística significativa (p= 0,0009). Dos três parâmetros anatômicos, a angulação dorsal inferior a 10° e a perda da inclinação radial inferior a 9° apresentaram associação estatisticamente significativa com os resultados funcionais (p= 0,0006), mas não a perda de altura radial inferior a 6 mm (p= 0,0568); no entanto, a perda da altura radial inferior a 4 mm foi associada de forma significativa aos desfechos funcionais (p= 0,00062). Conclusão As fraturas com redução anatômica apresentam melhores desfechos funcionais. Os parâmetros anatômicos limítrofes aceitáveis para a obtenção de resultados funcionais excelentes ou bons são angulação dorsal inferior a 10°, perda da inclinação radial inferior a 9° e perda da altura radial inferior a 4 mm.


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Anormalidades Congênitas , Atividades Cotidianas , Distribuição de Qui-Quadrado , Estudos Prospectivos , Fraturas Ósseas , Fratura-Luxação/cirurgia
5.
Chinese Journal of Experimental Traditional Medical Formulae ; (24): 196-202, 2021.
Artigo em Chinês | WPRIM | ID: wpr-906223

RESUMO

In China, about 100 million people currently have chronic obstructive pulmonary disease (COPD). At the same time, COPD is a multisystem disease, not only affecting the function of musculoskeletal, cardiovascular, kidney and immune systems in patients, but also causing intestinal dysfunction as its extrapulmonary manifestations. From the perspective of traditional Chinese medicine (TCM), after COPD is formed, deficiency, phlegm stasis and toxicity were accumulated in the lungs, which leads to dysfunction of lung in dispersing and descending, and eventually causes ascending and descending disorder of Qi activities, disorder of fluid supply and distribution, and stagnation of blood stasis. The viscera disease would affect the bowels, and the large intestine is thus affected. Modern medical discovers that, the lungs and intestines have common origins and similar physiological structures, in pathological circumstances, their common mucosal immune system may lead to similar immune factors and inflammatory manifestations in the lungs and intestines. At the same time, the studies have confirmed that there is also a close relationship between intestinal flora and lung, that is "lung-gut axis". These theories partially illustrate the mechanism of COPD in inducing intestinal injury. The specific manifestations of COPD intestinal dysfunction, ① Flora disorder, with increased abundance of intestinal gram-negative bacilli, and inhibited reproduction of Bifidobacterium, Lactobacillus and short-chain fatty acid-producing bacteria. ② Intestinal barrier damage: characterized by the destruction of intestinal epithelium tight connectivity, increased intestinal permeability, and thinning of the mucus layer. ③ Intestinal motility disorder: mostly manifested as weight loss and malnutrition. At present, for the intestinal dysfunction in COPD patients, most of the relevant discussions and targeted treatment methods in TCM are scattered and unsystematic. Guided by the idea of treating different diseases with the same treatment, we summarized the etiology and pathogenesis of COPD intestinal dysfunction by learning from the experience of TCM in treating intestinal flora disorders and inflammatory bowel disease, and proposed preliminary formulation with Tiaoqi Qushi,Tongfu Tongluo as its basic treatment principles in this paper, hoping to provide new ideas for the treatment of COPD.

6.
International Eye Science ; (12): 1154-1157, 2019.
Artigo em Chinês | WPRIM | ID: wpr-742614

RESUMO

@#Amblyopia is one of the common eye diseases that seriously impairs children's vision. The past concept holds that amblyopia rarely has organic changes corresponding to vision loss. In recent years, with the development of examination methods, anatomical abnormalities have been found in the choroid, retina and brain structure of amblyopia patients, which provides a powerful basis for elucidating the pathogenesis of amblyopia. Furthermore, in addition to traditional occlusion therapy to treat amblyopia, some emerging treatments have also achieved excellent results. Therefore, this article reviews the anatomical and physiological changes and the progress of treatment methods of amblyopia.

7.
Chinese Critical Care Medicine ; (12): 188-192, 2017.
Artigo em Chinês | WPRIM | ID: wpr-510315

RESUMO

Heat stroke (HS) is a life-threatening illness characterized by core body temperatures above 40 ℃ coupled with central nervous system (CNS) dysfunction, including delirium, convulsions, and/or coma. Its morbidity has increased dramatically in the past few decades. Multiple organ dysfunction syndrome (MODS) is not only the most serious complication of HS, but also the leading cause of deaths. Understanding the pathogenesis, characteristic and advancement pattern of MODS caused by HS will have a profound effect on the clinical treatment, research and mortality decrease. The pathogenesis, injury characteristic of each system and organ, and treatment methods were summarized in this review so as to deepen the clinical recognition of this disease.

8.
Chinese Journal of Experimental Ophthalmology ; (12): 122-127, 2017.
Artigo em Chinês | WPRIM | ID: wpr-638267

RESUMO

Background Immediately ocular rinsing is a key step for the prevention of eye tissue damage after acute chemical bums.A good ophthalmic rinsing solution can neutralize chemical substance and improve the prognosis of patients.Objective This study attempted to evaluate the therapeutic effect of self-made citric aciddisodium hydrogen phosphate buffer and citric acid-disodium hydrogen phosphate-potassium chloride buffer on corneal chemical burns in mice.Methods Citric acid-disodium hydrogen phosphate buffer solution (solution 1) and citric acid-disodium hydrogen phosphate-potassium chloride buffer solution (solution2) with the pH 7.4 were prepared.One hundred and twenty clean male C57 mice aged 6-8 weeks were randomized to two groups,and filter papers containing 1 mol/L H2SO4 or 0.15 mol/L NaOH were attached to the central corneas of the right eyes to create the acid or alkali burning models.Then the eyes were immediately rinsed by 40 ml solution 1,tap water or solution 2 according to the grouping and the model eyes without rinsing served as the control group.The corneal opacity was examined by slit lamp microscope and scored in 3,7 and 14 days after modeling.The percentages of corneal fluorescein staining,corneal neovascularization and corneal ulcer were analyzed.The study protocol was approved by Experimental Animal Ethic Commission of Second Military Medical University.Results In the corneal acid burning models,the number of eye with corneal opacity scored 1 in the solution 1 group,tap water group and solution 2 group was significantly more than that in the non-rinsing group in 3,7 and 14 days after modeling (all at P<0.01);In 3 days after modeling,the numbers of eye scored 1 were more in the solution 1 group than those in the tap water group and solution 2 group (x2 =11.000,P =0.001;x2 =4.000,P =0.046).There were no differences in the eye number of different corneal opacity scores in 14 days after acid burning (all at P>0.05).In 3,7 and 14 days after corneal alkali burning,the number of eyes with corneal opacity scored 1-2 was significantly increased in the solution 1 group,tap water group and solution 2 group compared with non-rinsing group (all at P<0.01).The percentage of corneal ulcer in the solution 1 group,tap water group and solution 2 group was 7%,27% and 13%,respectively,which was significantly lower than 73% in the non-rinsing group (P =0.000,0.027,0.003),and no significant differences were seen in various time points after corneal alkali burning (all at P>O.05).Corneal neovascularization occurred in 50% mice in non-rinsing group in 14 days after acid burning.However,no neovascularization was seen in the mice of the solution 1 group,tap water group and solution 2 group in both acid and alkali burning mice.Conclusions Citric aciddisodium hydrogen phosphate buffer (pH 7.4) appears to be an effective emergency rinsing solution for corneal chemical burns and the rinsing solution with or without potassium chloride is not obviously affected to the prognosis of corneal chemical burns in the mice.

9.
Artigo em Inglês | IMSEAR | ID: sea-167756

RESUMO

Background: Femoral neck fractures are rare in children. This type of fracture usually originates from high energy traumas. This fracture has serious complications and one of the most disabling one is avascular necrosis. The goal of this research is active follow up of patients in order to decide about the rate of late complications, patient `s function after surgery and residual pain. Methods: In this five year study 35 patients were evaluated and different parameters studied. These parameters included: age, sex, side of fracture, mechanis of injury, type of reduction, rate and type of complication followed surgery. Results: In general, femoral neck fractures are more common between 16 and 20.It is two fold common in females than males and it was more common in left side. The most common mechanisms was falling. Treatment methods were open reduction in 88 % and close reduction in 12%.The most common type of fractures was type3. Following treatment, 60% of patients remained uncomplicated and 40% had complication. In fact limitation in internal and external rotation in 20 to 30 degree was the most common complication. 30% of patients complained of mild pain during walking. Conclusion: After appropriate treatment most patients with femoral neck fracture have no complications, however in some cases a vascular necrosis occurs as a serious complication. This study will provide clues and information to design studies with more patients to assess how different treatment methods have impact on outcomes of patients.

10.
Chinese Journal of General Practitioners ; (6): 15-19, 2015.
Artigo em Chinês | WPRIM | ID: wpr-468897

RESUMO

Objective To compare blood pressure control in community hypertensive patients with different management methods.Methods Two neighborhood committees in a community of Pudong were selected as study area using cluster sampling method.A total of 5 166 residents aged ≥35 y were screened for blood pressure; the subjects with high blood pressure and had antihypertensive medication in last 6 months were included,and patients with secondary hypertension was excluded.The patients who entered community hypertension management program and got medication from community were included in community group; those who did not enter in community management program and/or not get medication from community were included in non-community group.Self-designed questionnaire was used for investigation.The medication compliance,awareness of hypertension risk factors and high blood pressure control were compared between two groups.Results Among 5 166 residents 4 763 were surveyed for hypertension with a response rate of 92.2% and hypertension prevalence rate of 23.2% (1 105/4 763).Among 1 012 patients with drug treatment for more than 6 months,there were 878 cases in community (86.8%) and 134 cases (13.2%) in non-community group.There were no significant differences in gender,age,education,working condition between community group and non-community group (P > 0.05).44.3% (389/878) patients in community group had a history of high blood pressure > 10 y and that was 56.7% (76/134) in non-community group (P =0.011) ; 28.6% (251/878) patients in community group were at high risk for risk stratification and that in non-community group was 47.8% (64/134) (P <0.001).The awareness of hypertension risk factors in community group and non-community group was 83.9% and 95.5%,respectively (P < 0.001).The medication compliance and blood pressure control rates in two groups were 93.2 % and 84.3 % (P < 0.001),68.6% and 51.5 %,respectively (P < 0.001).Conclusion The outcomes of hypertension management in terms of medication compliance and blood pressure control in community group are better than those in non-community group.

11.
China Medical Equipment ; (12): 19-22,23, 2013.
Artigo em Chinês | WPRIM | ID: wpr-598712

RESUMO

Objective: To provide a basis for proper use of the continuous blood purification machine through analysis of its malfunction related factors. Methods: Through study of using continuous blood purification machine by Baxter Aquarius in four of the best hospitals in Shanghai for the past three years, lists frequent incidences of malfunction classification, causes, and treatment methods based on statistics on the process of using the alarm malfunction, and solved malfunction by manufacturer’s engineers. Results:To provide clinical guidance for operation of CRRT equipment, improve the safe and stable operating condition through comparison and analysis of the continuous blood purification machine malfunction. Conclusion: The regular maintenance and proper use of clinical operations will help the stability of operating condition of the continuous blood purification machine.

12.
Rev. bras. psicodrama ; 20(2): 127-139, dez. 2012.
Artigo em Português | LILACS | ID: lil-703197

RESUMO

Este artigo trata de atendimentos psicoterapêuticos realizados com autores de violência sexual contra crianças e adolescentes, condenados pela justiça brasileira pelo crime de estupro (abuso sexual). Esses atendimentos foram desenvolvidos no Projeto Invertendo a Rota, do Centro de Estudo, Pesquisa e Extensão Aldeia Juvenil, da Pontifícia Universidade Católica de Goiás (PUC-GO).


This article explores the psychotherapeutic work with sex offenders, convicted by the Brazilian justice system for rape (sexual abuse), committed against children and adolescents. These interventions were developed at the ‘Reversing the Path Project’, run by the Centre for Study, Research and Expansions of the Juvenile Village, at the Pontifical Catholic University of Goias.


Assuntos
Adolescente , Criança , Metodologia como Assunto , Psicodrama , Delitos Sexuais
13.
Ciênc. rural ; 40(1): 7-11, jan.-fev. 2010. tab
Artigo em Português | LILACS | ID: lil-537376

RESUMO

A aplicação do regulador de crescimento via embebição de sementes apresenta alguns inconvenientes, dentre eles, a necessidade de secagem das sementes após o tratamento. O objetivo do trabalho foi avaliar o efeito do tratamento de sementes com Cloreto de Mepiquat (CM), embebidas e aplicadas diretamente nas sementes de algodão, no crescimento das plantas. Os tratamentos foram arranjados em blocos casualizados, com seis repetições, utilizando a linhagem PR 02-307. O experimento foi constituído por cinco tratamentos: sementes sem tratamento; aplicação direta sobre as sementes de CM a 3,75 e 7,5g i.a. kg-1 de sementes e embebidas em solução de CM a 3,75 e 7,5g i.a. kg-1 de sementes. Após os tratamentos, a semeadura foi feita em vasos com três litros de solo em casa de vegetação. Foram determinadas a altura e a área foliar do início até 90 dias após emergência e a fitomassa da matéria seca no final do experimento. Os tratamentos em que os reguladores de crescimento independentes da dose e forma de aplicação foram utilizados na semente provocaram redução na altura da planta desde a emergência. O CM pode ser utilizado no tratamento de sementes, tanto por embebição, quanto por aplicação direta, com efeitos semelhantes na redução da altura, da área foliar e da massa seca de folhas e de caules das plantas de algodoeiro, com efeito proporcional à dose utilizada.


The application of growth regulator through seed imbibitions has some drawbacks, including the requirement of drying the seeds after treatment. The objective of this research was to evaluate the effect of seeds treatment with Mepiquat Chloride (MC) on cotton plant growth by direct application and soaking. The treatments were arranged in randomized blocks with six replicates, using PR 02-307 lineage. The experiment consisted of five treatments: untreated seeds; direct application of MC on the seeds with 3.75 and 7.5g a.i. kg-1 of seed and soaking in solutions of 3.75 and 7.5g a.i. kg-1 of seeds. After the treatments, the seeds were sowed in three liters vases in a greenhouse. Height and leaf area were evaluated until 90 days after emergency and dry matter weight was evaluated at end of the experiment. The treatments that used growth regulator on seeds led to plant height reduction from emergency, regardless of dose and form of application. MC can be used by seed soaking or direct application on the seeds, as both have similar effects on height reduction, leaf area, dry matter of leaves and stems of cotton plants. The effect is dose-proportional.

14.
Rev. cienc. med. Pinar Rio ; 13(4): 66-75, oct.-dic. 2009.
Artigo em Espanhol | LILACS | ID: lil-739333

RESUMO

Las agudizaciones endodónticas constituyen eventos inflamatorios periapicales que se producen durante y después de concluida la terapéutica endodóntica, complicando y tornando más costosos dichos procederes. Para determinar su aparición e intensidad se realizó la presente investigación en la Clínica Estomatológica Docente Provincial "Antonio Briones Montoto" entre septiembre de 2007 y julio de 2008. El muestreo realizado fue de tipo opinático, constituido por 80 casos. Fueron divididos en 4 grupos de 20 casos, aplicándoseles diferentes esquemas de tratamiento. Los datos, recogidos en una planilla, se representaron en las tablas y gráficos en medidas resúmenes para variables cualitativas. Se empleó la estadística descriptiva: pruebas de 2 y K proporciones y la prueba no paramétrica Ji cuadrado. Se pudo constatar que el 17,5% de los casos tratados presentaron algún grado de agudización. El total de casos con agudizaciones resultó significativamente superior con la técnica estandarizada, no hubo diferencias en la aparición de las mismas en tratamientos en una o dos visitas, el mejor esquema de tratamiento empleado fue la técnica cérvico-apical en una sesión y los conductos abiertos al medio bucal el principal factor de riesgo asociado.


Endodontic acuteness constitutes periapical inflammatory events that are produced during and after concluding the endodontic therapeutic, complicating and increasing the cost of the dental procedures. This research was aimed at determining their onset and intensity at "Antonio Briones Montoto" Dentist's Teaching Clinic from September 2007 to July 2008. The sampling was based on opinions and with 80 cases that were divided into 4 groups of 20 cases applying different treatment schedules. Data were collected in tables and graphics and in measures summed up to qualitative variables. A descriptive statistics was used: the two tests, K-proportions and the non-parametric chi-square test to compare the categories as well as the relation and homogeneity of the variables respectively. The total of the cases with acuteness resulted significantly higher with the standardized techniques, no differences in number or the intensity of the acuteness in the treatments in one and two sessions were observed, the best schedule of the treatment was the cervical-apical technique in a session.

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