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1.

Objective

To evaluate the effectiveness of abdominal acupuncture plus the Confluent Points of the Eight Extraordinary Meridian in treating chronic pharyngitis.

Methods

Thirty eligible subjects with chronic pharyngitis were given abdominal acupuncture plus needling Lieque (LU 7) and Zhaohai (KI 6), two out of the Confluent Points of the Eight Extraordinary Meridian, once a day, 10 sessions as a course, and the therapeutic efficacy was evaluated after a treatment course.

Results

After a treatment course, of the 30 subjects, 21 were recovered, 5 showed markedly effective, 2 were improved, and 2 failed, the total effective rate was 93.3%.

Conclusion

Abdominal acupuncture plus the Confluent Points of the Eight Extraordinary Meridian is effective in treating chronic pharyngitis, worth promoting in clinic.
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2.

Objective

To explore the action mechanism of electroacupuncture (EA) in improving the gastric motility of rats with diabetic gastroparesis (DGP).

Methods

Forty-eight healthy Sprague-Dawley (SD) rats were randomly assigned into four groups: a normal group (group A), a model group (group B), a group of EA at acupoints (group C), and a group of EA at non-acupoints (group D), 12 rats in each group. The animal model of DGP was established by intraperitoneal injection of streptozotocin (STZ) plus high glucose and fat diet. The blood glucose, urine glucose and gastric emptying rate (GER) were observed. The content of insulin (INS) in serum and ghrelin in gastric antrum tissue were detected by enzyme linked immunoassay (ELISA). The expression of growth hormone secretagogue receptor mRNA (GHSR mRNA) in gastric antrum tissue was detected by real-time fluorescent quantitative polymerase chain reaction (PCR).

Results

Compared with group A, blood glucose and urine glucose increased significantly (P<0.01), GER, content of serum insulin, the content of ghrelin and expression of GHSR mRNA in gastric antrum tissue decreased significantly (P<0.05 or P<0.01) in group B. Compared with group B, blood glucose and urine glucose decreased significantly (P<0.05), GER, the content of insulin in serum, the content of ghrelin and expression of GHSR mRNA in gastric antrum tissue increased significantly (P<0.05 or P<0.01) in group C.

Conclusion

EA at acupoints can down-regulate the content of blood and urine sugar, and promote gastric emptying, which is possibly related to the regulation of serum insulin, and the expressions of ghrelin and GHSR mRNA in gastric antrum.
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3.
4.

Objective

To investigate the effects of electroacupuncture (EA) at Neiguan (PC 6) and Baihui (GV 20) by observing the changes of CCAAT/enhancer-binding protein(C/EBP) homologous protein (CHOP) and caspase-12 gene expressions in rats after cerebral ischemia-reperfusion injury (IRI), and explore whether the apoptosis pathway of endoplasmic reticulum stress (ERS) is involved in the protective mechanisms of EA.

Methods

Sixty rats were randomly assigned to five groups (12 in each group): a normal control group (group A), a sham-operation group (group B), an operation group (group C), an Edaravone group (group D) and an EA group (group E). The cerebral IRI rat model was induced by middle cerebral artery occlusion (MCAO) using intraluminal monofilament. 2,3,5-triphenyl tetrazolium chloride (TTC) staining was adopted in the measurement of cerebral infarction volume. Real-time polymerase chain reaction (RT-PCR) was used to determine the mRNA expressions of CHOP and caspase-12.

Results

Compared with group A and group B, the volume of cerebral infarction and mRNA expressions of CHOP and caspase-12 in group C, group D and group E were increased, with statistical significances (P<0.05 or P<0.01); compared with group C, the volume of cerebral infarction and mRNA expressions of CHOP and caspase-12 in group D and group E were decreased significantly (P<0.05 or P<0.01); there were no significant differences between group D and group E in comparing the above items (P>0.05).

Conclusion

EA at Neiguan (PC 6) and Baihui (GV 20) can effectively suppress the volume of cerebral infarction. Furthermore, the underlying mechanism of EA at Neiguan (PC 6) and Baihui (GV 20) is possibly related to the down-regulation of CHOP and caspase-12 mRNA expressions, so as to decrease cell apoptosis.
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5.
6.

Objective

To observe the therapeutic effect of electroacupuncture (EA) at local points plus point injection on House-Brackmann facial nerve function classification grade (H-B) and facial disability index (FDI) in pregnant women with Bell palsy (BP).

Methods

A total of 40 eligible BP patients during pregnancy were randomized into a treatment group (n=20) and a control group (n=20). The treatment group was intervened by EA at Sizhukong (TE 23), Tongziliao (GB 1), Sibai (ST 2), Quanliao (SI 18), Yifeng (TE 17), Dicang (ST 4), Jiache (ST 6) and point injection at Zusanli (ST 36) and Yanglingquan (GB 34) on the affected side, 30 min every time, 10 sessions as a course, for 2 courses in total while control group by EA with the same points, manipulation and courses as the treatment group.

Results

After the treatment, the H-B classification in the treatment group was better than that in the control group, with a significant inter-group difference (P<0.05); after the treatment, the change of FDI score in the treatment group was significantly different from that in the control group (P<0.05).

Conclusion

EA at local points plus point injection can produce a more significant efficacy than EA in the treatment of BP during pregnancy.
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7.

Objective

To explore and analyze the points-selection rules in acupuncture treatment of mammary gland hyperplasia (MGH) by data mining and statistical method.

Methods

Clinical literatures about the treatment of MGH with acupuncture published in the recent 16 years were retrieved from Chinese Journal Full-text Database (CJFD) and established into a database by Excel. The SPSS 20 version software and Clementine 12.0 version software were adopted to analyze the frequency and association rules of points-selection in the treatment of MGH with acupuncture.

Results

The top 3 points used most frequently in acupuncture treatment of MGH were Danzhong (CV 17), Taichong (LR 3) and Zusanli (ST 36); points from the Stomach Meridian of Foot Yangming and Liver Meridian of Foot Jueyin were most commonly used; the commonly selected points were predominantly distributed in thoracic and abdominal regions and lower limbs; emphasis on the combination use of local and distal points; of the specific points, the five Shu-Transmitting points were mostly used; association analysis showed that the associations among Taichong (LR 3), Danzhong (CV 17) and Zusanli (ST 36) were the most significant.

Conclusion

The data mining results substantially accord with the general rules of acupuncture-moxibustion theories in traditional Chinese medicine, able to reflect the points-selection principles and features in acupuncture treatment of MGH and provide evidence for the points selection in the treatment of MGH in acupuncture clinic.
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8.

Objective

To determine whether six weeks' of acupuncture has a positive effect on plantar flexion muscle strength and whether electroacupuncture (EA) has a greater effect than manual acupuncture (MA) on plantar flexion, so that the most beneficial method of acupuncture can be established for strengthening muscles.

Methods

A randomized controlled trial with parallel groups. A total of 20 participants were randomly assigned to three groups: a control/non-acupuncture group (n=6), a manual acupuncture group (MAG) (n=8) and an electroacupuncture group (EAG) (n=6). MAG and EAG received three 25-minute treatments per week for 6 weeks. The control group continued with their normal training activity and received no treatment. The maximal voluntary contraction (MVC) of the ankle plantar-flexors at 30° per second was measured using Biodex system 3.

Results

Both MA and EA had a positive effect in increasing plantar flexion strength. The likelihood for this happening was high; 69% for MA and 92% for EA when compared with the control group. However the effect size was small for both groups. There was only a trivial difference in the effect size between the EAG and the MAG in regards to average plantar flexion torque.

Conclusion

EA and MA have a beneficial effect on plantar flexion muscle strength compared with the control group in healthy population.
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9.

Objective

To observe the effect of electroacupuncture (EA) at Huantiao (GB 30) and Weizhong (BL 40) on thigmesthesia, gait function, and expression levels of serum immunoglobulin G (IgG) and immunoglobulin M (IgM) in rabbits with lumbar intervertebral disc herniation (LIDH).

Methods

Forty healthy New Zealand rabbits were randomly divided into a blank control group, a model group, an EA at acupoint group and an EA at non-acupoint group, with 10 rabbits in each group. The LIDH pathological model of rabbit was established using the self-made LIDH model maker. The thigmesthesia and gait function of rabbits were recorded by Siegal method. The serum IgG and IgM expression levels were detected by enzyme-linked immunosorbent assay.

Results

EA at Huantiao (GB 30) and Weizhong (BL 40) could improve the clinical symptoms of thigmesthesia and gait function, and inhibit the expressions of serum IgG and IgM in the LIDH rabbits, which were significantly different compared with those in the model group and EA at non-acupoint group.

Conclusion

EA at Huantiao (GB 30) and Weizhong (BL 40) can improve the clinical symptoms of LIDH rabbits, which is associated with inhibition of the serum IgG and IgM expressions and reduction of the immunoinflammatory factor release. This may be one of the mechanisms of EA at Huantiao (GB 30) and Weizhong (BL 40) in the treatment of LIDH.
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10.

Objective

To observe the clinical effect of electroacupuncture (EA) at four sacral points on overactive bladder syndrome.

Methods

A total of 120 female patients with overactive bladder syndrome were allocated to a treatment group of 80 cases and a control group of 40 cases on a voluntary basis. The patients in the treatment group received EA at four sacral points, and the treatment was given three times a week for 6 consecutive weeks, while the patients in the control group received oral administration of M-receptor antagonist tolterodine tartrate, which was given 4 mg each time, once a day for 6 consecutive weeks. Then the symptom scores were compared between the two groups before and after treatment.

Results

At the end of treatment, the symptom scores showed statistical significant differences in comparing with those before treatment in both groups (both P<0.01); the symptom score in the treatment group was lower than that in the control group, showing a statistically significant difference (P<0.05).

Conclusion

EA at four sacral points is an effective method for overactive bladder syndrome.
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11.

Objective

To observe the effect of electroacupuncture (EA) at Jiaji (EX-B 2) points plus hydro-acupuncture with sinomenine hydrochloride for low back pain caused by compression fractures in the elderly.

Methods

Ninety-five elderly in-patients with low back pain caused by compression fractures were randomly divided into an observation group and an EA group according to the visit sequence. Both groups received the same basic treatment. In the EA group, 48 cases were treated with EA at Jiaji (EX-B 2) points plus the basic therapy; 47 cases in the observation group received the basic treatment plus EA and hydro-acupuncture with sinomenine hydrochloride at Jiaji (EX-B 2) points. The levels of osteoprotegerin (OPG) and interleukin-1β (IL-1β) in peripheral blood were measured by enzyme-linked immunosorbent assay (ELISA) before and at the 21st day of treatment in both groups. Oswestry disability index (ODI) and visual analog scale (VAS) scores were used to analyze the clinical efficacy.

Results

After treatment, the OPG content in the observation group was higher with statistical significance compared with that before treatment in the observation group and after the treatment in the EA group, respectively (both P<0.05); the content of IL-1β, ODI and VAS scores were lower than those before treatment in the observation group and after treatment in the EA group with statistical significances (all P<0.05).

Conclusion

The combination of EA and hydro-acupuncture with sinomenine hydrochloride at Jiaji (EX-B 2) points is effective for low back pain caused by compression fractures in the elderly, and is superior to EA at Jiaji (EX-B 2) points alone.
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12.

Objective

To observe the effect of electroacupuncture (EA) and herbal cake-partitioned moxibustion on anxiety and depression in patients with Crohn’s disease (CD) in remission.

Methods

Sixty CD cases were randomly allocated into an EA group (n=30) and an herbal cake-partitioned moxibustion group (n=30) using the random number table by the ratio of 1:1. In addition, 30 healthy subjects were included in a control group. Bilateral Tianshu (ST 25), Qihai (CV 6) and Zhongwan (CV 12) were used in the EA and herbal cakepartitioned moxibustion groups. The treatment was done 3 times a week, for a total of 12 weeks. The efficacy was evaluated using self-rating anxiety scale (SAS), self-rating depression scale (SDS) and traditional Chinese medicine (TCM) symptom scores.

Results

Before treatment, the SAS and SDS scores in CD patients were remarkably higher than those in healthy subjects. After EA or herbal cake-partitioned moxibustion treatment, the SAS and SDS scores were significantly decreased in both groups, showing significant intra-group differences (P<0.05); the symptom scores of abdominal pain (severity, frequency and duration), bowel sounds/flatus and general fatigue were significantly decreased, showing significant intra-group differences (P<0.05); however, there were no between-group statistical differences (P>0.05).

Conclusion

Both EA and herbal cake-partitioned moxibustion can significantly decrease abnormally high SAS and SDS scores in CD patients as well as TCM symptom scores. The two therapies share similar effects in alleviating common symptoms and improving anxiety and depression.
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13.

Objective

To explore the clinical effects of electroacupuncture (EA) at Zusanli (ST 36) and Fenglong (ST 40) in treating senile dementia.

Methods

A total of 74 patients were randomly divided into an EA group and a medication group based upon the random digital table, 37 cases in each group. EA at Zusanli (ST 36) and Fenglong (ST 40) was given in the EA group, once every day, for six treatments per week. Donepezil Hydrochloride Tablets were given to the medication group, 5 mg per time and once a day in the former four weeks, 10 mg per time and once a day after 4 weeks, oral administration before sleep at night. The courses of the treatment were 12 weeks in both groups. The scores of mini-mental state examination (MMSE) and Barthel index (BI) were observed before and after the treatment, for processing the comparative analysis of the clinical effects after the course of the treatment.

Results

The total effective rate was 86.5% in the EA group and 70.3% in the medication group. The therapeutic effect was better in the EA group than that in the medication group, and the difference between the two groups was statistically significant (P<0.05). MMSE and BI scores after the treatment in the two groups were all elevated than those of the same groups before the treatment (P<0.05, P<0.01). The improving situation was obviously better in the EA group than that in the medication group, and the difference between the two groups was statistically significant (P<0.05).

Conclusion

EA at Zusanli (ST 36) and Fenglong (ST 40) is affirmative in the therapeutic effect for senile dementia and can also improve the cognitive function and enhance the patients’ quality of life.
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14.

Objective

To observe different efficacies of low-frequency electroacupuncture (EA) on pancreatic endocrine system in male and female patients with simple obesity due to spleen deficiency-related dampness.

Methods

A total of 80 simple obesity patients were assigned to a male group (n=37) and a female group (n=43). Both groups received a 30-minute low-frequency EA at Yinlingquan (SP 9), Sanyinjiao (SP 6), Zusanli (ST 36), Fenglong (ST 40), Quchi (LI 11), Tianshu (ST 25), Zhongwan (CV 12), Shuifen (CV 9), Qihai (CV 6) and Guanyuan (CV 4). The treatment was done once a day, and 10 times made up a course of treatment. Patients in both groups were treated for 2 courses. Then the changes in body mass index (BMI), serum insulin, insulin antibodies and leptin level in the two groups were observed and analyzed.

Results

After treatment, the BMI, serum insulin, insulin antibodies and leptin levels were significantly reduced in both groups (P<0.01 or P<0.05); the BMI and serum insulin concentration were more significantly reduced in the male group than those in the female group (both P<0.01); and the leptin level was more significantly reduced in the female group than that in the male group (P<0.01).

Conclusion

EA can significantly regulate BMI and pancreatic endocrine system in both men and women with simple obesity; however, there is a gender difference: better effect for men in reducing BMI and serum insulin and better effect for women in reducing serum leptin level.
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15.

Objective

To observe the influence of electroacupuncture (EA) on histomorphologies of lacrimal glands, cornea and conjunctiva in experimental dry eye syndrome, and to explore the repair effects of EA on lacrimal glands and ocular surface damage.

Methods

Twenty-four healthy male New Zealand rabbits were randomly divided into a normal group, a model group, an EA group and a medication group, 6 rabbits in each group. Experimental dry eye syndrome models were prepared in rabbits by using 0.1% benzalkonium chloride for eye drops. Tear secretion volume, break-up time of tear film (BUT) and corneal fluorescein staining score were observed before and after the treatment. Periodic acid Schiff (PAS) staining method was used to observe the changes of conjunctival goblet cells in rabbits. After hematoxylin eosin (HE) staining, morphological changes of rabbit cornea, conjunctiva and lacrimal gland tissues were observed under light microscope.

Results

Compared with the normal group, tear secretion volume and BUT were significantly reduced (both P<0.01), while the corneal fluorescein staining score was significantly increased (P<0.01) in the model group. Compared with the model group, tear secretion volume and BUT were significantly increased, while the corneal fluorescein staining score was significantly decreased in the EA group and the medication group (all P<0.01). Compared with the normal group, the number of conjunctival goblet cells in the model group was significantly reduced; compared with the model group, the numbers of conjunctival goblet cells were all relatively higher in the EA group and the medication group. Pathological lesions of cornea, conjunctiva and lacrimal glands all showed improvement by HE staining in the EA group and the medication group after the intervention.

Conclusion

EA can improve tear secretion and tear film stability of rabbit dry eye syndrome, and repair the pathologic lesions of conjunctival goblet cells, corneal epithelia, cornea, conjunctiva and lacrimal glands.
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16.

Objective

To analyze the meridian and acupoint-selection patterns in acupuncture-moxibustion treatment of polycystic ovarian syndrome (PCOS) by data mining technique, for exploring acupoints that could be effective for PCOS and providing suggestion and reference in selecting acupoints for the acupuncture-moxibustion treatment of PCOS.

Methods

Literatures related to the acupuncture-moxibustion treatment of PCOS published before April 2018 were collected. By a self-made data mining program developed using Microsoft Excel 2007, a database of acupuncturemoxibustion treatment of PCOS was then established. The correlation analysis was performed for the frequency of use of acupoints and acupoint groups. Cluster analysis was also conducted.

Results

A total of 92 articles were recruited finally. Sanyinjiao (SP 6), Conception Vessel and chest-abdomen region ranked the top on the list of the most frequently used acupoints, meridians and regions, respectively. Correlation analysis showed that the acupoint group with the highest confidence was Sanyinjiao (SP 6) and Zusanli (ST 36), and the group with the highest support was Sanyinjiao (SP 6) and Guanyuan (CV 4). Cluster analysis revealed five effective clusters: Guanyuan (CV 4) and Sanyinjiao (SP 6); Zhongwan (CV 12) and Tianshu (ST 25); Zhongji (CV 3), Zusanli (ST 36) and Qihai (CV 6); Xuehai (SP 10), Shenshu (BL 23), Taichong (LR 3) and Guilai (ST 29); Ganshu (BL 18), Taixi (KI 3), Yinlingquan (SP 9) and Pishu (BL 20).

Conclusion

According to the confidence and support report, Sanyinjiao (SP 6) and Zusanli (ST 36) or Sanyinjiao (SP 6) and Guanyuan (CV 4) are recommended in acupuncture-moxibustion treatment of PCOS, with adjunct points selected for different patterns, e.g. Zhongwan (CV 12) and Tianshu (ST 25) for tonifying spleen and expelling dampness; Zhongji (CV 3) and Qihai (CV 6) for supplementing qi and cultivating blood; Xuehai (SP 10), Shenshu (BL 23), Taichong (LR 3) and Guilai (ST 29) for tonifying kidney and dissolving stasis; Ganshu (BL 18), Taixi (KI 3), Yinlingquan (SP 9) and Pishu (BL 20) for tonifying kidney and spleen and regulating liver.
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17.

Objective

To investigate the clinical efficacy of Zhang’s acupoint pressure therapy plus electroacupuncture (EA) in treating post-traumatic knee osteoarthritis.

Methods

A total of 98 eligible patients with post-traumatic knee osteoarthritis were divided into group A and B by the random number table, 49 cases in each group. Group A was intervened by Zhang’s acupoint pressure therapy plus EA; group B was given medicinal fumigation. The clinical efficacies of the two groups were compared.

Results

The markedly effective rate of group A was significantly higher than that of group B.

Conclusion

Zhang’s acupoint pressure therapy plus EA can produce a satisfactory clinical efficacy in treating post-traumatic knee osteoarthritis, and is worth promotion.
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18.

Objective

By taking the holism and differentiation concepts of traditional Chinese medicine (TCM) as the guidance, physical, mental and workplace factors were recruited in the observation of depression in employees, and were systematically classified to establish a workplace-related Liver Meridian-depression scale, for providing an evaluation index for depression in employees.

Methods

NVIVO 11 software was adopted to assort ancient TCM classics. Based on the holism and differentiation concepts of TCM and well-developed scales, the item pool was determined via brain storm and screened by Delphi method after classified; a Wechat questionnaire was handed out 240 times via the online system ‘Wen Juan Xing’, and the results were statistically analyzed by the SPSS 17.0 version software.

Results

Five dimensions consisting of 80 items were obtained after classification, and 60 items were selected by Delphi method; a total of 216 questionnaires were returned and the return rate was 90%. Of which, 215 questionnaires were valid ones, and the valid rate was 99%. By exploratory factor analysis (EFA), 44 items were obtained, and the aggregate split-half reliability coefficient was 0.922. The Cronbach’s alpha coefficient for the five dimensions, i.e. Liver Meridian, relevant meridians, basic psychological activities, work cognition and emotional reactions, was respectively 0.841, 0.842, 0.914, 0.836 and 0.839, indicating a content internal consistency. The score of each item was highly correlated with the corresponding dimension, and the intercommunity was between 0.474 and 0.801. Nine factors were generated, 2 in the dimension of Liver Meridian, 3 in the dimension of relevant meridians, 2 in the dimension of basic psychological activities, 1 in the dimension of work cognition, and 1 in the dimension of emotional reactions, and the load of each factor was between 0.438 and 0.859. The reliability and validity of the scale were well examined.

Conclusion

The scale can be applied to evaluate the qi activities of Liver Meridian and depression symptoms related to workplace.
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19.

Objective

To observe the effect of electroacupuncture (EA) at Zusanli (ST 36) on the gastrointestinal motility and the ultrastructures of pacemaker cells [the interstitial cells of Cajal (ICC)] in diabetic gastroparesis (DGP) rats and explore the mechanism of EA for DGP.

Methods

A total of 50 Sprague-Dawley (SD) rats were randomly divided into group A, group B, group C, group D and group E, with 10 rats in each group. Group A was the blank control; a single intraperitoneal injection of 2% streptozotocin (STZ) was performed in rats of group B, group C, group D and group E, with high glucose and high fat diet for 8 weeks to establish the DGP rat models. Group B was the model group and the rats did not receive any treatment; group C was EA at acupoint group and the rats received EA at Zusanli (ST 36), Liangmen (ST 21) and Sanyinjiao (SP 6); group D was EA at non-acupoint group and the rats received EA at the control points of Zusanli (ST 36), Liangmen (ST 21) and Sanyinjiao (SP 6); group E was metoclopramide group and the rats were treated by intragastric administration of metoclopramide. Blood glucose was detected using ONE TOUCH blood glucose meter; gastric emptying rate and small intestine migration rate were measured using intragastric phenol red; ultrastructures of gastric antrum ICC were detected by transmission electron microscopy.

Results

The differences of blood glucose between group B, group C, group D, group E versus that of group A were statistically significant after modeling (P<0.01); after treatment, the differences of blood glucose between group D, group E versus that of group C were statistically significant (P<0.05, P<0.01); the gastric emptying rate of rats in group B was statistically significant different from that in group A (P<0.01); the gastric emptying rate of rats in group C was statistically significant different from that in group B (P<0.01). The migration rates of rats’ small intestines in group B, group C, group D and group E were all statistically significant different from that in group A (P<0.01); the migration rate of rats’ small intestines in group C was statistically significant different from that in group B (P<0.01). The ultrastructure of rat’s ICC in group B showed apoptosis compared with that in group A; rat‘s ICC in group C had complete basement membrane, more cytoplasm mitochondria, Golgi and rough endoplasmic reticulum, showing clear structure, occasional mitochondria swelling and gap junctions with adjacent smooth muscle cells; there were no significant differences between group D, group E versus group B.

Conclusion

EA at Zusanli (ST 36) plus other acupoints can regulate the blood glucose and promote gastrointestinal motility in DGP rats, and the mechanism may be related to repairing the damaged ICC structure.
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20.

Objective

To categorize and summarize the clinical and mechanism studies of the past 30 years on the treatment of Hashimoto’s thyroiditis (HT) with moxibustion, moxibustion plus medication, and acupuncture plus medication, etc., and to analyze the current problems.

Methods

The clinical and laboratory studies related to the treatment of HT with acupuncture-moxibustion therapies published before June 2015 were retrieved from MEDLINE, Excerpta Medica Database (EMBASE), China National Knowledge Infrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang) and Chongqing VIP Database (CQVIP).

Results

Moxibustion, moxibustion plus medication, and acupuncture plus medication can produce certain therapeutic effects in treating HT.

Conclusion

The research on the treatment of HT with acupuncture-moxibustion therapies is rather limited in the amount and content. In the future, standardization should be fortified, specific moxibustion research needs deepening, and the action mechanism of moxibustion should be emphasized.
  相似文献   

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