CovidSeniorV1, Main, Exploration, bibRecord, 000786

Clinical Characteristics and Risk Factors of Acute Respiratory Distress Syndrome (ARDS) in COVID-19 Patients in Beijing, China: A Retrospective Study.

Identifieur interne : 000786 ( Main/Exploration ); précédent : 000785; suivant : 000787

Clinical Characteristics and Risk Factors of Acute Respiratory Distress Syndrome (ARDS) in COVID-19 Patients in Beijing, China: A Retrospective Study.

Auteurs : Aibin Wang ; Guiju Gao ; Sa Wang ; Meiling Chen ; Fang Qian ; Weiming Tang [États-Unis] ; Yanli Xu ; Rui Song ; Liwei Zhuang ; Xiaoyang Ma ; Tianwei Zhao ; Xiaodi Guo ; Wei Li ; Xudong Wang ; Baoliang Li ; Chun Hu ; Zhihai Chen ; Fujie Zhang

Source :

Medical science monitor : international medical journal of experimental and clinical research [ 1643-3750 ] ; 2020.

RBID : pubmed:32973126

Descripteurs français

English descriptors

KwdEn :
- Adult (MeSH), Aged (MeSH), Aged, 80 and over (MeSH), Bacterial Infections (etiology), Betacoronavirus (MeSH), China (MeSH), Cities (epidemiology), Comorbidity (MeSH), Coronavirus Infections (complications), Coronavirus Infections (epidemiology), Female (MeSH), Fever (etiology), Humans (MeSH), Logistic Models (MeSH), Lymphopenia (etiology), Male (MeSH), Middle Aged (MeSH), Pandemics (MeSH), Pneumonia, Viral (complications), Pneumonia, Viral (epidemiology), Respiratory Distress Syndrome, Adult (etiology), Retrospective Studies (MeSH), Risk Factors (MeSH).
MESH :
- geographic , epidemiology : Cities.
- geographic : China.
- complications : Coronavirus Infections, Pneumonia, Viral.
- epidemiology : Coronavirus Infections, Pneumonia, Viral.
- etiology : Bacterial Infections, Fever, Lymphopenia, Respiratory Distress Syndrome, Adult.
- Adult, Aged, Aged, 80 and over, Betacoronavirus, Comorbidity, Female, Humans, Logistic Models, Male, Middle Aged, Pandemics, Retrospective Studies, Risk Factors.

Abstract

BACKGROUND Coronavirus disease 2019 (COVID-19) is a new infectious disease, and acute respiratory syndrome (ARDS) plays an important role in the process of disease aggravation. The detailed clinical course and risk factors of ARDS have not been well described. MATERIAL AND METHODS We retrospectively investigated the demographic, clinical, and laboratory data of adult confirmed cases of COVID-19 in Beijing Ditan Hospital from Jan 20 to Feb 29, 2020 and compared the differences between ARDS cases and non-ARDS cases. Univariate and multivariate logistic regression methods were employed to explore the risk factors associated with ARDS. RESULTS Of the 130 adult patients enrolled in this study, the median age was 46.5 (34-62) years and 76 (58.5%) were male. ARDS developed in 26 (20.0%) and 1 (0.8%) death occurred. Fever occurred in 114 patients, with a median highest temperature of 38.5 (38-39)°C and median fever duration of 8 (3-11) days. The median time from illness onset to ARDS was 10 (6-13) days, the median time to chest CT improvement was 17 (14-21) days, and median time to negative nucleic acid test result was 27 (17-33) days. Multivariate regression analysis showed increasing odds of ARDS associated with age older than 65 years (OR=4.75, 95% CL1.26-17.89, P=0.021), lymphocyte counts [0.5-1×10⁹/L (OR=8.80, 95% CL 2.22-34.99, P=0.002); <0.5×10⁹/L(OR=36.23, 95% CL 4.63-2083.48, P=0.001)], and temperature peak ≥39.1°C (OR=5.35, 95% CL 1.38-20.76, P=0.015). CONCLUSIONS ARDS tended to occur in the second week of the disease course. Potential risk factors for ARDS were older age (>65 years), lymphopenia (≤1.0×10⁹/L), and temperature peak (≥39.1°C). These findings could help clinicians to predict which patients will have a poor prognosis at an early stage.

DOI: 10.12659/MSM.925974
PubMed: 32973126
PubMed Central: PMC7523414

Affiliations:

Links toward previous steps (curation, corpus...)

to stream Main, to step Corpus: 000089
to stream Main, to step Curation: 000089

Le document en format XML

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<author><name sortKey="Guo, Xiaodi" sort="Guo, Xiaodi" uniqKey="Guo X" first="Xiaodi" last="Guo">Xiaodi Guo</name>
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<author><name sortKey="Li, Wei" sort="Li, Wei" uniqKey="Li W" first="Wei" last="Li">Wei Li</name>
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<wicri:noCountry code="subField">China (mainland)</wicri:noCountry>
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<wicri:noCountry code="subField">China (mainland)</wicri:noCountry>
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<wicri:noCountry code="subField">China (mainland)</wicri:noCountry>
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<author><name sortKey="Zhang, Fujie" sort="Zhang, Fujie" uniqKey="Zhang F" first="Fujie" last="Zhang">Fujie Zhang</name>
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<wicri:noCountry code="subField">China (mainland)</wicri:noCountry>
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<term>Aged (MeSH)</term>
<term>Aged, 80 and over (MeSH)</term>
<term>Bacterial Infections (etiology)</term>
<term>Betacoronavirus (MeSH)</term>
<term>China (MeSH)</term>
<term>Cities (epidemiology)</term>
<term>Comorbidity (MeSH)</term>
<term>Coronavirus Infections (complications)</term>
<term>Coronavirus Infections (epidemiology)</term>
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<term>Logistic Models (MeSH)</term>
<term>Lymphopenia (etiology)</term>
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<term>Pneumonia, Viral (complications)</term>
<term>Pneumonia, Viral (epidemiology)</term>
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<term>Adulte d'âge moyen (MeSH)</term>
<term>Betacoronavirus (MeSH)</term>
<term>Chine (MeSH)</term>
<term>Comorbidité (MeSH)</term>
<term>Facteurs de risque (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Fièvre (étiologie)</term>
<term>Humains (MeSH)</term>
<term>Infections bactériennes (étiologie)</term>
<term>Infections à coronavirus (complications)</term>
<term>Infections à coronavirus (épidémiologie)</term>
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<term>Pandémies (MeSH)</term>
<term>Pneumopathie virale (complications)</term>
<term>Pneumopathie virale (épidémiologie)</term>
<term>Sujet âgé (MeSH)</term>
<term>Sujet âgé de 80 ans ou plus (MeSH)</term>
<term>Syndrome de détresse respiratoire de l'adulte (étiologie)</term>
<term>Villes (épidémiologie)</term>
<term>Études rétrospectives (MeSH)</term>
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<term>Pneumonia, Viral</term>
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<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Bacterial Infections</term>
<term>Fever</term>
<term>Lymphopenia</term>
<term>Respiratory Distress Syndrome, Adult</term>
</keywords>
<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Infections à coronavirus</term>
<term>Pneumopathie virale</term>
<term>Villes</term>
</keywords>
<keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Fièvre</term>
<term>Infections bactériennes</term>
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<term>Syndrome de détresse respiratoire de l'adulte</term>
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<term>Aged</term>
<term>Aged, 80 and over</term>
<term>Betacoronavirus</term>
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<term>Female</term>
<term>Humans</term>
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<front><div type="abstract" xml:lang="en">BACKGROUND Coronavirus disease 2019 (COVID-19) is a new infectious disease, and acute respiratory syndrome (ARDS) plays an important role in the process of disease aggravation. The detailed clinical course and risk factors of ARDS have not been well described. MATERIAL AND METHODS We retrospectively investigated the demographic, clinical, and laboratory data of adult confirmed cases of COVID-19 in Beijing Ditan Hospital from Jan 20 to Feb 29, 2020 and compared the differences between ARDS cases and non-ARDS cases. Univariate and multivariate logistic regression methods were employed to explore the risk factors associated with ARDS. RESULTS Of the 130 adult patients enrolled in this study, the median age was 46.5 (34-62) years and 76 (58.5%) were male. ARDS developed in 26 (20.0%) and 1 (0.8%) death occurred. Fever occurred in 114 patients, with a median highest temperature of 38.5 (38-39)°C and median fever duration of 8 (3-11) days. The median time from illness onset to ARDS was 10 (6-13) days, the median time to chest CT improvement was 17 (14-21) days, and median time to negative nucleic acid test result was 27 (17-33) days. Multivariate regression analysis showed increasing odds of ARDS associated with age older than 65 years (OR=4.75, 95% CL1.26-17.89, P=0.021), lymphocyte counts [0.5-1×10⁹/L (OR=8.80, 95% CL 2.22-34.99, P=0.002); <0.5×10⁹/L(OR=36.23, 95% CL 4.63-2083.48, P=0.001)], and temperature peak ≥39.1°C (OR=5.35, 95% CL 1.38-20.76, P=0.015). CONCLUSIONS ARDS tended to occur in the second week of the disease course. Potential risk factors for ARDS were older age (>65 years), lymphopenia (≤1.0×10⁹/L), and temperature peak (≥39.1°C). These findings could help clinicians to predict which patients will have a poor prognosis at an early stage.</div>
</front>
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<Month>10</Month>
<Day>10</Day>
</DateRevised>
<Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">1643-3750</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>26</Volume>
<PubDate><Year>2020</Year>
<Month>Sep</Month>
<Day>25</Day>
</PubDate>
</JournalIssue>
<Title>Medical science monitor : international medical journal of experimental and clinical research</Title>
<ISOAbbreviation>Med Sci Monit</ISOAbbreviation>
</Journal>
<ArticleTitle>Clinical Characteristics and Risk Factors of Acute Respiratory Distress Syndrome (ARDS) in COVID-19 Patients in Beijing, China: A Retrospective Study.</ArticleTitle>
<Pagination><MedlinePgn>e925974</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.12659/MSM.925974</ELocationID>
<Abstract><AbstractText>BACKGROUND Coronavirus disease 2019 (COVID-19) is a new infectious disease, and acute respiratory syndrome (ARDS) plays an important role in the process of disease aggravation. The detailed clinical course and risk factors of ARDS have not been well described. MATERIAL AND METHODS We retrospectively investigated the demographic, clinical, and laboratory data of adult confirmed cases of COVID-19 in Beijing Ditan Hospital from Jan 20 to Feb 29, 2020 and compared the differences between ARDS cases and non-ARDS cases. Univariate and multivariate logistic regression methods were employed to explore the risk factors associated with ARDS. RESULTS Of the 130 adult patients enrolled in this study, the median age was 46.5 (34-62) years and 76 (58.5%) were male. ARDS developed in 26 (20.0%) and 1 (0.8%) death occurred. Fever occurred in 114 patients, with a median highest temperature of 38.5 (38-39)°C and median fever duration of 8 (3-11) days. The median time from illness onset to ARDS was 10 (6-13) days, the median time to chest CT improvement was 17 (14-21) days, and median time to negative nucleic acid test result was 27 (17-33) days. Multivariate regression analysis showed increasing odds of ARDS associated with age older than 65 years (OR=4.75, 95% CL1.26-17.89, P=0.021), lymphocyte counts [0.5-1×10⁹/L (OR=8.80, 95% CL 2.22-34.99, P=0.002); <0.5×10⁹/L(OR=36.23, 95% CL 4.63-2083.48, P=0.001)], and temperature peak ≥39.1°C (OR=5.35, 95% CL 1.38-20.76, P=0.015). CONCLUSIONS ARDS tended to occur in the second week of the disease course. Potential risk factors for ARDS were older age (>65 years), lymphopenia (≤1.0×10⁹/L), and temperature peak (≥39.1°C). These findings could help clinicians to predict which patients will have a poor prognosis at an early stage.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Wang</LastName>
<ForeName>Aibin</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Gao</LastName>
<ForeName>Guiju</ForeName>
<Initials>G</Initials>
<AffiliationInfo><Affiliation>Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Wang</LastName>
<ForeName>Sa</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Chen</LastName>
<ForeName>Meiling</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Medical Record Statistics Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Qian</LastName>
<ForeName>Fang</ForeName>
<Initials>F</Initials>
<AffiliationInfo><Affiliation>Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Tang</LastName>
<ForeName>Weiming</ForeName>
<Initials>W</Initials>
<AffiliationInfo><Affiliation>University of North Carolina Project-China, Chapel Hill, NC, USA.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Xu</LastName>
<ForeName>Yanli</ForeName>
<Initials>Y</Initials>
<AffiliationInfo><Affiliation>Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Song</LastName>
<ForeName>Rui</ForeName>
<Initials>R</Initials>
<AffiliationInfo><Affiliation>Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Zhuang</LastName>
<ForeName>Liwei</ForeName>
<Initials>L</Initials>
<AffiliationInfo><Affiliation>Department of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Ma</LastName>
<ForeName>Xiaoyang</ForeName>
<Initials>X</Initials>
<AffiliationInfo><Affiliation>Department of Neurology, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Zhao</LastName>
<ForeName>Tianwei</ForeName>
<Initials>T</Initials>
<AffiliationInfo><Affiliation>Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Guo</LastName>
<ForeName>Xiaodi</ForeName>
<Initials>X</Initials>
<AffiliationInfo><Affiliation>Department of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Li</LastName>
<ForeName>Wei</ForeName>
<Initials>W</Initials>
<AffiliationInfo><Affiliation>Department of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Wang</LastName>
<ForeName>Xudong</ForeName>
<Initials>X</Initials>
<AffiliationInfo><Affiliation>Surgical Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Li</LastName>
<ForeName>Baoliang</ForeName>
<Initials>B</Initials>
<AffiliationInfo><Affiliation>Surgical Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Hu</LastName>
<ForeName>Chun</ForeName>
<Initials>C</Initials>
<AffiliationInfo><Affiliation>Surgical Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Chen</LastName>
<ForeName>Zhihai</ForeName>
<Initials>Z</Initials>
<AffiliationInfo><Affiliation>Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Zhang</LastName>
<ForeName>Fujie</ForeName>
<Initials>F</Initials>
<AffiliationInfo><Affiliation>Department of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China (mainland).</Affiliation>
</AffiliationInfo>
</Author>
</AuthorList>
<Language>eng</Language>
<PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType>
</PublicationTypeList>
<ArticleDate DateType="Electronic"><Year>2020</Year>
<Month>09</Month>
<Day>25</Day>
</ArticleDate>
</Article>
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<MedlineTA>Med Sci Monit</MedlineTA>
<NlmUniqueID>9609063</NlmUniqueID>
<ISSNLinking>1234-1010</ISSNLinking>
</MedlineJournalInfo>
<SupplMeshList><SupplMeshName Type="Disease" UI="C000657245">COVID-19</SupplMeshName>
<SupplMeshName Type="Organism" UI="C000656484">severe acute respiratory syndrome coronavirus 2</SupplMeshName>
</SupplMeshList>
<CitationSubset>IM</CitationSubset>
<MeshHeadingList><MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D001424" MajorTopicYN="N">Bacterial Infections</DescriptorName>
<QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="Y">Betacoronavirus</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D002681" MajorTopicYN="N" Type="Geographic">China</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D002947" MajorTopicYN="N" Type="Geographic">Cities</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D015897" MajorTopicYN="N">Comorbidity</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName>
<QualifierName UI="Q000150" MajorTopicYN="Y">complications</QualifierName>
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<MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
</MeshHeading>
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<MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D016015" MajorTopicYN="N">Logistic Models</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008231" MajorTopicYN="N">Lymphopenia</DescriptorName>
<QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D058873" MajorTopicYN="Y">Pandemics</DescriptorName>
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<MeshHeading><DescriptorName UI="D012128" MajorTopicYN="N">Respiratory Distress Syndrome, Adult</DescriptorName>
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<MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName>
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<name sortKey="Chen, Zhihai" sort="Chen, Zhihai" uniqKey="Chen Z" first="Zhihai" last="Chen">Zhihai Chen</name>
<name sortKey="Gao, Guiju" sort="Gao, Guiju" uniqKey="Gao G" first="Guiju" last="Gao">Guiju Gao</name>
<name sortKey="Guo, Xiaodi" sort="Guo, Xiaodi" uniqKey="Guo X" first="Xiaodi" last="Guo">Xiaodi Guo</name>
<name sortKey="Hu, Chun" sort="Hu, Chun" uniqKey="Hu C" first="Chun" last="Hu">Chun Hu</name>
<name sortKey="Li, Baoliang" sort="Li, Baoliang" uniqKey="Li B" first="Baoliang" last="Li">Baoliang Li</name>
<name sortKey="Li, Wei" sort="Li, Wei" uniqKey="Li W" first="Wei" last="Li">Wei Li</name>
<name sortKey="Ma, Xiaoyang" sort="Ma, Xiaoyang" uniqKey="Ma X" first="Xiaoyang" last="Ma">Xiaoyang Ma</name>
<name sortKey="Qian, Fang" sort="Qian, Fang" uniqKey="Qian F" first="Fang" last="Qian">Fang Qian</name>
<name sortKey="Song, Rui" sort="Song, Rui" uniqKey="Song R" first="Rui" last="Song">Rui Song</name>
<name sortKey="Wang, Aibin" sort="Wang, Aibin" uniqKey="Wang A" first="Aibin" last="Wang">Aibin Wang</name>
<name sortKey="Wang, Sa" sort="Wang, Sa" uniqKey="Wang S" first="Sa" last="Wang">Sa Wang</name>
<name sortKey="Wang, Xudong" sort="Wang, Xudong" uniqKey="Wang X" first="Xudong" last="Wang">Xudong Wang</name>
<name sortKey="Xu, Yanli" sort="Xu, Yanli" uniqKey="Xu Y" first="Yanli" last="Xu">Yanli Xu</name>
<name sortKey="Zhang, Fujie" sort="Zhang, Fujie" uniqKey="Zhang F" first="Fujie" last="Zhang">Fujie Zhang</name>
<name sortKey="Zhao, Tianwei" sort="Zhao, Tianwei" uniqKey="Zhao T" first="Tianwei" last="Zhao">Tianwei Zhao</name>
<name sortKey="Zhuang, Liwei" sort="Zhuang, Liwei" uniqKey="Zhuang L" first="Liwei" last="Zhuang">Liwei Zhuang</name>
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Clinical Characteristics and Risk Factors of Acute Respiratory Distress Syndrome (ARDS) in COVID-19 Patients in Beijing, China: A Retrospective Study.

Clinical Characteristics and Risk Factors of Acute Respiratory Distress Syndrome (ARDS) in COVID-19 Patients in Beijing, China: A Retrospective Study.

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