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"Pengaruh suplementasi Astaxamin terhadap kadar Malondialdehida plasma dan skor National Institute of health Stroke Scale (NU-ISS) pada penderila stroke iskemik. Mengetahui efek pcmberian suplementasi Astaxantin selama tujuh hari terhadap kadar malondialdehida plasma dan skor NIHSS pada penderita stroke iskemik Penelitian ini merupakan uji klinis pamlel, acak, tcrsamar ganda antara kelompok yang znendapat suplementasi astaxantin (P) dengan kelompok yang mendapat plasebo (K), Sebanyak 24 orang pasien stroke iskemik akut dengan onset < 48 jam di RSUPNCM Jakarta memenuhi kriteria dan diikutkan dalam penelitian, dilakukan alokasi random menggunakan randomini blok untuk menemukan kelompok perlakuan dan kontrol. Kelompok perlakuan mendapatkan suplementasi Astaxantin 2 x 8mg/had peroml selama tujuh hari, sementara kelompok kontrol mendapat plascbo. Data yang dikumpulkan meliputi data demografi (usia, jenis kelamin, tingkat pcndidikan, tingkat penghasilan), onset serangan, faktor risiko, IMT, analisis asupan zat gizi, kadar malondialdehida plasma, serta skor NIHSS. Analisis dam menggunakan uji 1 tidak berpasangan atau uji Man Whitney dengan batas kemaknaan p < 0,05. Rerata usia subjek penelitian ini adalah 56,0l=i:6,44 tahun. Sebagian besar subyek berjenis kelamin laki-laki, berpendidikan rendah dan tingkat penghasilan di bawah garis kemiskinan. Faktor risiko stroke yang paling banyak dimiliki subyek penelitian adalah hipertensi, diikuti kebiasaan merokok, dislipidemia, obesitas, diabetes mellitus, dan penyakit jantung. Selama perlakuan, asupan energi dan protein subyek penelitian tergolong cukup, asupan lemak tergolong lebih, asupan vitamin C tergolong cukup, sedangkan asupan vitamin E dan beuz kanaten tagolong kurang pada kedua kelompok. Terdapat penurunan kadar MDA plasma dan skor NIHSS pada kedua kelompok selama perlakuan. Rerata penurunan kadar MDA plasma pada kelompok perlakuan adalah -0,3l6i0,l8 normal dan secara bermakna lebih bcsar dibandingkan kelompok kontrol yaitu -0,1241 0,I08 nmol/mL (p<0,05). Penurunan skor NIHSS pada kelompok perlakuan sebesar -5,67=|=l,37 secara bermakna lebih besar dibandingkan kelompok kontrol yaitu ~3,‘25:&0,87 (p <0,0S). Suplcmentasi aataxantin sebanyak 2 x 8 mg solama 7 hari sccara bermakna dapal menurunkan kadar MDA plasma dan skor NIHSS penderila stroke iskemik. Astaxantin, antioksidan, malondialdehida plasma, skor Nll-ISS, stroke iskemik.

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Bilects of Astaxantin suplcmentation on malondialdehyde plasma level and National Institute of health Stroke Scale (NIHSS) score of ischemic stroke patients To investigate the effects of Astaxantin supplementation during seven days on Malondialdchida plasma level and NIHSS score of ischemic strokc patients. This is a parallel randomized double-blind clinical study between interventional group which has astaxantin supplementation (P) and control group which has placebo (K). Twenty-four acute ischemic stroke patients with onset < 48 hours in RSUPNCM Jakarta had fullilled the criteria and recruited in the research. Subjects were random allocated by block randomimtion into intervention and control group. Intervention group treated by Astaxnntin 2 x Sing,/day supplementation orally during 7 days, while control group treated by placebo. Data collection includes demographic characteristic (nge, sex, educational level, income level), stroke onset, risk factors, body mass index (BMI), daily nutrient analysis, malondialdchida plasma level, and Nil-lSS score. Statistical analysis is using unpaired t test or Mann Whitney test with significant level at p < 0,05. The mean age of subjects were 56,0li6,44 years old. Majoritics of suljects were male, low educational level and below poverty level income. The most liequent stroke risk factors in subjects were hypertension, followed by smoking habit. dyslipidemia, obesity, diabetes mellitus, and heart diseases. During intervention, energy and proteins intake were adequate, fat intake tends to be excess, vitamin C intake was adequate, whiie vitamin E and beta kamten tends to be low in both two groups. 'lhere was decreasing in MDA plasma level and NI]-ISS score in both two groups during intervention. The mean decreasing of MDA plasma in interventional group was -0,3lG.k0,l8 nmol/mL which significantly greater than control group -0,1242 0,108 nmol/mL (p<0,05). The mean decreasing ofNlHSS score in interventional group was -5,67=el,37 which significantly greater than control group -3,25i0,87 (p <0,05). Astaxantin supplementation 2 x 8 mg during 'l days is signiiicant on decreasing MDA plasma level and NH-ISS score in ischemic stroke patients. Astaxantin, antioxidant, rnalondialdehicla plasma, NIHSS score, ischemic stroke. "

"Mengetahui pengaruh suplementasi vitamin C 1000 mg i.v dan E 400 mg oral selama empat hari berturut-turut terhadap kadar malondialdehid (MDA) plasma, sebagai penanda stres oksidatif pada penderita luka bakar sedang berat. Penelitian ini merupakan one group pre post test, yang memberikan suplementasi vitamin C 1000 mg i.v dan vitamin E 400 mg oral yang pada 13 subyek penclitian, yaitu penderita luka bakar kategori sedang berat dengan tuas luka bakar kurang dari 60%, yang dirawat di Unit Luka Bakar RSUPN Cipto Mangunkusumo. Data diperoleh melalui wawancara, rekam medik, pengukuran antropometri, analisis asupan menggunakan metodefood record, dan pemeriksaan laboratorium. berupa pemeriksaan kadar vitamin Ct E serum dan MDA plasma pada sebeium dan setelah suplementasi. Analisis data untuk data berpasangan menggunakan uji t berpasangan dan uji Wileoxon, sedangkan untuk dua kelompok tidak berpasangan menggunakan uji Mann Whitney. Batas kemaknaan pada penelitian ini adalah 5%. Sebanyak 13 orang subyek penelitian~ terdiri dari perempuan 53,85%, dengan median usia 32 (18-55) tahun, sebagian besar subyek memiliki status gizi normal (61.54%). Median luas luka bakar adalah 22 (5-57)"/o, dengan kasus terbanyak adalah luka bakar berat (61.50%), dan penyebab terbanyak adalah api (76.9%). Kadar vitamin C pasca suplementasi mengalami sedikit peningkatan yang tidak bennakna. Kadar vitamin E subyek penelitian meningkat bermakna (p=O,Ol6) pasea suplementasi, walaupun masih dalam kategori rendah. Kadar MDA pada suplementasi mengalami penurunan bermakna W'(l,O 19). Simpulan: Terdapat penurunan bermakna kadar MDA plasma pada subyek penelitian setelah suplementasi vitamin C 1000 mg i.v dan vitamin E 400 mg oral selama empat hari.

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To study the effect of vitamin C 1000 mg i.v and E 400 mg oral supplementation on plasma malondialdehyde level as parameter of oxidative stress in bum patients.

This study was a one group pre post test that gave i.v 1000 mg vitamin C and omi 400 mg vitamin E supplementations to thirteen moderate-severe bum patient$. with percentage of bum less than 60%, in burn unit Cipto Mangunkusurno HospitaL Data were collected using questionnaire, medical record, anthropometric measurement. dietary assessment using four consecutive days food record. Laboratory test for serum vitamin C, B and plasma malondialdehyde levels were evaluated before and after supplementations. Differences in mean values were assessed by paired t-test for normal distribution data or Wilcoxon fur the not normal distribution. Mann Whitney was used for unpaired data. Values of p < O~OS were considered to indicate statistical significance.

Results Among thirteen subjects. seven (53.80%) subjects were female, median of age 32 (18-55) years. Body mass indek in most subjects (61.54%) were categorized as normal. The median percentages of bum injury 22 (5-51)%, and the frequency of severe bum was 61.50%, while the most cause of bum was flame (76,9%). Level of vitamin C after treatment was increased, but not significant. Level of vitamin E after treatment was significantly increased (p=O,Ol6). Level of MDA after supplementation significantly reduced (Jl 0,0l9).

Conclusion There was significantly reduced of level plasma MDA after four days vitamin CIOOO mg i.v danE 400 mg oral supplementations. "

"Cedera serebrovaskuler (CVA) merupakan berhentinya aliran darah ke otak yang mengakibatkan terjadi kehilangan fungsi dari otak tersebut,defisit yang umumnya terjadi yaitu kesulitan bicara dan mobilitas. Stroke juga berdampak pada kesehatan fisik dan kognitif sehingga mempengaruhi kemampuan dalam melakukan mobilisasi fisik. Kemampuan mobilisasi fisik pasien stroke iskemik fase rehabilitasi dipengaruhi oleh beberapa faktor. Tujuan penelitian ini adalah untuk mengidentifikasi faktor- faktor yang berhubungan dengan kemampuan mobilisasi fisik pasien stroke iskemik fase rehabilitasi di RSUPN Dr. Cipto Mangunkusumo. Penelitian ini menggunakan metode cross sectional. Sebanyak 100 pasien stroke iskemik yang dipilih menggunakan teknik consecutive sampling. Hasil penelitian menunjukkan bahwa mayoritas pasien stroke iskemik memiliki kemampuan mobilisasi fisik cukup baik (75%). Faktor-faktor yang berhubungan dengan kemampuan mobilisasi fisik pada pasien stroke iskemik fase rehabilitasi adalah usia (p=0,003), jenis kelamin (p=0,124), tingkat keparahan stroke (p=0,0001), fatigue (p=0,159), kekuatan otot(p=0,0001), cemas (p=0,047), efikasi diri (p=0,001), dukungan keluarga (p=0,0001) dan dukungan sosial (p=0,001). Hasil analisis multivariat menunjukkan variabel yang paling berhubungan dengan mobilisasi fisik pasien stroke iskemik pada fase rehabilitasi yaitu usia (OR=0,134; CI 95% 0,031-0583), tingkat keparahan stroke (OR= 63,565; CI 95% 5,386-532,719), kekuatan otot (OR=67,699; CI 95% 7,303-627,581), dan efikasi diri (OR=189,718; CI 95% 3,402-3668,197) danfaktor yang paling dominan berhubungan dengan kemampuan mobilisasi fisik pasien stroke iskemik fase rehabilitasi adalah efikasi diri dengan nilai OR 189,718 (CI 95%= 3,402 ; 3668,1971). Penelitian ini dapat dijadikan acuan bagi perawat untuk mencermati efikasi diri pada pasien stroke dan mengatasi pasien pasca stroke yang mengalami gangguan efikasi diri agar dapat melakukan mobilisasi fisik dengan rasa percaya diri.

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Cerebrovascular injury (CVA) is the cessation of blood flow to the brain which results in loss of function of the brain, a deficit that generally occurs namely speech difficulties and mobility. Stroke also has an impact on physical and cognitive health which affects the ability to carry out physical mobilization. The ability to physically mobilize ischemic stroke patients in the rehabilitation phase is influenced by several factors. The purpose of this study was to identify factors related to the ability of physical mobilization in the rehabilitation phase of ischemic stroke patients at Dr. RSUPN. Cipto Mangunkusumo. This study uses a cross sectional method. A total of 100 ischemic stroke patients were selected using consecutive sampling technique.

The results showed that the majority of ischemic stroke patients had good physical mobilization ability (75%). Factors related to physical mobilization ability in ischemic stroke patients in the rehabilitation phase were age (p = 0.003), gender (p = 0.124), stroke severity (p = 0.0001), fatigue (p = 0.159), strength muscle (p = 0,0001), anxiety (p = 0,047), self efficacy (p = 0,001), family support (p = 0,0001) and social support (p = 0,001). The results of multivariate analysis showed that the variables most associated with physical mobilization of ischemic stroke patients in the rehabilitation phase were age (OR = 0.134; 95% CI 0.031-0583), stroke severity (OR = 63.565; 95% CI 5,386-532,719), muscle strength (OR = 67,699; CI 95% 7,303-627,581), and self-efficacy (OR = 189,718; CI 95% 3,402-3668,197) and the most dominant factor related to the ability of physical mobilization of ischemic stroke patients in the rehabilitation phase is self-efficacy with value OR 189,718 (95% CI = 3,402; 3668,1971). This study can be used as a reference for nurses to examine self-efficacy in stroke patients and overcome post-stroke patients who experience impaired self-efficacy in order to be able to carry out physical mobilization with confidence."

"[Latar Belakang. Aterosklerosis merupakan salah satu penyebab stroke iskemik yang diawali dengan terjadinya disfungsi endotel akibat dari peningkatan stress oksidatif oleh reactive oxygen species (ROS). Proses ini mengakibatkan penebalan komplek intima media (KIM) pada pembuluh darah karotis. Vitamin C (antioksidan) berperan dalam proteksi terhadap stress oksidatif dengan mencegah oksidasi LDL. Penelitian ini bertujuan untuk mengetahui kadar dan asupan vitamin C dengan ketebalan komplek intima-media, sehingga konsumsi makanan yang tinggi vitamin C diharapkan dapat menghambat perjalanan aterosklerosis.Metode. Desain penelitian adalah potong lintang untuk mengetahui gambaran kadar dan asupan vitamin C dengan komplek intima media penderita stroke iskemik onset sampai dengan 2 minggu. Subjek penelitian sejumlah 40 orang didapatkan di ruang rawat inap, poli neurologi dan IGD RSCM. Dilakukan wawancara pola maka melalui metode food recall, pemeriksaan laboraturium kadar vitamin C plasma dan USG carotis doppler. Hasil. Didapatkan kadar rerata vitamin C plasma sebesar 0,13 ± 0,11mg/dl dan rerata asupan vitamin C yang dikonsumsi pasien perhari dalam 1 minggu terakhir SMRS adalah 102 ±74mg. Rerata ketebalan komplek intima media pada subyek penelitian adalah 0,98 ± 0,23mm. Tidak terdapat hubungan antara rerata kadar Vitamin C plasma dengan ketebalan komplek intima media dan asupan vitamin C. Terdapat hubungan antara asupan vitamin C dengan ketebalan komplek intima media (p = 0,05).Simpulan. Kadar rerata vitamin C plasma pada penderita stroke iskemik lebih rendah dari nilai normal. Rerata ketebalan komplek intima media pada pasien stroke lebih tinggi dibandingkan nilai normal. Asupan vitamin C yang tinggi memiliki kemungkinan ketebalan kompleks intima media yang tidak menjadi semakin tebal.;Background. Atherosclerosis is one of the cause of ischemic stroke that is initiated by endothelial dysfuncion caused by increased oxidative stress from reactive oxygen species (ROS). This process leads to the thickening of intima media complex within the carotid arteries. Vitamin C, an antioxidant, plays a protective role against oxidative stress by preventing LDL oxidation. This research is aimed to study the level and intake of vitamin C in relation to intima media complex thickness so that high vitamin C intake is expected to decelerate the atherosclerotic process.Method. This research is a cross-sectional study to know the level and intake of vitamin C in relation to the thickness of intima media complex in ischemic stroke patients at the time of onset until 2 weeks after the onset. This study recruited 40 patients from the inpatient, outpatient, and emergency deparments of Cipto Mangunkusumo hospital. Daily food consumption was assessed using food recall interview method. The serum vitamin C level was measured in the laboratorium and the intima media thickness was assessed using carotid doppler sonogram.Result. The mean serum vitamin C level was 0.13 ± 0.11mg/dL and the mean daily vitamin C intake within the last week before hospital admission was 102 ±74mg. The mean intima media thickness was 0.98 ± 0.23mm. There was no relation between the mean serum vitamin C level with the thickness of intima media complex and vitamin C intake. There was a significant relation between vitamin C intake and the intima media thickness (p = 0.05).Conclusion. The mean serum vitamin C level in ischemic stroke patient was lower than normal level. The mean inima media complex thickness in stroke patients was higher than normal thickness. High vitamin C intake may have a preventive relation in intima media complex thickening., Background. Atherosclerosis is one of the cause of ischemic stroke that is initiated by endothelial dysfuncion caused by increased oxidative stress from reactive oxygen species (ROS). This process leads to the thickening of intima media complex within the carotid arteries. Vitamin C, an antioxidant, plays a protective role against oxidative stress by preventing LDL oxidation. This research is aimed to study the level and intake of vitamin C in relation to intima media complex thickness so that high vitamin C intake is expected to decelerate the atherosclerotic process.Method. This research is a cross-sectional study to know the level and intake of vitamin C in relation to the thickness of intima media complex in ischemic stroke patients at the time of onset until 2 weeks after the onset. This study recruited 40 patients from the inpatient, outpatient, and emergency deparments of Cipto Mangunkusumo hospital. Daily food consumption was assessed using food recall interview method. The serum vitamin C level was measured in the laboratorium and the intima media thickness was assessed using carotid doppler sonogram.Result. The mean serum vitamin C level was 0.13 ± 0.11mg/dL and the mean daily vitamin C intake within the last week before hospital admission was 102 ±74mg. The mean intima media thickness was 0.98 ± 0.23mm. There was no relation between the mean serum vitamin C level with the thickness of intima media complex and vitamin C intake. There was a significant relation between vitamin C intake and the intima media thickness (p = 0.05).Conclusion. The mean serum vitamin C level in ischemic stroke patient was lower than normal level. The mean inima media complex thickness in stroke patients was higher than normal thickness. High vitamin C intake may have a preventive relation in intima media complex thickening.]"

"Latar Belakang: Stroke merupakan penyakit neurologi yang sering dijumpai dengan disabilitas dan mortalitas yang tinggi. Defisiensi vitamin D sering dijumpai pada pasien stroke dan berhubungan dengan meningkatnya risiko stroke serta luaran klinis yang buruk. Terapi medik gizi termasuk pemberian vitamin D diperlukan untuk membantu proses penyembuhan dan memberikan luaran klinis yang baik pada pasien stroke iskemik.Kasus: Serial kasus ini membahas empat pasien stroke iskemik yaitu dua pasien laki-laki dan dua pasien perempuan dengan usia 46-86 tahun. Tiga pasien didiagnosis sebagai malnutrisi berat secara klinis dan satu pasien dengan berat badan berlebih. Empat pasien tersebut memiliki kadar vitamin D yang rendah yaitu tiga pasien dengan defisiensi vitamin D dan satu pasien dengan insufisiensi vitamin D. Pasien mendapatkan tatalaksana nutrisi selama perawatan di rumah sakit dan rawat jalan.Hasil: Durasi perawatan rumah sakit pada empat pasien tersebut antara 22-59 hari. Dua pasien stroke iskemik dengan defisiensi vitamin D mengalami kematian saat perawatan di rumah sakit. Dua pasien yang hidup hingga akhir pemantauan mendapatkan suplementasi vitamin D dan didapatkan perbaikan kadar vitamin D. Pasien tersebut menunjukkan perbaikan klinis berupa perbaikan status gizi dan kapasitas fungsional.Kesimpulan: Tatalaksana medik gizi yang adekuat dan suplementasi vitamin D dapat memperbaiki luaran klinis pasien stroke iskemik.

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Background: Stroke is a neurological disease with high disability and mortality. Vitamin D deficiency is common in stroke patients and is associated with increased risk of stroke and poor clinical outcome. Nutritional medical therapy is needed to help the healing process and provide a good clinical outcome in ischemic stroke patients.

Methods: This case series discusses four ischemic stroke patients, consist of two male patients and two female patients with aged 46-86 years. Three patients were diagnosed as clinically severe malnutrition and one patient was overweight. Four patients had low vitamin D levels, consist of three patients with vitamin D deficiency and one patient with vitamin D insufficiency. The patients received nutritional management during hospitalization and outpatient treatment.

Results: The length of stay of these four patients was 22-59 days. Two ischemic stroke patients with vitamin D deficiency were died during hospitalization. Two patients who lived until the end of monitoring received vitamin D supplementation and had improvement in vitamin D levels. These patients showed clinical improvement in nutritional status and functional capacity.

Conclusions: Adequate nutritional medical management and vitamin D supplementation can improve the clinical outcome of ischemic stroke patients."

"Mengetahui pcngaruh pemberian kombinasi suplementasi vitamin E dan C terhadap peroksidasi lipid pada usila dengan hiperkolesterolemia. Penelitian uji klinis paralel, tertutup timggai, alokasi acak, untuk membandingkan kadar malondialdehida usila 2,60 tahun dengan hiperkolesterolemia yang mendapatkan kombinasi supiementasi vitamin E 400 IU dan vitamin C 500 mg, masing~masing sebutir sehari selama 45 hari dengan kelompok yang mendapat vitamin E 400 IU dan plascbo.Terdapat 42 subyek penelitian yang berasal dari Yayasan Kebagusan, Yayasan Yasni, dan Yayasan Yakin, Pasar Minggu Jakarta Selatan yang dibagi menjadi dua kelompok masing-masing berjumlah 21 orang. Data yang diambil adalah : data dcmograti, antropometzi, data asupan makanan pada minggu pertama, ketiga dan ketujuh, kadar kolesterol LDL dan MDA plasma sebelum dan sesudah perlakuan. Uji statistik yang digunakan adalah uji t-tidak bezpasangan bila distribusi nonnal dan uji Manmwhimey bila distribusi tidak normal dengan tingkat kemaknaan p<0.05. Sebanyak 20 subyek penelitian dad masing-masing kelompok yang dapat mengikuti penelitian sampai sclesai. Sebelum perlakuan, nilai median kadar kolesterol LDL kelompolc vitamin E+plasebo dan vitamin E+C masing- masing adalah I46.50(l30-190) mg/dL dan 146.50(l3I-196) mg/dL. Setelah 45 hari perlakuan, rerata kadar kolesterol LDL kelompok vitamin E4-plasebo (151.9.+:2.2.l mg/dl.) meningkat sedangkan kelompok vitamin B+-C (l46.8i28.21 mg/dL) menurun. Sebelum p¢rIakuan, nilai median kadar MDA plasma kelornpok vitamin E+plasebo dan rerata kadar MDA plasma kelompok vitamin E4-C masing-masing adalah 2.63(l.92-4.42) nmol/ml., dan 3.03:l:0.62 nmol/mL. Setelah 45 haii pcrlakuan rerata kadar MDA plasma kedua keiompok menunm menjadi 2.30i0.67 nmol/mL (p<0.01) pada kelompok vitamin E+plasebo dan 28810.88 nmol/mL (p=0.36) untuk kelompok vitamin E+C. Penurunan kadar MDA plasma kelompok vitamin E+plasebo lcbih besar (-0.5:!:0.55 nmol/mL) daripada kelompok vitamin E+C (-0.28(l.31-1.63) nmol/mL), tetapi dcngan uji statislik terhadap kedua nilai tersebut, tidalc berbeda bcrma!ma(p=0.09). Pembenan kombinasi vitamin E dan vitamin C pada usila dengan hiperkolesternlemia tidak dapat rnenurunkan kadar MDA plasma lcbih besar dibandingl-can dengan hanya pemberian vitamin E.

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This parallel, single blind, randomization clinical trial purpose was to compare plasma malondyaldehydc level in hypercholesterolemic elderly aged more than 60 years old. Forty two people from Yayasan Kebagusan, Yayasan Yasni and Yayasan Yakin, Pasar Minggu, South Jakarta which participated the study, were divided into two groups. Twenty one elderly were supplemented with 400 IU vitamin E and 500 mg vitamin C for 45 consecutive days, while the other group was supplemented with 400 IU vitamin E and placebo. The data of demographic, anthropometric, food intake in the first, third and seventh weeks, plasma LDL and MDA levels before and alter period were taken. Statistical analyzes was performed by SPSS 11.5.

Twenty people for each group had followed the study until the end of period. Before study, LDL cholesterol median for vitamin E + placebo group and vitamin E+C group were 146.50(l30-190) mg/dL and l46.50( 130-190) mg/dL respectively. Alter 45 of days treatment, there was an increase in mean LDL cholesterol in vitamin E + placebo group 15l.9i22.1 mg/dL while in vitamin E+C group was decreased to l46.8:l:28.2l mg/dl Before study, plasma MDA level in vitamin E + placebo group and vitamin E+C group were 2.63(l.92-4.42) and 3.031052 nmol/mL, respectively. After 45 days, mean MDA plasma in vitamin E + placebo group was 2.30i0.67 nmol/mL (p<0.01) and was 2.881088 nmol/ml.. (p=0.36) in vitamin E+C group. The decreased on plasma MDA levels in vitamin E+placebo group was higher (-0,510.55 nmol/mL) than vitamin E+C (-0.28(1.3l-1.63) nmol/mL), but statistical test showed not significant different between both group (p=0.09). Combined supplementation vitamin E and vitamin C in hypercholesterolemic elderly couldnot decrease plasma MDA higher than supplementation of vitamin E alone."