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Advances in Critical Care Pediatric Nephrology : Point of Care Ultrasound and Diagnostics / / edited by Sidharth Kumar Sethi, Rupesh Raina, Mignon McCulloch, Timothy E. Bunchman
| Advances in Critical Care Pediatric Nephrology : Point of Care Ultrasound and Diagnostics / / edited by Sidharth Kumar Sethi, Rupesh Raina, Mignon McCulloch, Timothy E. Bunchman |
| Edizione | [1st ed. 2021.] |
| Pubbl/distr/stampa | Singapore : , : Springer Nature Singapore : , : Imprint : Springer, , 2021 |
| Descrizione fisica | 1 online resource (X, 207 p. 59 illus., 43 illus. in color.) |
| Disciplina | 616.028 |
| Soggetto topico |
Critical care medicine
Emergency medicine Radiology Pediatrics Nephrology Intensive Care Medicine Emergency Medicine Nefrologia pediàtrica Medicina intensiva |
| Soggetto genere / forma | Llibres electrònics |
| ISBN | 981-334-554-3 |
| Formato | Materiale a stampa  |
| Livello bibliografico | Monografia |
| Lingua di pubblicazione | eng |
| Nota di contenuto | SECTION I: Point of Care Ultrasound: Introduction and advantages of point of care ultrasound in intensive care -- Modes and equipment -- Sonography of the kidneys -- Ultrasound guidance for procedure -- Lung ultrasound and cardiac assessment for intravascular volume status -- Permanent vascular access for hemodialysis -- Focused echocardiogram -- Need for training and certification -- SECTION II: Diagnostics: Fluid overload and kidney injury score: a multidimensional real-time assessment of renal disease burden in the critically ill patient -- Blood volume monitoring on fluid removal during intermittent hemodialysis of critically ill children with acute kidney injury -- Subclinical acute kidney injury and adverse outcomes in critically ill neonates and children -- Acute kidney injury defined by fluid corrected creatinine in neonates after the cardiac surgeries -- Pediatric AKI based on the reference change value of serum creatinin-pROCK -- Cardiac surgery-associated kidney injury in children and renal oximetry -- Serum and urine FGF23 and IGFBP-7 for the prediction of acute kidney injury in critically ill children -- Renal functional reserve and furosemide stress test -- Associations of perioperative renal oximetry via near-infrared spectroscopy, and postoperative acute kidney injury in infants after congenital heart surgery -- Using age-specific biomarker ranges for diagnosis and prognosis in pediatric AKI. |
| Record Nr. | UNINA-9910484946903321 |
| Singapore : , : Springer Nature Singapore : , : Imprint : Springer, , 2021 | ||
| Materiale a stampa | ||
| Lo trovi qui: Univ. Federico II | ||
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Challenges in pediatric kidney transplantation : a practical guide / / edited by Katherine E. Twombley
| Challenges in pediatric kidney transplantation : a practical guide / / edited by Katherine E. Twombley |
| Pubbl/distr/stampa | Cham, Switzerland : , : Springer, , [2021] |
| Descrizione fisica | 1 online resource (429 pages) |
| Disciplina | 617.9540083 |
| Soggetto topico |
Pediatric nephrology
Kidneys - Transplantation Transplantation of organs, tissues, etc. in children Trasplantament renal Nefrologia pediàtrica Trasplantament d'òrgans |
| Soggetto genere / forma | Llibres electrònics |
| ISBN | 3-030-74783-2 |
| Formato | Materiale a stampa |
| Livello bibliografico | Monografia |
| Lingua di pubblicazione | eng |
| Nota di contenuto |
Intro -- Contents -- Contributors -- Part I: Immunologic Challenges -- 1: Immunologic Challenges Pre-transplant -- Introduction -- What Is Human Leukocyte Antigen (HLA)? -- Pre-transplant -- How Does Sensitization Occur? -- Why Is HLA Compatibility Important? -- Epitope Mismatch -- How Are HLA Antibodies Detected and HLA Matching Performed? -- Antibody Detection -- Cell-Based Assays -- Solid-Phase Assays -- Is Median Fluorescent Intensity (MFI) Signal a Surrogate Measure of the Level of HLA Antibody? -- Peri-transplant -- The Virtual Crossmatch (vXM) in Transplantation -- Unexpected Crossmatch Scenarios -- Clinical Scenarios and Interpretation of Crossmatch Results in Kidney Transplantation -- Conclusion -- Questions and Answers with Explanation -- References -- 2: Challenges in Post-transplant Immunologic Monitoring -- Challenges in Post-transplant Immunologic Monitoring -- Conventional Monitoring Post-Transplant -- Serum Creatinine (Graft Function) -- Drug Monitoring and Variability -- Surveillance Monitoring of Donor-Specific Antibodies -- Non-HLA Antibodies -- Surveillance Biopsies (SBs) -- Innovative Biomarkers for Immunologic Monitoring Post-transplant -- Donor-Derived Cell-Free DNA (dd-cfDNA) -- Urinary Biomarkers -- Molecular Diagnostics -- The Future of Post-transplant Immune Monitoring -- Q& -- A -- Bibliography -- 3: Rejection Challenges: Diagnosis and Management -- A Brief History of Rejection -- An Evolving Paradigm of Rejection: From Discreet Episodic Events to a Fluctuating Continuum of Immune Alloreactivity -- Pathophysiology of Alloimmune Activation and Downstream Processes -- T Cell Development and Activation -- T Cell Migration and Mechanisms of Injury in T Cell-Mediated Rejection with the Allograft -- B Cell Development and Activation -- Alloantibodies and Antibody-Mediated Rejection -- Alloimmune Chronicity.
Detecting Rejection and Monitoring Its Course -- Clinical Monitoring and Biopsy Indication -- Surveillance Biopsies -- Follow-Up Biopsies -- Biomarkers for Rejection -- Gene Expression Signatures -- Chemokines -- Metabolomics -- Cell-Free DNA -- Predisposing Risk Factors for Rejection -- Recipient-Related Risks -- Donor-Recipient Interface -- Donor-Related Risks -- Silent Sensitization -- HLA Mismatch -- Post-transplant Factors -- Hyperacute Rejection -- Acute T Cell-Mediated Rejection (TCMR) -- Clinical and Histological Features -- Treatment of TCMR -- Corticosteroids -- Lymphocyte-Depleting Therapies -- Late Acute TCMR -- B Cell-Rich and Plasma Cell-Rich Acute Rejection -- B Cell-Rich Rejection -- Plasma Cell-Rich Acute Rejection -- Active Antibody-Mediated Rejection (AMR) -- Clinical and Histological Features -- Treatment of AMR -- Plasmapheresis and IVIG -- Rituximab -- Bortezomib -- Emerging Treatments -- Response to Treatment -- Chronic Active TCMR -- Clinical and Histological Features -- Management -- Chronic Active AMR -- Clinical and Histological Features -- Management -- Emerging Therapies -- Post Rejection Infection Prophylaxis -- Special Circumstances: Infection and Rejection -- AGPN and Rejection -- BK Virus and Rejection -- Case Studies -- References -- Part II: Infectious Challenges -- 4: Pretransplant Donor and Recipient Infectious Challenges -- Pretransplant Infectious Disease Evaluation -- Evaluation of the Pediatric Kidney Transplant Candidate -- HIV and Hepatitis Viruses -- Cytomegalovirus/Epstein-Barr Virus Serostatus of Donor and Recipient -- Cytomegalovirus -- Epstein-Barr Virus -- Mycobacterium tuberculosis -- Fungal Infections and Endemic Mycoses -- Parasitic Infections -- COVID-19 -- Urinary Tract Infections -- PHS Increased Risk Donors -- Window Period Duration and the Risk of Virus Transmission. Outcomes of PHS Increased Risk Donors in Pediatric Kidney Transplantation -- Informed Consent -- Posttransplant Testing -- Immunizations -- Preparing the Dialysis Patient for Transplantation -- Vaccine Schedule: Current American Academy of Pediatrics Recommendations -- Summary of recommendations with end stage kidney disease, including transplant candidates [62-64] -- Hepatitis B -- Influenza Vaccine -- Pneumococcal Vaccine [68, 69] -- Special Situations [70, 71] -- Household/Live Donor Vaccination -- Live Vaccines -- Varicella Vaccine -- Measles-Mumps-Rubella Vaccine -- Recombinant and Inactivated ("Killed") Vaccines -- DTaP/Tdap/dT Vaccine -- Poliovirus Vaccine -- Haemophilus Influenzae Type B Vaccine -- Hepatitis A Vaccine -- Hepatitis B Vaccine -- Meningococcal Vaccine -- Human Papillomavirus -- Updating Immunizations for the Dialysis Patient Awaiting Transplant -- Questions -- References -- 5: Post-transplant Recipient Infectious Challenges -- Introduction -- Opportunistic Post-Kidney Transplant Infections (CMV, EBV, and BK Virus and PJP) -- Cytomegalovirus (CMV) -- Risk Factors -- Clinical Presentation -- Screening -- Prophylaxis and Preemptive Therapy -- Treatment -- BK Virus -- Risk Factors -- Clinical Presentation -- Screening -- Treatment -- Epstein-Barr Virus -- Risk Factors -- Clinical Presentation -- Screening -- Treatment -- Pneumocystis jirovecii pneumonia (PJP) -- Resurgent Viral Infection Outbreaks: Measles and Mumps -- Cancer Risks -- Cancer Incidence -- Cancer Risk Factors -- Immunosuppression Burden -- EBV Recipient-Donor Sero-Mismatch -- Time Since Transplant -- HLA Haplotypes -- Pre-transplant Malignancy -- Age -- Gender -- Race -- Donor Source -- Recombinant Growth Hormone (rGH) Use -- Cancer Prevention Strategies -- Cancer Treatment -- Cancer Outcomes -- Urinary Tract Infections (UTI) -- Prevalence -- Risk Factors. Prevention -- Treatment -- Asymptomatic Bacteriuria -- Outcomes -- MOC Questions -- References -- Part III: Disease Challenges -- 6: Urological Considerations for Pediatric Renal Transplantation: CAKUT Challenges -- Urological Complications Post-transplant -- References -- 7: Rheumatologic Challenges -- Systemic Lupus Erythematosus -- Introduction -- Clinical Course of Renal Involvement and Outcomes -- Renal Transplantation in Lupus Nephritis -- Recurrence of Lupus Nephritis Post-transplantation -- Health Disparities in Systemic Lupus Erythematosus and Lupus Nephritis -- Conclusion -- IgA Vasculitis -- Introduction -- Clinical Course of Renal Involvement and Outcomes -- Renal Transplantation in IgAV Nephritis and Outcomes -- ANCA-Associated Vasculitis -- Introduction -- Clinical Course of Renal Involvement and Outcomes -- Renal Transplantation in Childhood AAV and Outcomes -- Conclusion -- References -- 8: Recurrent Disease Challenges in Pediatric Kidney Transplantation -- Introduction -- Atypical Hemolytic Uremic Syndrome (aHUS) -- Nature and Frequency of Primary Disease -- Considerations for Transplant Planning -- Risk Factors for Recurrence and Treatment of Recurrence -- Risk of Disease Recurrence in the Era of Eculizumab -- Additional Post-transplant Considerations -- C3 Glomerulopathy (C3G) -- Nature and Frequency of C3G -- Considerations for Transplant Planning -- Risk Factors for Recurrence and Treatment of C3G Recurrence -- IgA Nephropathy -- Nature and Frequency of IgA Nephropathy (IgAN) -- Risk Factors for Recurrence -- Considerations for Transplant Planning -- Treatment of IgAN Recurrence -- Impact of IgAN on Graft Function and Survival -- IgA Vasculitis (Henoch-Schonlein Purpura) -- Lupus Nephritis -- Nature and Frequency of Disease -- Risk for Disease Recurrence -- Considerations for Transplant Planning. Impact of RLN on Graft Function and Survival -- Other Diseases -- Primary Hyperoxaluria Type 1 (Oxalosis) -- Membranous Nephropathy -- Conclusion -- References -- 9: Nephrotic Syndrome Challenges: An Old Recurring Problem -- APOL1 -- Mechanism of Renal Injury -- Second Hit Modifiers -- Clinical Implications -- Pre-transplant Nephrectomy -- Proteinuria -- WT1 Mutation -- Disease Recurrence -- Genetic Mutations -- Living vs Deceased Donation -- Clinical Features Predictive of DR -- Circulating Factor and DR -- Treatment of Disease Recurrence -- Plasmapheresis -- Immunoadsorption -- Rituximab -- Cyclosporine -- Lipid Apheresis -- Questions -- Bibliography -- 10: Challenges of Maintaining Adequate Health and Well-Being, Growth, Nutrition, and Development in Pediatric Transplant Recipients -- Vaccinations -- Pre-transplant -- Post-transplant -- Vaccines and Travel -- Nutritional Challenges -- Pre-transplant -- CKD 2-5 Pre-dialysis -- Hemodialysis -- Peritoneal Dialysis -- Nutritional Management in CKD and Dialysis -- Enteral Nutrition Support -- Post-transplant -- Appetite and Weight -- Transition from Enteral to Oral Feeding -- Medication Effects -- Nutritional Management Post-transplant -- Food Safety -- Growth Challenges -- Growth Hormone Physiology -- Growth and CKD -- Growth After Kidney Transplant -- Outcomes -- Growth Hormone Utilization -- Indications and Contraindications for Growth Hormone -- Work-Up, Treatment, and Monitoring -- Work-Up -- Treatment -- Monitoring -- Safety of Growth Hormone in Transplant Recipients -- Metabolic Bone Disease -- Pathophysiology of CKD-BMD -- Bone Mineral Monitoring -- Post-transplant Bone Metabolism -- PTH, FGF-23, and Hypophosphatemia -- Hypomagnesemia -- Vitamin D -- Immunosuppression -- Role of Sex Hormones -- Prevention Strategies -- Steroid Minimization -- Diet and Physical Activity -- Treatment. Pharmacologic Therapies. |
| Record Nr. | UNINA-9910488710503321 |
| Cham, Switzerland : , : Springer, , [2021] | ||
| Materiale a stampa | ||
| Lo trovi qui: Univ. Federico II | ||
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Pediatric dialysis / / Bradley Alan Warady, Steven R. Alexander, Franz Schaefer, editors
| Pediatric dialysis / / Bradley Alan Warady, Steven R. Alexander, Franz Schaefer, editors |
| Edizione | [3rd ed.] |
| Pubbl/distr/stampa | Cham, Switzerland : , : Springer, , [2021] |
| Descrizione fisica | 1 online resource (975 pages) : illustrations |
| Disciplina | 618.9261 |
| Soggetto topico |
Hemodialysis
Pediatric nephrology Hemodiàlisi Nefrologia pediàtrica |
| Soggetto genere / forma | Llibres electrònics |
| ISBN | 3-030-66861-4 |
| Formato | Materiale a stampa |
| Livello bibliografico | Monografia |
| Lingua di pubblicazione | eng |
| Nota di contenuto |
Intro -- Preface -- Acknowledgments -- Contents -- Contributors -- Part I: Essential Primers -- 1: Notes on the History of Dialysis Therapy in Children -- Introduction -- Peritoneal Dialysis -- Hemodialysis -- Patient Registries and Multicenter Studies -- Conclusion -- References -- 2: The Biology of Dialysis -- Introduction -- Biology of Uremic Toxicity -- Solute Removal Mechanisms in Extracorporeal Dialysis -- Diffusion -- Solute Removal by Convection -- Solute Removal by Internal Filtration -- New Membrane Designs for Enhanced Removal of Large Toxins -- Solute Removal by Adsorption -- Peritoneal Dialysis: Biologic and Mass Transfer Considerations -- Factors Affecting Solute Transport -- Relationship Between Clearance and Mass Removal Rate Among Various Renal Replacement Therapies -- Clearance as a Dialyzer Performance Parameter -- Whole-Blood Clearance -- Blood Water and Plasma Clearance -- Dialysate-Side Clearance -- Whole-Body Clearance -- References -- 3: The Demographics of Dialysis in Children -- Introduction -- Sources of Demographic Data on Pediatric Dialysis Patients -- Incidence and Prevalence -- Access to Dialysis Around the World -- Effect of Era on the Incidence and Prevalence of ESKD in Children -- Effect of Age on the Incidence of RRT and Treatment Modality -- Primary Kidney Disease Diagnosis -- Mortality Risk -- Conclusion -- References -- 4: Chronic Dialysis in Developing Countries -- Introduction -- Economic Indicators -- Epidemiology of Renal Replacement Therapy in Developing Countries -- Demographics of the ESRD Population in Developing Countries -- Challenges Faced by Developing Countries in the Provision of Pediatric RRT -- Conclusion -- References -- 5: Organization and Management of a Pediatric Dialysis Program -- Introduction -- Operational Management -- Facility Culture and Organization -- Physical Space Needs.
Staffing the Unit -- Billing and Regulatory Guidelines -- Care Implementation -- Modality Selection -- Patient/Family Education -- Patient Care Plans -- Patient and Family Support -- Transition and Transfer of Care -- Quality Improvement and Safety -- Oversight and Ongoing Operations -- Conclusion -- References -- 6: Role of the Advanced Practice Provider in a Pediatric Dialysis Program -- Introduction -- History of the Advanced Practice Provider (APP) -- Nurse Practitioner -- Physician Assistant -- Orientation for the APP -- The APP in the Dialysis Unit -- Role of the APP in Hemodialysis -- Role of the APP in Peritoneal Dialysis -- Role of the APP in Critical Care Nephrology -- Billing Practices for the APP -- The Role of the APP in Transitions of Care -- CKD-ESKD -- Dialysis to Transplant -- Pediatric to Adult Care -- The Role of the APP in Improving Patient Outcomes -- Conclusion -- References -- 7: Quality Improvement Strategies and Outcomes in Pediatric Dialysis -- Introduction -- Clinical Practice Guidelines and Clinical Performance Measures -- Oversight of Centers for Medicaid and Medicare (CMS) and State Regulations -- Quality Assessment and Performance Improvement Program -- Networks -- The ESRD Quality Incentive Program of the USA -- Consolidated Renal Operations in a Web-Enabled Network (CROWNWeb) -- National Healthcare Safety Network (NHSN) -- Dialysis Facility Report (DFR) -- Dialysis Facility Compare -- Developing a Quality Assessment Performance Improvement (QAPI) Program -- Challenges for the Small Pediatric Program -- Quality Improvement Design -- What Is the Problem? -- Quality Improvement Methodology -- What Are We Trying to Accomplish? -- How Will We Know a Change Is an Improvement? -- What Changes Can We Make That Will Result in Improvement? -- Plan -- Do -- Study -- Act -- Sustainability -- Conclusion -- References. 8: Antibiotic Stewardship in the Pediatric Dialysis Unit -- Introduction -- Antibiotic-Resistant Bacterial Infections in Children -- Common Pathogens in Pediatric Dialysis Patients -- Negative Consequences of Antibiotic Use -- Antibiotic Use in Children -- Antibiotic Use in Dialysis Patients -- Antimicrobial Stewardship -- Antimicrobial Stewardship Strategies -- Inpatient -- Outpatient -- Dialysis Specific -- Diagnostics -- Hemodialysis -- Peritoneal Dialysis -- Infection Prevention -- Vaccination -- Summary -- References -- Part II: Considerations Around the Initiation of Dialysis -- 9: The Decision to Initiate Dialysis in Children and Adolescents -- Introduction -- Methodology for Measuring Kidney Function -- Predialysis Patient Monitoring and Preparation for Dialysis -- Indications for Initiating Dialysis -- Absolute Indications for Initiating Dialysis -- Relative Indications for Initiating Dialysis -- Uremic Symptoms -- Hyperkalemia -- Hyperphosphatemia -- Malnutrition -- Growth Failure -- Timing of Elective Dialysis Initiation -- Estimated GFR at Dialysis Initiation -- Consensus Statements Regarding Dialysis Initiation -- Arguments for Early ("Timely") Initiation -- Arguments for Delayed Initiation -- Choice of Mode of Dialysis -- References -- 10: Urological Issues in Pediatric Dialysis -- Introduction -- Urological Causes of Chronic Kidney Disease -- Posterior Urethral Valves -- Vesicoureteral Reflux in the Pediatric Dialysis Patient -- Neurogenic Voiding Dysfunction -- Bladder Augmentation and End-Stage Kidney Disease -- Prune Belly Syndrome -- Urological Issues in the Pretransplant Workup -- Nephrectomy -- Inguinal Hernias and Peritoneal Dialysis -- Stomas, Catheters, Vascular Access, and Incisions -- Summary -- References -- 11: Preservation of Residual Renal Function in Children Reaching End-Stage Renal Disease -- Introduction. Measurement of RRF -- Clinical Benefits of RRF -- General Risk Factors for Loss of Renal Function -- Specific Risk Factors for Loss of RRF in Patients on Dialysis -- Clinical Management Options to Slow CKD Progression and Preserve RRF on Dialysis -- Avoidance of Risk Factors -- Blood Pressure Control -- RAS Inhibition -- Diuretics -- Peritoneal Dialysis -- Hemodialysis -- Emerging Therapies -- Special Conditions -- References -- Part III: Peritoneal Dialysis -- 12: Peritoneal Access in Children Receiving Dialysis -- Peritoneal Dialysis Access -- Access Types -- Preoperative Evaluation and Preparation -- Omentectomy -- Fibrin Sealant -- Surgical Technique -- Laparoscopic Technique -- Open Technique -- Postimplantation Care -- Timing of Catheter Use -- Chronic Exit-Site Care -- Mechanical Complications -- Exit-Site Infection, Tunnel Infection, and Peritonitis -- PD Catheter Care Post-Kidney Transplantation -- Complications with PD Catheter Removal -- Conclusion -- References -- 13: Technical Aspects and Prescription of Peritoneal Dialysis in Children -- Introduction -- Update on PD Connection Technology -- Catheter-to-Transfer Set Connectors -- Transfer Set-to-Container Connection -- Transfer Sets -- Straight Transfer Set (the Standard Oreopoulos System) -- The Y-Set -- Peritoneal Dialysis Prescription -- The Peritoneal Dialysis System -- Peritoneal Microcirculation -- Peritoneal Membrane -- Dialysis Fluid Compartment -- Driving Forces of Solute and Water Exchange -- Diffusive Transport -- Ultrafiltration -- Convective Mass Transfer -- Peritoneal Membrane Function Tests -- Mass Transfer Area Coefficient -- Peritoneal Equilibration Test -- Standard Permeability Analysis -- Personal Dialysis Capacity Test -- Prescription of Peritoneal Fill Volume -- Prescription of Dwell Time -- Peritoneal Dialysis Methods and Regimens. Continuous Ambulatory Peritoneal Dialysis (CAPD) -- Automated Peritoneal Dialysis (APD) -- Nightly Intermittent Peritoneal Dialysis (NIPD) -- Continuous Cyclic Peritoneal Dialysis (CCPD) -- Tidal Peritoneal Dialysis (TPD) -- Adapted APD -- Concluding Remarks -- Peritonitis in APD Patients -- Evaluation of the Adequacy of Peritoneal Dialysis Treatment -- Clearance of Small Solutes -- Clearance of Middle-Sized Molecules -- Fluid Balance -- The Role of Residual Renal Function in Treatment Adequacy -- Clinical Evaluation of PD Treatment Adequacy -- Monitoring PD Adequacy in the Clinical Setting -- Machines for Automated Peritoneal Dialysis -- Characteristics of Cyclers for Automated Peritoneal Dialysis -- Registration of Treatment Data -- Transmission of Treatment Data -- Monitoring of Patient Adherence to the Prescribed APD Treatment -- Strategies to Enhance Patient Adherence to PD Prescriptions -- Conclusions -- References -- 14: Peritoneal Dialysis Solutions -- Introduction -- Biocompatibility -- PD Solution Components -- Electrolyte Composition -- Calcium -- Magnesium -- Alternate PD Solutions and Membrane-Sparing Strategies -- Conclusion -- References -- 15: Peritoneal Dialysis During Infancy -- Introduction -- Incidence and Etiology -- Ethical Considerations: Should Dialysis Be Initiated? -- Peritoneal Dialysis Access -- Prescription -- Nutrition and Growth -- Complications -- Hospitalization and Long-Term Outcomes -- Conclusions -- References -- 16: Infectious Complications of Peritoneal Dialysis in Children -- Introduction -- Incidence of PD-Related Infections -- Microbiology of PD-Related Infections -- Peritonitis -- PD Catheter-Related Infections -- Risk Factors and Prevention -- Patient Age -- PD Catheter Design, Insertion, and Postoperative Exit-Site Care -- Training -- Chronic Exit-Site Care -- Touch Contamination -- Ostomies. Antibiotic and Antifungal Prophylaxis. |
| Record Nr. | UNINA-9910483328203321 |
| Cham, Switzerland : , : Springer, , [2021] | ||
| Materiale a stampa | ||
| Lo trovi qui: Univ. Federico II | ||
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