1
|
Vandelli G, Giacobazzi L, Ciolli L, Dell’Acqua ML, Vandelli L, Picchetto L, Rosafio F, Borzì GM, Ricceri R, Meletti S, Vallone S, Salvarani C, Sebastiani M, Sacchetti F, Verganti L, Merolla S, Zelent G, Bigliardi G. Intracranial Stenosis Treated with Stenting in Patients with Suspected Cerebral Vasculitis: Two Case Reports. Case Rep Neurol 2023; 15:100-107. [PMID: 37476369 PMCID: PMC10355127 DOI: 10.1159/000529942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/03/2023] [Indexed: 07/22/2023] Open
Abstract
Central nervous system vasculitis (CNSV) is an uncommon and poorly understood form of vasculitis. Early recognition is important because medical treatment might improve the outcome. However, randomized clinical trials on CNSV treatment do not exist. Endovascular treatment has been reported in few cases, but no data exist for intracranial stenting. We report 2 cases of patients with suspected CNSV and recurrent clinical episodes, treated with intracranial stenting. A 48-year-old man had relapsing episodes of right hemiparesis. Neuroradiological exams showed severe left carotid terminus stenosis. Despite immunosuppressive therapy, neuroradiological follow-up exams showed a worsening of the aforementioned stenosis with many transient episodes of weakness in the right limbs and aphasia. A 64-year-old woman had a sudden onset of dysarthria and transient aphasia. Neuroradiological exams showed a severe arterial stenosis involving the origin of left anterior cerebral artery and middle cerebral artery (MCA). Despite dual antiplatelet therapy, she presented an acute onset of severe aphasia, due to an occlusion of the left carotid terminus and proximal MCA. In both cases, endovascular procedure and intracranial stenting was performed, with marked improvement of cerebral blood flow. No more clinical episodes were reported. Intracranial stenting may be a valid therapeutic option in selected patients with CNSV and involvement of medium or large size vessels with clinical worsening despite best medical treatment.
Collapse
Affiliation(s)
- Gabriele Vandelli
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Giacobazzi
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Ludovico Ciolli
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Luisa Dell’Acqua
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Vandelli
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Livio Picchetto
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Francesca Rosafio
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Giuseppe Maria Borzì
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Riccardo Ricceri
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Stefano Meletti
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Vallone
- Neuroradiology, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Carlo Salvarani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Rheumatology Unit, IRCCS Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Modena, Italy
| | - Marco Sebastiani
- Rheumatology Unit, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Federico Sacchetti
- Neuroradiology, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Luca Verganti
- Neuroradiology, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Stefano Merolla
- Neuroradiology, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Gabriele Zelent
- Neuroradiology, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Guido Bigliardi
- Neurology Clinic, Stroke Unit, Ospedale Civile di Baggiovara, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| |
Collapse
|
3
|
Capasso R, Vallone S, Serra N, Zelent G, Verganti L, Sacchetti F, Bigliardi G, Picchetto L, Caranci F, Zini A. Qualitative versus automatic evaluation of CT perfusion parameters in acute posterior circulation ischaemic stroke. Neuroradiology 2020; 63:317-330. [PMID: 32813027 PMCID: PMC7880970 DOI: 10.1007/s00234-020-02517-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/06/2020] [Indexed: 11/29/2022]
Abstract
Purpose To compare the diagnostic accuracy (ACC) in the detection of acute posterior circulation strokes between qualitative evaluation of software-generated colour maps and automatic assessment of CT perfusion (CTP) parameters. Methods Were retrospectively collected 50 patients suspected of acute posterior circulation stroke who underwent to CTP (GE “Lightspeed”, 64 slices) within 24 h after symptom onset between January 2016 and December 2018. The Posterior circulation-Acute Stroke Prognosis Early CT Score (pc-ASPECTS) was used for quantifying the extent of ischaemic areas on non-contrast (NC)CT and colour-coded maps generated by CTP4 (GE) and RAPID (iSchemia View) software. Final pc-ASPECTS was calculated on follow-up NCCT and/or MRI (Philips Intera 3.0 T or Philips Achieva Ingenia 1.5 T). RAPID software also elaborated automatic quantitative mismatch maps. Results By qualitative evaluation of colour-coded maps, MTT-CTP4D and Tmax-RAPID showed the highest sensitivity (SE) (88.6% and 90.9%, respectively) and ACC (84% and 88%, respectively) compared with the other perfusion parameters (CBV, CBF). Baseline NCCT and CBF provided by RAPID quantitative perfusion mismatch maps had the lowest SE (29.6% and 6.8%, respectively) and ACC (38% and 18%, respectively). CBF and Tmax assessment provided by quantitative RAPID perfusion mismatch maps showed significant lower SE and ACC than qualitative evaluation. No significant differences were found between the pc-ASPECTSs assessed on colour-coded MTT and Tmax maps neither between the scores assessed on colour-coded CBV-CTP4D and CBF-RAPID maps. Conclusion Qualitative analysis of colour-coded maps resulted more sensitive and accurate in the detection of ischaemic changes than automatic quantitative analysis.
Collapse
Affiliation(s)
- Raffaella Capasso
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, Italy. .,Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy.
| | - Stefano Vallone
- Neuroradiology Unit, Ospedale Civile S.Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, Dipartimento di Neuroscienze, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Serra
- Statistic Unit, Department of Public Health, University of Federico II, Naples, Italy
| | - Gabriele Zelent
- Neuroradiology Unit, Ospedale Civile S.Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, Dipartimento di Neuroscienze, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Verganti
- Neuroradiology Unit, Ospedale Civile S.Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, Dipartimento di Neuroscienze, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Sacchetti
- Neuroradiology Unit, Ospedale Civile S.Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, Dipartimento di Neuroscienze, University of Modena and Reggio Emilia, Modena, Italy
| | - Guido Bigliardi
- Stroke Unit, Ospedale Civile S.Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, Dipartimento di Neuroscienze, University of Modena and Reggio Emilia, Modena, Italy
| | - Livio Picchetto
- Stroke Unit, Ospedale Civile S.Agostino-Estense, Azienda Ospedaliero-Universitaria di Modena, Dipartimento di Neuroscienze, University of Modena and Reggio Emilia, Modena, Italy
| | - Ferdinando Caranci
- Department of Medicine and Health Science "V. Tiberio", University of Molise, Via Francesco De Sanctis, 1, 86100, Campobasso, Italy.,Department of Precision Medicine, School of Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| |
Collapse
|
4
|
Cappellari M, Mangiafico S, Saia V, Pracucci G, Nappini S, Nencini P, Konda D, Sallustio F, Vallone S, Zini A, Bracco S, Tassi R, Bergui M, Cerrato P, Pitrone A, Grillo F, Saletti A, De Vito A, Gasparotti R, Magoni M, Puglielli E, Casalena A, Causin F, Baracchini C, Castellan L, Malfatto L, Menozzi R, Scoditti U, Comelli C, Duc E, Comai A, Franchini E, Cosottini M, Mancuso M, Peschillo S, De Michele M, Giorgianni A, Delodovici ML, Lafe E, Denaro MF, Burdi N, Internò S, Cavasin N, Critelli A, Chiumarulo L, Petruzzellis M, Doddi M, Carolei A, Auteri W, Petrone A, Padolecchia R, Tassinari T, Pavia M, Invernizzi P, Turcato G, Forlivesi S, Ciceri EFM, Bonetti B, Inzitari D, Toni D, Limbucci N, Consoli A, Renieri L, Fainardi E, Gandini R, Pampana E, Diomedi M, Koch G, Verganti L, Sacchetti F, Zelent G, Bigliardi G, Picchetto L, Vandelli L, Romano DG, Cioni S, Gennari P, Cerase A, Martini G, Stura G, Daniele D, Naldi A, Papa R, Vinci SL, Bernava G, Velo M, Caragliano A, Tessitore A, Buonomo O, Musolino R, La Spina P, Casella C, Carolina Fazio M, Cotroneo M, Onofrio M, Azzini C, Casetta I, Mardighian D, Frigerio M, Costa A, Di Egidio V, Lattanzi R, Assetta M, Cester G, Mavilio N, Serrati C, Piazza P, Epifani E, Andreone A, Castellini P, Latte L, Grisendi I, Vaudano G, Comelli S, Cavallo R, Chianale G, Simonetti L, Taglialatela F, Isceri S, Procaccianti G, Zaniboni A, Borghi A, Bonatti G, Ferro F, Bonatti M, Dall’Ora E, Currò Dossi R, Turri E, Turri M, Puglioli M, Lazzarotti G, Lauretti D, Giannini N, Maccarone M, Orlandi G, Chiti A, Guidetti G, Biraschi F, Falcou A, Anzini A, Mancini A, Fausti S, Di Mascio MT, Durastanti L, Sbardella E, Mellina V, Baruzzi F, Pellegrino C, Terrana A, Carimati F, Ruggiero M, Sanna A, Passarin MG, Colosimo C, Pedicelli A, D’Argento F, Alexandre A, Frisullo G, Zappoli F, Martignoni A, Cavallini A, Persico A, Valvassori L, Piano M, Agostoni E, Motto C, Gatti A, Longoni M, Guccione A, Tortorella R, Zampieri P, Zimatore DS, Grazioli A, Ricciardi GK, Augelli R, Bovi P, Tomelleri G, Micheletti N, Semeraro V, Lucarelli N, Ganimede M, Tinelli A, Pia Prontera M, Pesare A, Cagliari E, Quatrale R, Federico F, Passalacqua G, Filauri P, Orlandi B, De Santis F, Gabriele A, Tiseo C, Armentano A, Di Benedetto O, Silvagni U, Perrotta P, Crispino E, Stancati F, Rizzuto S, Pugliese P, Pisani E, Siniscalchi A, Gaudiano C, Pirritano D, Del Giudice F, Calia S, Ganci G, Sugo A, Scomazzoni F, Simionato F, Roveri L, De Nicola M, Giannoni M, Bruni S, Gambelli E, Provinciali L, Carriero A, Coppo L, Baldan J, Paolo Nuzzi N, Marcheselli S, Corato M, Cotroneo E, Ricciardi F, Gigli R, Pozzessere C, Pezzella FR, Corsi F, Squassina G, Cobelli M, Morassi M, Magni E, Pepe F, Bigni B, Costa P, Crabbio M, Griffini S, Palmerini F, Piras MP, Natrella M, Fanelli G, Cristoferi M, Bottacchi E, Corso G, Tosi P, Amistà P, Russo M, Tettoni S, Gallesio I, Mascolo MC, Meloni GB, Fabio C, Maiore M, Pintus F, Pischedda A, Manca A, Mongili C, Zanda B, Sanna A, Baule A, Pappalardo MP, Craparo G, Gallo C, Monaco S, Mannino M, Terruso V, Muto M, Guarnieri G, Andreone V, Dui G, Ticca A, Salmaggi A, Iannucci G, Pinna V, Di Clemente L, Perini F, De Boni A, De Luca C, De Giorgi F, Corraine S, Enne P, Ganau C, Piras V. IER-SICH Nomogram to Predict Symptomatic Intracerebral Hemorrhage After Thrombectomy for Stroke. Stroke 2019; 50:909-916. [DOI: 10.1161/strokeaha.118.023316] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
As a reliable scoring system to detect the risk of symptomatic intracerebral hemorrhage after thrombectomy for ischemic stroke is not yet available, we developed a nomogram for predicting symptomatic intracerebral hemorrhage in patients with large vessel occlusion in the anterior circulation who received bridging of thrombectomy with intravenous thrombolysis (training set), and to validate the model by using a cohort of patients treated with direct thrombectomy (test set).
Methods—
We conducted a cohort study on prospectively collected data from 3714 patients enrolled in the IER (Italian Registry of Endovascular Stroke Treatment in Acute Stroke). Symptomatic intracerebral hemorrhage was defined as any type of intracerebral hemorrhage with increase of ≥4 National Institutes of Health Stroke Scale score points from baseline ≤24 hours or death. Based on multivariate logistic models, the nomogram was generated. We assessed the discriminative performance by using the area under the receiver operating characteristic curve.
Results—
National Institutes of Health Stroke Scale score, onset-to-end procedure time, age, unsuccessful recanalization, and Careggi collateral score composed the IER-SICH nomogram. After removing Careggi collateral score from the first model, a second model including Alberta Stroke Program Early CT Score was developed. The area under the receiver operating characteristic curve of the IER-SICH nomogram was 0.778 in the training set (n=492) and 0.709 in the test set (n=399). The area under the receiver operating characteristic curve of the second model was 0.733 in the training set (n=988) and 0.685 in the test set (n=779).
Conclusions—
The IER-SICH nomogram is the first model developed and validated for predicting symptomatic intracerebral hemorrhage after thrombectomy. It may provide indications on early identification of patients for more or less postprocedural intensive management.
Collapse
Affiliation(s)
- Manuel Cappellari
- Stroke Unit (M. Cappellari, S.F., B.B.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Salvatore Mangiafico
- Interventional Neuroradiology Unit (S.M., S.N.), Ospedale Careggi-University Hospital, Firenze, Italy
| | - Valentina Saia
- Neurology and Stroke Unit (T.T., V.S.), Santa Corona Hospital, Pietra Ligure, Italy
| | - Giovanni Pracucci
- Stroke Unit (D.I., P.N., G.P.), Ospedale Careggi-University Hospital, Firenze, Italy
- University of Florence, Firenze, Italy (G.P., P.N., D.I.)
| | - Sergio Nappini
- Interventional Neuroradiology Unit (S.M., S.N.), Ospedale Careggi-University Hospital, Firenze, Italy
| | - Patrizia Nencini
- Stroke Unit (D.I., P.N., G.P.), Ospedale Careggi-University Hospital, Firenze, Italy
- University of Florence, Firenze, Italy (G.P., P.N., D.I.)
| | - Daniel Konda
- Interventional Neuroradiology Unit (D.K.), Policlinico Tor Vergata, Roma, Italy
| | | | - Stefano Vallone
- Neuroradiology Unit, Ospedale Civile S. Agostino-Estense University Hospital, Modena, Italy (S.V.)
| | - Andrea Zini
- Stroke Unit, IRCCS Istituto delle Scienze Neurologiche, Maggiore Hospital, Bologna, Italy (A.Z.)
| | - Sandra Bracco
- Interventional Neuroradiology Unit (S.B.), Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Rossana Tassi
- Stroke Unit (R.T.), Ospedale S. Maria delle Scotte-University Hospital, Siena, Italy
| | - Mauro Bergui
- Interventional Neuroradiology Unit (M.B.), Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Paolo Cerrato
- Stroke Unit (P.C.), Città della Salute e della Scienza-Molinette, Torino, Italy
| | - Antonio Pitrone
- Interventional Neuroradiology Unit (A. Pitrone), Policlinico G. Martino, Messina, Italy
| | | | - Andrea Saletti
- Interventional Neuroradiology Unit (A.S.), Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | - Alessandro De Vito
- Stroke Unit (A.D.V.), Arcispedale S. Anna-University Hospital, Ferrara, Italy
| | | | - Mauro Magoni
- Stroke Unit (M. Magoni), Spedali Civili, Brescia, Italy
| | - Edoardo Puglielli
- Vascular and Interventional Radiology Unit (E.P.), Ospedale Civile Mazzini, Teramo, Italy
| | | | - Francesco Causin
- Neuroradiology Unit (F.C.), Azienda Ospedaliero-Univeristaria, Padova, Italy
| | | | - Lucio Castellan
- Interventional Neuroradiology Unit (L. Castellan), IRCCS San Martino-IST, Genova, Italy
| | - Laura Malfatto
- Stroke Unit (L.M.), IRCCS San Martino-IST, Genova, Italy
| | - Roberto Menozzi
- Interventional Neuroradiology Unit (R.M.), Ospedale Universitario, Parma, Italy
| | | | - Chiara Comelli
- Interventional Neuroradiology Unit (C.C.), Ospedale San Giovanni Bosco, Torino, Italy
| | - Enrica Duc
- Neurology Unit (E.D.), Ospedale San Giovanni Bosco, Torino, Italy
| | - Alessio Comai
- Radiology Unit (A. Comai), Ospedale Centrale, Bolzano, Italy
| | | | - Mirco Cosottini
- Neuroradiology Unit (M. Cosottini), Ospedale Cisanello, Pisa, Italy
| | | | - Simone Peschillo
- Interventional Neuroradiology Unit (S.P.), Sapienza University Hospital, Roma, Italy
| | | | - Andrea Giorgianni
- Neuroradiology Unit (A.G.), Ospedale Universitario Circolo, ASST Sette Laghi, Varese, Italy
| | | | - Elvis Lafe
- Diagnostic and Interventional Neuroradiology Unit (E.L.), San Matteo Hospital and C. Mondino Foundation, Pavia, Italy
| | | | - Nicola Burdi
- Interventional Radiology Unit (N.B.), Ospedale SS. Annunziata, Taranto, Italy
| | | | - Nicola Cavasin
- Neuroradiology Unit (N.C.), Ospedale dell’Angelo, USSL3 Serenissima, Mestre, Italy
| | - Adriana Critelli
- Neurology Unit (A. Critelli), Ospedale dell’Angelo, USSL3 Serenissima, Mestre, Italy
| | | | - Marco Petruzzellis
- Interventional Neuroradiology Unit (M. Petruzzellis), Policlinico, Bari, Italy
| | - Marco Doddi
- Interventional Neuroradiology Unit (M.D.), Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy
| | - Antonio Carolei
- Stroke Unit (A. Carolei), Presidio Ospedaliero SS. Filippo e Nicola, Avezzano, Italy
| | - William Auteri
- Interventional Neuroradiology Unit (W.A.), Azienda Ospedaliera Annunziata, Cosenza, Italy
| | - Alfredo Petrone
- Neurology Unit (A. Petrone), Azienda Ospedaliera Annunziata, Cosenza, Italy
| | | | - Tiziana Tassinari
- Neurology and Stroke Unit (T.T., V.S.), Santa Corona Hospital, Pietra Ligure, Italy
| | - Marco Pavia
- Interventional Neuroradiology Unit (M. Pavia), Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Paolo Invernizzi
- Stroke Unit (P.I.), Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy
| | - Gianni Turcato
- Emergency Department, Girolamo Fracastoro Hospital, San Bonifacio (Verona), Italy (G.T.)
| | - Stefano Forlivesi
- Stroke Unit (M. Cappellari, S.F., B.B.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Bruno Bonetti
- Stroke Unit (M. Cappellari, S.F., B.B.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Domenico Inzitari
- Stroke Unit (D.I., P.N., G.P.), Ospedale Careggi-University Hospital, Firenze, Italy
- University of Florence, Firenze, Italy (G.P., P.N., D.I.)
| | - Danilo Toni
- Stroke Unit (M.D.M., D.T.), Sapienza University Hospital, Roma, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|