Maintaining a steady calorie deficit is the most effective way to lower your BMI. An official website of the United States government. Close this message to accept cookies or find out how to manage your cookie settings. The prevalence of fatty liver disease ranges from 25% to 35%. (Log in options will check for institutional or personal access. The liver was enlarged and showed mild increase in parenchymal echogenicity suggesting mild fatty infiltration. Before This site needs JavaScript to work properly. You should follow this treatment carefully in order to prevent further damage to the liver. Adenomatous changes are benign, due to a "polyp" that does not have any more ominous or pre cancerous features. However, the following factors can cause it to do so . Amsety Bars are created with the intention of helping those with liver conditions maintain a healthy diet. Br J Radiol. Answer (1 of 6): Coarsened liver texture is generally a descriptive phrase used in an ultrasound report. I heard docs say "gallbladder is distended multiple calcified gallstones seen". Hepatic pseudotumor due to nodular fatty sparing: the diagnostic role of opposed-phase MRI. Gallbladder surgery 5 days ago. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Rozmiarek J, Bell D, et al. Individual calorie needs are determined by your individual metabolism, activity level, and any specific needs. Focal fatty deposition and focal fatty sparing may manifest as a "pseudolesion". should it have been drained? hida scan showed no definite extravasation. 05 November 2011. and transmitted securely. These are the areas prone to altered hepatic blood flow with systemic . : S5/6 , IVC 2.6 cm focal hypoechoic nodular lesion . Subsequently, the insulin blocks the oxidation of free fatty acids in the hepatocytes and leads to preferential esterification of triglycerides which then accumulate within the cell . Connect with a U.S. board-certified doctor by text or video anytime, anywhere. Some of the common symptoms of fatty infiltration of the liver include fatigue, and pain in the upper right abdomen (where your liver sits). Numbers alone really don't tell much without the story behind it. MRI can be very helpful in establishing the diagnosis of nodular focal fatty sparing [2]. At the time the article was created Frank Gaillard had no recorded disclosures. Longitudinal Changes in Liver Fat Content in Asymptomatic Adults: Hepatic Attenuation on Unenhanced CT as an Imaging Biomarker for Steatosis. Your physician may also refer you to a specialist in the field of hepatology, also called a hepatologist. Harder tissue suggests the presence of fat or inflammatory damage in the liver. official website and that any information you provide is encrypted Focal fatty sparing around the gallbladder is also probably related to . Case Rep Gastroenterol. In patients with steatosis, focal fatty sparing may be seen around the gallbladder fossa in segments 4 and 5. Disclaimer. 1.1 cm . 3. Video chat with a U.S. board-certified doctor 24/7 in less than one minute for common issues such as: colds and coughs, stomach symptoms, bladder infections, rashes, and more. Essential amino acids help the body repair from injury, build muscle tissue, and produce enzymes and hormones. Educational text answers on HealthTap are not intended for individual diagnosis, treatment or prescription. The likelihood of developing fatty liver disease is influenced in part by genetics. If your doctor has told you that you have an echogenic liver, you may be wondering what this means. Fatty infiltration is generally a benign process which often resolves on its o. told results were norma. Histologically, it resembles alcoholic liver injury but occurs in patients who deny significant alcohol consumption. Get prescriptions or refills through a video chat, if the doctor feels the prescriptions are medically appropriate. It is generally a nonspecific finding possibly related to fatty infiltration but can also mean virtually nothing. (give in NS) Has a high pH, will cause severe local tissue necrosis in cases of infiltration (g ive antecubital or central line) Elevate limb, apply d ry heat and cool compresses after extravasation Side effects Hypotension Heart blocks . However, the patient may be symptomatic from the abnormally increased fattiness of the remainder of the liver. Its critical to treat fatty liver disease as soon as it is diagnosed, to prevent progression to other serious liver conditions. (2012) Clinical radiology. Why does the radiologist say "probable"? Find Out How Protein Is Vital for Metabolism and Liver Health, What to Do If You Have Hepatic Encephalopathy, Signs You May Have an Amino AcidDeficiency, How to Live to 100: What You Can Do to Increase Longevity. 1. This site needs JavaScript to work properly. Focal fat may simulate a liver tumor; however, the area of involvement has a density characteristic of fat. Fatty liver disease is very responsive to interventions. I have been *very sick and mostly in bed since the end of September with many concerning and ongoing symptoms, I have also lost a lot of weight and am down to 100 lbs . 2 (5): 533-538. 442 Disorders of liver except malignancy . Vessels run their normal course through the area of involvement. **Is a 4 cm focal fatty infiltration of the liver a very serious matter? The stress response increases adrenaline and leads to high levels of serum cortisol and blood sugar. Dong Z, Luo Y, Zhang Z, Cai H, Li Y, Chan T, Wu L, Li ZP, Feng ST. PLoS One. TO cut down on your saturated fat intake, steer clear of full-fat animal products like whole milk, hard cheese, cream, butter, and animal fat. The superior part of the duodenum, hepatic flexure and proximal transverse colon, are posteriorly related to it. AJR Am J Roentgenol. Yoo KD, Jun DW. Int J Chron Obstruct Pulmon Dis. Just make sure you are equipped with all the information you need to make healthy food choices that support your liver and metabolic health. By using our website, you consent to our use of cookies. Development and validation of artificial intelligence to detect and diagnose liver lesions from ultrasound images. There are many ways to diagnose fatty infiltration of the liver: physical exam at the doctor, ultrasound, liver biopsies, and blood tests. What Your Liver Size Says About Your Health, fatty liver disease can be managed and possibly reversed, alcohol dependence, avoid going cold turkey with alcohol, First Liver Transplant: Its Success and its Effect to Future Surgeries, Is an Enlarged Liver Dangerous? Doctors typically provide answers within 24 hours. The doc who treated you will decide - so pl see him/her. Conversely, you dont have to have the fatty liver disease gene to develop fatty liver disease. Lupsor M, Badea R. Imaging diagnosis and quantification of hepatic steatosis: is it an accepted alternative to needle biopsy? Diffusive focal liver changes. As those with liver conditions have very specific dietary restrictions, finding nutrition that is not only healthy but tasty can be quite a challenge. Although fatty liver disease may progress, it can also be reversed with diet and lifestyle changes. Cheap 20 mg erectafil Claudon M, Dietrich CF, Choi BI, Cosgrove DO, Kudo M, Nolse CP, Piscaglia F, Wilson SR, Barr RG, Chammas MC, Chaubal NG, Chen MH, Clevert DA, Correas JM, Ding H, Forsberg F, Fowlkes JB, Gibson RN, Goldberg BB, Lassau N, Leen EL, Mattrey RF, Moriyasu F, Solbiati L, Weskott HP, Xu HX. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. A non-neoplastic, regenerating hepatocellular hyperplasia, secondary to the presence of focal vascular abnormalities in the liver. In some cases, your physician may prescribe medications like metformin and statins to help concurrent metabolic conditions like insulin resistance and high cholesterol. In this case, the liver is no longer able to carry out any of its functions. 1987 Sep;149(3):491-4. doi: 10.2214/ajr.149.3.491. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Whenever the word . inr test 1.1 high. When you lose weight, you also lose fat content in your liver. is there a problem of fatty lever? Read on to find out more about what it means to have an echogenic liver and how you can address it. on the Manage Your Content and Devices page of your Amazon account. To find out more about Amsety Bars click here. please confirm that you agree to abide by our usage policies. When fatty liver disease progresses, it may cause symptoms like weakness, fatigue, unintentional weight loss, yellowing of the skin (jaundice), easily bruising, spider angiomas, ascites, and muscle wasting. When an atypical form of fatty liver deposition is suspected on ultrasound or CT, MRI may be used to confirm the diagnosis . Fatty liver disease occurs when the body begins to store too many lipids in the liver. FOIA 1995 Feb;14(2):77-80. doi: 10.7863/jum.1995.14.2.77. Fatty infiltration of the liver is common, reportedly affecting 10-58% of the general population [1-5].It is caused by excessive accumulation of triglycerides within hepatocytes and is associated with many significant health issues, including alcohol consumption, obesity, medications, and type 2 diabetes [].Obesity is the most common risk factor for nonalcoholic fatty liver disease, with . Content may require purchase if you do not have access. Similar to its inverse pathological counterpart, focal fatty change, regions of focal fatty sparing are thought to have altered perfusion compared to the rest of the liver (also, known as liver third inflow). The cause of this is incompletely understood. Hostname: page-component-7fc98996b9-jxww4 In right-sided paraduodenal hernia There are different types of internal hernias depending on bowel loops herniate into Waldeyer's fossa, which is a rare the orifice localisation. Conclusion: Unable to process the form. You may be at a higher risk of developing fatty liver disease if you have any of the following conditions: If taken care of during these early stages, hepatic steatosis can be easily reversed. Sometimes, fatty infiltration of the liver is focal and occasionally, it is generalized with focal sparing of the normal liver tissue creating some problems in the diagnosis. Is it dangerous, can it be prevented, and how do you know if you have it? What is fatty infiltration of the liver? Dandelion root - helps to alleviate some of the symptoms linked to cysts. i am having burning sharp pains in the right side of my abdomen. Most patients with If the entire liver tissue becomes hypodense, and especially if the mean attenuation is considerably less than that of the spleen, it suggests diffuse infiltration with fatty change. There is focal fatty sparing adjacent to gallbladder fossa. Elastography is a particular form of ultrasound imaging that yields diagnostic information about the liver. According to the American Liver Foundation, fatty liver disease occurs when more than 5% - 10% of the liver is made up of fat. Small collections often get absorbed, If not they can be drained by a needle . Focal sparing is seen in the region adjacent to the gallbladder fossa. Both lymphoid and myeloid leukemia have been reported to involve the gallbladder. Fatty infiltration of the liver is also referred to as fatty liver disease, which is also known as Steatohepatitis. Specific variants of each gene are associated with increased risk of conditions associated with fatty liver disease, such as insulin resistance and type 2 diabetes. The term 'fatty infiltration of the liver' is often erroneously used to describe liver steatosis. u/s showed echogenic material in gallbladder fossa.what can i expect as a treatment plan? PubMed. Published online by Cambridge University Press: To lower the risk of developing fatty liver disease, it is important to cut out foods that inhibit healthy metabolic function and negatively alter the expression of genes that play a role in metabolic processes. Fatty liver disease is characterized by the accumulation of fat within liver cells. Eating these foods will ensure that you get optimal amounts of fiber, complex carbohydrates, and essential amino acids needed to power biological functions. Focal sparing of liver parenchyma in steatosis: role of the gallbladder and its vessels. Of the 752 cases of nonalcoholic diffuse fatty liver, 301 participants had nonalcoholic diffuse homogeneous fatty liver, and 68 (9.04%) had focal fatty sparing. Check for errors and try again. CT scan results: LIVER: "There is diffuse low-density throughout the liver compatible fatty infiltration. Limiting alcohol is vital for protecting your liver from fatty liver disease progression or liver disease. Right now my anxiety is worse than anything. It is located on the visceral surface of the liver, between the right and quadrate liver lobes. FOIA Ultrasound examination by an expert gynecological sonographer at tertiary center revealed unremarkable findings in the abdomen and . Fat accumulation: It means the liver has increase amount of fat in the hepatocytes. Pseudolesions (focal sparing) are better seen on out-of-phase imaging, but otherwise, appear normal and similar to the rest of the liver on T2 and contrast-enhanced sequences 1. The https:// ensures that you are connecting to the Unusual patterns of hepatic steatosis caused by the local effect of insulin revealed on chemical shift MR imaging. Immunotherapy is based on manipulation of the immune system in order to act against tumour cells, with growing evidence especially in melanoma patients. Alt 142 ast 77 are these bad? [1] Nonalcoholic fatty liver disease (NAFLD) is evidence of hepatic steatosis (imaging or histologic) in the absence of secondary causes of hepatic fat accumulation, such as significant alcohol consumption. Focal fatty sparing of the liver. Eating an abundance of fruits and veggies is vital for protecting your liver from fatty liver progression and worsening liver conditions. Instead, stick to whole foods like vegetables, fruits, whole grains, nuts, seeds, beans, lean meat, low-fat dairy, and fish. No hepatic lesion. Aubin B, Denys A, Lafortune M, Dry R, Breton G. J Ultrasound Med. It would be preferred, however, to see them return to normal, sugge if it is not functioning properly and giving you symptoms. Halvorsen RA, Korobkin M, Ram PC, Thompson WM. How severe is fatty infiltration of the liver? Keep in mind that developing liver fibrosis and cirrhosis also increases the risk of developing liver cancer. Nonalcoholic hepatic steatosis - also called liver steatosis, hepatosteatosis, or nonalcoholic fatty liver disease ( NAFLD) - and describes the accumulation of fat in the liver that is not related to alcohol consumption. : Increased echogenicity of the liver. Accessibility Stress is also a major DNA-methylator that can negatively impact many normal biological functions. Sonographic evaluation of the abdomen was performed and is compared to the prior examination of 02/01/02 (gallbladder attack at 7 months pregnancy with 4th child) Increased echogenicity of the hepatic parenchyma suggests a mild to moderate degree of diffuse fatty infiltration. Focal motor activity; Somatic sensory experiences; Disturbances in vision, hearing, smell or taste . If the gallbladder has been removed, Incidental observation of fatty liver with fatty sparing around the gallbladder fossa in ct trauma analysis? Right side pain under ribcage, spreading to back throughout the day. It occurs when an excess amount of fat accumulates in the livers cells. No focal lesion was seen. Is hepatic steatosis influenced primarily by genetic or environmental factors? (2014) The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi. Bethesda, MD 20894, Web Policies Doctors typically provide answers within 24 hours. 1993 Jul-Aug;17(4):590-5. Hahn L, Reeder SB, Muoz del Rio A, Pickhardt PJ. Focal fatty liver infiltration was described . Is this pain coming from Fatty Liver, or is it more likely a recurrence of my lifelong battle with digestive issues? Liver with generalized steatosis demonstrates reduced liver attenuation on both precontrast and portal venous phase imaging. Radiographics. 2 minths of indegestion issues. I have a cyst close to the gallbladder fossa. Nonalcoholic fatty liver disease, sometimes called NAFLD, is not connected to alcohol intake. This, in turn, leads to better blood flow and lower blood pressure. eCollection 2014. What You Need to Know If You Have an Enlarged Liver, Ascites and Everything That You Need to Know About it. @free.kindle.com emails are free but can only be saved to your device when it is connected to wi-fi. If you struggle withalcohol dependence, avoid going cold turkey with alcohol. Occasionally, focal sparing is nodular and located elsewhere in the liver. Puranik AD, Purandare NC, Agrawal A, Shah S, Rangarajan V. Indian J Nucl Med. The portal vein and hepatic veins are patent." Blood: "AST 40 _ ALT 89." 2 minths of indegestion issues. total protein 8.6 high. Food can help you change how your DNA is expressed and following a hepatic steatosis diet can help reverse fat accumulation in your liver. what does that mean? Detection is by either ultrasound study or a CT scan.. tous infiltration and 16 nodes of the ileum and 2 of the jejunum were reactive. 2013 Apr;28(2):99-101. doi: 10.4103/0972-3919.118263. Commonly, fatty infiltration of the liver is generalized and both CT scans and sonograms can easily demonstrate changes related to this condition. A review of the literature and 19 new cases. he patient did not experience any incidences t postoperatively, and was thus discharged from the hospital 9 days later. Research has shown that there is not just one gene that determines the risk of developing fatty liver disease, but rather an interaction of many genes in your DNA. Porcelain gallbladder. Features include: MRI is the imaging modality of choice in any case where the diagnosis is felt to be less than certain. How do I know if I have fatty infiltration of the liver? By using our website, you consent to our use of cookies. Internal Medicine 37 years experience. please confirm that you agree to abide by our usage policies. No intra- or extrahepatic biliary dilation was present. Chronic consumption of sugar also causes insulin to function less effectively, worsening metabolic dysfunction. In addition to fatty liver disease, an echogenic liver might accompany other root causes. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Since fat is intracellular in liver steatosis,and not in the extracellular matrix,using infiltration to describe it is factually incorrect. When striving to protect your liver, aim to drink lots of water, eat high-quality protein, and lots of veggies. Historically, a thick-walled gallbladder has been regarded as proof of primary gallbladder disease, and it is a well-known hallmark feature of acute cholecystitis. ADVERTISEMENT: Supporters see fewer/no ads. A diagnostic imaging test can confirm swelling and enlargement of the liver, as well as the presence of excess fat in the liver. Therefore the severity of fatty infiltration of the liver can be quite dangerous if left untreated. As the name suggests, elastography can assess the texture of liver tissue. 1. 1986 Jan;59(697):25-8. doi: 10.1259/0007-1285-59-697-25. A recent CT scan showed this "probable" focal fatty infiltration. . An ultrasound examination also yields a sonography image, which can also indicate the presence of liver lesions and other abnormalities. Strive to incorporate stress management techniques into your daily routine, even if you can only find a few minutes to yourself. Also, experts do not exclude parasites or . Find out more about saving to your Kindle. However, focal fatty infiltration of the liver is uncommon in infants and young children and should be a diagnosis of exclusion. Bothcoffeeand green tea are liver-friendly drinks that you can incorporate into your daily routine. after 1 month, the patient visited the emergency service with abdominal pain, a fever of 38.4C, with no functioning Then enter the name part If you have already been diagnosed with NAFLD, your physician will give you specific recommendations. We often found a high attenuation region around the gallbladder bed in the fatty liver patients on CT examination. NAFLD encompasses a spectrum of conditions, ranging from benign hepatocellular steatosis to inflammatory nonalcoholic . Ultrasound features only become apparent when the amount of fat reaches 15-20%. Without intervention, fibrosis causes liver cirrhosis. An individuals personality like introversion or open-mindedness is highly influenced by both genes and the environment. The pancreas then releases insulin, which signals to cells throughout the body to uptake the glucose and use it as energy. We retrospectively analyzed 305 consecutive contrast-enhanced abdominal CT examinations of 218 children and young adults with no known liver disease, performed during 2 years at our institution, to identify focal fatty infiltration of the liver. Focal fatty sparing is usually geographic in shape and located near the gallbladder fossa and porta hepatis [1]. Evaluation of Hemodynamics in Focal Steatosis and Focal Spared Lesion of the Liver Using Contrast-Enhanced Ultrasonography with Sonazoid. 2021 Jun 8;16(6):e0252882. In focal fatty infiltration, the normal hepatic vessels traverse the area of decreased attenuation, a finding not usually present in malignancy. 63 (6): 382-5. Essentially the same as those that contribute to diffuse hepatic steatosis: In general, the treatment of the underlying condition will reverse the findings. Multiple liver lesions in an immunosuppressed patient: is infection always the answer. A hepatologist is a doctor who specializes in treating and managing conditions of the liver, gallbladder, and pancreas. In NAFLD, the excess accumulation of fat in the liver is not caused by the consumption of alcohol. ct scan showed stranding and edema and fluid throughout the gallbladder fossa. Such micronutrients play a role in reversing fatty liver disease, improving insulin sensitivity, and lowering blood pressure. diffuse hepatic steatosis. Occasionally, hepatic steatosis can present a random, irregular geographic configuration [ 1 ]. (2011) Insights into imaging. 2017 Jun;42(6):1667-1678. doi: 10.1007/s00261-017-1049-z. The liver is responsible for detoxifying chemicals that we ingest, including medications and alcohol. To make it easier to have a healthy liver diet, Amsety created the first nutrition bar for those with liver conditions such as fatty liver disease. Research from the American Liver Foundation has also found that up to 25% of Americans suffer from fatty liver disease. Hepatic pseudolesion: appearance of focal low attenuation in the medial segment of the left lobe at CT arterial portography. Focal fatty infiltration can often look like a cholangiocarcinoma, gallbladder carcinoma, or metastases within the liver. or irritation which may be from several causes, the two most common reasons would be elevated cholesterol/triglycerides and alcohol abuse. Exercising more frequently helps reduce systemic inflammation while also encouraging weight loss and a healthy metabolism. I have a long time till follow up appointments, so I'm looking for a little bit of hope. Hepatic metastasis disguised as fat spared area in the background of fatty liver: Detection on FDG PET/CT. What Does It Mean to Have an Opioid Overdose? Al In this paper, we presented the CT scans of 57 fatty liver cases and compared them with the CT scans of 50 normal patients to discuss the possible cause of the phenomenon and its usage in the diagnosis of the fatty liver. Focal fatty infiltration of the liver, a benign entity that can be confused with a malignant lesion, is well characterized in adults but not in children. When you are not eating the fat is broken down and u fossa is simply an anatomic description of the location of the gallbladder on the liver. 2014: 604594. There is a increased hepatic echogenicity which may be fatty infiltration. Kissin CM, Bellamy EA, Cosgrove DO, Slack N, Husband JE. Federal government websites often end in .gov or .mil. 1982 Aug;139(2):277-81. doi: 10.2214/ajr.139.2.277. good luck. HealthTap uses cookies to enhance your site experience and for analytics and advertising purposes. approximately 75% of obese people have fatty infiltration.It is the most common cause of abnormal liver function tests in the United States. At the time the article was last revised Jeremy Jones had no recorded disclosures. Idilman IS, Ozdeniz I, Karcaaltincaba M. Hepatic Steatosis: Etiology, Patterns, and Quantification. Fatty liver disease is when excess fat accumulates in the liver. It turns out that hepatic steatosis is influenced by a mixture of both. It is also crucial to get the essential vitamins and minerals your body needs. Focal fatty sparing of the liver is the localized absence of increased intracellular hepatic fat, in a liver otherwise fatty in appearance i.e. Amsety does not offer any medical diagnosis or treatment advice and our products are not intended to diagnose, Focal hepatic steatosis, also known as focal hepatosteatosis or (erroneously)focal fatty infiltration,represents small areas of liver steatosis. We have written these articles to try and teach others about the importance of liver health and a healthy liver diet. 2014 Oct 24;9(10):e111283. Fatty infiltration of the liver comes in two types: Non Alcoholic Fatty Liver Disease (NAFLD) and Alcoholic Fatty Liver Disease. Federal government websites often end in .gov or .mil. The challenges faced by this new therapeutic tool are (i) finding valid evaluation criteria for response assessment; (ii) knowing and distinguishing between "atypical" response patterns; (iii) using PET biomarkers as predictive and . Start out slow and gradually increase your exercise levels, allowing your body to adjust to your new lifestyle. Drinking excess alcohol puts stress on the liver and causes oxidative stress, or the buildup of waste products like reactive free radicals. Bhatnagar G, Sidhu HS, Vardhanabhuti V, Venkatanarasimha N, Cantin P, Dubbins P. The varied sonographic appearances of focal fatty liver disease: review and diagnostic algorithm. ICD-10-CM K76.89 is grouped within Diagnostic Related Group (s) (MS-DRG v40.0): 441 Disorders of liver except malignancy, cirrhosis or alcoholic hepatitis with mcc. The portal vein and hepatic veins are patent.". I also suffer from health anxiety, so of course I'm terrified after finding this CT scan result while my mom is in care. Yoshikawa J, Matsui O, Takashima T, Sugiura H, Katayama K, Nishida Y, Tsuji M. AJR Am J Roentgenol. While diffuse hepatic steatosis is considered common, affecting approximately 25% of the population, focal fatty sparing of the liver is considered a slightly less common pattern across multiple studies 7-9. (2). The problem arises when the concentration of triglycerides exceeds the normal levels. June 1991 MORPHOMETRIC STUDY OF FOCAL FATTY LIVER CHANGE 1681 Although the above interpretation has, in some cases, been supported by CT imaging, it conflicts with our knowledge of the generally diffuse nature of fatty infiltration of the liver. Unable to load your collection due to an error, Unable to load your delegates due to an error. AJR Am J Roentgenol. Ciprofloxin dosages: 1000 mg, 750 mg, 500 mg, 250 mg Ciprofloxin packs: 30 pills, 60 pills, 90 pills, 120 pills, 180 pills, 270 pills, 360 pills The role of CT in the diagnosis of fatty liver is well established. Note you can select to save to either the @free.kindle.com or @kindle.com variations. If you have the fatty liver disease gene, your diet and lifestyle can prevent the expression of these genes. Abdom Radiol (NY). Crossref. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver - update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS.
March 10, 2023abhi ramesh net worth 2021
