颈椎前路术后吞咽困难的相关因素分析

目的:探讨颈椎前路手术后发生吞咽困难的相关因素。方法:随访2008年8月～2010年7月收治的颈椎前路手术患者135例,其中男82例,女53例;年龄32～80岁,平均58.2岁;诊断为脊髓型颈椎病58例,神经根型颈椎病32例,混合型颈椎病18例,后纵韧带骨化症27例。入院后均由同一组医师治疗,手术方式分为颈椎前路减压融合术(ACDF)、颈椎前路次全切减压融合术(ACCF)和人工颈椎间盘置换术(TDR)。观察患者手术后是否存在吞咽困难:对于存在吞咽困难的患者均静脉应用甲泼尼松龙及对症治疗。结果:术后共有36例(26.7%)患者出现吞咽困难,男11例,女25例,年龄42～80岁,平均59.6岁;其余99例,年龄32~76岁,平均52.3岁,发生吞咽困难者平均年龄显著高于未发生者(P<0.05)。发生吞咽困难患者中使用钛板内固定35例,其中单节段2例(9.1%),双节段13例(21.0%),多节段(包括三节段及三节段以上者)20例(52.6%);颈椎人工椎间盘置换者1例;术后吞咽困难发生率使用内固定者较人工椎间盘置换者高(P<0.05),多节段内固定者较单、双节段者明显升高(P<0.05)。手术最高节段累及C2或C3者23例,术后吞咽困难发生率26.1%;累及C4或C5者88例,发生率28.4%;累及C6或C7者24例,发生率20.1%,三组两两比较无统计学差异(P>0.05)。吞咽困难者的手术时间、失血量及住院天数与未发生吞咽困难者比较均无统计学差异(P>0.05)。35例(97.2%)患者的吞咽困难症状在术后6个月内减轻或消失,1例至随访1年时症状才消失。结论:女性、高龄、使用钛板内置物、手术节段多可能是颈椎前路手术后发生吞咽困难的相关因素,临床医生应给予相应重视和采取相应措施以减少其发生。     

颈椎前路术后吞咽困难危险因素的Meta分析

【摘要】 目的：系统评价颈椎前路术后发生吞咽困难的危险因素,明确独立危险因素,为颈椎前路手术围术期并发症的防治提供指导。方法：检索万方数据库（WanFang）、中国生物医学文献数据库（CBM）、中国知网（CNKI）、维普（VIP）、PubMed、Embase、 Cochrane Library、Web of Science共8个数据库,检索时限从建库至2023年7月15日,搜索关于颈椎前路术后吞咽困难的危险因素的病例对照研究和队列研究,采用纽卡斯尔-渥太华质量评定量表（Newcastle-Ottawa Scale,NOS）对纳入研究进行质量评价和数据提取（包括第一作者、发表年份、研究类型、样本量、评估方式、评估时间及危险因素）,通过Stata12软件进行Meta分析。结果：共纳入29篇文献,其中队列研究4篇,病例对照研究25篇,所有文献均为高质量研究,包括颈椎前路术后吞咽困难患者89571 例,对照组3092967例。年龄[优势比（odds ratio,OR）=1.093,95%置信区间（confidential interval,CI）：1.067~1.120]、女性（OR=2.419,95%CI：1.654~3.539）、糖尿病（OR=2.733,95%CI：2.240~3.333）、病程（OR=4.259,95%CI：2.458~7.381）、手术节段数量（OR=1.791,95%CI：1.718~1.868）、手术节段位置（OR=2.332,95%CI：1.812~3.003）、手术时间（OR=1.434,95%CI：1.110~1.852）、钢板内置物（OR=2.188,95%CI：1.413~3.175）及翻修手术（OR=2.687,95%CI：2.316-3.119）与颈椎前路术后发生吞咽困难相关,而吸烟（OR=1.323,95%CI：0.852~2.056）、高血压（OR=1.006,95%CI：0.591~1.713）、体重指数（body mass index,BMI）（OR=1.037,95%CI：0.929~1.159）、颈椎间盘置换（OR=0.577,95%CI：0.085~3.943）、C2-7角度变化（difference between postoperative and preoperative C2-C7 angle,dC2-7）＞5°（OR=1.716,95%CI：0.925~3.183）等因素与其不相关。结论：女性、高龄、术前病程长、合并糖尿病、双节段或多节段手术、高位颈椎手术、手术时间长、使用钢板及翻修手术的患者颈椎前路术后更易发生吞咽困难。     

前或后路手术治疗颈椎退变性疾病的远期疗效分析

目的：探讨前路或后路手术治疗颈椎退变性疾病的远期疗效.方法：回顾分析前或后路手术治疗的462例颈椎退行性疾病患者.采用环锯法颈椎前路扩大脊髓减压并椎体间自体髂骨移植346例;颈椎后路手术116例,其中,中野术式56例,改良中野术式60例.采用40分法评定疗效.结果：颈椎前路手术后随访4.1～18年,平均13.5年,优185例（53.5%）,良126例（36.4%）,有效13例（3.7%）,差22例（6.4%）,优良率为89.9%.颈椎后路手术后随访4.2～16年,平均12.8年,优63例（54.3%）,良41例（35.3%）,有效3例（2.6%）,差9例（7.8%）,优良率为89.6%,且以改良中野术式的效果最佳,优良率为95%,无1例再关门.结论：前路或后路手术治疗颈椎退变性疾病均可获得较满意的远期疗效.远期效果与正确选择手术入路、有效减压、稳定颈椎有关.     

前路颈椎融合术后吞咽困难危险因素的研究进展

吞咽困难是前路颈椎融合术(ACF)后常见并发症之一,表现为吞咽食物过程中出现功能障碍及吞咽时产生咽部、胸骨后或食管部位的梗阻、停滞、烧灼等不适感,通常为一过性,且预后较好,但临床不乏长期吞咽困难病例。据文献报道,术后1年仍有1.1%~15.2%的患者存在吞咽困难[1-4]。目前其病理生理机制及危险因素尚不明确。有研究提出,喉上/喉返神经损伤[5]、术中食管过度牵拉[6]、术后椎前软组织肿胀[7]等因素可导致术后吞咽困难。术后吞咽困难不仅对患者康复造成不利影响,同时也造成患者住院时间延长,经济负担加重[8],亦增加了住院患者死亡率及30 d再入院率[9]。因此,提升对ACF术后吞咽困难危险因素的认识,有助于脊柱外科医师更好地理解并降低该并发症的发生率,提高患者术后生活质量。本研究对ACF术后吞咽困难的危险因素进行分析,综述如下。     

颈椎前路术后吞咽困难的相关原因分析

目的 :探讨颈椎前路术后发生吞咽困难的相关原因。方法 :对2011年7月至2013年10月进行颈前路手术的328例患者进行回顾性分析,其中男157例,女171例;年龄28~81岁。手术方式包括颈椎体次全切钛网植骨融合内固定术、颈前路椎间盘摘除植骨融合内固定术、颈椎体次全切椎间盘摘除植骨融合内固定术、颈椎间盘置换。术后1个月根据Bazaz食道功能标准对患者进行评价,将所有患者分成吞咽困难组和吞咽正常组,比较两组年龄、性别、手术节段数、颈前路钛板使用率。结果:术后1个月共有63例患者出现吞咽困难,男19例,女44例,男女性别之间吞咽困难发生率差异有统计学意义(P=9.1×10-280.05);吞咽困难组:年龄38~81岁,平均年龄65.0岁;吞咽正常组:年龄28~73岁,平均年龄53.6岁;发生吞咽困难组与吞咽正常组之间年龄差异有统计学意义(P=1.4×10-80.05);63例吞咽困难患者均使用钛板内固定,而21例吞咽正常患者均为人工颈椎间盘置换(未使用颈前路钛板固定),应用颈前路钛板固定与人工颈椎间盘置换术后的吞咽困难差异有统计学意义(P=0.0180.05);手术单节段3例,双节段24例,3节段及3个以上节段36例,3节段及3个以上节段钛板内固定组与单、双节段钛板内固定组吞咽困难发生率之间差异有统计学意义(P=3.6×10-330.05)。结论 :颈前路术后吞咽困难的原因较多,其中应包括女性、高龄、钛板内固定的应用以及多节段手术等因素,临床医生在进行颈前路手术时应引起高度重视。     

颈前路减压Zero-P融合固定术后吞咽困难的影响因素

目的 :分析颈前路减压Zero-P融合固定术后吞咽困难的影响因素。方法 :对2011年1月～2016年12月行颈前路减压Zero-P融合固定术且至少1年以上的115例患者的资料进行回顾性分析。其中男66例,女49例。采用电话或门诊随访的方式,以Bazaz评分系统评估术后3d吞咽困难程度,根据是否存在术后吞咽困难将所有患者分为吞咽困难组(轻、中、重度吞咽困难患者)和无吞咽困难组,分析性别、年龄、身体质量指数(body mass index,BMI)、糖尿病、高血压、吸烟、饮酒、手术时间、术中出血量、术后椎前软组织肿胀程度(术后软组织厚度与术前软组织厚度的差值)、术后O-C2角度、术后C2-7角度、手术最高节段、手术节段数等因素与术后吞咽困难发生的相关性,并重点探讨术后C2-7角度这一因素。两组间定量变量的差异采用独立样本t检验的方法进行比较,定性变量差异进行卡方检验。为排除混杂因素影响,将单因素分析中P<0.2的因素纳入二元Logistic回归模型进行多因素汇总分析。采用Spearman秩相关检验验证术后C2-7角度与吞咽困难严重程度的相关性。结果:吞咽困难组18例,男11例,女7...     

椎前软组织肿胀和颈椎前路融合术后吞咽困难的相关性研究

目的 探讨颈椎前路融合术后椎前软组织肿胀和吞咽困难是否存在相关性。方法 随访研究自2009-01-2011-01接受颈椎前路融合术的患者73例,按照Bazaz-Yoo吞咽困难评分方法分为正常组（无/轻症状组,n=38）和吞咽困难组（中/重症状组,n=35）,参照Penning法测量颈椎侧位X线片上术前、术后软组织宽度,分析2组椎前软组织宽度变化值（即椎前软组织肿胀程度）。结果 2组间术前椎前软组织宽度比较,差异无统计学意义（P〉0.05）,2组间术前-术后椎前软组织宽度变化值有显著差异,吞咽困难组明显高于正常组,差异有统计学意义（P〈0.05）。结论 颈椎前路融合术后椎前软组织肿胀和吞咽困难的发生具有正相关性,推测椎前软组织肿胀可能是吞咽困难发生的机制之一。椎前软组织肿胀（程度）作为预测颈椎前路融合术后吞咽困难发生率的有效指标,具有一定的临床指导意义。     

The association between psychiatric factors and the development of chronic dysphagia after anterior cervical spine surgery

Purpose

Little data are available regarding the influence of psychiatric factors on chronic dysphagia after anterior cervical spine surgery. The purpose of this study was to identify associations between psychiatric factors and the development of chronic dysphagia in patients after anterior cervical spine surgery.

Methods

The authors prospectively examined 72 patients with degenerative disc disease of the cervical spine who were treated by single-level anterior cervical discectomy and fusion. Demographic data including age, gender, body mass index, and smoking status were collected. Short form-36, mental component scores (MCS), physical component scores (PCS), Neck Disability Indices (NDI), and the Neck Pain and Disability Scale (NPDS) were assessed before surgery and at final follow-up. Psychiatric conditions were evaluated using the Zung depression scale and the Zung anxiety scale. At 1 year postoperatively, patients were contacted by telephone to determine the presence and severity of dysphagia. For statistical analyses, patients were divided into two groups: group I, those with No or Mild dysphagia; and group II, those with Moderate or Severe dysphagia at 1 year after surgery. Potential risk factors of chronic dysphagia were evaluated by multivariate logistic regression analysis.

Results

The patients included 22 women and 50 men of overall average age 47.1 ± 7.8 years. The prevalences of No/Mild (group I) and Moderate/Severe (group II) dysphagia were 69.4 % (50 patients) and 30.6 % (22 patients), respectively. Mean preoperative NDI, NPDS, PCS, and MCS scores of 34.2, 44.8, 33.7, and 46.2 in the 72 study subject improved to 9.9, 16.1, 55.1, and 56.2, respectively, at 1 year after surgery. The mean preoperative ZDS and ZAS scores were 35.2 and 34.2, respectively. The two study groups were significantly different in terms of the presence of a psychiatric problem, preoperative NDIs, and MCS scores. However, multivariate logistic regression showed that the presence of a psychiatric problem prior to surgery (P = 0.005) was the only significant predictor of chronic dysphagia.

Conclusions

The presence of a psychiatric problem seems to be an important risk factor of chronic dysphagia in patients with cervical disc herniation. The study shows that psychiatric factors should be evaluated prior to surgery to determine the risk of chronic dysphagia.     

Risk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study.

BACKGROUND CONTEXT: Severe and disabling dysphagia is a relatively uncommon complication of anterior cervical spine surgery. However, the incidence of dysphagia ranges widely (2% to 60%). Furthermore, risk factors that contribute to the development of dysphagia have not been well identified. PURPOSE: The purpose of this study was to evaluate the prevalence of dysphagia after anterior cervical spine surgery, and to identify any risk factors associated with increased dysphagia. STUDY DESIGN: This study is a prospective cohort study designed to evaluate the prevalence of dysphagia at 1, 2, 6, 12, and 24 months. Patients were prospectively interviewed at 1, 2, 6, 12, and 24 months regarding the presence and subjective severity of dysphagia. PATIENT SAMPLE: Between the period of 1999 and 2002, 348 cervical spine surgeries were performed using the anterior Smith Robinson approach. 310 of these patients were available for 2-year follow-up. OUTCOMES MEASURE: Using the dysphagia grading system defined by Bazaz et al. (Spine 2002), we prospectively evaluated patients' postoperative dysphagia. METHODS: The presence and severity of dysphagia were reported during the telephone interviews performed at 1, 2, 6, 12, and 24 months after the procedure. Proportion analysis (chi-square or a Fisher Exact Test), prevalence ratios, and 95% confidence intervals were used to compare the prevalence of dysphagia with age, gender, type of surgery (eg, discectomy vs. corpectomy, primary vs. revision), use of instrumentation, number and location of surgical levels. RESULTS: The overall prevalences for dysphagia at 1, 2, 6, 12, and 24 months were 54.0%, 33.6%, 18.6%, 15.2%, and 13.6%. The prevalence of dysphagia was found to be significantly higher in women (18.3%) than men (9.9%) 2 years after the surgery. Revision surgery patients (27.7%) also had a significantly higher prevalence of dysphagia than primary surgery (11.3%) patients 2 years after the surgery. Patients who underwent more than two-level surgery (19.3%) also had significantly higher rates of dysphagia 2 years after their procedures than patients who had two or less levels (9.7%) operated on. CONCLUSION: Overall the incidence of dysphagia 2 years after anterior cervical spine surgery was 13.6%. Risk factors for long-term dysphagia after anterior cervical spine surgery include gender, revision surgeries, and multilevel surgeries. The use of instrumentation, higher levels, or corpectomy versus discectomy did not significantly increase the prevalence of dysphagia.     

Identification of risk factors for postoperative dysphagia after primary anti-reflux surgery

Background  

Transient postoperative dysphagia is not uncommon after antireflux surgery and usually runs a self-limiting course. However, a subset of patients report long-term dysphagia. The purpose of this study was to determine the risk factors for persistent postoperative dysphagia at 1 year after surgery.     

咀嚼口香糖对颈椎前路术后患者早期吞咽功能的影响

目的探讨咀嚼口香糖在颈椎前路术后患者早期吞咽功能训练中的应用效果。方法使用随机数字表法将行颈椎前路内固定手术的颈椎病患者90例分为对照组和干预组各45例,对照组按常规进行术后护理,干预组在常规护理基础上,于术后6 h在患者生命体征平稳、意识清楚的情况下,即开始咀嚼无糖口香糖(木糖醇,市售)行吞咽功能训练,每日三餐后30 min及睡前咀嚼,每次2粒,咀嚼15 min,持续至术后第7天。术后第1天及第3天测评切口引流量、颈部疼痛程度。术后7 d统计两组患者吞咽困难发生率及颈部伤口红肿、渗液、肿胀等发生率。结果干预组术后吞咽困难发生率为24.44%,对照组为51.11%,两组比较,差异有统计学意义(P0.01)。干预组术后第1天、第3天疼痛评分、切口引流量及术后第7天伤口红肿发生率与对照组比较,差异无统计学意义(均P0.05);两组均无伤口渗液、颈部肿胀、伤口开裂等并发症发生。结论颈椎前路术后早期咀嚼口香糖进行吞咽功能训练,可降低患者术后吞咽困难发生率,不会增加疼痛及伤口并发症,有利于促进病情转归。     

Risk factors for postoperative dysphagia and dysphonia following anterior cervical spine surgery: a comprehensive study utilizing the hospital for special surgery dysphagia and dysphonia inventory (HSS-DDI)

BACKGROUND CONTEXTPostoperative dysphagia and dysphonia (PDD) are prevalent complications after anterior cervical discectomy and fusion (ACDF). Identification of risk factors for these complications is necessary for effective prevention. Recently, patient reported outcome measures (PROM) have been used to determine PDD after ACDF. The Hospital for Special Surgery Dysphagia and Dysphonia Inventory (HSS-DDI) is a validated PROM that specifically assesses dysphagia and dysphonia after anterior cervical spine surgery.PURPOSETo identify the perioperative risk factors for PDD utilizing the HSS-DDI.STUDY DESIGN/SETTINGObservational study of prospectively collected data at a single academic institution.PATIENT SAMPLEPatients undergoing anterior cervical discectomy and fusion from 2015 to 2019 who enrolled in the prospective data collection.OUTCOME MEASUREThe HSS-DDI administered 4 weeks, 8 weeks, and 4-6 months after surgery.METHODSAs potential risk factors, the data on demographic factors, analgesic medications, history of psychiatric illness, preoperative sagittal alignment, surgical factors, preoperative diagnoses, and preoperative Neck Disability Index (NDI) scores were collected. Bivariate and multivariable regression analyses utilizing the Tobit model were conducted.RESULTS291 patients were included in the final analysis. The median HSS-DDI at 4-weeks, 8 weeks, and 4-6 months postoperatively, were 80.7, 92.7, and 98.4, respectively. Multivariable analysis demonstrated that current smoking, previous cervical spine surgery, preoperative C2-7 angle, upper level surgery, multilevel surgery, opioid use, and a high preoperative NDI score, were independent contributing factors to a low HSS-DDI score at 4-weeks follow-up. Intraoperative topical steroid use was an independent protective factor for a low HSS-DDI score. Opioid use and high NDI score remained independent factors at 4-6 months. Sub-domain analysis demonstrated that prior cervical surgery, preoperative C2-7 angle, multilevel surgery, and intraoperative topical steroid use were significant for dysphagia only. Current smoking was significant for dysphonia only.CONCLUSIONSOur results showed that preoperative opioid use and a high preoperative NDI score are novel independent risk factors for postoperative dysphagia and dysphonia in addition to other known factors.     

退行性颈椎病颈椎前路手术后气道再插管的多因素分析

[目的]探讨颈前路手术后气道阻塞再次插管的相关危险因素。[方法]回顾性研究2007年1月~2016年6月774例颈前路手术的病史及随访资料,以是否并发气道阻塞将患者分为两组,记录患者的年龄、性别、吸烟史、饮酒史、高血压、有无合并糖尿病、慢性咽炎、体重指数(body mass index,BMI)、病程时间、手术方式、术前JOA评分、手术节段位置、手术时间、术中出血量、手术节段数、术中神经损伤。将上述可能与并发气道阻塞相关的因素先行单因素分析,筛选出有统计学意义的因素再行多因素Logistic回归分析,分析其与颈前路手术后气道阻塞再插管的关系。[结果]744例患者中14例出现术后气道阻塞再插管,颈前路术后气道阻塞的发生率为1.81%(14/774)。14例颈前路术后气道阻塞再插管患者中,12例(85.71%)术后48 h内出现气道阻塞再插管,2例(14.29%)为迟发性术后气道阻塞再插管,迟发性颈前路术后气道阻塞出现时间为术后9~11 d。单因素分析结果显示两组病例在年龄、吸烟、体重指数、高血压、慢性咽炎、JOA评分、手术方式、手术节段位置、手术时间、手术节段数方面差异有统计学意义(P0.05);多因素Logistic回归分析显示:年龄、吸烟、高血压、慢性咽炎、JOA评分、体重指数、手术时间、手术方式、节段位置及手术节段数是颈前路术后气道阻塞再插管的危险因素(P0.05)。[结论]年龄、吸烟、体重指数、高血压、慢性咽炎、手术时间、手术方式、手术节段数及手术节段位置是诱发颈前路术后气道阻塞导致再次插管的重要因素。     

Early dysphagia complicating anterior cervical spine surgery: incidence and risk factors

Background

Dysphagia is a common complication of anterior cervical spine surgery, and most of them occurred in the early postoperative period. This study aimed to determine the incidence of early dysphagia after anterior cervical spine surgery and to identify its risk factors.

Methods

A review of 186 consecutive patients undergoing anterior cervical spine surgeries in a 3-year period was performed. Dysphagia at postoperative 1 month was surveyed, and the severity of dysphagia was evaluated. Demographic information and procedural characters were collected to determine their relationships to dysphagia.

Results

A total of 50 patients developed early postoperative dysphagia, including 23 males and 27 females. The incidence of early dysphagia after anterior cervical spine surgery was 26.9 % in this study. Mild, moderate, and severe dysphagia were found in 30, 14, and 6 patients, respectively. Female, advanced age, multi-levels surgery, use of plate, and a big protrusion of plate were found to be significantly increased early dysphagia after anterior cervical spine surgery.

Conclusion

There is a relatively high incidence of early dysphagia after anterior cervical spine surgery, which may be attributable to multiple factors.     

颈椎病前路择期手术早期并发症危险因素分析

目的: 分析与颈椎病前路择期手术后的早期并发症发生率有关的危险因素。方法: 研究本院 1997年~2003年的 250例颈椎病前路择期 [1]手术病人的出院病历, 确定术后早期并发症; 用logistic回归分析评价早期并发症的危险因素。结果: 在所有病人中 24%的病人有一种或多种并发症,其中 17. 6%为非感染性手术并发症, 4. 0%为感染性并发症, 6. 8%为其它医疗并发症, 1. 2%在住院期间接受无计划的二次手术, 1例病人院内死亡。危险因素包括: 女性、高龄、全费、手术持续时间过长和既往有颈椎手术史者。结论: 对于高龄、女性、全费、手术持续时间过长和有既往颈椎手术史的患者, 应该充分做好术前准备, 手术应尽量采用简单实用手术时间少的术式, 以降低术后早期并发症发生率。     

Spinal posterior movement after posterior cervical decompression surgery: clinical findings and factors affecting postoperative functional recovery

This study investigated the posterior movement of the spinal cord after posterior decompression surgery and evaluated factors affecting postoperative functional recovery in patients with cervical spondylotic myelopathy (CSM). Thirty-two patients with CSM underwent posterior decompression from C3 to C7 through laminectomy (n=12) and single, open-door laminoplasty (n=20). There were no significant differences between laminectomy and laminoplasty in degree of spinal posterior movement, recovery rate, and curvature index. Japanese Orthopedic Association (JOA) scores improved from preoperative (10.63±1.77; range, 7-14) to 3-months postoperative (13.57±1.50; range, 11-16) (n=32, P<.05) and from preoperative (10.24±1.87; range, 7-14) to 6-months postoperative (14.16±1.54; range, 12-16) (n=21) (P<.05). C5 palsy was observed in 1 (3.1%) patient. The vertebral body-to-spinal cord distances significantly increased after operations, with the greatest posterior movement at C5 and the least posterior movement at C3 and C7. However, the difference in the degree of the spinal movement of C3 to C7 was not statistically significant (P>.05). Furthermore, no correlation was found between the magnitude of spinal posterior movement and the curvature index. In addition, the magnitude of posterior movement and age were not correlated with the postoperative JOA improvement, but the preoperative JOA scores were. Our study shows that both laminectomy and laminoplasty can produce a similar degree of posterior movement of the spinal cord. Cervical lordosis is not associated with the posterior movement of the cord. The preoperative JOA scores, but not posterior movement of the cord and age, are important determinants for postoperative outcome.     

颈椎前路术后患者吞咽困难护理干预方案的制订及实施

目的 降低颈椎前路术后患者吞咽困难程度,提高患者舒适度.方法 将60例颈椎前路术后患者根据入住病房分为观察组和对照组各30例,对照组按照颈椎全麻术后护理常规进行护理,观察组在常规护理基础上实施颈椎前路术后吞咽困难护理干预方案.结果 术后1周两组吞咽困难、吞咽疼痛发生率比较,差异有统计学意义(P＜0.05,P＜0.01)...