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  • 1
    Language: English
    In: Journal of Applied Physiology, 2009-02-01, Vol.106 (2), p.454-460
    Description: Little is known about the ocular and cerebral blood flow during exposure to increasingly hypoxic conditions at high altitudes. There is evidence that an increase in cerebral blood flow resulting from altered autoregulation constitutes a risk factor for acute mountain sickness (AMS) and high-altitude cerebral edema (HACE) by leading to capillary overperfusion and vasogenic cerebral edema. The retina represents the only part of the central nervous system where capillary blood flow is visible and can be measured by noninvasive means. In this study we aimed to gain insights into retinal and choroidal autoregulatory properties during hypoxia and to correlate circulatory changes to symptoms of AMS and clinical signs of HACE. This observational study was performed within the scope of a high-altitude medical research expedition to Mount Muztagh Ata (7,546 m). Twenty seven participants underwent general and ophthalmic examinations up to a maximal height of 6,800 m. Examinations included fundus photography and measurements of retinal and choroidal blood flow, as well as measurement of arterial oxygen saturation and hematocrit. The initial increase in retinal blood velocity was followed by a decrease despite further ascent, whereas choroidal flow increase occurred later, at even higher altitudes. The sum of all adaptational mechanisms resulted in a stable oxygen delivery to the retina and the choroid. Parameters reflecting the retinal circulation and optic disc swelling correlated well with the occurrence of AMS-related symptoms. We demonstrate that sojourns at high altitudes trigger distinct behavior of retinal and choroidal blood flow. Increase in retinal but not in choroidal blood flow correlated with the occurrence of AMS-related symptoms.
    Subject(s): Acclimatization ; Adaptation, Physiological ; Adult ; Altitude ; Altitude Sickness - physiopathology ; Biological and medical sciences ; Blood Flow Velocity ; Blood Pressure ; Cerebrovascular Circulation ; Choroid - blood supply ; Female ; Fluorescein Angiography ; Fundamental and applied biological sciences. Psychology ; Hematocrit ; Homeostasis ; Humans ; Hypoxia - physiopathology ; Intraocular Pressure ; Laser-Doppler Flowmetry ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Oxygen - blood ; Prospective Studies ; Regional Blood Flow ; Retinal Vessels - diagnostic imaging ; Retinal Vessels - physiopathology ; Risk Assessment ; Switzerland ; Time Factors ; Ultrasonography ; Visual Acuity
    ISSN: 8750-7587
    E-ISSN: 1522-1601
    Source: Alma/SFX Local Collection
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  • 2
    Language: English
    In: European journal of applied physiology, 2013-04-06, Vol.113 (8), p.2025-2037
    Description: Impairment of cognitive performance during and after high-altitude climbing has been described in numerous studies and has mostly been attributed to cerebral hypoxia and resulting functional and structural cerebral alterations. To investigate the hypothesis that high-altitude climbing leads to cognitive impairment, we used of neuropsychological tests and measurements of eye movement (EM) performance during different stimulus conditions. The study was conducted in 32 mountaineers participating in an expedition to Muztagh Ata (7,546 m). Neuropsychological tests comprised figural fluency, line bisection, letter and number cancellation, and a modified pegboard task. Saccadic performance was evaluated under three stimulus conditions with varying degrees of cortical involvement: visually guided pro- and anti-saccades, and visuo-visual interaction. Typical saccade parameters (latency, mean sequence, post-saccadic stability, and error rate) were computed off-line. Measurements were taken at a baseline level of 440 m and at altitudes of 4,497, 5,533, 6,265, and again at 440 m. All subjects reached 5,533 m, and 28 reached 6,265 m. The neuropsychological test results did not reveal any cognitive impairment. Complete eye movement recordings for all stimulus conditions were obtained in 24 subjects at baseline and at least two altitudes and in 10 subjects at baseline and all altitudes. Measurements of saccade performances showed no dependence on any altitude-related parameter and were well within normal limits. Our data indicates that acclimatized climbers do not seem to suffer from significant cognitive deficits during or after climbs to altitudes above 7,500 m. We demonstrated that investigation of EMs is feasible during high-altitude expeditions.
    Subject(s): Adult ; Altitude ; Biomedical and Life Sciences ; Biomedicine ; Cognition ; Cognitive function ; Female ; High altitude ; Human Physiology ; Humans ; Hypoxia ; Male ; Middle Aged ; Mountaineering - physiology ; Neuropsychological testing ; Neuropsychological Tests ; Occupational Medicine/Industrial Medicine ; Original Article ; Saccades ; Saccadic eye movement ; Sports Medicine
    ISSN: 1439-6319
    E-ISSN: 1439-6327
    Source: Alma/SFX Local Collection
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  • 3
    Language: English
    In: American journal of respiratory and critical care medicine, 2010, Vol.182 (4), p.562-568
    Description: Quantitative data on ventilation during acclimatization at very high altitude are scant. Therefore, we monitored nocturnal ventilation and oxygen saturation in mountaineers ascending Mt. Muztagh Ata (7,546 m). To investigate whether periodic breathing persists during prolonged stay at very high altitude. A total of 34 mountaineers (median age, 46 yr; 7 women) climbed from 3,750 m within 19-20 days to the summit at 7,546 m. During ascent, repeated nocturnal recordings of calibrated respiratory inductive plethysmography, pulse oximetry, and scores of acute mountain sickness were obtained. Nocturnal oxygen saturation decreased, whereas minute ventilation and the number of periodic breathing cycles increased with increasing altitude. At the highest camp (6,850 m), median nocturnal oxygen saturation, minute ventilation, and the number of periodic breathing cycles were 64%, 11.3 L/min, and 132.3 cycles/h. Repeated recordings within 5-8 days at 4,497 m and 5,533 m, respectively, revealed increased oxygen saturation, but no decrease in periodic breathing. The number of periodic breathing cycles was positively correlated with days of acclimatization, even when controlled for altitude, oxygen saturation, and other potential confounders, whereas symptoms of acute mountain sickness had no independent effect on periodic breathing. Our field study provides novel data on nocturnal oxygen saturation, breathing patterns, and ventilation at very high altitude. It demonstrates that periodic breathing increases during acclimatization over 2 weeks at altitudes greater than 3,730 m, despite improved oxygen saturation consistent with a progressive increase in loop gain of the respiratory control system. Clinical trial registered with www.clinicaltrials.gov (NCT00514826).
    Subject(s): Abridged Index Medicus ; Acclimatization - physiology ; Adult ; Aged ; Altitude Sickness - complications ; Altitude Sickness - diagnosis ; Altitude Sickness - physiopathology ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; China ; Emergency and intensive respiratory care ; Female ; Humans ; Hypoxia - complications ; Hypoxia - diagnosis ; Hypoxia - physiopathology ; Intensive care medicine ; Male ; Medical sciences ; Middle Aged ; Mountaineering - physiology ; Oximetry - methods ; Oxygen Consumption - physiology ; Plethysmography - methods ; Plethysmography - statistics & numerical data ; Polysomnography - methods ; Polysomnography - statistics & numerical data ; Respiration ; Sleep Apnea, Central - complications ; Sleep Apnea, Central - diagnosis ; Sleep Apnea, Central - physiopathology
    ISSN: 1073-449X
    E-ISSN: 1535-4970
    Source: ProQuest Central
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  • 4
    Language: English
    In: American journal of ophthalmology, 2010, Vol.150 (3), p.360-365.e2
    Description: Purpose To evaluate the intraoperative use of handheld Fourier-domain optical coherence tomography (OCT) during Descemet stripping automated endothelial keratoplasty (DSAEK) to assess the donor-host interface. Design Prospective, observational case series. Methods Six patients undergoing DSAEK surgery were included. OCT scans of the cornea were performed intraoperatively after insertion of the donor disc, after instillation of air in the anterior chamber beneath the disc, after vent incisions in the host cornea in each quadrant, following air-fluid exchange at the end of operation, and on day 1 after surgery. The central 3 mm of each cornea was scanned. The broadest gap between donor and host cornea (interface space) was measured. Results Adequate readings could be obtained from all patients without any complications. In 2 patients there was a decrease in the width of the interface space after each surgical step documented by the OCT scans. At the end of their operation, no interface space was detectable. In 2 patients, interface space disappeared after the vent incisions and did not reappear during the further course of the surgery. In further 2 patients the separation between the host and donor was still detectable at the end of the operation. All patients had no detectable interface gap on day 1. Conclusions Handheld anterior segment OCT can be used to assess the host-donor interface in lamellar corneal transplantation surgery. Donor adherence can occur in spite of residual interface space at the end of surgery. Further studies should be conducted to answer the question of which surgical steps are useful in assisting with donor adhesion.
    Subject(s): Abridged Index Medicus ; Aged ; Aged, 80 and over ; Automation ; Biological and medical sciences ; Cell Adhesion ; Colleges & universities ; Cornea - pathology ; Descemet Stripping Endothelial Keratoplasty ; Endothelium ; Endothelium, Corneal - pathology ; Eye diseases ; Female ; Fourier Analysis ; Fuchs' Endothelial Dystrophy - surgery ; Humans ; Intraoperative Care ; Male ; Medical sciences ; Middle Aged ; Miscellaneous ; Ophthalmology ; Prospective Studies ; Surgery ; Tissue Donors ; Tomography ; Tomography, Optical Coherence
    ISSN: 0002-9394
    E-ISSN: 1879-1891
    Source: Alma/SFX Local Collection
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  • 5
    Language: English
    In: American journal of ophthalmology, 2006, Vol.141 (6), p.1068-1077.e2
    Description: To evaluate ophthalmologic findings and long-term course in patients with neurofibromatosis type 2 (NF2). Retrospective observational case series. setting : Single-center institutional practice. study population : Thirty referred patients with NF2 were enrolled from 1991 to 2003 and underwent at least one thorough neuroophthalmologic examination. Follow-up of 23 patients ranged from 4.3 to 12.5 years. main outcome measures : Visual function, structural ocular abnormalities, onset and type of presenting NF2-related symptoms, and number of central nervous system tumors. Initial symptoms for patients with early-onset NF2 mostly comprised ophthalmologic symptoms (n = 7) and lower motor neuron extremity weakness (n = 6), as opposed to eighth nerve impairment (n = 11) in late disease onset. NF2-specific ocular findings were noted in 83% of all patients (94% childhood onset; 67% adult onset): 67% had cataracts, 40% epiretinal membranes, 3% hamartoma, 13% disk gliomas, and 27% optic nerve sheath meningiomas. Only 14% in the childhood-onset group—as opposed to 78% in the adult-onset group—sustained visual acuity of 1.0 in both eyes at final examination. Significantly more patients with early onset of symptoms developed multiple central nervous system tumors ( P = .004) and showed a higher amount of NF2-specific findings ( P = .015). Initial manifestations of NF2 differ between children and adults. NF2-specific ophthalmologic findings can help establish the diagnosis. Symptom onset at a young age is clearly a risk factor for marked disease progression. These patients should be carefully followed because survival rates have increased, and vision becomes increasingly important as the disease progresses.
    Subject(s): Abridged Index Medicus ; Adolescent ; Adult ; Age ; Aged ; Biological and medical sciences ; Care and treatment ; Child ; Demographic aspects ; Development and progression ; Disease Progression ; Eye Diseases - diagnosis ; Eye Diseases - physiopathology ; Female ; Follow-Up Studies ; Genotype & phenotype ; Humans ; Magnetic Resonance Imaging ; Male ; Medical research ; Medical sciences ; Medicine, Experimental ; Middle Aged ; Miscellaneous ; Motility ; Neurofibromatosis ; Neurofibromatosis 2 - diagnosis ; Neurofibromatosis 2 - physiopathology ; Neurology ; Ocular manifestations of general diseases ; Ophthalmology ; Patient outcomes ; Patients ; Phenotype ; Research ; Retrospective Studies ; Study and teaching ; Tumors ; Tumors of the nervous system. Phacomatoses ; Visual Acuity
    ISSN: 0002-9394
    E-ISSN: 1879-1891
    Source: Alma/SFX Local Collection
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  • 6
    Language: English
    In: Ophthalmic research, 2013-06, Vol.50 (1), p.13-18
    Description: Purpose: To compare three different treatment modalities for traumatic corneal abrasions. Methods: We conducted a prospective, randomized, masked, three-arm clinical study of patients presenting with superficial corneal foreign bodies. Treatment modalities were: (1) pressure patching with ofloxacin ointment (patch group, PG, n = 18), (2) therapeutic contact lens with ofloxacin eye drops (contact lens group, CLG, n = 20) and (3) ofloxacin ointment alone (ointment group, OG, n = 28). Primary outcome measure was the difference of the mean corneal abrasion area between the three groups at 3 different time points (baseline, day 1 and day 7). Results: A total of 66 patients were included in the study over a period of 2 years. Mean initial corneal abrasion area was 3.6 ± 3.4 mm2 in the PG, 4.2 ± 4.0 mm2 in the CLG and 3.7 ± 3.1 mm2 in the OG (p = 0.875). Differences in corneal abrasion area at any time point were not statistically significant (abrasion area decrease from presentation to day 1 was 3.4 ± 3.3 mm2 in the PG, 4.1 ± 4.0 mm2 in the CLG and 3.5 ± 3.1 mm2 in the OG, p = 0.789). The epithelium was healed in all patients at day 7. Conclusions: Treating traumatic corneal abrasions by pressure patching, a bandage contact lens or ointment alone was equal in reducing the abrasion area or reducing pain. According to our results the treatment of choice for traumatic abrasions may be adapted to the needs and preferences of the patient.
    Subject(s): Adolescent ; Adult ; Analysis of Variance ; Anti-Bacterial Agents - administration & dosage ; Contact Lenses ; Corneal Injuries ; Eye Foreign Bodies - complications ; Eye Foreign Bodies - surgery ; Eye Injuries, Penetrating - drug therapy ; Eye Injuries, Penetrating - etiology ; Female ; Humans ; Male ; Occlusive Dressings ; Ofloxacin - administration & dosage ; Ointments ; Original Paper ; Prospective Studies ; Young Adult
    ISSN: 0030-3747
    E-ISSN: 1423-0259
    Source: Karger Journals Archiv (DFG Nationallizenzen)
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  • 7
    Language: English
    In: PloS one, 2011-02-17, Vol.6 (2), p.e11532-e11532
    Description: Retinal hemorrhages have been described as a component of high altitude retinopathy (HAR) in association with altitude illness. In this prospective high altitude study, we aimed to gain new insights into the pathophysiology of HAR and explored whether HAR could be a valid early indicator of altitude illness. 28 mountaineers were randomly assigned to two ascent profiles during a research expedition to Mt. Muztagh Ata (7546 m/24,751 ft). Digital fundus photographs were taken prior to expedition at 490 m (1,607 ft), during expedition at 4497 m (14,750 ft = base camp), 5533 m (18,148 ft), 6265 m (20,549 ft), 6865 m (22,517 ft) and 4.5 months thereafter at 490 m. Number, size and time of occurrence of hemorrhages were recorded. Oxygen saturation (SpO₂) and hematocrit were also assessed. 79% of all climbers exhibited retinal hemorrhages during the expedition. Number and area of retinal bleeding increased moderately to medium altitudes (6265 m). Most retinal hemorrhages were detected after return to base camp from a high altitude. No post-expeditional ophthalmic sequelae were detected. Significant negative (SpO₂ Beta: -0.4, p〈0.001) and positive (hematocrit Beta: 0.2, p = 0.002, time at altitude Beta: 0.33, p = 0.003) correlations with hemorrhages were found. When closely examined, a very large amount of climbers exhibit retinal hemorrhages during exposure to high altitudes. The incidence of retinal hemorrhages may be greater than previously appreciated as a definite time lag was observed between highest altitude reached and development of retinal bleeding. Retinal hemorrhages should not be considered warning signs of impending severe altitude illness due to their delayed appearance.
    Subject(s): Adult ; Aged ; Altitude ; Altitude Sickness - complications ; Altitude Sickness - diagnosis ; Altitude Sickness - physiopathology ; Ascent ; Bleeding ; Blood Pressure - physiology ; Complications ; Delayed Diagnosis ; Edema ; Endothelium ; Expeditions ; Female ; Fundus Oculi ; Hematocrit ; Hemorrhage ; High altitude ; High-altitude environments ; Hospitals ; Humans ; Hypoxia ; Illnesses ; Intensive care ; Ischemia ; Male ; Medical research ; Medicine, Experimental ; Middle Aged ; Mountain climbing ; Mountain sickness ; Mountaineering - physiology ; Ophthalmology ; Ophthalmoscopy ; Oxygen ; Oxygen content ; Photographs ; Physiology ; Radiography ; Research ; Research expeditions ; Retina ; Retinal Disorders ; Retinal Hemorrhage - diagnosis ; Retinal Hemorrhage - diagnostic imaging ; Retinal Hemorrhage - etiology ; Retinal Hemorrhage - physiopathology ; Retinopathy ; Saturation ; Time Factors ; Time lag ; Young Adult
    ISSN: 1932-6203
    E-ISSN: 1932-6203
    Source: Academic Search Ultimate
    Source: PubMed Central
    Source: DOAJ Directory of Open Access Journals - Not for CDI Discovery
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  • 8
    Language: English
    In: Medical journal of Australia, 2009-02, Vol.190 (4), p.210-211
    Description: A 55-year-old woman who was treated with long-term, high-dose clozapine for schizophrenia presented with bilateral decreased visual acuity. She had pigmentary changes affecting the cornea and the retina, as well as stellate cataract. Chlorpromazine use is known to produce similar changes, but this is the first report to our knowledge of pigmentation associated with clozapine use.
    Subject(s): Antipsychotic Agents - administration & dosage ; Antipsychotic Agents - adverse effects ; Antipsychotic Agents, administration and dosage ; Biological and medical sciences ; Clozapine - administration & dosage ; Clozapine - adverse effects ; Clozapine, administration and dosage ; Corneal Opacity - chemically induced ; Eye diseases ; Eye Diseases - chemically induced ; Female ; General aspects ; Humans ; Hyperpigmentation - chemically induced ; Medical sciences ; Middle Aged ; Neuropharmacology ; Pharmaceutical preparations ; Pharmacology. Drug treatments ; Psycholeptics: tranquillizer, neuroleptic ; Psychology. Psychoanalysis. Psychiatry ; Psychopharmacology ; Schizophrenia - drug therapy
    ISSN: 0025-729X
    E-ISSN: 1326-5377
    Source: Wiley Online Library All Journals
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  • 9
    Language: English
    In: Ophthalmology (Rochester, Minn.), 2009, Vol.116 (8), p.1450-1454
    Description: Purpose To compare the newly developed handheld dynamic contour tonometer (hh-DCT) with the established slit-lamp–mounted DCT (sl-DCT) in terms of agreement for intraocular pressure (IOP) and ocular pulse amplitude (OPA) measurements, intraobserver variability, and tonography effect. Design Evaluation of diagnostic technology. Participants Fifty eyes of 50 healthy volunteers were examined with the hh-DCT and sl-DCT. Methods A paired t test was performed to analyze differences in IOP and OPA readings. Measurements were compared for bias and agreement according to the method of Bland and Altman. Intraclass correlation coefficients (ICCs) were calculated to compare intraobserver variability. A mixed model analysis was performed to assess a possible tonography effect. Main Outcome Measures The differences in IOP and OPA measurements, intraobserver variability, and tonography effect between the hh-DCT and the sl-DCT were examined. Results No statistically significant differences in IOP (sl-DCT−hh-DCT: 0.1±1.43 mmHg, 95% confidence interval [CI], −0.31 to 0.5, P = 0.63) or OPA (sl-DCT−hh-DCT: −0.1±0.52 mmHg, 95% CI, −0.28 to 0.01, P = 0.08) measurements were detected. Bland-Altman analysis revealed a bias of 0.1 with the limits of agreement of IOP measurement differences ranging from −2.71 to +2.90 mmHg. With regard to IOP readings obtained by sl-DCT, hh-DCT overestimated IOPs less than 15.6 mmHg and underestimated IOPs more than 15.6 mmHg. ICCs calculated for IOP readings were 0.87 (95% CI, 0.8–0.92) for hh-DCT and 0.85 (95% CI, 0.78–0.90) for sl-DCT. ICCs for OPA readings were 0.86 (95% CI, 0.79–0.91) for hh-DCT and 0.87 (95% CI, 0.8–0.91) for sl-DCT. Comparing the ICCs revealed no statistically significant difference between the devices with regard to IOP and OPA measurements ( P = 0.53 and P = 0.93, respectively). Mixed model analysis of 3 consecutive IOP measurements revealed a decrease in IOP of 0.5 mmHg after each measurement in both devices, which was not significant between the 2 methods ( P = 0.68). Conclusions IOP and OPA readings obtained by the novel hh-DCT were shown to be strongly concordant with measurements obtained by the sl-DCT device. The hh-DCT may be a valuable alternative to the sl-DCT in clinical practice. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
    Subject(s): Adolescent ; Adult ; Biological and medical sciences ; Female ; Humans ; Intraocular Pressure - physiology ; Male ; Medical sciences ; Middle Aged ; Miscellaneous ; Observer Variation ; Ophthalmology ; Prospective Studies ; Reproducibility of Results ; Sensitivity and Specificity ; Tonometry, Ocular - instrumentation ; Young Adult
    ISSN: 0161-6420
    E-ISSN: 1549-4713
    Source: Alma/SFX Local Collection
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  • 10
    Language: English
    In: Investigative ophthalmology & visual science, 2010-03-01, Vol.51 (3), p.1609-1613
    Description: Reports on intraocular pressure (IOP) changes at high altitudes have provided inconsistent and even conflicting The purpose of this study was to investigate the effect of very high altitude and different ascent profiles on IOP in relation to simultaneously occurring ophthalmic and systemic changes in a prospective study. This prospective study involved 25 healthy mountaineers who were randomly assigned to two different ascent profiles during a medical research expedition to Mt. Muztagh Ata (7,546 m/24,751 ft). Group 1 was allotted a shorter acclimatization time before ascent than was group 2. Besides IOP, oxygen saturation (SaO(2)), acute mountain sickness symptoms (AMS-c score), and optic disc appearance were assessed. Examinations were performed at 490 m/1,607 ft, 4,497 m/14,750 ft, 5,533 m/18,148 ft, and 6,265 m/20,549 ft above sea level. Intraocular pressure in both groups showed small but statistically significant changes: an increase during ascent from 490 m/1,607 ft to 5,533 m/18,148 ft and then a continuous decrease during further ascent to 6,265 m/20,549 ft and on descent to 4,497 m/14,750 ft and to 490 m. Differences between groups were not significant. Multiple regression analysis (IOP-dependent variable) revealed a significant partial correlation coefficient of beta = -0.25 (P = 0.01) for SaO(2) and beta = -0.23 (P = 0.02) for acclimatization time. Hypobaric hypoxia at very high altitude leads to small but statistically significant changes in IOP that are modulated by systemic oxygen saturation. Climbs to very high altitudes seem to be safe with regard to intraocular pressure changes.
    Subject(s): Acclimatization - physiology ; Adult ; Altitude ; Altitude Sickness - physiopathology ; Female ; Humans ; Hypoxia - physiopathology ; Intraocular Pressure - physiology ; Male ; Middle Aged ; Mountaineering ; Optic Disk - pathology ; Oxygen - metabolism ; Oxygen Consumption - physiology ; Prospective Studies ; Tonometry, Ocular
    ISSN: 0146-0404
    ISSN: 1552-5783
    E-ISSN: 1552-5783
    Source: Alma/SFX Local Collection
    Source: DOAJ Directory of Open Access Journals - Not for CDI Discovery
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