Effect of Levosimendan on Estimated Glomerular Filtration Rate in Hospitalized Patients with Decompensated Heart Failure and Renal Dysfunction
Summary Background Only limited data of the long‐term effect of levosimendan on renal dysfunction in patients with decompensated heart failure (DHF) have been published previously. To date, there has been no similar study carried out in a Chinese population. Design and Methods A prospective, randomi...
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| Veröffentlicht in: | Cardiovascular therapeutics 2013-04, Vol.31 (2), p.108-114 |
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| creator | Hou, Zhi‐Qiang Sun, Zhao‐Xia Su, Chong‐Yi Tan, Hui Zhong, Xia Hu, Bo Zhou, Yi Shang, De‐Ya |
| description | Summary
Background
Only limited data of the long‐term effect of levosimendan on renal dysfunction in patients with decompensated heart failure (DHF) have been published previously. To date, there has been no similar study carried out in a Chinese population.
Design and Methods
A prospective, randomized, placebo‐controlled, and double‐blind study was performed to investigate the effect of levosimendan on estimated glomerular filtration rate (eGFR) in DHF patients with renal dysfunction during a 30‐day period. Sixty‐six patients with left ventricular ejection fraction (LVEF) ≤40% and eGFR 15–89 mL/min/1.73 m2 were randomized in a 1:1 ratio to receive a 24‐h infusion with levosimendan or placebo. The B‐type natriuretic peptide (BNP) and eGFR were determined at baseline and day 1, 3, 7, 14, 30 after the start of treatment.
Results
The eGFR levels were obviously enhanced following levosimendan, peaked at 3 days, sustained for at least 14 days, and returned to baseline by day 30 after starting infusion. In contrast, placebo did not induce any significant changes in eGFR levels during the follow‐up. In addition, levosimendan resulted in a distinct decrease in BNP levels in comparison with placebo, and the beneficial effect returned to baseline by day 14 and remained so at day 30 postinfusion.
Conclusions
A 24‐h infusion with levosimendan transiently improved the renal dysfunction compared with placebo in patients with DHF, and its beneficial effects persisted for at least 14 days after the initiation of treatment. |
| doi_str_mv | 10.1111/1755-5922.12001 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_24P</sourceid><recordid>TN_cdi_proquest_miscellaneous_1317848852</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2920281241</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4011-b38b7ffbcd8768aa9fd1f80c4e26045af91ed7ea736ffc96509bf52d9cb04d543</originalsourceid><addsrcrecordid>eNqFkU9r3DAQxU1padK0596KoBRy2USyJcs6lv2TLSw0LOnZyPKIKsjSVpIbNh8inznaeLuFXqrLCL3fvBn0iuIjwVckn2vCGZsxUZZXpMSYvCrOTy-vT3dCz4p3Md5jXGNRk7fFWVlRgcuKnxdPS61BJeQ12sBvH80ArpcOeYeWMZlBJujRjfUDhNHKgFbGpiCTyfo2a8g4tPZxZ5K05jGjt1kDlyJ6MOknWoDyww5cfLFZgwwJraSxYwAkXY-24KRFi33Uo1MH0_fFGy1thA_HelH8WC3v5uvZ5vvNt_nXzUxRTMisq5qOa92pvuF1I6XQPdENVhTKGlMmtSDQc5C8qrVWomZYdJqVvVAdpj2j1UVxOfnugv81QkztYKICa6UDP8aWVIQ3tGlYmdHP_6D3fgx574miouGMZ-p6olTwMQbQ7S7k3wv7luD2EFV7CKM9BNO-RJU7Ph19x26A_sT_ySYDX46AjEpaHaRTJv7lOKGsok3m2MQ9GAv7_81t54vttMAzeoGsbA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1317498757</pqid></control><display><type>article</type><title>Effect of Levosimendan on Estimated Glomerular Filtration Rate in Hospitalized Patients with Decompensated Heart Failure and Renal Dysfunction</title><source>Wiley-Blackwell Open Access Titles</source><creator>Hou, Zhi‐Qiang ; Sun, Zhao‐Xia ; Su, Chong‐Yi ; Tan, Hui ; Zhong, Xia ; Hu, Bo ; Zhou, Yi ; Shang, De‐Ya</creator><creatorcontrib>Hou, Zhi‐Qiang ; Sun, Zhao‐Xia ; Su, Chong‐Yi ; Tan, Hui ; Zhong, Xia ; Hu, Bo ; Zhou, Yi ; Shang, De‐Ya</creatorcontrib><description>Summary
Background
Only limited data of the long‐term effect of levosimendan on renal dysfunction in patients with decompensated heart failure (DHF) have been published previously. To date, there has been no similar study carried out in a Chinese population.
Design and Methods
A prospective, randomized, placebo‐controlled, and double‐blind study was performed to investigate the effect of levosimendan on estimated glomerular filtration rate (eGFR) in DHF patients with renal dysfunction during a 30‐day period. Sixty‐six patients with left ventricular ejection fraction (LVEF) ≤40% and eGFR 15–89 mL/min/1.73 m2 were randomized in a 1:1 ratio to receive a 24‐h infusion with levosimendan or placebo. The B‐type natriuretic peptide (BNP) and eGFR were determined at baseline and day 1, 3, 7, 14, 30 after the start of treatment.
Results
The eGFR levels were obviously enhanced following levosimendan, peaked at 3 days, sustained for at least 14 days, and returned to baseline by day 30 after starting infusion. In contrast, placebo did not induce any significant changes in eGFR levels during the follow‐up. In addition, levosimendan resulted in a distinct decrease in BNP levels in comparison with placebo, and the beneficial effect returned to baseline by day 14 and remained so at day 30 postinfusion.
Conclusions
A 24‐h infusion with levosimendan transiently improved the renal dysfunction compared with placebo in patients with DHF, and its beneficial effects persisted for at least 14 days after the initiation of treatment.</description><identifier>ISSN: 1755-5914</identifier><identifier>EISSN: 1755-5922</identifier><identifier>DOI: 10.1111/1755-5922.12001</identifier><identifier>PMID: 23490237</identifier><language>eng</language><publisher>Oxford: Blackwell</publisher><subject>Aged ; Aged, 80 and over ; Analysis of Variance ; Biological and medical sciences ; Biomarkers - blood ; Blood Pressure - drug effects ; B‐type Natriuretic peptide ; Cardiology. Vascular system ; Cardiotonic Agents - administration & dosage ; Cardiotonic Agents - therapeutic use ; Cardiovascular system ; Chi-Square Distribution ; China ; Decompensated heart failure ; Double-Blind Method ; Drug therapy ; Estimated glomerular filtration rate ; Female ; Glomerular Filtration Rate - drug effects ; Heart ; Heart failure ; Heart Failure - blood ; Heart Failure - complications ; Heart Failure - diagnosis ; Heart Failure - drug therapy ; Heart Failure - physiopathology ; Heart failure, cardiogenic pulmonary edema, cardiac enlargement ; Heart Rate - drug effects ; Hospitalization ; Humans ; Hydrazones - administration & dosage ; Hydrazones - therapeutic use ; Infusions, Intravenous ; Kidney Diseases - blood ; Kidney Diseases - complications ; Kidney Diseases - physiopathology ; Levosimendan ; Linear Models ; Male ; Medical sciences ; Middle Aged ; Natriuretic Peptide, Brain - blood ; Nephrology. Urinary tract diseases ; Nephropathies. Renovascular diseases. Renal failure ; Pharmacology. Drug treatments ; Placebo ; Prospective Studies ; Pyridazines - administration & dosage ; Pyridazines - therapeutic use ; Renal dysfunction ; Renal failure ; Stroke Volume ; Time Factors ; Treatment Outcome ; Urination - drug effects ; Ventricular Function, Left - drug effects</subject><ispartof>Cardiovascular therapeutics, 2013-04, Vol.31 (2), p.108-114</ispartof><rights>2012 Blackwell Publishing Ltd</rights><rights>2014 INIST-CNRS</rights><rights>2012 Blackwell Publishing Ltd.</rights><rights>2013 Blackwell Publishing Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4011-b38b7ffbcd8768aa9fd1f80c4e26045af91ed7ea736ffc96509bf52d9cb04d543</citedby><cites>FETCH-LOGICAL-c4011-b38b7ffbcd8768aa9fd1f80c4e26045af91ed7ea736ffc96509bf52d9cb04d543</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2F1755-5922.12001$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2F1755-5922.12001$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1427,11541,27901,27902,46027,46384,46451,46808</link.rule.ids><linktorsrc>$$Uhttps://onlinelibrary.wiley.com/doi/abs/10.1111%2F1755-5922.12001$$EView_record_in_Wiley-Blackwell$$FView_record_in_$$GWiley-Blackwell</linktorsrc><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27145348$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23490237$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hou, Zhi‐Qiang</creatorcontrib><creatorcontrib>Sun, Zhao‐Xia</creatorcontrib><creatorcontrib>Su, Chong‐Yi</creatorcontrib><creatorcontrib>Tan, Hui</creatorcontrib><creatorcontrib>Zhong, Xia</creatorcontrib><creatorcontrib>Hu, Bo</creatorcontrib><creatorcontrib>Zhou, Yi</creatorcontrib><creatorcontrib>Shang, De‐Ya</creatorcontrib><title>Effect of Levosimendan on Estimated Glomerular Filtration Rate in Hospitalized Patients with Decompensated Heart Failure and Renal Dysfunction</title><title>Cardiovascular therapeutics</title><addtitle>Cardiovasc Ther</addtitle><description>Summary
Background
Only limited data of the long‐term effect of levosimendan on renal dysfunction in patients with decompensated heart failure (DHF) have been published previously. To date, there has been no similar study carried out in a Chinese population.
Design and Methods
A prospective, randomized, placebo‐controlled, and double‐blind study was performed to investigate the effect of levosimendan on estimated glomerular filtration rate (eGFR) in DHF patients with renal dysfunction during a 30‐day period. Sixty‐six patients with left ventricular ejection fraction (LVEF) ≤40% and eGFR 15–89 mL/min/1.73 m2 were randomized in a 1:1 ratio to receive a 24‐h infusion with levosimendan or placebo. The B‐type natriuretic peptide (BNP) and eGFR were determined at baseline and day 1, 3, 7, 14, 30 after the start of treatment.
Results
The eGFR levels were obviously enhanced following levosimendan, peaked at 3 days, sustained for at least 14 days, and returned to baseline by day 30 after starting infusion. In contrast, placebo did not induce any significant changes in eGFR levels during the follow‐up. In addition, levosimendan resulted in a distinct decrease in BNP levels in comparison with placebo, and the beneficial effect returned to baseline by day 14 and remained so at day 30 postinfusion.
Conclusions
A 24‐h infusion with levosimendan transiently improved the renal dysfunction compared with placebo in patients with DHF, and its beneficial effects persisted for at least 14 days after the initiation of treatment.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis of Variance</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - blood</subject><subject>Blood Pressure - drug effects</subject><subject>B‐type Natriuretic peptide</subject><subject>Cardiology. Vascular system</subject><subject>Cardiotonic Agents - administration & dosage</subject><subject>Cardiotonic Agents - therapeutic use</subject><subject>Cardiovascular system</subject><subject>Chi-Square Distribution</subject><subject>China</subject><subject>Decompensated heart failure</subject><subject>Double-Blind Method</subject><subject>Drug therapy</subject><subject>Estimated glomerular filtration rate</subject><subject>Female</subject><subject>Glomerular Filtration Rate - drug effects</subject><subject>Heart</subject><subject>Heart failure</subject><subject>Heart Failure - blood</subject><subject>Heart Failure - complications</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - physiopathology</subject><subject>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</subject><subject>Heart Rate - drug effects</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Hydrazones - administration & dosage</subject><subject>Hydrazones - therapeutic use</subject><subject>Infusions, Intravenous</subject><subject>Kidney Diseases - blood</subject><subject>Kidney Diseases - complications</subject><subject>Kidney Diseases - physiopathology</subject><subject>Levosimendan</subject><subject>Linear Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Natriuretic Peptide, Brain - blood</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Nephropathies. Renovascular diseases. Renal failure</subject><subject>Pharmacology. Drug treatments</subject><subject>Placebo</subject><subject>Prospective Studies</subject><subject>Pyridazines - administration & dosage</subject><subject>Pyridazines - therapeutic use</subject><subject>Renal dysfunction</subject><subject>Renal failure</subject><subject>Stroke Volume</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Urination - drug effects</subject><subject>Ventricular Function, Left - drug effects</subject><issn>1755-5914</issn><issn>1755-5922</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU9r3DAQxU1padK0596KoBRy2USyJcs6lv2TLSw0LOnZyPKIKsjSVpIbNh8inznaeLuFXqrLCL3fvBn0iuIjwVckn2vCGZsxUZZXpMSYvCrOTy-vT3dCz4p3Md5jXGNRk7fFWVlRgcuKnxdPS61BJeQ12sBvH80ArpcOeYeWMZlBJujRjfUDhNHKgFbGpiCTyfo2a8g4tPZxZ5K05jGjt1kDlyJ6MOknWoDyww5cfLFZgwwJraSxYwAkXY-24KRFi33Uo1MH0_fFGy1thA_HelH8WC3v5uvZ5vvNt_nXzUxRTMisq5qOa92pvuF1I6XQPdENVhTKGlMmtSDQc5C8qrVWomZYdJqVvVAdpj2j1UVxOfnugv81QkztYKICa6UDP8aWVIQ3tGlYmdHP_6D3fgx574miouGMZ-p6olTwMQbQ7S7k3wv7luD2EFV7CKM9BNO-RJU7Ph19x26A_sT_ySYDX46AjEpaHaRTJv7lOKGsok3m2MQ9GAv7_81t54vttMAzeoGsbA</recordid><startdate>201304</startdate><enddate>201304</enddate><creator>Hou, Zhi‐Qiang</creator><creator>Sun, Zhao‐Xia</creator><creator>Su, Chong‐Yi</creator><creator>Tan, Hui</creator><creator>Zhong, Xia</creator><creator>Hu, Bo</creator><creator>Zhou, Yi</creator><creator>Shang, De‐Ya</creator><general>Blackwell</general><general>Hindawi Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>201304</creationdate><title>Effect of Levosimendan on Estimated Glomerular Filtration Rate in Hospitalized Patients with Decompensated Heart Failure and Renal Dysfunction</title><author>Hou, Zhi‐Qiang ; Sun, Zhao‐Xia ; Su, Chong‐Yi ; Tan, Hui ; Zhong, Xia ; Hu, Bo ; Zhou, Yi ; Shang, De‐Ya</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4011-b38b7ffbcd8768aa9fd1f80c4e26045af91ed7ea736ffc96509bf52d9cb04d543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis of Variance</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - blood</topic><topic>Blood Pressure - drug effects</topic><topic>B‐type Natriuretic peptide</topic><topic>Cardiology. Vascular system</topic><topic>Cardiotonic Agents - administration & dosage</topic><topic>Cardiotonic Agents - therapeutic use</topic><topic>Cardiovascular system</topic><topic>Chi-Square Distribution</topic><topic>China</topic><topic>Decompensated heart failure</topic><topic>Double-Blind Method</topic><topic>Drug therapy</topic><topic>Estimated glomerular filtration rate</topic><topic>Female</topic><topic>Glomerular Filtration Rate - drug effects</topic><topic>Heart</topic><topic>Heart failure</topic><topic>Heart Failure - blood</topic><topic>Heart Failure - complications</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - physiopathology</topic><topic>Heart failure, cardiogenic pulmonary edema, cardiac enlargement</topic><topic>Heart Rate - drug effects</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Hydrazones - administration & dosage</topic><topic>Hydrazones - therapeutic use</topic><topic>Infusions, Intravenous</topic><topic>Kidney Diseases - blood</topic><topic>Kidney Diseases - complications</topic><topic>Kidney Diseases - physiopathology</topic><topic>Levosimendan</topic><topic>Linear Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Natriuretic Peptide, Brain - blood</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Nephropathies. Renovascular diseases. Renal failure</topic><topic>Pharmacology. Drug treatments</topic><topic>Placebo</topic><topic>Prospective Studies</topic><topic>Pyridazines - administration & dosage</topic><topic>Pyridazines - therapeutic use</topic><topic>Renal dysfunction</topic><topic>Renal failure</topic><topic>Stroke Volume</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Urination - drug effects</topic><topic>Ventricular Function, Left - drug effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hou, Zhi‐Qiang</creatorcontrib><creatorcontrib>Sun, Zhao‐Xia</creatorcontrib><creatorcontrib>Su, Chong‐Yi</creatorcontrib><creatorcontrib>Tan, Hui</creatorcontrib><creatorcontrib>Zhong, Xia</creatorcontrib><creatorcontrib>Hu, Bo</creatorcontrib><creatorcontrib>Zhou, Yi</creatorcontrib><creatorcontrib>Shang, De‐Ya</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Cardiovascular therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Hou, Zhi‐Qiang</au><au>Sun, Zhao‐Xia</au><au>Su, Chong‐Yi</au><au>Tan, Hui</au><au>Zhong, Xia</au><au>Hu, Bo</au><au>Zhou, Yi</au><au>Shang, De‐Ya</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Levosimendan on Estimated Glomerular Filtration Rate in Hospitalized Patients with Decompensated Heart Failure and Renal Dysfunction</atitle><jtitle>Cardiovascular therapeutics</jtitle><addtitle>Cardiovasc Ther</addtitle><date>2013-04</date><risdate>2013</risdate><volume>31</volume><issue>2</issue><spage>108</spage><epage>114</epage><pages>108-114</pages><issn>1755-5914</issn><eissn>1755-5922</eissn><abstract>Summary
Background
Only limited data of the long‐term effect of levosimendan on renal dysfunction in patients with decompensated heart failure (DHF) have been published previously. To date, there has been no similar study carried out in a Chinese population.
Design and Methods
A prospective, randomized, placebo‐controlled, and double‐blind study was performed to investigate the effect of levosimendan on estimated glomerular filtration rate (eGFR) in DHF patients with renal dysfunction during a 30‐day period. Sixty‐six patients with left ventricular ejection fraction (LVEF) ≤40% and eGFR 15–89 mL/min/1.73 m2 were randomized in a 1:1 ratio to receive a 24‐h infusion with levosimendan or placebo. The B‐type natriuretic peptide (BNP) and eGFR were determined at baseline and day 1, 3, 7, 14, 30 after the start of treatment.
Results
The eGFR levels were obviously enhanced following levosimendan, peaked at 3 days, sustained for at least 14 days, and returned to baseline by day 30 after starting infusion. In contrast, placebo did not induce any significant changes in eGFR levels during the follow‐up. In addition, levosimendan resulted in a distinct decrease in BNP levels in comparison with placebo, and the beneficial effect returned to baseline by day 14 and remained so at day 30 postinfusion.
Conclusions
A 24‐h infusion with levosimendan transiently improved the renal dysfunction compared with placebo in patients with DHF, and its beneficial effects persisted for at least 14 days after the initiation of treatment.</abstract><cop>Oxford</cop><pub>Blackwell</pub><pmid>23490237</pmid><doi>10.1111/1755-5922.12001</doi><tpages>7</tpages></addata></record> |
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| ispartof | Cardiovascular therapeutics, 2013-04, Vol.31 (2), p.108-114 |
| issn | 1755-5914 1755-5922 |
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| subjects | Aged Aged, 80 and over Analysis of Variance Biological and medical sciences Biomarkers - blood Blood Pressure - drug effects B‐type Natriuretic peptide Cardiology. Vascular system Cardiotonic Agents - administration & dosage Cardiotonic Agents - therapeutic use Cardiovascular system Chi-Square Distribution China Decompensated heart failure Double-Blind Method Drug therapy Estimated glomerular filtration rate Female Glomerular Filtration Rate - drug effects Heart Heart failure Heart Failure - blood Heart Failure - complications Heart Failure - diagnosis Heart Failure - drug therapy Heart Failure - physiopathology Heart failure, cardiogenic pulmonary edema, cardiac enlargement Heart Rate - drug effects Hospitalization Humans Hydrazones - administration & dosage Hydrazones - therapeutic use Infusions, Intravenous Kidney Diseases - blood Kidney Diseases - complications Kidney Diseases - physiopathology Levosimendan Linear Models Male Medical sciences Middle Aged Natriuretic Peptide, Brain - blood Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Pharmacology. Drug treatments Placebo Prospective Studies Pyridazines - administration & dosage Pyridazines - therapeutic use Renal dysfunction Renal failure Stroke Volume Time Factors Treatment Outcome Urination - drug effects Ventricular Function, Left - drug effects |
| title | Effect of Levosimendan on Estimated Glomerular Filtration Rate in Hospitalized Patients with Decompensated Heart Failure and Renal Dysfunction |
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