Endodontic Photodynamic Therapy Ex Vivo
Abstract Introduction The objective of this study was to evaluate the antimicrobial effects of photodynamic therapy (PDT) on infected human teeth ex vivo. Methods Fifty-two freshly extracted teeth with pulpal necrosis and associated periradicular radiolucencies were obtained from 34 subjects. Twenty...
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| Veröffentlicht in: | Journal of endodontics 2011-02, Vol.37 (2), p.217-222 |
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| creator | Ng, Raymond, DDS Singh, Fiza, DDS Papamanou, Despina A., DDS Song, Xiaoqing, MD, MS Patel, Chitrang, BS Holewa, Colleen, BS Patel, Niraj, BS, MS Klepac-Ceraj, Vanja, PhD Fontana, Carla R., DDS, PhD Kent, Ralph, ScD Pagonis, Tom C., DDS, MS Stashenko, Philip P., DMD, PhD Soukos, Nikolaos S., DDS, PhD |
| description | Abstract Introduction The objective of this study was to evaluate the antimicrobial effects of photodynamic therapy (PDT) on infected human teeth ex vivo. Methods Fifty-two freshly extracted teeth with pulpal necrosis and associated periradicular radiolucencies were obtained from 34 subjects. Twenty-six teeth with 49 canals received chemomechanical debridement (CMD) with 6% NaOCl, and 26 teeth with 52 canals received CMD plus PDT. For PDT, root canal systems were incubated with methylene blue (MB) at concentration of 50 μg/mL for 5 minutes, followed by exposure to red light at 665 nm with an energy fluence of 30 J/cm2 . The contents of root canals were sampled by flushing the canals at baseline and after CMD alone or CMD+PDT and were serially diluted and cultured on blood agar. Survival fractions were calculated by counting colony-forming units (CFUs). Partial characterization of root canal species at baseline and after CMD alone or CMD+PDT was performed by using DNA probes to a panel of 39 endodontic species in the checkerboard assay. Results The Mantel-Haenszel χ2 test for treatment effects demonstrated the better performance of CMD+PDT over CMD ( P = .026). CMD+PDT significantly reduced the frequency of positive canals relative to CMD alone ( P = .0003). After CMD+PDT, 45 of 52 canals (86.5%) had no CFUs as compared with 24 of 49 canals (49%) treated with CMD (canal flush samples). The CFU reductions were similar when teeth or canals were treated as independent entities. Post-treatment detection levels for all species were markedly lower for canals treated by CMD+PDT than they were for those treated by CMD alone. Bacterial species within dentinal tubules were detected in 17 of 22 (77.3%) and 15 of 29 (51.7%) canals in the CMD and CMD+PDT groups, respectively ( P = .034). Conclusions Data indicate that PDT significantly reduces residual bacteria within the root canal system, and that PDT, if further enhanced by technical improvements, holds substantial promise as an adjunct to CMD. |
| doi_str_mv | 10.1016/j.joen.2010.10.008 |
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| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_3034089</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S0099239910008472</els_id><sourcerecordid>843413553</sourcerecordid><originalsourceid>FETCH-LOGICAL-c509t-8c703432a7b1ed3a766dd54d945d16a745dfa173de84f2e95bd5fa18dce7c1403</originalsourceid><addsrcrecordid>eNp9kU9PGzEQxa2qVQm0X6AHlBunDeM_G3slhFShFJCQqATt1XLsSeNlYwd7EzXfHi-hqPTQ08jj996MfkPIFwoTCnR62k7aiGHC4LkxAVDvyIgqqSpe1-I9GQE0TcV40xyQw5xbACo5lx_JAaOMKwX1iJzMgosuht7b8fdl7KPbBbMqj_slJrPejWe_xz_9Nn4iHxamy_j5pR6RH99m9xdX1c3t5fXF15vK1tD0lbISuODMyDlFx42cTp2rhWtE7ejUyFIWpmzhUIkFw6aeu7o0lLMoLRXAj8j5Pne9ma-wtEOfTKfXya9M2ulovH77E_xS_4pbzctcUE0JOHkJSPFxg7nXK58tdp0JGDdZK8EFLXx4UbK90qaYc8LF6xQKegCsWz0A1gPgoVcAF9Px3_u9Wv4QLYKzvQALpa3HpLP1GCw6n9D22kX___zzf-y288Fb0z3gDnMbNykU_prqzDTou-HEw4UpFLeQjD8BLamhZg</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>843413553</pqid></control><display><type>article</type><title>Endodontic Photodynamic Therapy Ex Vivo</title><source>MEDLINE</source><source>Access via ScienceDirect (Elsevier)</source><creator>Ng, Raymond, DDS ; Singh, Fiza, DDS ; Papamanou, Despina A., DDS ; Song, Xiaoqing, MD, MS ; Patel, Chitrang, BS ; Holewa, Colleen, BS ; Patel, Niraj, BS, MS ; Klepac-Ceraj, Vanja, PhD ; Fontana, Carla R., DDS, PhD ; Kent, Ralph, ScD ; Pagonis, Tom C., DDS, MS ; Stashenko, Philip P., DMD, PhD ; Soukos, Nikolaos S., DDS, PhD</creator><creatorcontrib>Ng, Raymond, DDS ; Singh, Fiza, DDS ; Papamanou, Despina A., DDS ; Song, Xiaoqing, MD, MS ; Patel, Chitrang, BS ; Holewa, Colleen, BS ; Patel, Niraj, BS, MS ; Klepac-Ceraj, Vanja, PhD ; Fontana, Carla R., DDS, PhD ; Kent, Ralph, ScD ; Pagonis, Tom C., DDS, MS ; Stashenko, Philip P., DMD, PhD ; Soukos, Nikolaos S., DDS, PhD</creatorcontrib><description>Abstract Introduction The objective of this study was to evaluate the antimicrobial effects of photodynamic therapy (PDT) on infected human teeth ex vivo. Methods Fifty-two freshly extracted teeth with pulpal necrosis and associated periradicular radiolucencies were obtained from 34 subjects. Twenty-six teeth with 49 canals received chemomechanical debridement (CMD) with 6% NaOCl, and 26 teeth with 52 canals received CMD plus PDT. For PDT, root canal systems were incubated with methylene blue (MB) at concentration of 50 μg/mL for 5 minutes, followed by exposure to red light at 665 nm with an energy fluence of 30 J/cm2 . The contents of root canals were sampled by flushing the canals at baseline and after CMD alone or CMD+PDT and were serially diluted and cultured on blood agar. Survival fractions were calculated by counting colony-forming units (CFUs). Partial characterization of root canal species at baseline and after CMD alone or CMD+PDT was performed by using DNA probes to a panel of 39 endodontic species in the checkerboard assay. Results The Mantel-Haenszel χ2 test for treatment effects demonstrated the better performance of CMD+PDT over CMD ( P = .026). CMD+PDT significantly reduced the frequency of positive canals relative to CMD alone ( P = .0003). After CMD+PDT, 45 of 52 canals (86.5%) had no CFUs as compared with 24 of 49 canals (49%) treated with CMD (canal flush samples). The CFU reductions were similar when teeth or canals were treated as independent entities. Post-treatment detection levels for all species were markedly lower for canals treated by CMD+PDT than they were for those treated by CMD alone. Bacterial species within dentinal tubules were detected in 17 of 22 (77.3%) and 15 of 29 (51.7%) canals in the CMD and CMD+PDT groups, respectively ( P = .034). Conclusions Data indicate that PDT significantly reduces residual bacteria within the root canal system, and that PDT, if further enhanced by technical improvements, holds substantial promise as an adjunct to CMD.</description><identifier>ISSN: 0099-2399</identifier><identifier>EISSN: 1878-3554</identifier><identifier>DOI: 10.1016/j.joen.2010.10.008</identifier><identifier>PMID: 21238805</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Bacteria - radiation effects ; Chi-Square Distribution ; Combined Modality Therapy ; Debridement - methods ; Dental Pulp Cavity - microbiology ; Dental Pulp Cavity - radiation effects ; Dental Pulp Cavity - surgery ; Dental Pulp Necrosis - therapy ; Dentistry ; Disinfection - instrumentation ; Disinfection - methods ; Endocrinology & Metabolism ; Endodontic disinfection ; ex vivo ; Humans ; methylene blue ; Methylene Blue - radiation effects ; Methylene Blue - therapeutic use ; Periapical Periodontitis - therapy ; Photochemotherapy - instrumentation ; Photochemotherapy - methods ; photodynamic therapy ; Radiation-Sensitizing Agents - radiation effects ; Radiation-Sensitizing Agents - therapeutic use ; Root Canal Therapy - instrumentation ; Root Canal Therapy - methods ; Treatment Outcome</subject><ispartof>Journal of endodontics, 2011-02, Vol.37 (2), p.217-222</ispartof><rights>American Association of Endodontists</rights><rights>2011 American Association of Endodontists</rights><rights>Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.</rights><rights>2010 American Association of Endodontics. Published by Elsevier Inc. All rights reserved. 2010</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c509t-8c703432a7b1ed3a766dd54d945d16a745dfa173de84f2e95bd5fa18dce7c1403</citedby><cites>FETCH-LOGICAL-c509t-8c703432a7b1ed3a766dd54d945d16a745dfa173de84f2e95bd5fa18dce7c1403</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.joen.2010.10.008$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,780,784,885,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21238805$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ng, Raymond, DDS</creatorcontrib><creatorcontrib>Singh, Fiza, DDS</creatorcontrib><creatorcontrib>Papamanou, Despina A., DDS</creatorcontrib><creatorcontrib>Song, Xiaoqing, MD, MS</creatorcontrib><creatorcontrib>Patel, Chitrang, BS</creatorcontrib><creatorcontrib>Holewa, Colleen, BS</creatorcontrib><creatorcontrib>Patel, Niraj, BS, MS</creatorcontrib><creatorcontrib>Klepac-Ceraj, Vanja, PhD</creatorcontrib><creatorcontrib>Fontana, Carla R., DDS, PhD</creatorcontrib><creatorcontrib>Kent, Ralph, ScD</creatorcontrib><creatorcontrib>Pagonis, Tom C., DDS, MS</creatorcontrib><creatorcontrib>Stashenko, Philip P., DMD, PhD</creatorcontrib><creatorcontrib>Soukos, Nikolaos S., DDS, PhD</creatorcontrib><title>Endodontic Photodynamic Therapy Ex Vivo</title><title>Journal of endodontics</title><addtitle>J Endod</addtitle><description>Abstract Introduction The objective of this study was to evaluate the antimicrobial effects of photodynamic therapy (PDT) on infected human teeth ex vivo. Methods Fifty-two freshly extracted teeth with pulpal necrosis and associated periradicular radiolucencies were obtained from 34 subjects. Twenty-six teeth with 49 canals received chemomechanical debridement (CMD) with 6% NaOCl, and 26 teeth with 52 canals received CMD plus PDT. For PDT, root canal systems were incubated with methylene blue (MB) at concentration of 50 μg/mL for 5 minutes, followed by exposure to red light at 665 nm with an energy fluence of 30 J/cm2 . The contents of root canals were sampled by flushing the canals at baseline and after CMD alone or CMD+PDT and were serially diluted and cultured on blood agar. Survival fractions were calculated by counting colony-forming units (CFUs). Partial characterization of root canal species at baseline and after CMD alone or CMD+PDT was performed by using DNA probes to a panel of 39 endodontic species in the checkerboard assay. Results The Mantel-Haenszel χ2 test for treatment effects demonstrated the better performance of CMD+PDT over CMD ( P = .026). CMD+PDT significantly reduced the frequency of positive canals relative to CMD alone ( P = .0003). After CMD+PDT, 45 of 52 canals (86.5%) had no CFUs as compared with 24 of 49 canals (49%) treated with CMD (canal flush samples). The CFU reductions were similar when teeth or canals were treated as independent entities. Post-treatment detection levels for all species were markedly lower for canals treated by CMD+PDT than they were for those treated by CMD alone. Bacterial species within dentinal tubules were detected in 17 of 22 (77.3%) and 15 of 29 (51.7%) canals in the CMD and CMD+PDT groups, respectively ( P = .034). Conclusions Data indicate that PDT significantly reduces residual bacteria within the root canal system, and that PDT, if further enhanced by technical improvements, holds substantial promise as an adjunct to CMD.</description><subject>Bacteria - radiation effects</subject><subject>Chi-Square Distribution</subject><subject>Combined Modality Therapy</subject><subject>Debridement - methods</subject><subject>Dental Pulp Cavity - microbiology</subject><subject>Dental Pulp Cavity - radiation effects</subject><subject>Dental Pulp Cavity - surgery</subject><subject>Dental Pulp Necrosis - therapy</subject><subject>Dentistry</subject><subject>Disinfection - instrumentation</subject><subject>Disinfection - methods</subject><subject>Endocrinology & Metabolism</subject><subject>Endodontic disinfection</subject><subject>ex vivo</subject><subject>Humans</subject><subject>methylene blue</subject><subject>Methylene Blue - radiation effects</subject><subject>Methylene Blue - therapeutic use</subject><subject>Periapical Periodontitis - therapy</subject><subject>Photochemotherapy - instrumentation</subject><subject>Photochemotherapy - methods</subject><subject>photodynamic therapy</subject><subject>Radiation-Sensitizing Agents - radiation effects</subject><subject>Radiation-Sensitizing Agents - therapeutic use</subject><subject>Root Canal Therapy - instrumentation</subject><subject>Root Canal Therapy - methods</subject><subject>Treatment Outcome</subject><issn>0099-2399</issn><issn>1878-3554</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU9PGzEQxa2qVQm0X6AHlBunDeM_G3slhFShFJCQqATt1XLsSeNlYwd7EzXfHi-hqPTQ08jj996MfkPIFwoTCnR62k7aiGHC4LkxAVDvyIgqqSpe1-I9GQE0TcV40xyQw5xbACo5lx_JAaOMKwX1iJzMgosuht7b8fdl7KPbBbMqj_slJrPejWe_xz_9Nn4iHxamy_j5pR6RH99m9xdX1c3t5fXF15vK1tD0lbISuODMyDlFx42cTp2rhWtE7ejUyFIWpmzhUIkFw6aeu7o0lLMoLRXAj8j5Pne9ma-wtEOfTKfXya9M2ulovH77E_xS_4pbzctcUE0JOHkJSPFxg7nXK58tdp0JGDdZK8EFLXx4UbK90qaYc8LF6xQKegCsWz0A1gPgoVcAF9Px3_u9Wv4QLYKzvQALpa3HpLP1GCw6n9D22kX___zzf-y288Fb0z3gDnMbNykU_prqzDTou-HEw4UpFLeQjD8BLamhZg</recordid><startdate>20110201</startdate><enddate>20110201</enddate><creator>Ng, Raymond, DDS</creator><creator>Singh, Fiza, DDS</creator><creator>Papamanou, Despina A., DDS</creator><creator>Song, Xiaoqing, MD, MS</creator><creator>Patel, Chitrang, BS</creator><creator>Holewa, Colleen, BS</creator><creator>Patel, Niraj, BS, MS</creator><creator>Klepac-Ceraj, Vanja, PhD</creator><creator>Fontana, Carla R., DDS, PhD</creator><creator>Kent, Ralph, ScD</creator><creator>Pagonis, Tom C., DDS, MS</creator><creator>Stashenko, Philip P., DMD, PhD</creator><creator>Soukos, Nikolaos S., DDS, PhD</creator><general>Elsevier Inc</general><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>7X8</scope><scope>5PM</scope></search><sort><creationdate>20110201</creationdate><title>Endodontic Photodynamic Therapy Ex Vivo</title><author>Ng, Raymond, DDS ; Singh, Fiza, DDS ; Papamanou, Despina A., DDS ; Song, Xiaoqing, MD, MS ; Patel, Chitrang, BS ; Holewa, Colleen, BS ; Patel, Niraj, BS, MS ; Klepac-Ceraj, Vanja, PhD ; Fontana, Carla R., DDS, PhD ; Kent, Ralph, ScD ; Pagonis, Tom C., DDS, MS ; Stashenko, Philip P., DMD, PhD ; Soukos, Nikolaos S., DDS, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c509t-8c703432a7b1ed3a766dd54d945d16a745dfa173de84f2e95bd5fa18dce7c1403</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Bacteria - radiation effects</topic><topic>Chi-Square Distribution</topic><topic>Combined Modality Therapy</topic><topic>Debridement - methods</topic><topic>Dental Pulp Cavity - microbiology</topic><topic>Dental Pulp Cavity - radiation effects</topic><topic>Dental Pulp Cavity - surgery</topic><topic>Dental Pulp Necrosis - therapy</topic><topic>Dentistry</topic><topic>Disinfection - instrumentation</topic><topic>Disinfection - methods</topic><topic>Endocrinology & Metabolism</topic><topic>Endodontic disinfection</topic><topic>ex vivo</topic><topic>Humans</topic><topic>methylene blue</topic><topic>Methylene Blue - radiation effects</topic><topic>Methylene Blue - therapeutic use</topic><topic>Periapical Periodontitis - therapy</topic><topic>Photochemotherapy - instrumentation</topic><topic>Photochemotherapy - methods</topic><topic>photodynamic therapy</topic><topic>Radiation-Sensitizing Agents - radiation effects</topic><topic>Radiation-Sensitizing Agents - therapeutic use</topic><topic>Root Canal Therapy - instrumentation</topic><topic>Root Canal Therapy - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ng, Raymond, DDS</creatorcontrib><creatorcontrib>Singh, Fiza, DDS</creatorcontrib><creatorcontrib>Papamanou, Despina A., DDS</creatorcontrib><creatorcontrib>Song, Xiaoqing, MD, MS</creatorcontrib><creatorcontrib>Patel, Chitrang, BS</creatorcontrib><creatorcontrib>Holewa, Colleen, BS</creatorcontrib><creatorcontrib>Patel, Niraj, BS, MS</creatorcontrib><creatorcontrib>Klepac-Ceraj, Vanja, PhD</creatorcontrib><creatorcontrib>Fontana, Carla R., DDS, PhD</creatorcontrib><creatorcontrib>Kent, Ralph, ScD</creatorcontrib><creatorcontrib>Pagonis, Tom C., DDS, MS</creatorcontrib><creatorcontrib>Stashenko, Philip P., DMD, PhD</creatorcontrib><creatorcontrib>Soukos, Nikolaos S., DDS, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of endodontics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ng, Raymond, DDS</au><au>Singh, Fiza, DDS</au><au>Papamanou, Despina A., DDS</au><au>Song, Xiaoqing, MD, MS</au><au>Patel, Chitrang, BS</au><au>Holewa, Colleen, BS</au><au>Patel, Niraj, BS, MS</au><au>Klepac-Ceraj, Vanja, PhD</au><au>Fontana, Carla R., DDS, PhD</au><au>Kent, Ralph, ScD</au><au>Pagonis, Tom C., DDS, MS</au><au>Stashenko, Philip P., DMD, PhD</au><au>Soukos, Nikolaos S., DDS, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Endodontic Photodynamic Therapy Ex Vivo</atitle><jtitle>Journal of endodontics</jtitle><addtitle>J Endod</addtitle><date>2011-02-01</date><risdate>2011</risdate><volume>37</volume><issue>2</issue><spage>217</spage><epage>222</epage><pages>217-222</pages><issn>0099-2399</issn><eissn>1878-3554</eissn><abstract>Abstract Introduction The objective of this study was to evaluate the antimicrobial effects of photodynamic therapy (PDT) on infected human teeth ex vivo. Methods Fifty-two freshly extracted teeth with pulpal necrosis and associated periradicular radiolucencies were obtained from 34 subjects. Twenty-six teeth with 49 canals received chemomechanical debridement (CMD) with 6% NaOCl, and 26 teeth with 52 canals received CMD plus PDT. For PDT, root canal systems were incubated with methylene blue (MB) at concentration of 50 μg/mL for 5 minutes, followed by exposure to red light at 665 nm with an energy fluence of 30 J/cm2 . The contents of root canals were sampled by flushing the canals at baseline and after CMD alone or CMD+PDT and were serially diluted and cultured on blood agar. Survival fractions were calculated by counting colony-forming units (CFUs). Partial characterization of root canal species at baseline and after CMD alone or CMD+PDT was performed by using DNA probes to a panel of 39 endodontic species in the checkerboard assay. Results The Mantel-Haenszel χ2 test for treatment effects demonstrated the better performance of CMD+PDT over CMD ( P = .026). CMD+PDT significantly reduced the frequency of positive canals relative to CMD alone ( P = .0003). After CMD+PDT, 45 of 52 canals (86.5%) had no CFUs as compared with 24 of 49 canals (49%) treated with CMD (canal flush samples). The CFU reductions were similar when teeth or canals were treated as independent entities. Post-treatment detection levels for all species were markedly lower for canals treated by CMD+PDT than they were for those treated by CMD alone. Bacterial species within dentinal tubules were detected in 17 of 22 (77.3%) and 15 of 29 (51.7%) canals in the CMD and CMD+PDT groups, respectively ( P = .034). Conclusions Data indicate that PDT significantly reduces residual bacteria within the root canal system, and that PDT, if further enhanced by technical improvements, holds substantial promise as an adjunct to CMD.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>21238805</pmid><doi>10.1016/j.joen.2010.10.008</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Bacteria - radiation effects Chi-Square Distribution Combined Modality Therapy Debridement - methods Dental Pulp Cavity - microbiology Dental Pulp Cavity - radiation effects Dental Pulp Cavity - surgery Dental Pulp Necrosis - therapy Dentistry Disinfection - instrumentation Disinfection - methods Endocrinology & Metabolism Endodontic disinfection ex vivo Humans methylene blue Methylene Blue - radiation effects Methylene Blue - therapeutic use Periapical Periodontitis - therapy Photochemotherapy - instrumentation Photochemotherapy - methods photodynamic therapy Radiation-Sensitizing Agents - radiation effects Radiation-Sensitizing Agents - therapeutic use Root Canal Therapy - instrumentation Root Canal Therapy - methods Treatment Outcome |
| title | Endodontic Photodynamic Therapy Ex Vivo |
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