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Biomedical subjects

K Deguchi

Publications and source records attributed to K Deguchi.

At least 307 records · Page 17Linked to original sources
PubMed1986

[Studies on antimicrobial concentration of clindamycin phosphate in serum, pelvic dead space exudate, and pelvic organs/tissues].

In women undergoing radical and total abdominal hysterectomy, clindamycin phosphate (CLDM-P) in a dose of 1,200 mg was administered by intravenous drip infusion over 1 hour and the drug concentrations in serum and pelvic dead space exudate, as well as pelvic organs/tissues, were determined over time. The following results were obtained: The serum concentration of clindamycin (CLDM) after intravenous infusion showed the peak value of 24.54 +/- 7.02 micrograms/ml at the end of infusion and then gradually decreased to 3.87 +/- 0.70 micrograms/ml in 6 hours. Concentration in pelvic dead space exudate, which was 2.82 +/- 3.90 micrograms/ml at the end of intravenous infusion, gradually increased to the peak value of 13.49 +/- 6.62 micrograms/ml in 1 hour. Two hours after infusion, the level of 12.43 +/- 5.56 micrograms/ml outstripped serum concentration. Continuously in excess of serum concentration, the exudate concentration gradually decreased to 6.65 +/- 2.27 micrograms/ml at 6 hours after infusion. Cubital venous serum concentration (16.36 +/- 3.68 micrograms/ml) was almost equal to uterine arterial serum concentration (16.36 +/- 4.05 micrograms/ml) of CLDM at uterine removal. In the pelvic organ/tissue concentrations, 15.71 +/- 3.86 micrograms/g in endometrium was highest, followed by 15.19 +/- 3.80 micrograms/g in oviduct, 14.80 +/- 3.52 micrograms/g in myometrium, 14.74 +/- 4.02 micrograms/g in ovary, 14.09 +/- 2.90 micrograms/g in portio vaginalis. The concentration was lowest (11.49 +/- 1.44 micrograms/g) in cervix uteri. Clinically, combined treatment with CLDM-P and ceftizoxime was excellently effective for endometritis induced by P. asaccharolyticus.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[A study of concentration of ampicillin into middle ear effusion after administration of bacampicillin].

We studied the concentration of ampicillin (ABPC) into middle ear effusions after administration of bacampicillin (BAPC). Nine patients with acute purulent otitis media were given orally single doses of the drug at a level of 10 mg/kg, and concentrations of ABPC which is the active antibiotic metabolite of BAPC were determined in middle ear effusions periodically after the administration. Bacteria present in effusions were identified, and their ability to produce beta-lactamase was also determined. ABPC concentrations in middle ear effusions were inversely related to the ability of bacteria detected from the intratympanic cavity to produce beta-lactamase. ABPC concentrations in middle ear effusions from which only beta-lactamase negative organisms were detected were higher by 5.2- and 2.3- fold at 60 and 120 minutes after the administration of BAPC, respectively, than those in effusions from which beta-lactamase positive organisms were detected. ABPC concentrations achieved in middle ear effusions in cases where only beta-lactamase negative organisms were detected exceeded MIC80's of the drug against main causative bacteria of acute purulent otitis media such as Streptococcus pneumoniae, Streptococcus pyogenes, and Haemophilus influenzae. Because only 10% or less of these species produces beta-lactamase, BAPC appears to be one of the highly effective drugs in the treatment of this disease.

Acute Disease↗
PubMed1985

The potentiating effect of platelet on plasminogen activation by tissue plasminogen activator.

A new role for platelets in fibrinolysis is proposed. Platelets (euglobulin from platelet rich plasma and from human platelet extract) may potentiate plasminogen activation by tissue plasminogen activator (tPA). The potentiating activity was detected by both chromogenic substrate and fibrin plate analysis. The fibrinolysis-potentiating substance in the platelets required the presence of both tPA and plasminogen, suggesting that it potentiates the activation of plasminogen by tPA. This substance was not related to fibrinogen degradation products because it was also present in platelets from two afibrinogenemic patients and did not lose its activity when separated from fibrinogen-related antigen by Sepharose 2B gel filtration. Since platelets contain both activator(s) and inhibitor(s) of plasminogen activation by tPA, a balance between activator(s) and inhibitor(s) in platelets may also be required for control of the fibrinolytic pathway.

Antigen-Antibody Complex↗
PubMed1985

Bacteriological features and chemotherapy of adult acute purulent otitis media.

Eighty-eight patients from 16 to 79 years old, with acute purulent otitis media, were bacteriologically examined at the Otorhinolaryngology Department of a primary care hospital in Tokyo from July 1979 to May 1983. Fifty-six patients underwent paracentesis, and 32 patients exhibited otorrhea due to previous spontaneous perforation of the tympanic membrane. Bacteriologic cultures revealed the presence of Streptococcus pneumoniae (62.5 per cent), including S. pneumoniae Type III (28.1 per cent), Haemophilus influenzae (10.5 per cent), Staphylococcus aureus (11.5 per cent), and Streptococcus pyogenes (7.3 per cent). S. pneumoniae Type III had a notably high detection rate in patients from 50 to 79 years old (50-75 per cent). Because Haemophilus influenzae was detected at a relatively high rate in patients of all ages, if can be considered as a major causative pathogen of AOM. In 44 patients, selected mainly from those who underwent paracentesis, a comparative study of bacteria found in middle ear fluid and naso-pharyngeal mucus revealed the same bacteria in 43 out of 44 cases (97.7 per cent), indicating the presence of bacterial infection through the auditory canal. Antibiotics were selected according to an Expected Efficacy Index (EEI), the antibiotic of first choice being Ampicillin or Cefaclor.

Acute Disease↗
PubMed1985

[Study on the drug sensitivity of multiple drug-resistant Staphylococcus aureus].

Of clinically isolated Staphylococcus aureus showing resistance to multiple drugs among penicillins (PCs), cephem antibiotics (CEPs), aminoglycosides (AGs), minocycline (MINO) and fosfomycin (FOM), 64 strains were selected for the determination of MIC. Twenty-one drugs were used for the determination of MIC, with ampicillin (ABPC), cloxacillin (MCIPC), cephalothin (CET), cefazolin (CEZ), cefotiam (CTM), cefuroxime (CXM), cefamandole (CMD), cefotaxime (CTX), ceftizoxime (CZX), cefmenoxime (CMX), cefmetazole (CMZ), cefoxitin (CFX), latamoxef (LMOX), cefotetan (CTT), cefoperazone (CPZ), gentamicin (GM), dibekacin (DKB), tobramycin (TOB), amikacin (AMK), MINO, and FOM. MIC80 of each drug at 10(6) CFU/ml were: ABPC, MCIPC, CEZ, CTM, CXM, CTX, CZX, CMX, CFX, LMOX, CTT, CPZ, GM, DKB and TOB greater than 100 micrograms/ml; CET 50 micrograms/ml; CMD and AMK 25 micrograms/ml; CMZ 12.5 micrograms/ml; FOM 6.25 micrograms/ml; and MINO 0.78 micrograms/ml. The ratio of highly resistant strains with MIC greater than 100 micrograms/ml at 10(6) CFU/ml varied according to drug, and a difference tended to be seen in the degree of influence by resistant factors reflected upon MIC, e.g. drugs for which a high resistance of more than 50% was confirmed were ABPC, CXM, CZX, LMOX and TOB, and 20 approximately 30% MCIPC, CTM, CTX, CMX and CFX. MIC on MCIPC which has a correlation of structural activity with methicillin correlated with cephems (CEPs) resistance to a high degree, but many of the so-called new CEPs showed resistance even to the strains with a low MIC on MCIPC. It was assumed that CEPs resistant strains have multiple drug resistant factors based on the fact that such strains showed multiple drug resistance.(ABSTRACT TRUNCATED AT 250 WORDS)

Aminoglycosides↗
PubMed1985

[In vitro susceptibilities of causative organisms isolated from patients with primary respiratory tract infections to BRL 25000 (clavulanic acid/amoxicillin)].

The in vitro susceptibilities of various causative organisms recently isolated from patients with primary respiratory tract infections to BRL 25000 (a formulation of amoxicillin, 2 parts, and potassium clavulanate, 1 part), amoxicillin (AMPC), cefaclor (CCL), cephalexin (CEX), cefadroxil (CDX) and cefroxadine (CXD) were determined. beta-Lactamase producing strains were detected by nitrocefin chromogenic method and PCG acidometric method. The frequency of isolation of beta-lactamase production in strains of S. aureus, H. influenzae, B. catarrhalis and K. pneumoniae was 92%, 18%, 36% and 98%, respectively. Against S. aureus strains with MIC values to AMPC of less than or equal to 100 micrograms/ml and CEX of less than or equal to 25 micrograms/ml BRL 25000 showed MIC values in the range 0.39-6.25 micrograms/ml with inocula of 10(6) CFU/ml, while BRL 25000 required 12.5-100 micrograms/ml of concentrations for inhibition of the strains with MIC values to AMPC of greater than 100 micrograms/ml and CEX of greater than or equal to 25 micrograms/ml. Against S. pyogenes and S. pneumoniae BRL 25000 showed MIC values in the range less than 0.024-0.10 micrograms/ml with inocula of 10(6) CFU/ml, which is much more active than CCL, CEX, CDX and CXD and slight less active than AMPC. Against H. influenzae and B. catarrhalis BRL 25000 showed MIC values in the range 0.20-6.25 micrograms/ml with inocula of 10(6) CFU/ml, which showed most potent activity among the agents tested. The activity of BRL 25000 against K. pneumoniae was approximately equal to that of CCL and superior to that of AMPC, CEX, CDX and CXD.

Amoxicillin↗
PubMed1985

[Distribution and changes in the susceptibility of bacteria isolated from clinical samples. II].

In vitro activity of antimicrobial agents such as ABPC, SBPC, MPC, CEZ, CTM, CMZ, CTX, CMX, CZX, LMOX, CPZ, CFS and GM against major clinical isolates, S. aureus, S. pyogenes, E. coli, K. pneumoniae, P. mirabilis, C. freundii, Enterobacter spp., S. marcescens, P. vulgaris and P. aeruginosa, was examined. In this paper, we will report the susceptibility of S. aureus, S. pyogenes, E. coli, K. pneumoniae and P. mirabilis during a three-year period, 1981 to approximately 1983. CEZ- and GM-resistant S. aureus has markedly increased and occupied 24% and 18%, respectively, in 1983. CMZ and CFS have showed potent activity against CEZ-resistant S. aureus. It seems that the abuse of third generation-cephems and new oral cephalosporins is closely related with the increase of cephems-resistant S. aureus. The penicillin- and cephem-resistant strains of S. pyogenes could not be found in our study. Quite a few strains of E. coli, K. pneumoniae and P. mirabilis are resistant to penicillins, and also there is no appreciable change in susceptibility. Some strains of E. coli, K. pneumoniae and P. mirabilis showed low susceptibility to CPZ, but all strains showed high susceptibility and no change in susceptibility to third generations, and these strains showed no tendency to decrease in susceptibility to GM.

Anti-Bacterial Agents↗
PubMed1985

[Study of clinical bacteriological efficacy in a cefmenoxime ototopical solution].

One percent cefmenoxime (CMX) ototopical solution was administered to 302 patients with purulent otitis media and acute diffuse external otitis in open study fashion, and to 216 patients with purulent otitis media in double blind condition. From among the total of 518 cases various bacteria were detected, except 22 of negative detection after incubation and 3 of impossible determination. The main bacteria detected from the above 493 cases were S. aureus (242 strains = 49.1%), P. aeruginosa (105 strains = 21.3%), S. epidermidis (67 strains = 13.6%), Proteus spp. (indole positive) (31 strains = 6.3%) and P. mirabilis (24 strains = 4.9%) as well as anaerobic bacteria (26 strains = 5.3%). MIC of CMX against those bacteria detected was evaluated at 10(8) CFU/ml and 10(6) CFU/ml, respectively, up to the concentration of 800 micrograms/ml, with MIC of cefazolin (CEZ), chloramphenicol (CP) and fradiomycin (FRM) as the references. With respect to the antibacterial action of CMX against S. aureus, MIC50 of CMX was inferior to that of CEZ by 4-fold, but its MIC80 and MIC90 are almost equivalent to those of CEZ. These results were obtained because there existed relatively few CMX highly resistant strains, while more than 20% strains are said to resist cephem antibiotics. As far as MIC of CMX against P. aeruginosa was concerned, the MIC reached its peak with 100 micrograms/ml at the concentration of 10(8) CFU/ml and with 25 micrograms/ml at 10(6) CFU/ml, respectively, which indicated the real antibacterial value of CMX against P. aeruginosa. However, the strains which showed higher MIC of greater than 800 micrograms/ml were rather few, that is, only 8 out of 105 (7.6%). Antibacterial action of CMX against Streptococcus (except Enterococcus), GNR from intestinal bacteria and anaerobic bacteria was favorable, and the stable and strong antibacterial action was shown against C. freundii, Enterobacter spp., S. marcescens and Proteus spp. (indole positive) which produce chromosome mediated beta-lactamase. On the other hand, the antibacterial action of CMX against GNF-GNR except P. aeruginosa was unfavorable for P. cepacia, P. putida and A. xylosoxidans, but relatively favorable for A. calcoaceticus. As a result of MIC evaluation of reference drugs, S. aureus was resistant to CEZ, and Proteus spp. (indole-positive) was resistant to CP, while FRM was highly resisted by almost all strains of bacteria. However, the resistance rate of S. aureus to CP was relatively low, that is, as low as 16.1%.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Topical↗
PubMed1985

[Distribution and changes in the susceptibility of bacteria isolated from clinical samples. III].

This report presents data concerning in vitro activity of antimicrobial agents against Citrobacter freundii, Enterobacter spp., Serratia marcescens and Proteus vulgaris isolated from patients with complicated urinary tract infections and against Pseudomonas aeruginosa isolated from surgical wounds with postoperative infection and exudate from superficial abscesses. There was a marked increase of resistant strains of C. freundii, Enterobacter spp. and S. marcescens to penicillins, CEPs or GM. The isolates of these species obtained in 1983 showed MIC values of 100 micrograms/ml or more for the so-called new CEPs (CTX, CMX, CZX, LMOX and CPZ). The P. vulgaris isolates exhibited an increasing incidence of strains resistant to penicillins, and data on P. vulgaris isolates in 1983 indicated increase of strains resistant to CEPs. GM-resistant organisms were also noted to be increasing among the isolate of this species. The analysis did not reveal any appreciable change with calendar years among P. aeruginosa in respect of frequency of strains resistant to SBPC or CEPs (except CPZ). The data obtained in 1983, however, showed an indication of increasing incidence of organisms resistant to CPZ and GM. The increasing tendency of emergence of organisms resistant to new CEPs designed to expand activity against C. freundii, Enterobacter spp., S. marcescens and P. vulgaris, observed among the isolates of these species is considered probably to be the consequence of bacterial selective acquisition of R plasmid that carry drug resistant genes against CEPs. These are exactly reflected in the present data obtained in studies initiated in 1981 when the new CEPs became commonly prescribed in the daily clinics. It is concluded, accordingly, that organisms of these species resistant to CEPs have been increasing throughout the country.

Anti-Bacterial Agents↗
PubMed1985

[Study on the transfer of cefroxadine to human tears].

A comparative study to determine the transfer of cefroxadine (CXD), an oral cephem antibiotic, to the human tears was undertaken using cephalexin (CEX) as the control drug. The mean tear levels of 250 mg each of CXD and CEX after oral administration in 6 volunteers were equally peaked at 0.26 micrograms/ml with CXD after 1 to 2 hours and with CEX after 2 hours. The changes of tear levels were also equal for both drugs. The ratios between the tear and the blood levels at 2 hours after oral administration were almost equal with 4.1% for CXD and 3.7% for CEX. From the above evidence it has been confirmed that the both drugs were equivalent with regard to the concentration profiles in human tears after oral medication.

Administration, Oral↗
PubMed1984

Importance of the interaction between plasminogen and fibrin for plasminogen activation by tissue-type plasminogen activator.

The potentiating effect of fibrin monomer on plasminogen activation by tissue-type plasminogen activator is much more important with lys-plasminogen than with mini-plasminogen (which lacks the high affinity lysine-binding site important for binding to fibrin). Furthermore, this potentiating effect is totally abolished when lys-plasminogen is eluted from fibrin by the addition of 1 mM epsilon-amino caproic acid. Binding does however not seem to be the only condition required since it was found that fragment D is a much stronger potentiator of the activation of plasminogen by tissue-type plasminogen activator than fragment E although plasminogen binds to both fragment D and fragment E. Furthermore, fragment E has the same effect on the activation of lys-and mini-plasminogen by tissue-type plasminogen activator. Therefore, it is suggested that binding of plasminogen to fibrin involves a conformational change in the plasminogen molecule, facilitating its activation by tissue-type plasminogen activator.

Aminocaproic Acid↗
PubMed1984

[MICs and MBCs of cefotaxime, desacetylcefotaxime and ceftriaxone against four principal bacteria causing meningitis].

The MICs and MBCs of cefotaxime (CTX), desacetylcefotaxime (Des-CTX) and ceftriaxone (CTRX) were determined in relation to 4 of the principal bacterial species which cause meningitis, i.e., S. pneumoniae, S. agalactiae, H. influenzae and E. coli. These tests were performed using final inocula of 10(8) cells/ml and 10(6) cells/ml. Comparison was made with the MIC and MBC values of benzylpenicillin (PCG) and ampicillin (ABPC). 1. Against 25 strains of S. pneumoniae, the MIC 90 values with inocula levels of 10(8) and 10(6) cells/ml were as follows: CTX, 0.05 and 0.024 micrograms/ml; Des-CTX, 0.39 and 0.20 micrograms/ml; CTRX, 0.10 and 0.05 micrograms/ml, respectively; and PCG, less than 0.012 micrograms/ml at both size. Similarly, the MBC 90 values were: CTX, 0.01 and 0.05 micrograms/ml; Des-CTX, 0.78 and 0.39 micrograms/ml; CTRX, 0.20 and 0.10 micrograms/ml; and PCG, 0.024 and 0.012 micrograms/ml, respectively. It is thus apparent that PCG showed the lowest values for both the MIC and MBC, followed by CTX, CTRX and then Des-CTX. Against 25 strains of S. agalactiae, the MIC 90 values with inocula of 10(8) and 10(6) cells/ml were as follows: CTX, 0.05 and 0.05 micrograms/ml; Des-CTX, 0.39 and 0.20 micrograms/ml; CTRX, 0.10 and 0.05 micrograms/ml; and PCG, 0.39 and 0.20 micrograms/ml, respectively. Similarly, the MBC 90 values of Des-CTX were 0.78 and 0.39 micrograms/ml, while the other 3 antibiotics showed the same values with both the 10(8) and 10(6) cells/ml inocula: 0.10 micrograms/ml for CTX, 0.20 micrograms/ml for CTRX and 0.39 micrograms/ml for PCG. Accordingly, CTX showed the lowest values, followed by CTRX and then PCG being about the same as Des-CTX. Against 25 strains of H. influenzae, the MIC 90 values with inocula levels of 10(8) and 10(6) cells/ml were as follows: CTX, 0.10 and 0.05 micrograms/ml; Des-CTX, 0.39 and 0.39 micrograms/ml; CTRX, 0.10 and 0.05 micrograms/ml; and ABPC, 50 and 6.25 micrograms/ml, respectively. Similarly, the MBC 90 values were: CTX, 0.20 and 0.10 micrograms/ml; Des-CTX, 1.56 and 1.56 micrograms/ml; CTRX, 0.39 and 0.20 micrograms/ml; and ABPC, greater than 100 and 50 micrograms/ml, respectively. Accordingly, in terms of the MIC 90, CTX and CTRX showed the same values, but in terms of the MBC 90 CTX was superior. (ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1984

[Comparative studies of DL-8280 and pipemidic acid in complicated urinary tract infections by double-blind method].

The clinical efficacy, safety and usefulness of DL-8280 for the treatment of complicated urinary tract infections were compared with those of pipemidic acid (PPA) by a double-blind method. DL-8280 and PPA were orally administered at a daily dose of 600 mg (t.i.d.) and 2.0 g (q.i.d.) for 5 days, respectively. Of the 311 patients who received DL-8280 or PPA, clinical efficacy, safety and usefulness were evaluated in 228 patients (DL-8280, 115; PPA, 113), 306 patients (DL-8280, 153; PPA, 153) and 250 patients (DL-8280, 124; PPA, 126), respectively. There was no significant difference in the background characteristics between the two groups. In the DL-8280 group the overall clinical efficacy was excellent in 39.1% and moderate in 41.7%, the effectiveness rate being 80.9%, whereas in the PPA group it was excellent in 23.9% and moderate in 33.6%, the effectiveness rate being 57.5%. The efficacy in the DL-8280 group was significantly higher than that in the PPA group (P less than 0.001). According to classification by the type of infection, the overall clinical efficacy of DL-8280 in groups except group 2 (monomicrobial infection, post prostatectomy) and group 3 (monomicrobial infection, upper urinary tract infection) was superior to that of PPA, the difference being significant. Pyuria was cleared or improved in 59.1% of the patients treated with DL-8280 and in 46.0% of the patients with PPA. The difference was not significant. Bacteriuria was eliminated in 76.5% in the DL-8280 group and in 50.4% in the PPA group. DL-8280 demonstrated a significantly higher response than PPA (P less than 0.001). Of the bacteria isolated from the DL-8280 group and PPA group 89.0% and 72.1%, respectively, were eradicated after the treatment, a significant difference being observed between the two groups (P less than 0.001). The clinical efficacy evaluated by the doctor in charge was excellent in 46.1% and good in 37.4% of the patients treated with DL-8280 and excellent in 26.5% and good in 34.5% of the patients treated with PPA, the intergroup difference in the efficacy being significant (P less than 0.001). The evaluation of usefulness of DL-8280 and PPA was "satisfactory" for 71.8% and 47.6%, respectively, the difference being significant (P less than 0.001). Side effects were observed in 11 patients (7.2%) in the DL-8280 group and in 12 patients (7.8%) in the PPA group, but none were serious.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Oral↗
PubMed1984

Microorganisms isolated from infected aural fistulas.

Aural fistula is a congenital deformity of the external ear relatively common in Orientals and rare in Caucasians. Suppuration tends to occur, and chemotherapy rather than surgical drainage should be attempted. However, the lack of information concerning infected aural fistulas has made appropriate chemotherapy difficult. Microorganisms isolated from 13 cases of infected aural fistulas were studied from January 1981 to December 1982. Six species and 22 strains were isolated; nonsporeforming faculative anaerobes were detected in 12 cases. The isolated pathogens included Peptococcus sp (10 cases), Peptostreptococcus sp (3), Bacteroides sp (3), and Fusobacterium sp (2). One case exhibited only Staphylococcus aureus. Our data also stresses the etiologic importance of anaerobic gram-positive cocci in infected aural fistulas.

Abscess↗
PubMed1984

[Study of lincomycin concentrations in hepatocystic duct].

Penetration of lincomycin (LCM) in choledochal and cholecystic bile as well as in the gallbladder tissue and liver tissue was investigated together with bacteria detectable in the bile in order to evaluate basically usefulness of this antibiotic in the treatment of infections of the hepatocystic duct. Intravenous drip infusion of LCM 1.5 g (in 500 ml of 5% glucose solution) over 1.5--2 hours resulted in mean drug concentrations of 33.9 and 10.1 micrograms/ml in serum at 2 and 4 hours post start of infusion respectively; 215.5 micrograms/ml in choledochal bile at 3 hours 15 minutes; 252.7 micrograms/ml in cholecystic bile at 3 hours 36 minutes; 28.1 micrograms/g in gallbladder tissue at 2 hours 55 minutes; and 15.4 micrograms/g in liver tissue at 4 hours. A cross-over study of LCM and cefazolin (CEZ) in 2 cases where T-tubes were employed demonstrated evidently higher biliary levels of LCM than CEZ. Bacteriological examination showed that Hafnia alvei plus Streptococcus faecalis were presented in choledochal bile from just 1 of 4 cases while in cholecystic bile from 9 of 15 cases were detected 22 strains of organisms including Klebsiella pneumoniae (7 strains), Bacteroides fragilis (5), Escherichia coli (2), Citrobacter freundii (2) and Serratia marcescens (2). A total of 7 strains of anaerobes including B. fragilis was isolated. The above concentrations of LCM in the bile, gallbladder tissue and liver tissue sufficiently covered the MIC90 of this antibiotic determined by us in 1980 for major species of anaerobes including clinical isolates of B. fragilis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗