Biomedical subjects

M Franchi

Publications and source records attributed to M Franchi.

At least 55 records · Page 3Linked to original sources

PubMed1999

Prenatal assessment of Wharton's jelly in umbilical cords with single artery.

OBJECTIVE: To investigate whether the amount of Wharton's jelly in non-malformed fetuses with a single umbilical artery is different from that of fetuses with a normal umbilical cord. METHODS: We evaluated patients with singleton pregnancies, non-malformed fetuses and single umbilical artery undergoing sonographic evaluation at a gestational age ranging from 19 to 41 weeks' gestation. The cross-sectional areas of the umbilical cord and of the umbilical vessels were measured. The amount of Wharton's jelly was calculated by subtracting from the total cross-sectional area of the umbilical cord the areas of the artery and of the vein. The umbilical cord cross-sectional area, the umbilical artery and vein areas as well as the amount of Wharton's jelly were plotted on previously published nomograms. RESULTS: Twenty-two patients met the inclusion criteria. The umbilical cord cross-sectional area was within the normal range in 20 (90.1%) cases. The umbilical artery and vein areas were above 2 standard deviations from the mean in 20 cases and in 11 cases (50%), respectively. The amount of Wharton's jelly was below 2 standard deviations from the mean in all cases. An abnormal insertion of the umbilical cord (marginal, velamentous) was present in five cases (22.7%). CONCLUSIONS: A reduction of Wharton's jelly is frequently present in cases of single umbilical artery. The increased perinatal morbidity and mortality observed in cases of single umbilical artery, even in the absence of congenital or chromosomal abnormalities, could be in part the consequence of a reduced amount of Wharton's jelly.

Adult↗

PubMed1999

Prenatal assessment of the Hyrtl anastomosis and evaluation of its function: case report.

The presence of a communicating vessel, the Hyrtl anastomosis, between the umbilical arteries is well described in pathological studies. Using different injection techniques, it has been speculated that this vessel acts as a pressure-equalizing mechanism between the different lobes of the placenta. However, its detection during fetal life has never been reported. We report on two cases of ultrasonographic detection and Doppler assessment of the Hyrtl anastomosis during pregnancy. A pulsatile blood flow from the umbilical artery with higher resistance to that with lower resistance has been demonstrated at the level of the Hyrtl anastomosis, which was confirmed after delivery. In addition, this report supports the hypothesis that the anastomosis plays an important role in regulating the blood pressure in the placental lobes and in equalizing the blood pressure between umbilical arteries.

Adult↗

PubMed1999

[The role of antenatal courses in preventing the onset of altered pelvic statics and urinary incontinence].

BACKGROUND AND AIMS: This study was prompted by the frequent finding of urinary incontinence in peri- and postmenopausal women. In an attempt to reduce this incidence, the authors evaluated the role of antenatal courses as an important preventive and operative means of providing information aimed at preventing the onset of alterations to pelvic statics and urinary incontinence. The clinical data of 40 puerperae, of whom 45% had followed our antenatal course, were examined for this purpose. METHODS: A functional examination of the perineum was made in all subjects on discharge after birth and 6 months later. RESULTS: These findings appear to indicate that antenatal courses play an important role in preventing obstetric perineal complications. CONCLUSIONS: During the courses all women were given useful advice on hygiene and diet, including guidelines for suitable regular exercise, the need to drink about 1 litre of unsweetened liquid daily, a balanced diet and advice regardingf perineal relaxation. Subsequently, all subjects were advised to continue exercising after birth to ensure the correct rehabilitation of the perineal floor and they were also given a sheet containing the different learnt during the antenatal courses. In this way these subjects increased their awareness of the need not to underestimate the early symptoms of urinary incontinence should they occur after birth.

Adult↗

PubMed1999

[Perineal modification in pregnancy and puerperium, risk of urinary incontinence].

UNLABELLED: Pregnancy and delivery are important etiopathological factors in the alteration of pelvic equilibrium; in particular and the first delivery is the decisive factor in terms of perineal sequelae affecting pelvic equilibrium and urinary continence. Epidemiological studies have identified a number of pathogenic risk factors related to pregnancy (abnormal increase in maternal weight, diabetes in pregnancy and macrosoma) and the newborn (cranial circumference, newborn weight). Mechanical stress caused by the passage of the fetus may lead to the overstretching of the pelvic floor and the failure to recognise muscular damage even in the absence of macroscopic lesions. In the immediate postpartum or after a number of years these may damage the function of the musculo-aponeurotic structures of the perineum and foster the onset of alterations to pelvic equilibrium and urinary incontinence. In this study the authors have evaluated the modifications to the perineum and continence during pregnancy and puerperium. METHODS: Clinical data were analysed for 40 puerperae all of whom underwent a through perineal examination to assess the function of perineal muscles, both on discharge and 6 months after delivery. RESULTS: The authors tried to identify the main risk factors which predisposed the onset of changes to pelvic equilibrium and urinary continence. On the basis of the contemporary outcome of the Q-TIP test and TP, all women were divided into 4 groups: Group A (TP < 3 and positive Q-TIP test) (22.5%). CONCLUSIONS: In the light of these results, the authors affirm that during gestation it is important to concentrate preventive action on these risk factors.

Adult↗

PubMed1999

[Hypertension in pregnancy. Retrospective epidemiologic study].

BACKGROUND: Pregnancy hypertension today has not a valid etiological explanation. It's possible however that the association of more factors could determine the symptoms. The pregnancy hypertensive disorders are not uncommon, with an incidence estimated from 6 to 8%. Epidemiological studies have shown hypertension in pregnancy increases fetal and maternal mortality and morbidity. Preterm delivery is more common in women with hypertension in pregnancy. The aim of this retrospective study was to verify some epidemiological aspects of pregnancy hypertension at the IV Divisions of I Institute of Obstetrics and Gynaecology of the "La Sapienza" University of Rome. METHODS: 1926 pregnant women have been hospitalised at the IV Division from January 1993 to December 1997. Of these 101 had hypertension. Age, hypertension degree, type of job, smoking, parity, previous hypertension developed by patients and their relatives, birthweight, stage of development of hypertension and delivery procedures have been evaluated in this group. RESULTS: The main data obtained from this study are: strong correlation of primiparity and hypertension (55, 45% of observations); increased risk to have hypertension induced by pregnancy in women that have just incurred in hypertension in previous pregnancy; the high incidence of caesarean section in the group considered with respect to the general population (70.9%). CONCLUSIONS: Hypertension is still a frequent disorder in pregnancy which may lead to serious complications.

Adult↗

PubMed1999

[Stark's method of cesarean section. Advantages compared to the traditional method].

BACKGROUND AND AIM: The increased incidence of caesarean section has led, over the past few years, to the revision of surgical methods in order to reduce fetus extraction time and the total costs of surgery, without detracting from cosmetic advantages. Stark devised a surgical technique for this purpose which aims to reduce operating trauma and duration of surgery and to ensure a faster recovery and greater well being. METHODS: We performed a retrospective study in all patients undergoing caesarean section using Stark's technique and we evaluated their postoperative progress based on body temperature and any complications involving the suture (infections, hematoma, adhesions, pain). The results were compared to those obtained by other authors using traditional caesarean section. RESULTS: It was found that patients undergoing traditional caesarean section showed an incidence of wound infection which was higher than that observed in the Stark group (8.75%). Likewise, in relation to the onset of hypothermia, only 3 cases (3.75%) were observed in this study. CONCLUSIONS: Reduced short- and long-term maternal morbidity was obtained using this technique, together with a lower incidence of febrile morbidity and wound infection, less pain and a decreased risk of visceral adhesion.

Cesarean Section↗

PubMed1998

Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation.

OBJECTIVE: To assess the efficacy of two laparoscopic methods for the management of endometriomas with regard to pain relief, pregnancy rate, and disease recurrence. DESIGN: Prospective, randomized clinical trial. SETTING: Tertiary care hospital. PATIENT(S): Sixty-four patients with advanced stages of endometriosis. INTERVENTION(S): Patients were randomly allocated at the time of laparoscopy to undergo either cystectomy of the endometrioma (group 1) or drainage of the endometrioma and bipolar coagulation of the inner lining (group 2). MAIN OUTCOME MEASURE(S): Pain relief and pregnancy rate. RESULT(S): Thirty-two patients were enrolled in each group. The 24-month cumulative recurrence rates of dysmenorrhea, deep dyspareunia, and nonmenstrual pelvic pain were lower in group 1 than in group 2 (dysmenorrhea: 15.8% versus 52.9%; deep dyspareunia: 20% versus 75%; nonmenstrual pelvic pain: 10% versus 52.9%). The median interval between the operation and the recurrence of moderate to severe pelvic pain was longer in group 1 than in group 2 (19 months [range, 13.5-24 months] versus 9.5 months [range, 3-20 months]). The 24-month cumulative pregnancy rate was higher in group 1 than in group 2 (66.7% versus 23.5%). CONCLUSION(S): For the treatment of ovarian endometriomas, a better outcome with a similar rate of complications is achieved with laparoscopic cystectomy than with drainage and coagulation.

Adult↗

PubMed1998

Isolated hydramnios at term gestation and the occurrence of peripartum complications.

OBJECTIVE: To determine if hydramnios at term gestation is an independent risk factor for poor pregnancy outcome and perinatal death. STUDY DESIGN: The study population consisted of 60,702 patients with singleton gestation who delivered at term (>37 weeks). Patients were classified into two groups according to the presence or the absence of hydramnios. Hydramnios was diagnosed in the presence of an amniotic fluid index greater than 25 cm or of a maximum vertical pocket of amniotic fluid of at least 8 cm or by subjective assessment. Logistic regression analysis was used to evaluate the unique contribution of hydramnios to fetal death and to perinatal and maternal morbidity. RESULTS: The prevalence of hydramnios was 1211/60,702 (2%). Patients with hydramnios had a higher incidence of complications than those with a normal amount of amniotic fluid: cesarean section (22.8 vs. 8.5%, P<0.01), antepartum death (0.6 vs. 0.2%, P<0.005), postpartum death (2.8 vs. 0.4%, P<0.01), abruptio placenta (0.9 vs. 0.3%, P<0.001), fetal distress (6.1 vs. 3.65%, P<0.0015), meconium-stained amniotic fluid (17.8 vs. 15%, P<0.001), low Apgar score at 5 min (2.95 vs. 1%, P<0.01), malpresentation (6.8 vs. 2.9%, P<0.01), clinical chorioamnionitis (0.3 vs. 0.1%, P<0.05), prolapse of cord (2.2 vs. 0.3%, P<0.01), and large-for-gestational-age infant (LGA) (23.8 vs. 8.1%, P<0.01). When adjusted for confounding variables, the presence of hydramnios remained strongly associated with perinatal mortality (odds ratio 5.5 (95% CI 3.2-9.3)) and neonatal and maternal morbidity (odds ratios 2.1 (CI 1.1-3.7) and 2.3 (CI 1.9-2.7), respectively). CONCLUSIONS: (1) Hydramnios at term is an independent risk factor for perinatal death; (2) Fetal surveillance is warranted in patients with hydramnios even in the absence of other known risk factors for adverse pregnancy outcome.

Adult↗

PubMed1998

A randomized comparison of vaginal prostaglandin E2 with oxytocin plus amniotomy for induction of labour in women with intermediately ripe cervices.

OBJECTIVE: To compare the effects of oxytocin and amniotomy or vaginal prostaglandin E2 (PGE2) for induction of labour. STUDY DESIGN: We conducted a randomized clinical trial. Eligible for the trial were women with normal pregnancy, parity 0-3, with intact membranes, >40 weeks of gestation documented by ultrasound examination before 20 weeks gestation, observed in a network of 13 general and teaching hospitals in Italy. Inclusion criteria were cervical Bishop's score 5-7, less than six uterine contractions per hour, single pregnancy, cephalic presentation, no history of cesarean section and uterine surgery. Eligible women were randomly assigned by phone to oxytocin plus amniotomy (163 women) or vaginal PGE2 2 mg, two doses at 6-h intervals (157 women). RESULTS: Overall, 50 women (15.6%) delivered by cesarean section, 22 (13.5%) randomized to oxytocin, and 28 (17.8%) randomized to PGE2 (not significant). Twelve hours after randomization, induction had failed in 26 women of the 163 randomized to oxytocin plus amniotomy (21.6%) and 34 out of the 157 randomized to PGE2 (15.9%): the difference was not significant. Neonatal outcome was similar in the two groups. CONCLUSIONS: This study did not find marked differences in labour and neonatal outcome between women randomized to oxytocin plus amniotomy or vaginal PGE2. A shorter induction delivery interval in the group receiving amniotomy and oxytocin after PGE2 priming was observed.

Administration, Intravaginal↗

PubMed1998

Peripartum complications in grand multiparous women: para 6-9 versus para > or =10.

OBJECTIVE: To assess the importance of birth order and advanced maternal age on maternal and peripartum complications. STUDY DESIGN: The study population consisted of 12 296 multiparous women (six deliveries or more) with singleton gestation. Patients were classified into two groups according to the birth order: grand multiparous (between six and nine deliveries) and huge multiparous (ten or more deliveries). Peripartum complication was defined when at least one of the following conditions occurred: massive hemorrhage, uterine rupture, abruptio placentae, dysfunctional labor or malpresentations. Logistic regression analysis was used to evaluate the relationship between birth order and maternal age and peripartum complications. RESULTS: Among the study population, 9587 (78%) were grand multiparous and the remaining 2709 were huge multiparous women. The rate of peripartum complications was higher in huge multiparous than in grand multiparous women: malpresentation (6.2% versus 5%, P<.005), massive hemorrhage (0.7% versus 0.4%, P<.001) and dysfunctional labor (6.4% versus 3.5%, P<.001). Huge multiparous women also had a higher rate of the following complications than grand multiparous women: cesarean section (14.4% versus 10.4%, P<.01), chronic hypertension (7.9% versus 3%, P<.001), severe pregnancy induced hypertension (2.6% versus 1.1%, P<.01), diabetes class A (10.7% versus 7.5%, P<.005), diabetes class B-R (4.3% versus 2%, P<.01) congenital anomalies (3.3% versus 2.6%, P<.05) and large for gestational age infant, (17% versus 12.4%, P<.01). When adjusted for maternal age, high birth order remained strongly associated with the occurrence of peripartum complications. CONCLUSIONS: Huge multiparity was associated with a higher rate of maternal and peripartum complications than grand multiparity. Higher birth order remained an independent risk factor for peripartum complications after adjustment for maternal age.

Abruptio Placentae↗

PubMed1998

Collagen fibril arrangement and size distribution in monkey oral mucosa.

Collagen fibre organisation and fibril size were studied in the buccal gingival and hard palate mucosa of Macacus rhesus monkey. Light and electron microscopy analysis showed connective papillae exhibiting a similar inner structure in the different areas examined, but varying in distribution, shape and size. Moving from the deep to surface layers of the buccal gingival mucosa (free and attached portions), large collagen fibril bundles became smaller and progressively more wavy with decreasing collagen fibril diameter. This gradual diameter decrease did not occur in the hard palate mucosa (free portion, rugae and interrugal regions) where the fibril diameter remained constant. A link between collagen fibril diameter and mechanical function is discussed.

Animals↗

PubMed1998

A randomized clinical trial of two surgical techniques for cesarean section.

The Joel-Cohen incision followed by nonclosure of pelvic and parietal peritoneum has been advocated as an alternative method to the Pfannenstiel incision with peritonealization at cesarean section. A randomized trial was designed to compare intra- and postoperative morbidity between the two techniques. Women to undergo a cesarean section were randomly allocated to have either the Joel-Cohen incision with the parietal and pelvic peritoneum left open (group 1) or to have the Pfannenstiel incision with both peritoneal layers sutured (group 2). The myometrium was closed with 1-0 polyglactin 910 suture using a continuous single-layer nonlocking technique. Patients in group 2 had the peritoneum approximated with 2-0 polyglactin 910 suture. The fascia was sutured with continuous 1-0 polyglactin 910 suture in all cases. Opening time was defined as the interval from skin incision to the opening of the uterine cavity. Febrile morbidity was defined as a temperature > or =38 degrees C on two occasions 4 hours (hr) apart excluding the first postoperative day. Endometritis was defined as postpartum temperature > or =38 degrees C on two occasions 4 hr apart, with uterine tenderness and/or foul-smelling lochia. One hundred forty-nine and 150 patients were allocated to group 1 and to group 2, respectively. A shorter median (range) opening time [4 min (2-21) vs. 6 min (2-19), respectively, p < 0.01] and a shorter median (range) operative time [30 min (10-65) vs. 40 min (20-110), respectively, p < 0.01] were observed in group 1. No difference was found in terms of intraoperative complications, proportion of patients who required transfusion, endometritis, sepsis, febrile morbidity, and urinary tract infections. A higher rate of wound infections was found in group 2 than in group 1 [14 of 150 (9.3%) vs. 2 of 149 (1.3%), respectively, p < 0.01]. The Joel-Cohen incision without peritonealization resulted in a shorter opening and total operative time than the Pfannenstiel laparotomy with peritonealization. This was accomplished with a reduction of wound infections.

Adult↗

PubMed1998

Acid fast filaments in stool samples from an AIDS patient.

The presence of filamentous bacteria morphologically similar to Nocardia in a fresh stool sample from an AIDS patient with pulmonary nocardiosis is here reported. The material was submitted to our laboratory for a parasitologic examination and was stained by the Kinyoun method, revealing numerous delicate, irregularly stained, branching acid-fast filaments. Nocardia asteroides had been isolated from sputum samples of this patient. The patient was a 32 year-old HIV+ female admitted to our center on June 1997 because of productive cough, right-sided thoracic pain and weight loss. Chest X rays showed the presence of right superior lobe excavated pneumonia. This was the first time we had observed filamentous bacteria similar to Nocardia in a stool sample submitted to parasitologic examination. For similar cases, and when its presence was not detected in other specimens collected from the same patient, intestinal endoscopy and biopsy should be performed for eventual lesions and smear examination repeated with Kinyoun stain and cultures for Nocardia.

AIDS-Related Opportunistic Infections↗

PubMed1997

Nonclosure of peritoneum at radical abdominal hysterectomy and pelvic node dissection: a randomized study.

OBJECTIVE: To compare closure and nonclosure of the peritoneum at radical abdominal hysterectomy and pelvic node dissection with respect to postoperative morbidity. METHODS: Women with uterine cancer who underwent radical abdominal hysterectomy and node dissection type II or III of Piver-Rutledge were assigned randomly to have a standard closure of pelvic and parietal peritoneum and placement of a T-shaped suction drain or to have the peritoneum left open but the vagina closed and two abdominal drains placed. Adjuvant radiotherapy was given to patients with risk factors. The postoperative incidence of lymphocysts (within 8 weeks from the operation and after 1 year) and infection-related and non-infection-related complications were analyzed. RESULTS: One hundred twenty subjects were enrolled, of whom 59 had peritoneal closure and 61 did not. Both groups were similar with regard to age, weight, nodes removed, nodal metastases, operative time, type of surgery, need for transfusion, and incidence of postoperative radiotherapy. The median follow-up was 36 months (range 11-72). Eleven patients died, four because of treatment-related complications. The amount of drainage was significantly higher in the closed group than in the unclosed group (median 740 mL, range 50-5980 versus median 340 mL, range 40-4000; P < .005). The incidence of asymptomatic lymphocysts was similar in the closed and open groups at 2 weeks (17 of 59 versus 15 of 6, respectively), at 8 weeks (eight of 56 versus ten of 61, respectively), and after 1 year (one of 21 versus four of 22, respectively). No difference was found between closed and open groups in terms of symptomatic lymphocysts (one of 59 versus two of 61, respectively), wound and pelvic infection (seven of 59 versus 11 of 61, respectively), febrile morbidity (two of 59 versus 11 of 61, respectively), and obstruction (zero of 59 versus one of 61, respectively). CONCLUSION: Nonclosure of the peritoneum at radical abdominal hysterectomy and node dissection is not hazardous and is not associated with an increased incidence of infection- or adhesion-related complications.

Adult↗

PubMed1997

Involvement of chromosome 6 in endometrial cancer.

Cytogenetic investigation was performed on direct preparations of 15 endometrial cancers showing different histotypes. Clonal abnormalities were found in 11 out of 13 analysable cases. The modal chromosome number was near diploid in all cases. The abnormal karyotypes contained relatively simple numerical or structural aberrations in the majority of tumours. In contrast, two neoplasms with serous papillary and mixed mullerian morphological features shared multiple complex changes as well as cytogenetic evidence of intratumoral heterogeneity. The most frequent chromosome abnormality in our series of endometrial neoplasms was 6q deletion, which was detected in serous papillary, endometrioid and mixed mullerian tumours. The loss of the 6q region, which is also frequently involved in ovarian carcinoma, suggests a relationship between endometrial and ovarian cancers based on a common histogenesis.

Adenocarcinoma↗

PubMed1996

Early involvement of 6q in surface epithelial ovarian tumors.

Complex karyotypes are often seen in primary surface epithelial ovarian tumors (SEOTs). Conventional cytogenetic as well as fluorescence in situ hybridization analyses coupled with loss of heterozygosity studies identified abnormalities of chromosome 6 as one of the most frequent lesions in these types of tumors. We performed cytogenetic analysis of direct preparations from 40 SEOTs, including borderline tumors and low-, intermediate-, and high-grade carcinomas to verify the frequency of chromosome 6 alterations. We also carried out fluorescence in situ hybridization analysis with a chromosome 6 library and yeast artificial chromosome clones from a region of the same chromosome (6q27). Chromosome 6 abnormalities were identified in 30 of 32 analyzable SEOTs. Twenty-five of 32 cases showed a deletion of 6q irrespective of their histological grade. We wish to underline that this is the first report proving that del(6q) was the most frequent chromosome anomaly in near-diploid SEOTs and that it was the sole anomaly observed in four SEOTs with diploid complement. Our findings suggest that abnormalities of the telomeric region of chromosome 6 (6q27) may be considered one of the earliest lesions in the pathogenesis of ovarian carcinomas.

Aneuploidy↗

PubMed1996

Octreotide in the management of bowel obstruction in terminal ovarian cancer.

Intestinal obstruction is a common and distressing clinical complication in ovarian cancer. The aim of our study was to assess vomit control in terminal ovarian cancer patients with inoperable gastrointestinal obstruction, using a symptomatic pharmacological treatment with octreotide which obviates the need for nasogastric tube placement. We studied 13 patients, all of whom had advanced ovarian cancer FIGO stage IIIc. Seven patients were treated in the Gynecology Department of S. Raffaele Hospital, at the University of Milan, and 6 were managed in the University of Varese Hospital. Octreotide was administered at doses starting with 0.3 up to 0.6 mg (mean 0.44 mg) a day by subcutaneous bolus or continuous infusion. Octreotide controlled vomiting in all cases to grade 0 on the WHO emesis scale. Complete relief of symptoms was achieved within 3.07 days (range 1-6 days). Vomiting stopped within 2-3 days of starting treatment in most patients. In 8 patients with a nasogastric tube, drainage decreased from 2000 to under 100 ml/day after the start of octreotide treatment. No side effects were reported. All patients died with minimal distress or pain.

Adolescent↗

PubMed1996

Modulation of venous endothelial activity and transcellular calcium transport by defibrotide: the adenosine hypothesis.

Defibrotide is a polydeoxyribonucleotide that possesses profibrinolytic and cytoprotective activities. These properties have been associated with its capacity to induce the release of prostacyclin and tissue plasminogen activator (t-PA) from endothelial cells. In the present study, the bolus administration of defibrotide in humans was able to induce (100-800 mg) a dose-dependent decrease in plasminogen activator inhibitor (PAI) (from 19.4 +/- 7.11 to 7.20 +/- 6.41 AU/mL) and an increase in t-PA (from 3.70 +/- 0.96 to 4.50 +/- 1.20 IU/mL) and in the stable prostacyclin derivative 6-keto-PGF1 alpha (from 18.83 +/- 3.83 to 26.75 +/- 8.48 pg/0.1 mL) in the venous blood. In a second part of the study, defibrotide has been shown to inhibit dose-dependently (10-100 microns) neutrophil activation in vitro: it decreased lysosomal enzyme release and superoxide anion and chemiluminescence production induced by the oligopeptide fMLP and the ionophores A23187 and ionomycin. The increase in extracellular calcium concentration from 0.5 to 2 mm antagonized the inhibitory effect of the drug. Defibrotide was able to reduce the cytosolic free calcium increase induced by specific stimuli by blunting calcium entry. Such an inhibitory activity of defibrotide was antagonized by theophylline, an adenosine receptor antagonist. The study confirms some pharmacological activities of defibrotide (release of t-PA and prostacyclin in vivo), and it also suggests that the compound blocks Ca2+ entry into the cells, possibly by interfering with the adenosine receptors.

Adenosine↗