Among all the major infectious human diseases, gastro-intestinal infections caused by microbial pathogens are a major cause of morbidity and infant death in developing countries, largely due to inadequate sewage disposal and contaminated water. Traditional health practitioners in South Africa play a crucial role in providing health care to the majority of the population. Many plants are locally used by South African traditional healers to treat microbial infections related to gastro-intestinal tracts. Ethnopharmacological and ethnobotanical studies using traditional knowledge as a selection strategy has given priority to certain plants for isolation and identification of plant novel bioactive compounds. Pharmacological and phytochemical studies of the investigated twelve medicinal plant species (from 10 families) extensively used as antimicrobials against gastro-intestinal infections was necessary to validate the use of the plants. Furthermore, to provide sufficient preliminary information for the isolation and identification of active compounds that are present in the investigated plants. Plant parts were sequentially extracted using petroleum ether (PE), dichloromethane (DCM) and 70% ethanol (EtOH). Cold water and boiled (decoction) extracts of the plant materials were prepared non- sequentially. Among the extracts, EtOH yielded the highest amount of plant substances. A total number of 85 extracts were evaluated for antibacterial activity, 80 for antifungal activity, 64 for anti-inflammatory activity, and 27 biologically active extracts were tested for genotoxicity. The microdilution method was used to determine the minimum inhibitory concentration values in the antibacterial assay against two Gram-negative bacteria (Escherichia coli ATCC 11775 and Klebsiella pneumoniae ATCC 13883) and two Gram-positive bacteria (Bacillus subtilis ATCC 6051 and Staphylococcus aureus ATCC 12600). A modified microdilution method was used to determine the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) values in the antifungal assay against Candida albicans. Cyclooxygenase assay was used to evaluate the anti-inflammatory activity of the extracts against cyclooxygenase-1 and -2 (COX-1 and COX-2) enzymes. The plant extracts were screened first at a concentration of 250 ƒÊg/ml per test sample, and then further screened at concentrations of 125 and 62.5 ƒÊg/ml for extracts that inhibited the COX-2 enzyme. The Ames test was used to test for genotoxicity in extracts that showed interesting pharmacological activities using Salmonella typhimurium strain TA98. Among the screened extracts, 25 extracts showed good antibacterial activity with MIC values . 1.0 mg/ml. Dichloromethane extracts exhibited the greatest antibacterial activity, and Gram-positive bacteria were most susceptible. The best antibacterial activity was exhibited by Becium obovatum leaf EtOH extracts with an MIC value of 0.074 mg/ml. A broad spectrum antibacterial activity was observed by leaf extracts of Cucumis hirsutus (PE), Haworthia limifolia (PE), Protea simplex (PE and DCM) and Dissotis princeps (EtOH) against both Gram-negative and Gram-positive bacteria. No interesting antibacterial activity was exhibited by water extracts with the exception of Dissotis princeps water extract with a good antibacterial activity against Gram-positive and Gram-negative bacteria. In the antifungal assay, 6 extracts showed interesting antifungal activity. Protea simplex leaf PE extract showed the best fungicidal activity with an MFC value of 0.014 mg/ml. The best overall antifungal activity was observed in plant EtOH extracts. Some extracts from Agapanthus campanulatus (leaves and roots), Dissotis princeps (leaves), Gladiolus dalenii (corms) and Protea simplex (leaves) showed good activity against Candida albicans. Twenty one extracts inhibited the COX-1 enzyme, while fifteen extracts inhibited the COX-2 enzyme at the lowest screening concentration of 62.5 ƒÊg/ml. The highest COX-1 inhibition at a concentration of 62.5 ƒÊg/ml was exhibited by Diospyros lycioides leaf PE extract (89.1%) while Agapanthus campanulatus root DCM extract showed the highest COX-2 inhibitory activity (83.7%) at the same concentration. In the Ames test, no genotoxicity was observed in any of the extracts, however more tests need to be done to confirm these results. Thin layer chromatograms of the organic solvent plant extracts were developed. The fingerprints of the plant extracts showed colours of bands at different Rf values when viewed under UV254 and UV366 suggesting that the investigated plant species contained different compounds in the extracts. In the quest to understand the source of the plants pharmacological activities, total phenolic compounds including condensed tannins, gallotannins and flavonoids were quantitatively investigated in terms of their amounts in the aqueous methanol extracts of the plants materials using spectrophotometric methods. Alkaloids and saponins were qualitatively determined. The amounts of total phenolics were determined by the Folin Ciocalteu assay, condensed tannins were determined by the butanol-HCl assay, while rhodanine and vanillin assays were used to determine the amounts of gallotannins and flavonoids respectively. Dragendorff reagent was used to detect alkaloids in the plant extracts on thin layer chromatographic plates, while the froth test was employed to detect saponins. Secondary metabolites varied with plant parts and species with Cyperus textilis (leaf) having the highest amounts of total phenolics, condensed tannins and flavonoids. The highest amount of gallotannins was detected in Protea simplex leaf extracts. All the investigated plant materials with the exception of Haworthia limifolia leaf, Protea simplex leaf, Antidesma venosum leaf and Dissotis princeps leaf tested positively to saponins. Alkaloids were detected in Haworthia limifolia leaf (PE and EtOH), Cucumis hirsutus leaf (EtOH), Becium obovatum root (DCM), Protea simplex root and bark (EtOH), Agapanthus campanulatus root (DCM) and leaf (EtOH), Cyperus textilis root (DCM), Vernonia natalensis leaf (PE), Antidesma venosum leaf (PE), Diospyros lycioides leaf (PE) and Dissotis princeps leaf (DCM) extracts. The results obtained from the investigation of the pharmacology and phytochemistry of the plant species used to treat microbial infections related to gastro-intestinal tracts, provide sufficient preliminary information to validate the use of some of the plants in traditional medicine. The information provided might be considered sufficient for further studies aimed at isolating and identifying the active compounds in the plant species, and evaluating possible synergism amongst the isolated compounds. / Thesis (M.Sc)-University of KwaZulu-Natal, Pietermaritzburg, 2009.

Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

A reduction in voluntary feed intake is a major factor in the lost productivity of grazing lambs infected by gastrointestinal parasites yet the mechanisms involved are poorly understood. Potential pathways involved in parasite-induced feed intake depression were investigated in lambs with minimal previous exposure to parasites and artificially infected by the small intestinal parasite Trichostrongylus colubriformis. Six in vivo experiments were conducted on lambs housed in individual pens or metabolism crates with similar feeding and experimental procedures. In Experiment 1 (Chapter 4) the effect of T. colubriformis infection on short term feed intake in lambs and of some pharmacological agents on feed intake depression were investigated. Prior to and for the duration of infection, lambs were fed once per day and feed intake recorded at regular intervals over the day (8 h). Following the onset of feed intake depression in the infected group (9 weeks after commencing dosing), all animals were treated with an analgesic (codeine phosphate per os), an anti-inflammatory agent (indomethacin per os), a CCK antagonist (L364-718 by subcutaneous injection) or saline (control) in a replicated Latin square design (n = 8). Although the pattern of feed consumption was similar in infected and non-infected lambs, average daily intake was reduced 32 % and short term intake (recorded at 10 minute intervals for the first hour of feeding, 15 minute intervals for the second hour and hourly for the next 6 hours of feeding) reduced 40 % by infection. This identified the key component by which intake was depressed and enabled the use of a short term intake model and short duration of action compounds to identify the pathways involved in intake depression in this sequence of experiments. None of the pharmacological treatments increased intake in the infected group. These results suggest a reduction in the rate of consumption due to reduced hunger signals, rather than change of meal eating patterns, is the major cause of feed intake depression. Specific conclusions about the pathways investigated using the pharmacological agents could not be obtained. Experiment 2 (Chapter 5) was designed to investigate the roles of pain and osmolality on feed intake depression. Digesta samples collected prior to and during parasite infection and before and after feeding had similar osmolalities (240-260 mosmol/l) which indicated that feeding or infection had no effect on osmolality of digesta. Following the onset of feed intake depression in infected animals, all animals were treated in a Latin square design (n = 4) with no treatment, saline, local anaesthetic (xylocaine) or analgesic (codeine phosphate) solution 15 minutes before feeding, by slow injection into the duodenum. There was no effect of these treatments on food intake. In the second part of the experiment, hyperosmotic solutions (mannitol and NaCI) markedly depressed short term intake in non-infected animals, suggesting a role for osmoreceptors in intake regulation. However these effects were not blocked by local anaesthetic so the depressed intake may have resulted from generalised malaise rather than from specific osmoreceptor effects. In Experiment 3 (Chapter 6) the role of peripheral CCK on intake depression was examined by a dose-response study utilising the CCK antagonist, loxiglumide. Intravenous injection of 5, 10 or 20 mg/kg LW of loxiglumide to infected lambs 10-15 minutes before feeding (n = 6) had no effect on feed intake at any of the dose levels. In experiment 4 (Chapter 7) loxiglumide was infused intravenously for 10 minutes (30 mg/kg/h) before feeding and for the first 2 h (10 mg/kg/h) after feed was offered to minimise any effect of the rate of clearance of loxiglumide on the lack of feed intake response. As well, the rate of marker disappearance from the abomasum was recorded in both infected and non-infected animals. Continuous infusion of loxiglumide did not attenuate parasite induced intake depression nor did it have any effect on abomasal emptying. Abomasal volume was reduced by infection (66.3 vs 162 ml) as was the fractional outflow rate (2.2 vs 2.8 ml/min) but these differences were accounted for by the lower level of feed intake in the infected animals. In Experiment 5 (Chapter 8) brotizolam, a benzodiazepine appetite stimulant, thought to act on the hypothalamus, was administered in a dose-response study to infected and non-infected animals (n = 4) immediately prior to feeding or following termination of the first meal (45 minutes after feeding) and the feed intake response recorded. Brotizolam elevated both the short term (0-0.75 h), daily (22 h) intake and all time intervals in the first 5 h after feeding in infected and non-infected animals when administered after the first meal but when administered prior to feeding elevated intake only over the first 6 h of feeding. In both cases the magnitude of the response was greater in infected animals than in non-infected animals. Brotizolam appeared to increase the rate of eating without having a major impact on meal eating patterns when administered before feeding. Where administration was after the first meal, the effect was due to an "extra" meal being consumed. These findings showed that infected animals can respond to central stimulators of intake although the mechanism of the response is not known. Opioids were implicated in intake depression as the rate of intake rather than meal patterns appeared to be the major parameter depressed under parasitism. This was examined in experiment 6 (Chapter 9) where animals (n = 6) were fasted for 26 h or not fasted, then treated with saline (control), brotizolam (intake stimulant) or naloxone (opioid antagonist) immediately prior to feeding. Fasting stimulated feed intake in the short term (100 % increase in 75 min) and over the day (12 % increase) in both infected and non-infected animals. Following fasting, infected animals ate a similar amount of feed to the non-infected, fasted animals and more than the non-infected, non-fasted animals. The signals resulting from a one day fast were sufficient in the short term to override parasite induced mechanisms causing feed intake depression. Naloxone suppressed the intake stimulatory effects of a 26 h fast in both infected and non-infected animals, which supports a role for endogenous opioids as hunger signals. Where animals were not fasted, naloxone reduced intake only in the non-infected animals which suggested endogenous opioid levels may be lower in infected animals than in non-infected animals. In the final experiment (Experiment 7, Chapter 10) the role of central hunger and satiety mechanism were investigated. Infected and non-infected animals (n = 6) were treated with naloxone or saline by intravenous injection, or saline and met-enkephalinamide (an opioid analogue) by intracerebral infusion, or naloxone and the opioid analogue simultaneously to investigate the role of central opioids in feed intake depression. To determine the role of CCK induced satiety signals on feed intake at a central level, loxiglumide and CCK were infused separately and in combination for 30 minutes prior to feeding and for the first 60 minutes of feed on offer, into a lateral cerebral ventricle of the brain of infected and control animals (n = 6). The opioid analogue tended to increase intake in infected animals but the effect was not significant probably because the dose used was too low to elicit a response in sheep. Naloxone depressed intake only in the infected animals, which conflicted with the results of Experiment 4. As a consequence these results were inconclusive because of the single low dose of opioid analogue used and the conflicting naloxone responses. CCK alone depressed intake by 39-52 % only in infected animals and this effect of the 90 minute infusion was evident over the 8 h short term recording period. Loxiglumide attenuated the feed intake depressive effects of CCK in the infected animals to the extent that intake was elevated above control levels. Loxiglumide alone was an intake stimulant in both infected and non-infected animals. Intake was increased over the entire 8 h but mostly in the second hour when intake was increased by 188 % in infected animals and by 16 % in the non-infected animals and resulted in almost continuous eating. These results showed loxiglumide will temporarily block the effect of parasite infection on feed intake in sheep when administered centrally and the fact that it blocked the effects of exogenous CCK on intake indicated that the effect is mediated via CCK receptors. In conclusion GIT parasite infection reduced both short term and daily feed intake apparently by a change in rate of intake rather than any alteration in meal patterns. It was further suggested that anyone of a number of potential peripheral pathways, including changes to osmolality, gut emptying, pain and inflammation of the gut, alone is not involved in anorexia in sofar as the compounds used could block these factors and the results support the idea that intake depression is mediated via a central mechanism. Intake in infected animals responded to a much greater extent when fasting, i.c.v. loxiglumide or brotizolam were employed. Feed intake thus appears to be regulated through the same mechanisms in infected and non-infected animals. The results from compounds affecting the central mechanism suggest central CCK receptors are important in parasite induced anorexia, possibly by changing the onset of satiety or by interacting with endogenous opioids to reduce the rate of feed intake. Secondly reduced endogenous opioids may be causing the reduction in the rate of feed consumption alone or as a result of other interactions. It was concluded that intake in parasitised animals could be increased to that of control animals by employing procedures and compounds thought to act on the hypothalamus.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2007. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Η χολοπαγκρεατική εκτροπή αποτελεί την πιο αποτελεσματική μέθοδο της βαριατρικής χειρουργικής όσο αφορά την απώλεια του βάρους και την υποχώρηση του σακχαρώδους διαβήτη τύπου 2, συνοδεύεται όμως συχνά από σημαντική έλλειψη θρεπτικών συστατικών. Η επιμήκης γαστρεκτομή είναι μια σχετικά νέα επέμβαση, η οποία σύμφωνα με μελέτες προκαλεί σημαντικού βαθμού απώλεια βάρους και υποχώρηση του σακχαρώδους διαβήτη τύπου 2. Σκοπός: Η προοπτική εκτίμηση και σύγκριση της επίδρασης της χολοπαγκρεατικής εκτροπής μακρών ελίκων και της λαπαροσκοπικής επιμήκους γαστρεκτομής στην υποχώρηση του σακχαρώδους διαβήτη τύπου 2, της υπέρτασης και της δυσλιπιδαιμίας, καθώς επίσης και στα επίπεδα ινσουλίνης, γλυκαγόνης, γκρελίνης, PYY και GLP-1( σε νηστεία αλλά και μετά από τη λήψη γλυκόζης ) σε ασθενείς με κλινικά σοβαρή παχυσαρκία και σακχαρώδη διαβήτη τύπου2. Μέθοδος: Δώδεκα ασθενείς (ΔΜΣ 57.6±9.9 kg/m2) υποβλήθηκαν σε χολοπαγκρεατική εκτροπή μακρών ελίκων και δώδεκα (ΔΜΣ 43.7±2.1 kg/m2 ) σε λαπαροσκοπική επιμήκη γαστρεκτομή. Όλοι οι ασθενείς παρουσίαζαν σακχαρώδη διαβήτη τύπου 2 και μελετήθηκαν προεγχειρητικά και σε 1, 3 και 12 μήνες μετά το χειρουργείο. Σε όλους τους χρόνους υποβλήθηκαν σε από του στόματος δοκιμασία ανοχής γλυκόζης. Αποτελέσματα: Το σωματικό βάρος σημείωσε σημαντική και αναλόγου μεγέθους μείωση και στις δύο ομάδες (Ρ<0.001). Στους 12 μήνες η ποσοστιαία απώλεια του υπερβάλλοντος σωματικού βάρους ήταν παρόμοια στις δύο ομάδες (Ρ=0.8) και ο σακχαρώδης διαβήτης είχε υποχωρήσει σε όλους τους ασθενείς. Η γλυκόζη, η ινσουλίνη και η αντίσταση στη δράση της παρουσίαζαν σημαντική μείωση έπειτα και από τις δύο επεμβάσεις, όμως η ευαισθησία στην ινσουλίνη ενισχύθηκε περισσότερο έπειτα από τη χολοπαγκρεατική εκτροπή (Ρ=0.003). Η αρτηριακή πίεση, η ολική και η LDL χοληστερόλη μειώθηκαν σημαντικά έπειτα από τη χολοπαγκρεατική εκτροπή (Ρ<0.001), όχι όμως και μετά την επιμήκη γαστρεκτομή. Τα τριγλυκερίδια μειώθηκαν σημαντικά και στις δύο ομάδες, ενώ η HDL χοληστερόλη παρουσίασε σημαντική αύξηση μόνο μετά την επιμήκη γαστρεκτομή (Ρ<0.001). Τα επίπεδα γκρελίνης νηστείας δεν μεταβλήθηκαν σημαντικά μετά τη χολοπαγκρεατική εκτροπή (Ρ=0.2), ενώ σημείωσαν σημαντική μείωση μετά την επιμήκη γαστρεκτομή (Ρ<0.001). Η απόκριση των ΡΥΥ και GLP-1 ενισχύθηκε σημαντικά και στις δύο ομάδες ασθενών (Ρ=0.001). Συμπεράσματα: Η λαπαροσκοπική επιμήκης γαστρεκτομή οδήγησε σε αναλόγου βαθμού απώλεια σωματικού βάρους και υποχώρηση του σακχαρώδη διαβήτη τύπου 2 με τη χολοπαγκρεατική εκτροπή μακρών ελίκων. Η χολοπαγκρεατική εκτροπή όμως ήταν περισσότερο αποτελεσματική όσο αφορά τη βελτίωση της ευαισθησίας στην ινσουλίνη, της δυσλιπιδαιμίας και της αρτηριακής υπέρτασης. / Biliopancreatic diversion (BPD) is the most effective bariatric procedure in terms of weight loss and remission of diabetes type 2 (DM2) but it is accompanied by nutrient deficiencies. Sleeve gastrectomy (SG) is a relatively new restrictive operation that has shown promising results concerning DM2 resolution and weight loss. Objective: To evaluate and compare prospectively the effects of BPD long limb (BPDLL) and SG on remission of DM2, hypertension and dyslipidemia and also on fasting, and glucose-stimulated insulin, glucose, glucagon, ghrelin, PYY and glucagon-like peptide-1 (GLP-1) levels in morbidly obese patients with DM2. Methods: Twelve patients (BMI 57.6±9.9 kg/m2) underwent BPDLL and 12 (BMI 43.7±2.1 kg/m2) underwent SG. All patients had DM2 and were evaluated before and 1, 3 and 12 months after surgery. Oral glucose tolerance test and blood sampling were carried out after an overnight fast and 30, 60 and 120 minutes after glucose ingestion. Results: Body weight decreased markedly in both groups (P<0.001); excess weight loss was similar in both groups at 12 months (P=0.08) and DM2 resolved in all patients. Glucose, insulin and insulin resistance decreased significantly after both procedures, but the BPDLL group had higher insulin sensitivity than the SG group at 1 year (P=0.003). Blood pressure, total and LDL cholesterol decreased markedly after BPDLL (P<0.001) but not after SG. Triglycerides decreased significantly after both operations but HDL increased significantly after SG only (p<0.001). Fasting ghrelin did not change significantly after BPDLL (P=0.2), but decreased markedly after SG (P<0.001). Fasting GLP-1 and PYY increased significantly after BPDLL only (P=0.01), however GLP-1 and PYY responses to glucose were significantly enhanced in both groups (P=0.001). Conclusion: SG results in weight loss and resolution of DM2 comparable to BPDLL, but BPDLL is more effective in terms of dyslipidemia resolution and blood pressure reduction.

Syftet med studien är att, med hjälp av metoden contingent valuation (CV), undersöka betalningsviljan (willingness to pay, WTP) för en reducerad risk att drabbas av mag- och tarmsjukdomar på grund av förorenat dricksvatten i Skellefteå kommun. Studien undersöker också sambandet mellan WTP och tidigare erfarenheter av förorenat dricksvatten. Respondenterna fick besvara en sluten och en öppen WTP-fråga för ett föreslaget projekt. WTP varierar mellan 39 – 67 kronor per månad utöver den nuvarande avgiften för vatten och avlopp (VA-taxan). De variabler som förklarar individuella skillnader i WTP är budnivån, upplevd dricksvattenkvalitet, huruvida personen blev drabbad vid tidigare utbrottet, om konsumtionsbeteendet har förändrats, ålder, inkomst och hushåll med barn. Resultaten visar att de respondenter som drabbats vid ett tidigare utbrott är mindre benägna att acceptera en högre kostnad. Ett förändrat konsumtionsbeteende visar däremot att respondenter i genomsnitt har en högre WTP för en minskad risk av mag- och tarmsjukdomar. / The purpose of the study is to examine the willingness to pay (WTP) for a reduced risk of gastrointestinal diseases due to contaminated drinking water in the municipality of Skellefteå using the contingent valuation method (CV). The study also examines the relationship between WTP and previous experiences of contaminated drinking water. The respondents answered to a closed and an open WTP question for a proposed project.  WTP varies between SEK 39 – 67 per month in addition to the current fee on water and wastewater. The variables that explain individual differences in WTP are the bid level, experienced drinking water quality, impact of the previous outbreak, changed consumption behavior, age, income and households with children. The results show that respondents affected by the previous outbreak are less likely to accept a higher cost. Respondents who changed their consumption behavior want, on average, pay more for a reduced risk of gastrointestinal diseases.

Although it is not a new method endoscopy has undergone incredible development in recent years. The examination is however very unpleasant for a patient, which is why health care staff should be well trained, particularly for child patients. The aim of the thesis was to map the specifics of nursing care for children undergoing endoscopic examination of the gastrointestinal tract. We approached the whole issue from the point of view of caring staff ? nurses. In the theoretical part we first described the gastrointestinal tract anatomy, endoscopy development and types of endoscopic examination. Then we dealt with the role of a nurse in the care for child patients undergoing these examinations. We formed three goals for the research. Goal 1: To find out how nurses prepare child patients for the individual endoscopic examinations. Goal 2: To verify whether nurses caring about a child patient undergoing gastrointestinal tract endoscopy are specifically trained. Goal 3 served as the output of the work: To elaborate recommendation for nurses preparing child patients for the individual endoscopic examinations. We chose quantitative research for collection of the necessary information. A questionnaire designed for nurses caring for child patients was the data collection technique. The questionnaire was anonymous, distributed at paediatric clinics of faculty hospitals of Moravian region. 104 questionnaires suitable for processing returned from 140 issued. The research has shown that nurses working at the clinics where the research was performed master the correct nursing care for child patients undergoing endoscopic examination of the gastrointestinal tract. Nevertheless the fact that most information is gained upon practical experience, with low emphasis on initial and repeated training of nurses also results from the research. A recommendation was elaborated upon the gathered information in the form of a standard nursing procedure proposal.

Gastrointestinal bleeding is a symptom of numerous diseases that might be serious. Acute GI bleeding is the most frequent abdominal incident and has been occurring more and more often recently. Acute bleeding in the upper GI tract is a very urgent state affecting circulation stability. The bleeding may have adverse consequences. This is why a quick intervention and immediate bleeding stoppage are very important here. The aim of the thesis was to determine the principles of nursing care for patients with GI bleeding and what may be provided to a patient with acute GI bleeding within nursing care. Two research questions were set: 1 - What are the principles of nursing care for patients with GI bleeding? 2 - What may be provided to a patient with acute GI bleeding within nursing care? The thesis was elaborated by means of qualitative research. The technique of interview was used for data collection. Non-standardized interview was applied to patients. Individual case studies of the patients were elaborated from the information obtained. Semi-standardized interview was chosen for nurses, from which individual case studies were elaborated. We had the opportunity to use an analysis of nursing documentation of the Gastroenterological Department of the České Budějovice Hospital. The research has shown that nurses mostly have sufficient information on the principles of nursing care for patients with upper digestive system bleeding. From the patient answers we found that awareness of their needs was essential. This is why an informational brochure compiled upon request of the patients is an output of my thesis. A presentation for nurses describing insertion of an esophageal probe is the second output.

No description available.