AIM:To describe the clinicopathologic features and classification of pediatric and adolescent ocular tumors and tumor-like lesionsMETHODS:A total of 719 cases of pathologically confirmed ocular tumors and tumor-like l...AIM:To describe the clinicopathologic features and classification of pediatric and adolescent ocular tumors and tumor-like lesionsMETHODS:A total of 719 cases of pathologically confirmed ocular tumors and tumor-like lesions in a pediatric population from two academic institutions over an 18-year period were retrospectively analyzed.The main outcome measures were the clinical and pathological features of the cases.RESULTS:Benign tumors accounted for 92.1%of all cases while malignant tumors accounted for 7.9%.The most common ocular benign tumors were(epi-)dermoid cysts(19.8%),nevi(15.2%),corneal dermoid tumors(9.8%),and calcified epitheliomas(8.8%).The most common ocular malignant tumors were retinoblastoma(80.8%),and rhabdomyosarcoma(3.9%).Eyelid and ocular surface tumors comprised 73.3%of benign tumors while intraocular and orbital cavity comprised 94.2%of malignant tumors.For tumor site,the upper eyelid was up to 1.79 times more than lower eyelid(P<0.05).Age at surgery and sex also had an association with different lesions(P=0.006,P=0.035,respectively).CONCLUSION:Most ocular tumors and tumor-like lesions in children and adolescents are benign.Pediatric ocular tumors are distinct from those in adults in terms of histological origin.(Epi-)dermoid cysts are the most common benign tumors while retinoblastomas the most common malignant tumors.展开更多
Most of the ocular tumors have poor prognosis, and they remain a difficult problem in the area of ophthalmology. With the rapid development of molecular biology and immunologic techniques and the deep research on ocul...Most of the ocular tumors have poor prognosis, and they remain a difficult problem in the area of ophthalmology. With the rapid development of molecular biology and immunologic techniques and the deep research on ocular tumor related genes, it becomes possible to diagnose and treat malignant tumors from the molecular level. The tumor necrosis factor related apoptosis-inducing ligand (TRAIL), a member of the tumor necrosis factor (TNF) super family, is a promising candidate, either alone or in combination with established cancer therapies, since it can initiate apoptosis through the activation of their death receptors. The ability of TRAIL to selectively induce apoptosis of transformed, virus-infected or tumor cells but not normal cells promotes the development of TRAIL-based cancer therapy. Here, we will review TRAIL and its receptors' structure, function, mechanism of action and application in ocular tumors therapy.展开更多
AIM:To explore the role of positron emission tomographycomputed tomography(PET-CT)examination in the diagnosis and treatment of ocular adnexal mucosa associated lymphoid tissue lymphoma(OAML).METHODS:The general clini...AIM:To explore the role of positron emission tomographycomputed tomography(PET-CT)examination in the diagnosis and treatment of ocular adnexal mucosa associated lymphoid tissue lymphoma(OAML).METHODS:The general clinical data,postoperative PET-CT results,treatment regimens,and the prognosis of 21 histopathologically confirmed OAML patients between October 2017 and September 2021 were collected.Among the 21 patients,five patients underwent surgical treatment alone,13 patients underwent surgical treatment combined with radiotherapy,and three patients underwent surgical treatment combined with chemotherapy.RESULTS:The follow-up period ranged from 8 to 79mo,with four cases of recurrence and no deaths.Through PETCT examination,two patients exhibited both local ocular metabolic elevation and systemic metastasis,and one of these patients had cervical lymph node metastasis,while the other had submandibular and parotid gland metastasis.Nine patients showed only local ocular metabolic elevation,while 10 patients had no abnormal metabolic activity locally.CONCLUSION:PET-CT examination plays a crucial role in detecting residual lesions and recurrence following tumor resection,aiding in precise disease staging,and facilitating the development of personalized treatment plans,ultimately improving patient prognosis.展开更多
The clinical value of whole body positron emission tomography/computed tomography (PET/CT) as an imaging tool in diagnosis of ophthalmic tumors was investigated. The retrospective observational case series were perf...The clinical value of whole body positron emission tomography/computed tomography (PET/CT) as an imaging tool in diagnosis of ophthalmic tumors was investigated. The retrospective observational case series were performed on the patients with suspected ophthalmic tumors who underwent whole body PET/CT. The golden standard of diagnosis was the final pathological diagnosis or the results of long-term follow-up for patients without surgery/ biopsy. PET/CT findings were compared with the golden standard. The sensitivity, specificity, accuracy an^t positive likelihood ratio of PET/CT in the detection of ophthalmic tumors were calculated. The clinical application of PET/CT in different types of ophthalmic tumors was evaluated. The results showed that 30 patients (18 males and 12 females) with a mean age of 43.0 years (range 4-63 years) were collected. The mean sizes of orbital tumors and intraocular tumors were 26.8 mmxl7.8 mm and 11.2 minx6.1 mm, respectively. The overall sensitivity, specificity, accuracy and positive likelihood ratio of whole body PET/CT in ophthalmic tumors were 76.5%, 71.4%, 75.0% and 2.67, and were 62.5%, 100% and 70.0% in intraocular tumors, and those were 100%, 60.0% and 84.6% in orbital tumors, respectively. PET/CT findings were applied to help make appropriate treatment options in 27 out of 30 patients (90.0%), and 12 (40.0%) patients changed the treatment strategy. False negative results in 4 cases and false positive results in 2 cases were observed in this series. It was suggested that PET/CT was an effective imaging modality in detecting, diagnosing and developing therapeutic schedule for patients with ophthalmic tumors. It was more sensitive and accurate for detecting orbital tumors than for detecting intraocular tumors.展开更多
Introduction: Squamous cell carcinoma of the conjunctiva is one of the most common malignancies in the elderly. Purpose: To describe the specific aspects of squamous cell carcinoma of the conjunctiva and to determine ...Introduction: Squamous cell carcinoma of the conjunctiva is one of the most common malignancies in the elderly. Purpose: To describe the specific aspects of squamous cell carcinoma of the conjunctiva and to determine the therapeutic modalities. Materials and Methods: Descriptive cross-sectional retrospective study carried out at the University Hospital Center of Bouake over a period of 9 years (From January 2015 to December 2023). We identified all malignant oculo-adnexal and orbital tumors whose histopathological diagnosis was confirmed;monitoring the sorting of squamous cell carcinomas of the conjunctiva among these cancers and studying the different parameters linked to them. Results: The average age of patients is 44.3 years. Male predominance with a sex ratio of 1.12. HIV was the majority ATCD with 64.7%. The main reason for consultation was exophthalmos (36.11%). The average consultation time was 10 months 13 days. Invasive differentiated conjunctival squamous cell carcinoma was predominant at 55.56%. Enucleation was the most performed surgical method. Conclusion: Squamous cell carcinoma of the conjunctiva is a malignant ocular tumor of the elderly whose frequency increases in young adults infected with HIV-AIDS. Invasive differentiated forms are increasingly encountered, limiting treatment to mutilating surgery.展开更多
Since 1978, the University of California San Francisco (UCSF) Ocular Tumor Program has been using particle therapy for treating ocular patients with malignant as well as benign eye disease. Helium ion beams were used ...Since 1978, the University of California San Francisco (UCSF) Ocular Tumor Program has been using particle therapy for treating ocular patients with malignant as well as benign eye disease. Helium ion beams were used initially and were produced by two synchrotron-based systems: first by the 184-inch synchro-cyclotron and later by the Bevalac, at the Lawrence Berkeley National Laboratory (LBNL). Since 1994, protons, produced by a cyclotron-based system at the Crocker Nuclear Laboratory (CNL) Eye Treatment Facility (ETF), have been used for this purpose. The CNL cyclotron produces a 67.5 MeV beam, allowing for a uniquely homogeneous beam for eye treatment, without degradation of the beam or manipulation of the beam line. This paper describes, in detail, the control system for beam delivery, as implemented for measuring and delivering the radiation to ocular tumors at CNL. The control system allows for optimal delivery and rapid termination of the irradiation after the desired dose is achieved. In addition, several safeguard systems are discussed, as these are essential for such a system in the event of failure of software, electronics, or other hardware. The QA analysis shows that the total range of the proton beam is 30.7 ± 1.0 mm in water at iso-center. The beam distal penumbra (80% - 20%) is 1.1 mm for a range-modulated beam at a collimator to iso-center distance of 50 mm. Daily QA checks confirm that the range and modulation is within 0.1 mm. The beam flatness and symmetry in a 25 mm diameter beam are ±1% - 2%. Variation in the daily dosimetry system, as compared to standard dosimetry, is within ±3.5%, with a mean variation of 0.72(±1.9)% and 0.85(±2.3)% for segmented transmission ionization chambers IC1 (upstream) and IC2 (downstream), respectively. From May 1994 to the end of 2015, UCSF has treated 1838 proton ocular patients at the Davis ETF. During this period, no treatments were missed due to any cyclotron or control system failures. The overall performance, maintenance, and quality assurance of the cyclotron and the ocular control system have been excellent.展开更多
In a comprehensive literature review,PubMed,Embasem and Web of Science were searched for studies examining targeted therapy of ocular malignant melanomas to present and discuss targeted therapy treatment options of oc...In a comprehensive literature review,PubMed,Embasem and Web of Science were searched for studies examining targeted therapy of ocular malignant melanomas to present and discuss targeted therapy treatment options of ocular tumors,mainly conjunctival and uveal melanoma(UM).Conjunctival malignant melanomas showed similarities in clinical and genetic aspects with cutaneous melanomas.Many therapies with checkpoint inhibitors already established for cutaneous melanomas may be a treatment option for conjunctival malignant melanomas with shared traits.Existing targeted therapies are for example checkpoint inhibitors like pembrolizumab or nivolumab.As a corollary,due to marked differences in clinics and genetics between UMs and conjunctival melanomas(CMs)or cutaneous melanomas,it has remained elusive whether the available possibilities of molecular targeted therapy will be an option for the therapy of metastasizing UMs.Possible novel ways of treating UM are being explored.Fotemustine or the inoculation of dendritic cells with tumorous RNA or sunitinib in combination with cisplatin and or tamoxifen may be used in future to treat UM.While CM are treatable using targeted therapies,UM have not been researched enough to find working targeted therapy options.Further research has to be done in order to find acceptable treatment options.展开更多
目的·研究F-box蛋白38(F-box only protein 38,FBXO38)对眼部黑色素瘤增殖的作用以及潜在的调控通路。方法·使用FBXO38短发夹RNA(short hairpin RNA,shRNA)和FBXO38过表达质粒构建FBXO38敲低以及过表达的人皮肤黑色素瘤A375...目的·研究F-box蛋白38(F-box only protein 38,FBXO38)对眼部黑色素瘤增殖的作用以及潜在的调控通路。方法·使用FBXO38短发夹RNA(short hairpin RNA,shRNA)和FBXO38过表达质粒构建FBXO38敲低以及过表达的人皮肤黑色素瘤A375和葡萄膜黑色素瘤OMM2.3细胞系,并通过实时荧光定量PCR(quantitative real-time PCR,qRT-PCR)和Western blotting在转录和蛋白水平验证FBXO38的敲低和过表达效率。通过克隆形成实验、BrdU免疫荧光染色和CCK8细胞增殖实验,探究FBXO38对黑色素瘤细胞增殖的影响。使用肿瘤基因组图谱计划数据库(The Cancer Genome Atlas,TCGA),分析FBXO38高表达和低表达组中的差异表达基因,并进行京都基因与基因组数据库(Kyoto Encyclopedia of Genes and Genomes,KEGG)通路富集,揭示与FBXO38相关的信号通路。进一步通过CCK8细胞增殖实验检测信号通路抑制剂对不同FBXO38表达量细胞的抑制率。同时通过qRT-PCR和Western blotting,验证在敲低FBXO38之后该通路是否激活。结果·qRT-PCR和Western blotting验证A375和OMM2.3细胞系中的FBXO38的mRNA及蛋白质表达水平,发现与对照组相比敲低组的FBXO38表达水平下降,与野生型相比过表达组的FBXO38的表达水平提高(P<0.05)。克隆形成实验、BrdU免疫荧光染色和CCK8细胞增殖实验显示,敲低FBXO38显著增强A375和OMM2.3细胞的增殖能力(P<0.05),反之过表达FBXO38抑制A375和OMM2.3细胞增殖(P<0.05)。KEGG通路富集分析显示,在皮肤黑色素瘤和葡萄膜黑色素瘤中,FBXO38的表达影响磷脂酰肌醇3激酶/蛋白激酶B(phosphoinositide 3-kinase/protein kinase B,PI3K-Akt)通路激活。与对照组相比,PI3K抑制剂LY294002和mTOR1抑制剂Everolimus对FBXO38敲低组的抑制率显著提升(P<0.05),对FBXO38过表达组的抑制率则显著下降(P<0.05)。Western blotting结果显示,敲低FBXO38之后,与PI3K-Akt通路相关的PTEN、P21和P53蛋白水平下降,而MDM2蛋白水平上升。qRT-PCR结果显示在FBXO38敲低细胞中P53转录水平显著下降(P<0.05),而MDM2转录水平显著上升(P<0.05)。结论·FBXO38通过PI3K-Akt信号通路参与调控眼部黑色素瘤细胞的增殖。展开更多
基金Supported by National Natural Science Foundation of China(No.81670888,No.81870635)。
文摘AIM:To describe the clinicopathologic features and classification of pediatric and adolescent ocular tumors and tumor-like lesionsMETHODS:A total of 719 cases of pathologically confirmed ocular tumors and tumor-like lesions in a pediatric population from two academic institutions over an 18-year period were retrospectively analyzed.The main outcome measures were the clinical and pathological features of the cases.RESULTS:Benign tumors accounted for 92.1%of all cases while malignant tumors accounted for 7.9%.The most common ocular benign tumors were(epi-)dermoid cysts(19.8%),nevi(15.2%),corneal dermoid tumors(9.8%),and calcified epitheliomas(8.8%).The most common ocular malignant tumors were retinoblastoma(80.8%),and rhabdomyosarcoma(3.9%).Eyelid and ocular surface tumors comprised 73.3%of benign tumors while intraocular and orbital cavity comprised 94.2%of malignant tumors.For tumor site,the upper eyelid was up to 1.79 times more than lower eyelid(P<0.05).Age at surgery and sex also had an association with different lesions(P=0.006,P=0.035,respectively).CONCLUSION:Most ocular tumors and tumor-like lesions in children and adolescents are benign.Pediatric ocular tumors are distinct from those in adults in terms of histological origin.(Epi-)dermoid cysts are the most common benign tumors while retinoblastomas the most common malignant tumors.
文摘Most of the ocular tumors have poor prognosis, and they remain a difficult problem in the area of ophthalmology. With the rapid development of molecular biology and immunologic techniques and the deep research on ocular tumor related genes, it becomes possible to diagnose and treat malignant tumors from the molecular level. The tumor necrosis factor related apoptosis-inducing ligand (TRAIL), a member of the tumor necrosis factor (TNF) super family, is a promising candidate, either alone or in combination with established cancer therapies, since it can initiate apoptosis through the activation of their death receptors. The ability of TRAIL to selectively induce apoptosis of transformed, virus-infected or tumor cells but not normal cells promotes the development of TRAIL-based cancer therapy. Here, we will review TRAIL and its receptors' structure, function, mechanism of action and application in ocular tumors therapy.
基金Supported by the Beijing Science and Technology Rising Star Program-Cross-cooperation Project(No.20220484218)the Tai’an City Science and Technology Innovation Development Project(No.2021NS207).
文摘AIM:To explore the role of positron emission tomographycomputed tomography(PET-CT)examination in the diagnosis and treatment of ocular adnexal mucosa associated lymphoid tissue lymphoma(OAML).METHODS:The general clinical data,postoperative PET-CT results,treatment regimens,and the prognosis of 21 histopathologically confirmed OAML patients between October 2017 and September 2021 were collected.Among the 21 patients,five patients underwent surgical treatment alone,13 patients underwent surgical treatment combined with radiotherapy,and three patients underwent surgical treatment combined with chemotherapy.RESULTS:The follow-up period ranged from 8 to 79mo,with four cases of recurrence and no deaths.Through PETCT examination,two patients exhibited both local ocular metabolic elevation and systemic metastasis,and one of these patients had cervical lymph node metastasis,while the other had submandibular and parotid gland metastasis.Nine patients showed only local ocular metabolic elevation,while 10 patients had no abnormal metabolic activity locally.CONCLUSION:PET-CT examination plays a crucial role in detecting residual lesions and recurrence following tumor resection,aiding in precise disease staging,and facilitating the development of personalized treatment plans,ultimately improving patient prognosis.
文摘The clinical value of whole body positron emission tomography/computed tomography (PET/CT) as an imaging tool in diagnosis of ophthalmic tumors was investigated. The retrospective observational case series were performed on the patients with suspected ophthalmic tumors who underwent whole body PET/CT. The golden standard of diagnosis was the final pathological diagnosis or the results of long-term follow-up for patients without surgery/ biopsy. PET/CT findings were compared with the golden standard. The sensitivity, specificity, accuracy an^t positive likelihood ratio of PET/CT in the detection of ophthalmic tumors were calculated. The clinical application of PET/CT in different types of ophthalmic tumors was evaluated. The results showed that 30 patients (18 males and 12 females) with a mean age of 43.0 years (range 4-63 years) were collected. The mean sizes of orbital tumors and intraocular tumors were 26.8 mmxl7.8 mm and 11.2 minx6.1 mm, respectively. The overall sensitivity, specificity, accuracy and positive likelihood ratio of whole body PET/CT in ophthalmic tumors were 76.5%, 71.4%, 75.0% and 2.67, and were 62.5%, 100% and 70.0% in intraocular tumors, and those were 100%, 60.0% and 84.6% in orbital tumors, respectively. PET/CT findings were applied to help make appropriate treatment options in 27 out of 30 patients (90.0%), and 12 (40.0%) patients changed the treatment strategy. False negative results in 4 cases and false positive results in 2 cases were observed in this series. It was suggested that PET/CT was an effective imaging modality in detecting, diagnosing and developing therapeutic schedule for patients with ophthalmic tumors. It was more sensitive and accurate for detecting orbital tumors than for detecting intraocular tumors.
文摘Introduction: Squamous cell carcinoma of the conjunctiva is one of the most common malignancies in the elderly. Purpose: To describe the specific aspects of squamous cell carcinoma of the conjunctiva and to determine the therapeutic modalities. Materials and Methods: Descriptive cross-sectional retrospective study carried out at the University Hospital Center of Bouake over a period of 9 years (From January 2015 to December 2023). We identified all malignant oculo-adnexal and orbital tumors whose histopathological diagnosis was confirmed;monitoring the sorting of squamous cell carcinomas of the conjunctiva among these cancers and studying the different parameters linked to them. Results: The average age of patients is 44.3 years. Male predominance with a sex ratio of 1.12. HIV was the majority ATCD with 64.7%. The main reason for consultation was exophthalmos (36.11%). The average consultation time was 10 months 13 days. Invasive differentiated conjunctival squamous cell carcinoma was predominant at 55.56%. Enucleation was the most performed surgical method. Conclusion: Squamous cell carcinoma of the conjunctiva is a malignant ocular tumor of the elderly whose frequency increases in young adults infected with HIV-AIDS. Invasive differentiated forms are increasingly encountered, limiting treatment to mutilating surgery.
文摘Since 1978, the University of California San Francisco (UCSF) Ocular Tumor Program has been using particle therapy for treating ocular patients with malignant as well as benign eye disease. Helium ion beams were used initially and were produced by two synchrotron-based systems: first by the 184-inch synchro-cyclotron and later by the Bevalac, at the Lawrence Berkeley National Laboratory (LBNL). Since 1994, protons, produced by a cyclotron-based system at the Crocker Nuclear Laboratory (CNL) Eye Treatment Facility (ETF), have been used for this purpose. The CNL cyclotron produces a 67.5 MeV beam, allowing for a uniquely homogeneous beam for eye treatment, without degradation of the beam or manipulation of the beam line. This paper describes, in detail, the control system for beam delivery, as implemented for measuring and delivering the radiation to ocular tumors at CNL. The control system allows for optimal delivery and rapid termination of the irradiation after the desired dose is achieved. In addition, several safeguard systems are discussed, as these are essential for such a system in the event of failure of software, electronics, or other hardware. The QA analysis shows that the total range of the proton beam is 30.7 ± 1.0 mm in water at iso-center. The beam distal penumbra (80% - 20%) is 1.1 mm for a range-modulated beam at a collimator to iso-center distance of 50 mm. Daily QA checks confirm that the range and modulation is within 0.1 mm. The beam flatness and symmetry in a 25 mm diameter beam are ±1% - 2%. Variation in the daily dosimetry system, as compared to standard dosimetry, is within ±3.5%, with a mean variation of 0.72(±1.9)% and 0.85(±2.3)% for segmented transmission ionization chambers IC1 (upstream) and IC2 (downstream), respectively. From May 1994 to the end of 2015, UCSF has treated 1838 proton ocular patients at the Davis ETF. During this period, no treatments were missed due to any cyclotron or control system failures. The overall performance, maintenance, and quality assurance of the cyclotron and the ocular control system have been excellent.
文摘In a comprehensive literature review,PubMed,Embasem and Web of Science were searched for studies examining targeted therapy of ocular malignant melanomas to present and discuss targeted therapy treatment options of ocular tumors,mainly conjunctival and uveal melanoma(UM).Conjunctival malignant melanomas showed similarities in clinical and genetic aspects with cutaneous melanomas.Many therapies with checkpoint inhibitors already established for cutaneous melanomas may be a treatment option for conjunctival malignant melanomas with shared traits.Existing targeted therapies are for example checkpoint inhibitors like pembrolizumab or nivolumab.As a corollary,due to marked differences in clinics and genetics between UMs and conjunctival melanomas(CMs)or cutaneous melanomas,it has remained elusive whether the available possibilities of molecular targeted therapy will be an option for the therapy of metastasizing UMs.Possible novel ways of treating UM are being explored.Fotemustine or the inoculation of dendritic cells with tumorous RNA or sunitinib in combination with cisplatin and or tamoxifen may be used in future to treat UM.While CM are treatable using targeted therapies,UM have not been researched enough to find working targeted therapy options.Further research has to be done in order to find acceptable treatment options.
文摘目的·研究F-box蛋白38(F-box only protein 38,FBXO38)对眼部黑色素瘤增殖的作用以及潜在的调控通路。方法·使用FBXO38短发夹RNA(short hairpin RNA,shRNA)和FBXO38过表达质粒构建FBXO38敲低以及过表达的人皮肤黑色素瘤A375和葡萄膜黑色素瘤OMM2.3细胞系,并通过实时荧光定量PCR(quantitative real-time PCR,qRT-PCR)和Western blotting在转录和蛋白水平验证FBXO38的敲低和过表达效率。通过克隆形成实验、BrdU免疫荧光染色和CCK8细胞增殖实验,探究FBXO38对黑色素瘤细胞增殖的影响。使用肿瘤基因组图谱计划数据库(The Cancer Genome Atlas,TCGA),分析FBXO38高表达和低表达组中的差异表达基因,并进行京都基因与基因组数据库(Kyoto Encyclopedia of Genes and Genomes,KEGG)通路富集,揭示与FBXO38相关的信号通路。进一步通过CCK8细胞增殖实验检测信号通路抑制剂对不同FBXO38表达量细胞的抑制率。同时通过qRT-PCR和Western blotting,验证在敲低FBXO38之后该通路是否激活。结果·qRT-PCR和Western blotting验证A375和OMM2.3细胞系中的FBXO38的mRNA及蛋白质表达水平,发现与对照组相比敲低组的FBXO38表达水平下降,与野生型相比过表达组的FBXO38的表达水平提高(P<0.05)。克隆形成实验、BrdU免疫荧光染色和CCK8细胞增殖实验显示,敲低FBXO38显著增强A375和OMM2.3细胞的增殖能力(P<0.05),反之过表达FBXO38抑制A375和OMM2.3细胞增殖(P<0.05)。KEGG通路富集分析显示,在皮肤黑色素瘤和葡萄膜黑色素瘤中,FBXO38的表达影响磷脂酰肌醇3激酶/蛋白激酶B(phosphoinositide 3-kinase/protein kinase B,PI3K-Akt)通路激活。与对照组相比,PI3K抑制剂LY294002和mTOR1抑制剂Everolimus对FBXO38敲低组的抑制率显著提升(P<0.05),对FBXO38过表达组的抑制率则显著下降(P<0.05)。Western blotting结果显示,敲低FBXO38之后,与PI3K-Akt通路相关的PTEN、P21和P53蛋白水平下降,而MDM2蛋白水平上升。qRT-PCR结果显示在FBXO38敲低细胞中P53转录水平显著下降(P<0.05),而MDM2转录水平显著上升(P<0.05)。结论·FBXO38通过PI3K-Akt信号通路参与调控眼部黑色素瘤细胞的增殖。