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Biomedical subjects

G Hamami

Publications and source records attributed to G Hamami.

At least 19 recordsLinked to original sources

Assessment of health-related quality of life in renal transplant and hemodialysis patients using the SF-36 health survey.

OBJECTIVES: To determine whether the health-related quality of life (HQOL) for renal transplant patients improved using SF-36 survey scores and to examine which clinical measures after renal transplantation are connected to aspects of their HQOL. METHODS: A total of 117 renal transplant patients and 114 hemodialysis patients, including 49 awaiting transplantation and 65 not awaiting transplantation, were included in this study. The scale scores of the SF-36 survey concerning HQOL were compared between the two groups of patients. The relationships of the clinical episode and complications with the scale scores were examined. RESULTS: The renal transplant patients had significantly higher scores in the physical functioning, bodily pain, general health, and social functioning scales than did the hemodialysis patients. The role-physical functioning, bodily pain, and social functioning scales of the transplant patients were significantly higher than those of the hemodialysis patients not awaiting transplantation. In contrast, the scores, except for that of general health, of the transplant patients were not significantly different from those of the hemodialysis patients awaiting transplantation. Multiple regression analysis demonstrated that the scale scores of physical functioning, general health, and vitality were significantly dependent on the serum level of creatinine in the renal transplant patients (P <0.05). The scores of physical functioning and general health of the patients with a creatinine level >2 mg/dL were significantly lower than those of the patients with 1 mg/dL < creatinine level </=1.5 mg/dL or a creatinine level </=1 mg/dL (P <0.05). An episode of hospitalization was not related to the scale scores, but an instance of rejection had an effect on the scores of social functioning and role-emotional functioning. CONCLUSIONS: The SF-36 health survey is a short but comprehensive scale for evaluating a patient's HQOL. The renal transplant patients' HQOL improved compared with that of the hemodialysis patients. The most important factor affecting HQOL was the serum creatinine level at the time of testing with the SF-36 survey.

Adult↗

Comparison of the prophylactic usefulness of epirubicin and doxorubicin in the treatment of superficial bladder cancer by intravesical instillation: a multicenter randomized trial. Kobe University Urological Oncology Group.

A multicentric randomized trial was conducted for the purpose of investigating the prophylactic efficacy of intravesical epirubicin instillation following transurethral resection of superficial bladder cancer in comparison with the efficacy of doxorubicin. The patients were centrally randomized into 2 groups and received 19 intravesical instillations of epirubicin or doxorubicin at 30 mg/30 ml physiological saline twice a week for 4 weeks and then once monthly for 11 months. A total of 150 patients with Ta and T1 superficial bladder cancer were entered in the trial, and 114 were evaluable. The nonrecurrence rates determined for each group at 1 and 2 years by the Kaplan-Meier method were 92.8% and 88.6%, respectively, for the epirubicin group and 86.4% and 81.7%, respectively, for the doxorubicin group. The differences between the two groups were not statistically significant. The main side effects encountered in this study were symptoms of bladder irritation such as micturitional pain, pollakisuria, and hematuria. The respective frequencies of those symptoms were 10%, 15.0%, and 5.0% in the epirubicin group and 14.8%, 14.8%, and 0 in the doxorubicin group. These results suggest that epirubicin is a useful drug, comparable with doxorubicin, for intravesical instillation chemotherapy in the prophylactic treatment of superficial bladder cancer.

Administration, Intravesical↗

[Ritodrine induced pulmonary edema after caesarean section for a triplet pregnancy].

Selective beta-sympathomimetic drugs are frequently used for tocolysis. But, since these drugs exhibit some beta-1 activity as well, they may bring about pulmonary edema, myocardial ischemia, cardiac arrhythmia and others as side effects. A 29 year-old female with a triplet pregnancy had premature contraction at 26 weeks of gestation. High doses of IV ritodrine were given for tocolysis for 8 weeks until caesarean section. One hour after caesarean section at 35 weeks of gestation, she complained of dyspnea. Urinary output decreased and chest X-ray showed pulmonary edema. She was intubated and artificial ventilation with PEEP was performed in ICU. Echocardiogram showed left ventricular dilatation. ECG showed inverted T waves on all leads. We diagnosed her as suffering from acute heart failure, pulmonary edema and acute renal failure. Hemodialysis was performed for 6 hrs but PCWP was still 18 mmHg. So CVVH was added to hemodialysis. Five hrs after the start of CVVH, her symptoms gradually started to subside. Total fluid removal was 5.8 l over 16 hrs. Three days after admission she was extubated and five days later returned to her ward. We concluded that pulmonary edema, heart failure and renal failure were induced by the long-term high dose medication of ritodrine, resulting in volume overload and myocardial dysfunction.

Acute Disease↗

An analysis of flow volume curves during artificial ventilation.

Expiratory flow-volume curves during artificial ventilation (FV-av) were analyzed in 48 patients undergoing general anesthesia. They were divided into 4 groups according to preoperative respiratory disorders; obstructive type (group 1), restrictive type (group 2), small airway disease (group 3) and normal control (group 4). Expiratory flow rates and volumes during artificial ventilation were plotted on an X-Y recorder to calculate V50/V25, mean time constant ratio (MTCR), obstructive index (OI) and slope ratio (SR). FV-av values were compared among groups. FV-av values in groups 2 were significantly higher than those in group 4. The values in group 1 and those in group 3 were not significantly different from those in group 4. FV-av values may reflect restrictive respiratory dysfunctions but they are not sensitive enough to detect obstructive lung disease.

Journal Article↗

[Anesthetic experience of two patients with holoprosencephaly].

We experienced anesthetic management of two 6-month-old female patients with holoprosencephaly (HP). HP is characterized by hypoplasia of prosencephalon, facial anomalies (hypotelorism, flat nose, and/or small prolabium), abnormality of autonomic nervous system functions (hypernatremia and/or poikilothermia), and clonic convulsion. First case was a lobar type and the second case was an alobar type according to DeMyer's classification. In both cases repair of bilateral cleft lip was performed. Anesthesia was slowly induced with N2O-O2-halothane and maintained with fentanyl in N2O-O2. Body temperature (BT) was adjusted with a warming blanket while monitoring rectal temperature. In the first case clonic convulsion and bradycardias occurred during the postoperative period, which were treated with IV diazepam and isoproterenol. In the second case BT rose to 39 degrees C during postoperative period; 2 episodes of convulsions were observed; and airway obstruction occurred. They were treated accordingly. The most important points which should be kept in mind in the management of HP patients are the prevention of convulsion, adjustment of BT, maintenance of normal pulse rate and keeping a patient airway.

Anesthesia, Inhalation↗

[The relationship between the deep body temperature and hemodynamics after open-heart surgery in children].

The relationships of the forehead-sole deep body temperature difference with the cardiac index (CI), and with the systemic vascular resistance index (SVRI) were studied in 10 pediatric patients (TOF 5, ASD 3, VSD 2) for 24 hours after open-heart surgery. A correlation between the deep body temperature difference (X) and CI (Y) was expressed as, Y = -0.49X + 4.51 (r = 0.72), and that between the deep body temperature difference (X) and SVRI (Z) as Z = 152X + 1039 (r = 0.62). The deep body temperature difference was 1.0 degrees C on the average in patients whose CI was more than 3.0 l.min-1.m-2, and was 3.3 degrees C in patients whose CI was less than 3.0 l.min-1.m-2. Conversely CI was less than 3.0 l.min-1.m-2 in patients whose deep body temperature difference was more than 3.0 degrees C. We conclude that the measurement of deep body temperature difference is useful as a circulatory monitor, and that a critical level of deep body temperature difference is 3 degrees C in children.

Body Temperature↗

[A study on the treatment duration of an antibacterial agent in complicated urinary tract infections. Utility and recurrence after 14-day treatment by fleroxacin].

In this study, fleroxacin (FLRX), a new quinolone derivative, was orally given at 300 mg once daily for 14 days to 102 patients with non-catheterized complicated urinary tract infections in order to determine the optimal treatment duration. We investigated its efficacy at day 5-7 and day 14, according to the criteria proposed by the Japanese UTI Committee, and also to the recurrence rate after the withdrawal. The results were as follows: 1. Overall clinical efficacy rates were 86% at day 5-7 and 84% at day 14. Both incidence of bacterial replacement in bacteriuria and normalization in pyuria were increased at day 14 as compared with those at day 5-7. 2. Bacteriological eradication rates were 91% at day 5-7 and 89% at day 14. 3. Clinical efficacy rates from physicians' evaluation were 86% at day 5-7 and 88% at day 14. 4. Incidence of side effects was 9.1%, and most of the cases were gastrointestinal symptoms which appeared within 4 days. Slight and transitory changes in laboratory findings were noted in 2.3% of evaluable cases. 5. With the occurrence of pyuria and bacteriuria as markers, the "no recurrence" rates were 63% at 1 week, 54% at 2 weeks, 61% at 3 weeks, 81% at 4-6 weeks after the withdrawal, and the "recurrence" rates were 4%, 4%, 6% and 5%, respectively. Remaining cases were judged as "reserved assessment". Generally, aggravation of bacteriuria was found but the aggravation of pyuria was observed in only few cases. 6. According to breakdown of cases with bacteriuria only, cure rate was 67% and recurrence rate was 33%. Re-infections were observed much more frequently than relapse based on the identification of infecting organisms. These results suggest that sufficient bacteriological eradication and clinical efficacy could be obtained by 14-day treatment of FLRX in non-catheterized complicated urinary tract infections. The efficacy of the treatment became evident around day 7. In approximately 30% of the cases in which eradication of the initial causative organisms was observed at day 14 reappearance of bacteriuria (greater than or equal to 10(3) CFU/ml) occurred after withdrawal of the antibiotic, but cases with pyuria were few, and the incidence of true recurrence was generally low. Onset of side effect after 5-day was not seen, hence FLRX seemed to be a safe agent.

Administration, Oral↗

[The relationship between the deep body temperature and hemodynamics after open-heart surgery].

The relation of the forehead-sole deep body temperature difference with the cardiac index (CI), and the relation of that with the systemic vascular resistance index (SVRI) were studied in 61 adult patients after open-heart surgery for 24 hours. A correlation between the deep body temperature difference (X) and CI (Y) was expressed as, Y = -0.21X + 3.42 (r = 0.48), and that between the deep body temperature difference (X) and SVRI (Y), Y = 184X + 808 (r = 0.52). But immediately after the end of operation (n = 61), the correlation coefficients (r) were lower, 0.46 and 0.45, respectively. The deep body temperature difference was 1.8 degrees C on the average in patients whose CI was 2.21.min-1.m-2, and was 4.3 degrees C in patients whose CI was below 2.21.min-1.m-2. Conversely CI was below 2.21.min-1.m-2 in patients whose deep body temperature difference was more than 4 degrees C. We conclude that the measurement of deep body temperature difference is useful as a circulatory monitor, and that a critical level of deep body temperature difference is 4 degrees C.

Adult↗

[Clinical and pathological study on 47 cases of renal pelvic and ureteral tumors].

47 cases including 24 renal pelvic tumors, 20 ureteral tumors and 3 renal pelvic and ureteral tumors treated in our hospital from January, 1980 to December, 1987, were studied clinico-histopathologically. The patients ranged in age from 38 to 81 years (average 65 years) the sex ratio was 3:1 with male predominance over female. Tumor occurred on the right side in 19 cases, on the left side in 27 cases and bilaterally in 1 case. The most frequent sign was hematuria which was observed in 40 cases (85%). The interval from the onset of initial symptoms to the first visit was within one month in 9 cases (19.1%). The major findings of excretory urograms were filling defect in 21 cases (47.1%) and non-visualizing kidney in 15 cases (33.8%). Positive urinary cytology was obtained in 21 cases (44.7%). Operative therapy as performed in 45 cases, namely, nephroureterectomy and partial cystectomy in 30 cases (66.7%) and nephroureterectomy in 9 cases (20%). Histopathologically, all cases but two cases of squamous cell carcinoma and to cases of mixed type carcinoma are transitional cell carcinoma. Subsequent bladder tumors were found in 8 cases (17.7%). The overall survival rate at 1, 3 and 5 years were 80.2%, 41.1% and 41.1%, respectively by Kaplan-Meier method. In this series, the interval from the onset of initial symptoms, the grade and stage of tumor and metastasis of lymph nodes were to be considered in developing prognosis.

Adult↗

[Preoperative adjuvant therapy for urinary bladder cancer--preoperative intra-arterial anticancer drugs infusion using artificial liver, and preoperative radiotherapy].

One hundred patients with carcinoma of the urinary bladder were treated with preoperative intra-arterial anticancer drug infusion in combination with an active carbon-based artificial liver or preoperative radiotherapy (400 rad X 5 days, total 2000 rad) in order to alleviate systemic side effects after preoperative adjuvant therapy and to perform radical cystectomy as soon as possible. Five-year survival was 69.8% in the artificial liver combined preoperative intra-arterial anticancer drug infusion group, and that of the no-pretreatment group and the preoperative irradiated group was 48.6% and 45.8%, respectively. In particular, the CDDP treated group had a higher 5-year survival of 77.4% than did the without CDDP treated group. This was attributable mostly to improved prognosis of T2, whereas either of these preoperative adjuvant therapies failed to ameliorate the prognosis of T3 or T4 stage patients. Therefore, systemic preoperative anticancer chemotherapies such as M-VAC are necessary to destroy "micrometastases" and to improve the prognosis of highly advanced bladder cancer.

Adult↗

[Clinical study of S 6472 in urinary tract infection].

Clinical studies on S 6472, a longer lasting preparation of cefaclor (CCL), were performed and the following results were obtained. S 6472 was administered orally to 102 patients with urinary tract infections including 16 with acute uncomplicated pyelonephritis, 32 with acute uncomplicated cystitis, 31 with complicated pyelonephritis and 23 with complicated cystitis. 95 patients were treated with 375 mg of S 6472 2 times daily and 7 patients were treated with 750 mg of S 6472 2 times daily. The overall clinical efficacy was evaluated on the basis of the criteria proposed by the Japanese UTI Committee. 1. Clinical efficacies in 11 cases of acute uncomplicated pyelonephritis were excellent in 10 and moderate in 1, with an overall efficacy rate of 100%. Bacteriologically, all 12 strains identified in the acute uncomplicated pyelonephritis cases were eradicated, with an eradication rate of 100%. 2. Clinical efficacies in 21 cases of acute uncomplicated cystitis were excellent in 17, moderate in 3 and poor in 1, with an overall efficacy rate of 95%. As to bacteriological responses, 22 strains identified in the acute uncomplicated cystitis cases (except 1 of Escherichia coli) were eradicated, with an eradication rate of 95%. 3. Clinical responses in 43 cases of complicated urinary tract infections were excellent in 20, moderate in 15 and poor in 8, with an overall efficacy rate of 81%. Bacteriologically, 39 strains, including only one strain of P. aeruginosa, in the complicated urinary tract infection cases (except 4 of E. coli, 1 of Klebsiella pneumoniae, 1 of Enterococcus faecalis and 2 of Enterobacter cloacae) were eradicated, with an eradication rate of 83%. As side effects, slight stomatitis and gastric discomfort were noted in 1 patient each but we were able to continue the medication. Abnormal laboratory test values found were: 1 case of a slight and transient increase of lymphocytes in peripheral blood and 1 case of a slight and transient increase of serum creatinine level.

Administration, Oral↗

[A double-blind comparative study of S 6472 (a long-acting cefaclor) versus a conventional cefaclor preparation in complicated urinary tract infections].

For an objective evaluation of the clinical efficacy, safety and usefulness of S 6472 (a long acting cefaclor) in non-catheterized patients with complicated urinary tract infections, a double-blind comparative study was performed using conventional cefaclor preparation (hereafter, CCL) as the control drug. S 6472 was administered orally at a single dose of 750 mg twice daily, and CCL at a single dose of 500 mg 3 time daily. The duration of the treatment was 5 days for either drug. Clinical efficacies were evaluated according to the criteria for evaluation of drug efficacy by the Japanese UTI Committee (3rd edition), and the following results were obtained. 1. The initial distribution of the patients' background characteristics was not significantly different between the S 6472 and CCL groups. 2. The overall clinical efficacy rates were 76.2% in the S 6472 group and 75.5% in the CCL group, indicating no significant difference between the 2 groups. When clinical efficacies evaluated according to different types of infections (UTI groups), the differences between the 2 drug groups were not significant in any of disease groups 2, 3, 4, and 6. 3. Clinical efficacy rates as evaluated by attending physicians were not significantly different between the 2 groups, either. 4. Bacteriological responses were evaluated as eradicated in 81.2% in the S 6472 group and 78.3% in the CCL group, suggesting no statistically significant difference. 5. The incidences of side effects were 2.9% (4/139) in the S 6472 group and 0.7% (1/141) in the CCL group, thus no significant differences existed between the 2 groups. On laboratory examination, 4 and 5 abnormal test values, respectively, were detected in 3/94 patients in the S 6472 group and 5/100 patients in the CCL group, but the difference was not significant between the 2 groups, either. All of these side effect symptoms and abnormal laboratory test values were mild in severity and transient. The results of the overall safety rating which was based on the evaluations of the side effects and laboratory test values indicated no significant difference between the 2 groups. 6. According to judgement by the attending doctors, the clinical usefulness rates evaluated based on the results of the efficacy and safety ratings were not significantly different between the S 6472 and CCL groups. These findings suggest that S 6472 produces excellent therapeutic results in complicated UTI patients without indwelling catheters and its clinical efficacy, safety, and usefulness are equal to those of the conventional CCL.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Oral↗

[Clinical and pathological evaluations of methotrexate, vinblastine, adriamycin and cisplatin (M-VAC) chemotherapy for advanced urothelial cancers].

Fifteen patients with advanced transitional cell carcinoma of the urothelial tract were treated with methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) chemotherapy. Eleven patients were treated to metastatic lesions after surgical resection of primary cancers. One out of 15 patients died of chemotherapy. Of the remaining 14 patients, CR was achieved in one and PR was achieved in seven, clinically. The response rate was 57.1% and the median response duration was 12.6 months. In the patients who had been resected their primary lesions, the response rate was 70% and the duration was 14.1 months. Six patients, including five PRs and one NC, underwent surgical resection and re-staging of the residual tumors after chemotherapy. Clinical response coincided with pathological one in all 6 cases. Three patients were observed the decrease of the lung metastasis, which rate was more than 90%. Two out of 3 who did not show any invasion into the lymph channels in the resected residual tumors, have been free of a recurrence through-out the course of at 47 or at 42 months. However, another patient with lymph channel invasion died of metastasis of the mediastinal and paraaortic lymph nodes. Regarding the frequency of side effects, it seemed to be no significant difference between full and 80% doses administration. In the effectual cases, the residual tumors should be resected surgically and re-staged pathologically.

Adult↗

[Clinical analysis of renal cell carcinoma with extension into the inferior vena cava].

We performed clinical analysis of 12 patients with renal cell carcinomas associated with tumor thrombosis in the inferior vena cava. Eleven cases were men, and one was a woman; their ages range from 48 to 76 years old with a mean of 58 years. Nine tumors were observed on the right side, the other 3 tumors were observed on the left side. In five cases, the distant metastases of the disease were noticed at the first visiting to our hospital. Lung metastases were found in five and bone or liver in each one. Chief complaints were macroscopic hematuria in 8 cases (67%), and were weight loss or general fatigue. The symptoms of obstruction of the inferior vena cava, such as venous dilatation of abdominal wall, edema of lower extremities and varicocele of the testes, were seen in 6 cases. The level of the tumor thrombosis was preoperatively determined by CT, echography, cavography or MRI. The level was near the right atrium in one, near the hepatic vein in 8 and near the renal vein in 3, although there was no case extending into the right atrium. Transperitoneal nephrectomy and thrombectomy in the inferior vena cava were performed in 9 cases. Surgery could not be performed in the other 3 patients of their poor general condition or severe heart disease. One patient died because of massive hemorrhage during the operation. The other complications were transient renal failure in 3 cases and postoperative bleeding in one case. In 4 patients without distant metastases or regional lymph nodes metastasis, two died of multiple metastasis of renal cell carcinomas and diabetic coma. The other two cases are alive without disease for 4 and 40 months after operation. For renal cell carcinoma extending into the inferior vena cava without metastasis, nephrectomy and thrombectomy should be performed using the extracorporeal circulation.

Aged↗

[Clinical evaluation of M-VAC chemotherapy (methotrexate, vinblastine, adriamycin and cisplatin) for advanced urothelial cancer].

Combination chemotherapy with methotrexate, vinblastine, adriamycin and cisplatin (M-VAC regimen) was administered to 12 patients with advanced epithelial cancer of the urinary tract in a clinical trial undertaken to assess clinical efficacy of this multiagent therapy. This series comprised 11 males and 1 female ranging in age from 46 to 76 years (mean age: 63), with performance status (PS) being rated 0 in 2, 1 in 5, 2 in 2, 3 in 2 and 4 in 1 of these 12 patients. The site of primary lesion was bladder in 8, renal pelvis in 3 and ureter in 1. Histologically, these tumors were all identified as transitional cell carcinoma (grade 3) with the exception of 1 mixed type (transitional cell carcinoma plus squamous carcinoma). Nine of the patients had already their primary tumor resected surgically while the remaining 3 had undergone only biopsy. The site of metastasis was lung in 7, bone in 4 and lymph nodes in 3. In consideration of the patients' general condition, the dosages of the chemotherapeutic agents were set at 80% of those recommended by Sternberg. Of the 9 patients with primary tumor resected, 1 died of chemotherapy; of the remaining 9 patients, the M-VAC regimen brought about CR in 1 and PR in 4, hence with a response rate of 62.5%. The 4 patients showing PR underwent surgical resection of residual tumor and 2 of them achieved CR and have been free of a recurrence during a 33- or 29-month period of the chemotherapeutic regimen.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

[Significance of isoantigen in the management of the urinary bladder tumor--a basic study of ABO isoantigen in step sections of the entire bladder].

Twenty cases of bladder cancer which had been treated by radical cystectomy were investigated, five out of these twenty were rendered to a specific red cell adherence test (SRCA test) using step section of entire bladder and for the other 15 cases malignant lesions and surrounding non-malignant lesions, which had been determined by histological mapping, were compared using the SRCA test. The SRCA test positive and negative lesions could coexist within the same tumor. Thus in the case of a large tumor, multiple biopsies were required to evaluate the results of the SRCA test. Since multiple bladder cancer lesions of the same patient revealed different results of the SRCA test, each lesion should be evaluated individually. Some dysplasia, down growth and squamous metaplasia were SRCA test negative and this phenomenon was frequently observed in the surrounding tissue of the bladder cancer. Histologically normal bladder epithelium and hyperplasia showed SRCA test positive by 100%. All the CIS showed SRCA test negative. Positive percentage of SRCA test in grade II and grade III tumors were 40% and 23.1% respectively. There was no relationship between the pathological stage and the results of SRCA test. There was no relationship between the existence of the intramural lymphatic invasion and/or the intramural venous invasion and the result of the SRCA test. From these results, we conclude that the SRCA test is a useful tool to predict the malignant potential of the bladder cancer, but when we utilize this test for the bladder biopsy specimens we found its reliability limited.

ABO Blood-Group System↗

[An experimental study on bladder carcinogenesis in dogs by N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) and its urinary metabolites].

N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) was administered to beagle dogs to examine the urinary metabolites. After extraction and purification of the urine sample, the urinary metabolites were identified by gas-chromatography mass-spectrometry and measured using a gas chromatograph equipped with a thermal energy analyzer (GC-TEA). Five N-nitroso-compounds (N-butyl-N-(3-carboxypropyl)nitrosamine (BCPN), N-butyl-N-(2-hydroxy-3-carboxypropyl)-nitrosamine (BHCPN), N-butyl-N-(carboxymethyl)-nitrosamine (BCMN), N-butyl-N-(2-oxopropyl) nitrosamine (BOPN) and BBN-glucuronide) were detected and identified by comparison with mass spectra of synthetic specimens. In the quantitative analysis by GC-TEA, BCMN greater than BHCPN greater than BCPN were larger part than BOPN and BBN-glucuronide. In early experimental period (0-25 wks) administered BBN (600 mg/day) to two dogs, small tumor was recognized in the urinary bladder of one dog earlier than the other. The former dog excreted larger amounts of BCPN in the urine than the latter. In late experimental period (100 wks approximately) administered BBN (400 mg/day) to five dogs, the dog that was found initial tumor earliest (103 wk) excreted the largest amounts of BCPN in the urine. Therefore, the excretion of BCPN had correlated with the carcinogenesis.

Animals↗