A modified technique for implantation of polypropylene mesh for the repair of external abdominal hernias in horses: a review of 21 cases

During a 3-year period 21 horses were surgically treated because of large abdominal wall defects. In each case the defect was bridged with a polypropylene mesh, which was placed on the outside of the hernial ring. This was in contrast with the technique for mesh herniorrhaphy generally described in human and veterinary literature, in which the mesh is always implanted on the inside of the hernial ring. One horse was destroyed on the first postoperative day because of postanaesthetic myelomalacia. Surgical repair as described was successful in 18 patients. Recurrence of herniation occurred in two horses. On re-herniorrhaphy a second and larger mesh was successfully implanted.

Single intraoperative administration of antibiotic to cows with caecal torsion: wound infection and postoperative performance. A retrospective and prospective study

Wound infection and postoperative performance after a single intra-abdominal administration of 9 g sodium ampicillin in cows operated on for caecal dilatation or torsion (n = 33) were evaluated. In the 25 animals that left the clinic in good health (76% short-term survival), no wound infection occurred. Postoperative performance was normal in 21 of these animals (84%). The figures for short-term survival and postoperative performance are comparable to those from a retrospective study of 169 animals operated on between 1985 and 1990. Single intra-abdominal administration of sodium ampicillin during surgery provides good protection against infection without negative effects on the postoperative performance.

Oral bioavailability of pivampicillin in foals at different ages

The plasma disposition of ampicillin after intravenous administration at a dose rate of 15 mg/kg was studied in six healthy, 1-month-old foals. The oral bioavailability of pivampicillin was determined in the same foals at four ages, ranging from 11 days to 4 months. Pivampicillin was administered orally at a dose rate of 19.9 mg/kg, which is equivalent on a molecular basis to 15 mg/kg ampicillin. Ampicillin concentrations in plasma were determined up to 12 hours after administration. After intravenous administration, the mean distribution and elimination half-lives of ampicillin were 0.121 and 0.624 h, respectively. The volume of distribution (Vss) appeared to be 0.334 l/kg. Orally administered pivampicillin was rapidly absorbed in all age groups, producing mean peak plasma concentrations of 3.83 to 5.69 micrograms/ml 1 h after administration. The mean bioavailability of pivampicillin in the different age groups ranged from 39.4 to 52.9%. There was no statistically significant difference in peak plasma concentration or bioavailability between the age groups. It is concluded that pivampicillin at a dose rate of 19.9 mg/kg orally gives satisfactory plasma concentrations in foals of all ages.

The effects of cisapride on the restoration of gut motility after surgery of the small intestine in horses; a clinical trial

Seventy horses surgically treated for colic caused by disorders of the small intestine were included in a randomized blind trial to determine the effects of cisapride (0.1 mg/kg bw intramuscularly at 8-h intervals) on the post-operative restoration of gut motility. Cisapride appeared to reduce the incidence of post-operative ileus. It accelerated the restoration of bowel motility, reducing the period of post-operative intensive care. It is concluded that cisapride is an effective and useful drug in the post-operative treatment of horses after surgery of the small intestine.

Low doses of interleukin-2 can cure large bovine ocular squamous cell carcinoma

Four cows bearing large Ocular Squamous Cell Carcinomas (BOSCC) were treated by 10 intratumoral injections (Monday-Friday for 2 consecutive weeks) of 200,000 U Interleukin-2 (Cetus). Tumors regressed in 2 out of 4 cases. This result shows that even large tumors may regress after local IL-2 treatment.

In-vitro susceptibility to antimicrobial drugs of bacterial isolates from horses in The Netherlands

Minimum inhibitory concentrations (MICs) of 30 antimicrobial agents (including the hitherto unreported antimicrobial agents doxycycline, minocycline, vanomycin, 3 quinolones and 3 combinations of antimicrobial agents) for isolates of Salmonella spp. (20), Escherichia coli (17), Klebsiella spp. (8), Proteus spp. (7), Pseudomonas aeruginosa (7), Actinobacillus equuli (5), Rhodococcus equi (4), Streptococcus zooepidemicus (23), Streptococcus equisimilis (6), Streptococcus equi (4), coagulase-positive Staphylococcus spp. (20) and Taylorella equigenitalis (19) were determined using the agar dilution method. All isolates were of equine origin. MICs were compared with recommended MIC breakpoints. The results indicate that, for some of the pathogenic bacteria evaluated, susceptibility testing of isolates from the individual patient is essential to determine an appropriate antimicrobial treatment.

Search for bovine papilloma virus DNA in bovine ocular squamous cell carcinomas (BOSCC) and BOSCC-derived cell lines

Although the cause of bovine ocular squamous cell carcinoma (BOSCC) is attributed to viruses in addition to cofactors (eg, UV light), to our knowledge, the final causative agent has not been described. Bovine papilloma virus (BPV)-like particles were detected in approximately 33% of various putative precursor lesions of BOSCC. In contrast, it was reported that, using BPV-specific antibodies, it was not possible to detect viral antigens in BOSCC. Fourteen established BOSCC and 9 BOSCC-derived cell lines were examined for BPV DNA. Probes of all 6 known BPV types were used in various hybridization assays. Neither Southern blot analysis, under high and low stringency conditions, nor in situ hybridization resulted in detection of BPV DNA. Papilloma viruses were not observed in electron microscopic studies. Results exclude direct association between BOSCC and BPV types 1 to 6, or as yet unknown closely related BPV types. However, BPV may contribute to induction of precursor lesions or events leading to carcinogenic transformation, without being relevant for maintenance of the tumor.

Bioavailability of oral penicillins in the horse: a comparison of pivampicillin and amoxicillin

The pharmacokinetics of ampicillin and amoxicillin following intravenous administration at a dose rate of 15 and 10 mg/kg respectively were studied in four healthy adult horses. Pharmacokinetics of pivampicillin and amoxicillin were studied after oral administration to four healthy adult horses. Pivampicillin, a prodrug of ampicillin, was administered orally to starved and fed horses at a dose rate of 19.9 mg/kg, which is equivalent on a molecular basis to 15 mg/kg ampicillin. Amoxicillin was administered orally to starved horses only, at a dose rate of 20 mg/kg. Ampicillin and amoxicillin concentrations in plasma, synovial fluid and urine were determined. Mean biological half-life of intravenously administered ampicillin and amoxicillin was 1.72 and 1.43 h respectively, whilst the distribution volume (Vss) appeared to be 0.180 and 0.192 1/kg. Orally administered pivampicillin and amoxicillin were rapidly absorbed. A maximum concentration in plasma of 3.80 micrograms/ml was reached 2 h after administration of pivampicillin to starved horses; in fed horses a maximum concentration of 5.12 micrograms/ml was reached 1 h after administration. After oral administration of amoxicillin a maximum concentration of 2.03 micrograms/ml was reached after 1 h. The (absolute) bioavailability of pivampicillin administered orally was 30.9% in starved horses and 35.9% in fed horses. The bioavailability of amoxicillin administered orally was 5.3% in starved horses.

Effects of various medium formulations and attachment substrata on the performance of cultured ruminant hepatocytes in biotransformation studies

1. A procedure for the isolation and primary culture of hepatocytes from goat and cattle is described. Hepatocyte culture performance was monitored for 51 h by measuring viability, cytochrome P-450 maintenance, dealkylation of scoparone and ethylmorphine, and glucuronidation of phenol red. 2. Culture medium composition is discussed in relation to differences between splanchnic blood composition of ruminant and monogastric animal species. Main differences are in glucose and volatile fatty acid concentrations. Modified Williams' E culture medium did not yield higher culture performance than non-modified Williams' E. 3. Coating of culture dishes with either collagen or fibronectin did not improve culture performance. 4. Williams' E, although developed for rodent cells, proves to be a suitable basal medium for ruminant hepatocytes. In this medium, culture quality is high for at least several days. 5. In cultured goat hepatocytes, biotransformation rate for scoparone amounted to 20 nmol/mg protein per h, for ethylmorphine 96 nmol/mg protein per h and for phenol red 2 nmol/mg protein per h. Biotransformation activity in cow hepatocytes is approximately half that in goat hepatocytes.

[Cecum amputation in a blond d'Aquitaine bull]

A caecal torsion of 720 degrees was diagnosed in a one-and-a-half-year-old blonde d'Aquitaine bull. A partial amputation of the caecum had to be performed. The diagnosis and surgery of this case are described against the background of the usual dilatations and rotations of the caecum and ansa proximalis.

Effective immunotherapy with local low doses of interleukin-2

IL-2 treatment for metastatic tumors in man is usually given systemically with high doses, often in conjunction with large numbers of LAK-cells. Complete tumor regression is obtained in less than 10%, this treatment causes severe toxicity, and culturing of LAK-cells is laborious and expensive. In this paper we demonstrate that small amounts of locally applied rIL-2 alone, if given at the right time, can cure about 70% of DBA/2 mice with large metastasized syngeneic SL2 lymphoma comprising 4-10% of the total body weight, a tumor load hitherto considered fatal. Moreover, 3 out of 5 cows with ocular squamous cell carcinoma (BOSCC) of 1 x 1 up to 3 x 4 cm were cured with low doses of rIL-2 only. Taken together, we have now tested 11 tumors in animals. No antitumor effect was observed in EL4 lymphoma in C57BL mice. Partial antitumor effects were detected in RBL5 lymphoma in C57BL mice, stomach carcinoma in BALB/c mice, MOT-carcinoma in C3H mice, liver carcinoma in guinea pigs and bovine vulval papilloma/carcinoma. Complete tumor regression was obtained in SL2 lymphoma, L5178Y lymphoma, L1210 lymphoma, and P815 mastocytoma in DBA/2 mice and in bovine ocular squamous cell carcinoma. Low doses of locally injected IL-2 induce systemic immunity, as shown in DBA/2 mice bearing syngeneic SL2 lymphoma cells. We conclude that local low dose treatment can be effective and results in a high cure rate in several tumor models. In the DBA/2-SL2 lymphoma model this treatment is 100-1000 times more effective than any form of immunotherapy we have tested during 20 years in this model.(ABSTRACT TRUNCATED AT 250 WORDS)

The present status of BCG treatment in the veterinary practice

Horses with sarcoids, cows with ocular squamous cell carcinoma and dogs with mammary tumors were treated with intralesional injection of Bacillus Calmette Guérin. This treatment appeared to be effective in most cases of equine sarcoids, in 50 - 60% of the cows with ocular squamous cell carcinoma and was not effective in dogs with mammary tumors.

[A horse with Cushing's disease]

A thirteen-year-old Dutch warmblooded mare was referred to the Faculty of Veterinary Medicine because of a sinusitis. She was thin with a potbellied appearance. Her coat was dull with long wavy hair. Unilateral (left) purulent nasal discharge was evident. A cbc revealed leucopenia (3.9 G.L.-1) and plasma biochemical analysis revealed a plasma glucose concentration of 10.1 mmol.L-1. Thermostable alkaline phosphatase (at 65 degrees C during 2 minutes) could not be demonstrated. Basal plasma cortisol concentration was lowered (114 nmol.L-1) and basal plasma ACTH concentration was highly elevated (815 pg.ml-1), indicating adrenocortical insufficiency. A dexamethasone-suppression test was performed by intramuscular administering of 10 mg of dexamethasone showing a suppression of 32% instead of at least 50%. At necropsy a pituitary pars intermedia adenoma was found.

Immunotherapy of bovine ocular squamous cell carcinoma: isolation, culture and characterization of lymphocytes present in the tumor

Bovine ocular squamous cell carcinoma (BOSCC) is sensitive to intralesional immunotherapy with BCG or recombinant human IL-2 (rhIL-2). The mechanism of tumor regression is as yet unclear. Alterations in the concentration of IL-2 (and possibly other factors) in the tumor, due to regional injection or induction by BCG, may induce killer cell activity and thus tumor regression. To investigate this, lymphocytes were isolated by mechanical fractionation of biopsies of BOSCC. Growth, phenotypical, and functional characteristics were studied. TIL could be isolated and grown from all biopsies of BOSCC. An estimated increase in cell number of 50-150 fold was observed during 5-7 weeks of culture. FACS analysis of a limited number of the TIL cultures showed a characteristic shift in phenotypes until day 28 of culture. CD2+ cells (50-70%), and as a consequence of this CD2- cells, remained stable in number. The number of CD8+ cells increased. CD4+ cells were detected in low numbers by day 28. Prolonged culture resulted in an increase of CD2- gamma delta + cells, CD2+4-8- cells, and occasionally of both CD8+ and CD2+ cells. In 51Cr release assays TIL showed cytotoxicity for BOSCC-derived tumor cell lines in general, which increased transiently by cocultivation with tumor cells. Killing of YAC-1, and P815 was far less efficient. Preferential killing of autologous cell lines was not seen. In conclusion, TIL from bovine ocular squamous cell carcinomas can be cultured in the presence of rhIL-2, which induces cytotoxic activity for BOSCC-derived tumor cells. Cells responsible for killing in vitro and potentially for regression of the tumor after immunotherapy with BCG or rhIL2 cannot yet be identified. Depletion and blocking experiments are being conducted in order to identify the cells (CD2+8+, CD2-gamma delta + or other CD2 +/-) responsible for killing.

A comparative investigation on autologous mandibular and iliac crest bone grafts. An experimental study in sheep

Nine Friesian sheep (age 1.5-2 years) were used to evaluate the quality of bone repair in artificial cleft-like maxillary defects repaired with autologous bone grafts of embryologically different origin. After bilateral extraction of the upper first deciduous molar the tooth socket was enlarged resulting in an open connection between the oral and nasal cavities. In the same session a graft, obtained from the iliac crest, was implanted in one of the two bilateral maxillary defects and on the opposite side a graft, obtained from the mandible, was inserted. During the experiment, serial radiographs were taken. After six months the sheep were sacrificed and the bone of the grafted areas was submitted to histological and histomorphometric investigation. Comparing both areas, it appeared that the quality of bone remodelling and alveolar reconstruction was independent of the origin of the grafts.

[Rupture of the bladder and of the urachus in foals. A literature review]

It is well documented that the incidence of rupture of the urinary bladder or urachus is highest in newborn male foals and occurs during the (usually uncomplicated) parturition. Important clinical symptoms include frequent passing of small quantities of urine, abdominal distention and positive abdominal undulation. Hyperkalaemia, hyponatraemia, hypochloraemia and an elevated serum creatinine level are often present. The serum blood urea nitrogen concentration may be normal or only slightly elevated. The creatinine concentration in the peritoneal fluid is invariably higher than that in serum, and this finding is of importance in the diagnosis. A method for field diagnosis of bladder rupture is to instill a sterile solution of a dye into the bladder followed by its retrieval in the peritoneal fluid. Surgical treatment is indicated as soon as possible after diagnosis. Prior to inducing anaesthesia (oxygen, nitrous oxide and halothane by mask), fluid losses and electrolyte imbalance should be corrected and slow decompression of the abdomen should be performed in order to reduce the risk of cardiac dysrhythmias and hypovolaemic shock. The bladder defect is usually closed in two layers of inverting continuous sutures. If the diagnosis of bladder rupture is timely established, its prognosis is usually favourable.

Immunotherapy of bovine ocular squamous cell carcinoma by repeated intralesional injections of live bacillus Calmette-Guérin (BCG) or BCG cell walls

Thirty cows of the Dutch Friesian and the Maas-Rijn-Ijssel breed with histologically confirmed ocular squamous cell carcinoma were treated by repeated intralesional injection of live bacillus Calmette-Guérin (BCG) (n = 14) or a BCG cell-wall vaccine (n = 16). Complete regression of the primary tumour was observed in 64% and 57% of the animals respectively. In the 2-year follow-up period there was no recurrence of primary tumours. This sharply contrasts with the recurrence frequency (40%-50%) after complete remission induced by a single intralesional injection with BCG, observed in an earlier study. In 1 animal a new primary tumour developed. At necropsy metastases were present in 33% of the treated animals: in 3 of 17 animals that showed complete regression of the primary tumour and in 7 of 13 animals with partial regression or progressive disease. This did not differ significantly from results obtained after a single treatment (27%). Delayed-type hypersensitivity to M. bovis purified protein derivative (PPD) was more persistent in animals showing regression of the primary tumour than in non-responding animals. Of the animals with a positive PPD response 6 months after treatment, 79% showed tumour regression. Regression was observed in only 28% of the animals not responding to PPD after the same period of time.

IN CONCLUSION

(a) recurrence of the primary tumour was not observed after repeated BCG treatment; (b) the frequency of metastases was not decreased compared to results obtained with a single treatment; (c) regression was correlated with a positive delayed-type hypersensitivity reaction to PPD (P less than 0.05) 6 months after treatment; (d) no significant differences were observed when the clinical results of treatment with live BCG and the BCG cell wall vaccine were compared.

[Immunotherapy of squamous cell carcinoma of the bovine eye and of equine sarcoid]

Squamous cell carcinomas of the bovine eye and equine sarcoids are briefly reviewed. A single injection of BCG into the tumour results in permanent regression of the lesion in 37 per cent of the cattle, regression followed by recurrence of the tumour in 26 per cent and in progressive growth of the tumour in 37 per cent of the cases. Recurrence may be prevented by repeated injection into the lesion. From 50 to 60 per cent of the cows will remain free from tumours. Equine sarcoids show a complete regression in 70-80 per cent of the cases. Tumours on the limbs show a less satisfactory response (lower rates of success, more complications) than do tumours in other areas of the body.

The effect of phenylbutazone on the plasma disposition of penicillin G in the horse

A pilot study in two ponies showed that the plasma concentrations of intramuscularly administered procaine penicillin were higher if phenylbutazone was administered concurrently. In two other trials, each involving five horses, intravenous sodium penicillin was administered with and without concurrent intravenously injected phenylbutazone, and procaine penicillin was injected intramuscularly with and without oral phenylbutazone. In both cases the plasma concentrations of penicillin were higher when phenylbutazone was given. The pharmacokinetic parameters indicated that the effect was probably due to a lower peripheral distribution because the penetration of penicillin into the tissues was greatly reduced.

Hereditary cancer and its clinical implications: a view

In hereditary cancers the responsible inherited cancer genes are defective (mutated) anti-oncogenes (tumour suppressor genes). This inherited mutation is present in all cells of the organism, and only leads to cancer if in a somatic cell a complete set of specific cancer mutations is accumulated. Since one defective anti-oncogene has been inherited, only three additional somatic cancer mutations are required, according to our previously published view (Anticancer Res 10:1990). The number of de novo arising tumour cells in such a person is thus multiplied by a factor equal to the reverse of the mutant frequency, that is about 10(4)-10(5). This can be observed e.g. in retinoblastoma. Mutations occur in proliferating cells only. Consequently cancer mutations also depend on cell proliferation. If an inherited cancer mutation predisposes to cancer formation in certain organs, then the cancer risk in these organs is enhanced by 10(4)-10(5) times. Tumours in these organs will appear simultaneously if the number of cells and the growth kinetics are similar. This is of course observed in paired organs, like the retina and the female breast. In cancer family syndromes different organs may be affected at the same time. Examples are type I and type II cancer family syndrome and multiple endocrine neoplasia type 1 2a, and 2b. The secondly diagnosed tumours are not caused by metastatic spread. Tumours in two organs will arise at difference times if the number of end cells per organ and the growth kinetics differ. In this case the second tumour is called a second primary malignancy and is not caused by metastatic spread. A good example are the second primary malignancies in hereditary retinoblastoma. The inherited defective anti-oncogene is a recessive gene. This defective inherited gene causes a 10(4)-10(5) fold increase of the normal tumour incidence. This means that nearly always one or more tumours will arise. Evidently, this pattern of inheritance has led to the erroneous conclusion that the genetic abnormality is dominant at the level of the chromosome. The 10(4)-10(5) times enhanced tumour incidence in hereditary cancer is helpful for the clinical recognition of hereditary cancer. That is, hereditary cancer can be recognized not only by family history, but also by early occurrence, the multifocal and bilateral localisation, its occurrence as cancer family syndrome or by second primary malignancies. It is thus recommended to screen patients and families with hereditary cancer for first and second primary tumours. Treatment of patients with hereditary tumours requires extra care to avoid additional cancer mutations.(ABSTRACT TRUNCATED AT 400 WORDS)

Intra-abdominal versus intramuscular application of two ampicillin preparations in cows

Plasma ampicillin concentrations were determined in a cross-over trial involving five cows after single intramuscular or intra-abdominal administration of sodium ampicillin (10 mg/kg) and ampicillin anhydrate (40 mg/kg). After injection of sodium-ampicillin, high plasma concentrations were reached within 10 min; Cmax following intramuscular injection was 9.1 micrograms/ml and after intra-abdominal injection 7.5 micrograms/ml. Urine concentrations of ampicillin were low after 24 h (1-1.5 micrograms/ml). No significant changes in blood leucocyte numbers, plasma zinc, iron or fibrinogen levels occurred. After injection of ampicillin anhydrate 1 h elapsed before maximum plasma levels were obtained; Cmax was 5.4 micrograms/ml after intramuscular and 6.7 micrograms/ml after intra-abdominal administration. Urine concentrations were very high (238-303 micrograms/ml) after 24 h and stayed above 1 microgram/ml for 6 days. After administration of ampicillin anhydrate a significant increase in blood neutrophils (P less than 0.01) and a significant increase in plasma fibrinogen was measured after intramuscular and intra-abdominal injection (P less than 0.05). A significant decrease in plasma zinc concentration after intra-abdominal injection occurred (P less than 0.05). In abdominal surgery in cows in which contamination cannot be prevented, and practical objections inhibit preoperative administration, intramuscular or intra-abdominal administration during surgery of sodium ampicillin seems justified. Ampicillin anhydrate should not be used intra-abdominally.

Local interleukin-2 therapy in bovine ocular squamous cell carcinoma. A pilot study

Five cows bearing bovine ocular squamous cell carcinoma (BOSCC) were treated with low doses of recombinant human interleukin-2 (rhIL-2). A dose of 2500 U rhIL-2 was injected intralesionally and another 2500 U were injected into the subparotid regional lymph node once a day during a period of 5 consecutive days. This cycle of 5 days was repeated after an interval of 2 days. Total regression of the tumor was observed in three out of five animals. One cow showed tumor regression (greater than 80%) accompanied by metastases to the regional lymph node that were observed from the fifth week after the beginning of the treatment. Growth of the tumor of the fifth animal was retarded after treatment. In vitro proliferation of peripheral blood lymphocytes was investigated in two animals and tumor-infiltrating lymphocytes in one animal during incubation in various rhIL-2 concentrations. Cytotoxic activity of both cell populations against P815, Yac-1 and BOSCC-derived cell lines increased during incubation with rhIL-2. Cultured BOSCC-infiltrating lymphocytes showed predominant killing of the BOSCC-derived autologous cell line after 4 weeks of culture. Preliminary phenotype analysis did not give conclusive results with respect to the types of cells responsible for killing.

Infection rates in contaminated surgical procedures: a comparison of prophylactic treatment for one day or four days

Eighty-three calves with a complicated umbilical hernia were included in a randomised prospective study. The frequency of wound infection was compared in two groups. The first group received antibiotics for one day, the second group for four days. The infection rate in calves receiving antibiotics for one day was 25 per cent compared with 8 per cent in calves treated for four days (P less than 0.05). Male calves were more susceptible to infection than female calves.

Infection rates in clean surgical procedures with and without prophylactic antibiotics

One hundred calves with an uncomplicated umbilical hernia were included in a prospective study. The frequency of wound infection and recurrence of herniation were compared in animals operated on either with or without prophylactic antibiotics. In 90 calves operated on for the first time (60 without antibiotics and 30 with antibiotics) there were no infections and only one hernia recurred. In 10 calves operated on for the second time (seven without antibiotics and three with antibiotics) there were two infections and one hernia recurred in the group not receiving antibiotics.

Effect of induced synovial inflammation on pharmacokinetics and synovial concentration of sodium ampicillin and kanamycin sulfate after systemic administration in ponies

Single doses of sodium ampicillin (10 mg/kg) and kanamycin sulfate (5 mg/kg) were administered intramuscularly (i.m.) separately, and then together, to five pony mares. The plasma antibiotic concentration-time curves were constructed. The pharmacokinetic parameters of the antibiotics given separately were not altered by concurrent administration. Four of the five pony mares were then given the i.m. kanamycin/ampicillin combination 4 h after acute synovitis and fever had been induced by injection of lipopolysaccharide into the left intercarpal joint. The plasma concentration-time curves and the synovial concentration-time curves of inflamed and normal joints were constructed. The Cmax of ampicillin in the lipopolysaccharide experiment was significantly higher than in the other experiments. The antibiotics entered the synovial fluid of the inflamed joints more quickly and attained higher concentrations than in the uninflamed joints. The ampicillin concentration exceeded 5 micrograms/ml in inflamed synovial fluid for some 2.5 h after injection, and kanamycin sulfate concentration exceeded 2 micrograms/ml for 7 h.