1
|
Kalwaniya DS, Tolat A, Kumar D, Naga Rohith V. Modified Palomo Procedure Is an Effective Intervention for Improving Serum Testosterone Levels and Semen Parameters in Patients With Varicocele: A Prospective Study. Cureus 2023; 15:e35252. [PMID: 36968902 PMCID: PMC10035055 DOI: 10.7759/cureus.35252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND A varicocele can be defined as an abnormal venous dilatation and/or tortuosity of the pampiniform plexus. It is generally reported that varicoceles are present in 15% of the general male population and 35% of men as a cause of primary infertility and in up to 80% of men as a cause of secondary infertility. Differences in venous drainage anatomy between the left and right internal spermatic veins, venous valve incompetence resulting in venous blood reflux, and increased hydrostatic pressure are the most commonly cited theories. Various surgical and non-surgical techniques are in use for treating patients with varicocele. Here we used a modified Palamo procedure to treat the patients and observed the outcome. METHODOLOGY A total of 40 patients with varicocele were recruited for the study. A preoperative evaluation, along with serum testosterone levels and semen analysis, was done. A modified Palomo technique was used to treat varicocele. A postoperative follow-up with serum testosterone levels and semen analysis was done to observe improvement. RESULTS The mean (±SD) left testis size, right testis size, testosterone, sperm concentration, sperm vitality and sperm progressive motility were found statistically significantly higher in patients after surgery as compared to patients before surgery (p<0.05). However, there was statistically insignificant mean difference in semen volume between patients before surgery and patients after surgery (p>0.05). CONCLUSION Modified Palomo procedure can be used to treat varicocele with good improvement in serum testosterone levels and semen parameters.
Collapse
|
2
|
Khodamoradi K, Golan R, Dullea A, Ramasamy R. Exosomes as Potential Biomarkers for Erectile Dysfunction, Varicocele, and Testicular Injury. Sex Med Rev 2021; 10:311-322. [PMID: 34838504 DOI: 10.1016/j.sxmr.2021.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Optimal male reproductive health is dependent upon critical mediators of cell-cell communication: exosomes or extracellular vesicles. These vesicles are nano-sized particles released into a variety of bodily fluids, such as blood and semen. Exosomes are highly stable and can carry genetic and other molecules, including DNA, RNA, and proteins, which provide information about their origin cells. OBJECTIVE To identify exosomes as potential biomarkers or therapeutic mediators in male sexual and reproductive disorders like erectile dysfunction (ED), varicocele, and testicular injury. METHODS A PubMed search was performed to highlight all articles available relating to exosomes and extracellular vesicles in the pathogenesis of different male sexual and reproductive disorders, and their importance in clinical use as both diagnostic markers and potential therapeutic mediators. RESULTS Various male reproductive system disorders, such as ED, varicocele, and testicular injury, are linked to increased or decreased levels of exosomes. Exosomes have a higher number of molecules such as DNA, RNA, and proteins, which can give a more precise and comprehensive result when compared to other biomarkers. Exosomes can be considered as plausible diagnostic biomarkers for male sexual and reproductive diseases, with considerable advantages over other diagnostic procedures such as invasive tissue biopsy. Exosomes can carry cargo such certain drugs and therapeutic molecules making them a promising therapeutic approach. Several studies have begun to test treating various male sexual reproductive disorders with exosomes. CONCLUSION Exosomes deliver many components that can regulate gene expression and target signaling pathways. Understanding how extracellular vesicles can be utilized as biomarkers in diagnosing men, particularly those with idiopathic erectile dysfunction, will not only aid in diagnosis but also help with making therapeutic targets. Khodamoradi K, Golan R, Dullea A, et al. Exosomes as Potential Biomarkers for Erectile Dysfunction, Varicocele, and Testicular Injury. Sex Med Rev 2021;XX:XXX-XXX.
Collapse
Affiliation(s)
- Kajal Khodamoradi
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Roei Golan
- Departement of Clinical Sciences, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Alexandra Dullea
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA.
| |
Collapse
|
3
|
Hariri A, Abbarh S, Ameen A, Sabra A, Salman A, Alhulaimi Y, Aabed M, Habous M, Madbouly K, Binsaleh S. Prevalence and awareness of varicocele among athletes in Riyadh, Saudi Arabia. Res Rep Urol 2019; 11:21-27. [PMID: 30859094 PMCID: PMC6386205 DOI: 10.2147/rru.s195582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the prevalence and awareness about symptoms, and complications of varicocele among athletes (bodybuilding and aerobics exercises) in Riyadh, Saudi Arabia. Patients and methods A cross-sectional study of male athletes aged between 18 and 48 years old was carried out in multiple branches of fitness centers over a period of 13 months in Riyadh, Saudi Arabia. A total of 382 face-to-face interviews using a predesigned questionnaire were conducted to identify the levels of knowledge, attitude, and practice. A randomly selected 48 subjects were examined. Varicocele was diagnosed and graded based on clinical examination and Doppler ultrasonography. Results Of the participants, 157 (41%) lacked knowledge and awareness regarding varicocele, its symptoms and complications. Of the examined participants, 22 (46%) were found to have varicocele. No difference in varicocele was found among bodybuilders and aerobic athletes (P=0.249). Similarly, no difference was related to duration of exercise session whether for 1 hour or more (P=0.131). However, our study revealed a higher rate of varicocele among athletes who exercised more than three times per week (P=0.009). Testicular volume was neither significantly different among respondents with and without varicocele nor between the left or right sides within each group. Conclusion Knowledge about varicocele, its symptoms and complications is poor among male athletes in Riyadh, Saudi Arabia. Varicocele is more common in athletic men who are frequently exercising. Efforts to increase knowledge and enhance awareness of varicocele in young males, in general, are strongly warranted.
Collapse
Affiliation(s)
- Albara Hariri
- Faculty of Medicine, Al-Maarefa University, Riyadh, Saudi Arabia
| | - Shahem Abbarh
- Faculty of Medicine, Al-Maarefa University, Riyadh, Saudi Arabia
| | - Aref Ameen
- Faculty of Medicine, Al-Maarefa University, Riyadh, Saudi Arabia
| | - Ahmad Sabra
- Faculty of Medicine, Al-Maarefa University, Riyadh, Saudi Arabia
| | - Ahmad Salman
- Faculty of Medicine, Al-Maarefa University, Riyadh, Saudi Arabia
| | - Yaser Alhulaimi
- Faculty of Medicine, Al-Maarefa University, Riyadh, Saudi Arabia
| | - Mahmoud Aabed
- Faculty of Medicine, Al-Maarefa University, Riyadh, Saudi Arabia
| | - Mohamad Habous
- Department of Urology and Andrology, Elaj Medical Centers, Jeddah, Saudi Arabia
| | - Khaled Madbouly
- Department of Urology, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia
| | - Saleh Binsaleh
- Division of Urology, Department of Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia,
| |
Collapse
|
4
|
Sansone A, Sansone M, Vaamonde D, Sgrò P, Salzano C, Romanelli F, Lenzi A, Di Luigi L. Sport, doping and male fertility. Reprod Biol Endocrinol 2018; 16:114. [PMID: 30415644 PMCID: PMC6231265 DOI: 10.1186/s12958-018-0435-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 10/24/2018] [Indexed: 11/11/2022] Open
Abstract
It is universally accepted that lifestyle interventions are the first step towards a good overall, reproductive and sexual health. Cessation of unhealthy habits, such as tobacco, alcohol and drug use, poor nutrition and sedentary behavior, is suggested in order to preserve/improve fertility in humans. However, the possible risks of physical exercise per se or sports on male fertility are less known. Being "fit" does not only improve the sense of well-being, but also has beneficial effects on general health: in fact physical exercise is by all means a low-cost, high-efficacy method for preventing or treating several conditions, ranging from purely physical (diabetes and obesity) to psychological (depression and anxiety), highly influencing male reproduction. If male sexual and reproductive health could be positively affected by a proper physical activity, inadequate bouts of strength - both excessive intensity and duration of exercise training - are more likely to have detrimental effects. In addition, the illicit use of prohibited drugs (i.e. doping) has reached pandemic proportions, and their actions, unfortunately very often underestimated by both amateur and professional athletes, are known to disrupt at different levels and throughout various mechanisms the male hypothalamic-pituitary-gonadal axis, resulting in hypogonadism and infertility.
Collapse
Affiliation(s)
- Andrea Sansone
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza - University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Massimiliano Sansone
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza - University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Diana Vaamonde
- Morphological Sciences Department, School of Medicine, Universidad de Córdoba, Cordoba, Spain
| | - Paolo Sgrò
- Department of Movement, Human and Health Sciences, Unit of Endocrinology, Università degli Studi di Roma "Foro Italico", Largo Lauro de Bosis 15, 00135, Rome, Italy
| | - Ciro Salzano
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università "Federico II" di Napoli, Naples, Italy
| | - Francesco Romanelli
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza - University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza - University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Luigi Di Luigi
- Department of Movement, Human and Health Sciences, Unit of Endocrinology, Università degli Studi di Roma "Foro Italico", Largo Lauro de Bosis 15, 00135, Rome, Italy.
| |
Collapse
|
5
|
Abstract
Varicocele is a common problem in reproductive medicine practice. A varicocele is identified in 15% of healthy men and up to 35% of men with primary infertility. The exact pathophysiology of varicoceles is not very well understood, especially regarding its effect on male infertility. We have conducted a systematic review of studies evaluating the epidemiology of varicocele in the general population and in men presenting with infertility. In this article, we have identified some of the factors that can influence the epidemiological aspects of varicoceles. We also recognize that varicocele epidemiology remains incompletely understood, and there is a need for well-designed, large-scale studies to fully define the epidemiological aspects of this condition.
Collapse
Affiliation(s)
| | | | | | - Armand Zini
- Division of Urology, Department of Surgery, McGill University, Montreal, Québec, Canada
| |
Collapse
|
6
|
Radojevic N, Radunovic M, Pajovic B. Restricting sports activity in reducing the rate of varicocele and related infertility parameters in athletes. Arch Med Sci 2015; 11:169-73. [PMID: 25861305 PMCID: PMC4379365 DOI: 10.5114/aoms.2015.48146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/14/2013] [Accepted: 08/04/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of this study is to test the hypothesis that the cessation of sports training in young athletes reduces the prevalence of varicocele. MATERIAL AND METHODS 1,013 young males were divided into three age-matched groups based on their sport activity. The first group consisted of 305 athletically active boys in basketball, volleyball, handball, or football; the second of 44 active water-polo players, and the third of 664 sport-inactive controls. All participants had been initially examined for the presence of varicocele, and positive ones were submitted to orchidometry and seminal fluid analysis. Those with varicocele were then asked to cease all sport activity for the following six months, and the reassessing was performed. RESULTS The results showed a significantly higher percentage of varicocele present in the first group than in the control group (p < 0.49), while the percentage of young males diagnosed with varicocele in the second proved to be even lower than that of the control group (9.09% vs. 12.35%). After the 6-month period of cessation and abstention from all sporting activity, every parameter of the seminal fluid analysis improved in the first group, wherein statistical significance for both sperm concentration (p < 0.001) and sperm motility (p < 0.023) was found. The testicular volume was found not to have increased significantly in either group (p > 0.05). CONCLUSIONS The study shows that sport-associated varicocele has a positive prognosis when diagnosed early and upon the cessation of sports training.
Collapse
Affiliation(s)
- Nemanja Radojevic
- Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Miroslav Radunovic
- Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Bogdan Pajovic
- Clinical Centre of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| |
Collapse
|
7
|
Morphological and surgical overview of adolescent testis affected by varicocele. ScientificWorldJournal 2013; 2013:469413. [PMID: 24348160 PMCID: PMC3856136 DOI: 10.1155/2013/469413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 10/08/2013] [Indexed: 12/04/2022] Open
Abstract
Varicocele is a common pathology of the testis frequently associated with infertility. For its management, a fine morphological study of the testis, both macroscopically and microscopically, and an accurate choice of surgical procedure are mandatory. The present review focuses its attention on the anatomic substrates of adolescent varicocele and its pathophysiologic modifications. The comprehensive assessment of all the reported alterations should be considered by the clinician before deciding the type of treatment and the timing.
Collapse
|
8
|
Atar M, Söylemez H, Oguz F, Beytur A, Altunoluk B, Kahraman B, Islamoglu Y, Soylu A. Effects of acute exercise on the diameter of the spermatic vein, and duration of reflux in patients with varicocele. Scand J Urol 2012; 47:206-10. [PMID: 23035729 DOI: 10.3109/00365599.2012.727467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effects of acute exercise on the diameter of the spermatic vein, and on the duration of reflux in patients with varicocele. MATERIAL AND METHODS The study included 38 patients with complaints of infertility and scrotal pain between 2009 and 2010. The diagnoses were made by physical examination and colour Doppler ultrasound, with both performed before and after exercise tests. RESULTS The mean age of the participants was 25.7 ± 4.9 years. During the first examination, the grades of the varicoceles detected were as follows: grade I, n = 7; II, n = 10; and III, n = 21. The diameters of veins in patients with grades I, II and III varicocele were 2.1 mm, 2.9 mm and 4.2 mm, respectively, before exercise, whereas they were 2.6 mm, 3.2 mm and 4.3 mm, respectively, after exercise. In patients with grade I varicoceles, compared with pre-exercise values, the diameter of the left spermatic vein and duration of reflux measured during Valsalva manoeuvres were increased significantly after exercise (p = 0.042 and p = 0.034, respectively); similar results were obtained for the patients with grade II varicoceles (p = 0.007 and p = 0.008, respectively). However, the minimal relative increase in cases with grade III varicoceles was not statistically significant (p > 0.05). CONCLUSIONS This study demonstrates that acute exercise increases the spermatic vein diameter and reflux time in patients with varicoceles. These outcomes demonstrate that acute exercise may be an aggravating factor for varicocele, as seen in chronic exercise.
Collapse
Affiliation(s)
- Murat Atar
- Department of Urology, Medical Faculty, Dicle University, Diyarbakir, Turkey.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Di Luigi L, Romanelli F, Sgrò P, Lenzi A. Andrological aspects of physical exercise and sport medicine. Endocrine 2012; 42:278-84. [PMID: 22430368 DOI: 10.1007/s12020-012-9655-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 03/06/2012] [Indexed: 12/21/2022]
Abstract
Appropriate physical activity is one of the bases of healthy lifestyle. In fact, physical exercise and playing sport may be associated with both improvements and injury to both general and reproductive health. A biologically normal testosterone secretion appears fundamental in males to guarantee both a physiological exercise adaptation and safe sport participation. The reproductive system is highly sensitive to the effects of exercise-related stress and the reproductive hormones may both increase and decrease after different acute or chronic exercises. Exercise and sport participation may positively or negatively influence andrological health status depending on the type, intensity and duration of performed physical activity and on individual health status. In addition, prohibited substances administration (e.g. androgenic-anabolic steroids, and so forth) in competitive and non-competitive athletes represents the main cause of iatrogenic andrological diseases. Preventing and treating andrological problems in active healthy and unhealthy individuals is as important as promoting a correct lifestyle. Physicians need to be educated on the relationships between the male reproductive system and sport participation and on the great role of the pre-participation physical examination in the prevention of andrological diseases.
Collapse
Affiliation(s)
- Luigi Di Luigi
- Unit of Endocrinology, Department of Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis, 15, 00135 Rome, Italy.
| | | | | | | |
Collapse
|
10
|
Zampieri N, Dall'Agnola A. Subclinical Varicocele and Sports: A Longitudinal Study. Urology 2011; 77:1199-202. [DOI: 10.1016/j.urology.2010.09.057] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 09/03/2010] [Accepted: 09/03/2010] [Indexed: 10/18/2022]
|
11
|
Tsao CW, Hsu CY, Chou YC, Wu ST, Sun GH, Yu DS, Fan PL, Chen HI, Chang SY, Cha TL. The relationship between varicoceles and obesity in a young adult population. ACTA ACUST UNITED AC 2009; 32:385-90. [DOI: 10.1111/j.1365-2605.2008.00926.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
12
|
May M, Taymoorian K, Beutner S, Helke C, Braun KP, Lein M, Roigas J, Hoschke B. Body size and weight as predisposing factors in varicocele. ACTA ACUST UNITED AC 2006; 40:45-8. [PMID: 16452055 DOI: 10.1080/00365590500407795] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The literature regarding the constitutional type of children and adolescents with varicocele is inconsistent. The aim of this investigation was to examine a possible influence of weight, height and body mass index (BMI) on the formation of varicoceles during childhood and adolescence. MATERIAL AND METHODS In a retrospective data analysis, 193 Caucasian children and adolescents aged 9-19 years (mean age 14.7 years) with left-sided varicocele grade 2-3 were studied. The weight, height and BMI of the subjects were compared with the age-correlated normal values currently accepted in Germany. Additionally, the familial disposition for varicocele and the occurrence of relevant concurrent diseases were considered. RESULTS In the group of patients examined, the mean percentiles of weight (57th) and height (58th) were significantly above and the mean BMI percentile (42th) was significantly below the age-correlated 50th percentile for the normal population (p=0.019, 0.005 and 0.002). In our case material, 12.2% of all brothers of the patients had varicoceles. CONCLUSIONS The results of this investigation suggest a correlation between physical appearance and the formation of a varicocele during childhood or adolescence. We were able to demonstrate that patients with varicocele were heavier and taller than an age-correlated normal population, but had a distinctly lower BMI. Further studies are needed to verify whether this rather athletic habitus, together with the postulated difference in muscle:fat ratio, represents an important etiologic factor for varicocele formation.
Collapse
Affiliation(s)
- M May
- Department of Urology, Carl-Thiem Hospital Cottbus, Cottbus, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Unsal A, Yilmaz B, Turgut AT, Taşkin F, Alaca R, Karaman CZ. Evaluation of varicocele frequency of patients with spinal cord injury by color Doppler ultrasonography: a new etiological factor for varicocele? Eur J Radiol 2005; 57:154-7. [PMID: 16162396 DOI: 10.1016/j.ejrad.2005.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Revised: 08/10/2005] [Accepted: 08/10/2005] [Indexed: 01/14/2023]
Abstract
PURPOSE To evaluate the varicocele frequency of patients with spinal cord injury by color Doppler ultrasonography. MATERIALS AND METHODS Sixty patients {48 patients with upper motor neuron injury (U-MNI) and 12 patients with lower-MNI} with traumatic spinal cord injury and age matched 48 healthy volunteers were enrolled in this prospective study. Testis volumes and varicocele grades were determined. Presence of varicocele was also classified according to clinical significance. RESULTS Testis volumes of U-MNI sub-group (14.81 +/- 4.74 ml) were significantly smaller than the control group (18.20 +/- 4.52 ml, p = 0.000) and L-MNI sub-group (17.88 +/- 3.23 ml, p = 0.008). No left-sided clinical varicocele was found in L-MNI sub-group (0/12, 0%), whereas there were 14 patients in control group (14/48, 29%) and 7 patients in U-MNI sub-group (7/47, 15%), and the difference was statistically significant (p = 0.000, 0.007, respectively). CONCLUSION Clinical varicocele frequency of U-MNI patients, who have spastic paralysis of abdominal and lower extremity muscles, is similar to the control group. This finding inspires that increased intra-abdominal pressure via normal to increased abdominal muscle tonus may have a role in the varicocele etiology, beside the classical factors. Absence of clinical varicocele in L-MNI patients, who have flaccid paralysis of the same muscle groups, supports this observation.
Collapse
Affiliation(s)
- Alparslan Unsal
- Adnan Menderes University, Faculty of Medicine, Department of Radiology, Aydin, Turkey.
| | | | | | | | | | | |
Collapse
|