1
|
Soyalp C, Kocak MN, Ahiskalioglu A, Aksoy M, Atalay C, Aydin MD, Cakir M, Calikoglu C, Ozmen S. New determinants for casual peripheral mechanism of neurogenic lung edema in subarachnoid hemorrhage due to ischemic degeneration of vagal nerve, kidney and lung circuitry. Experimental study1. Acta Cir Bras 2019; 34:e201900303. [PMID: 30892389 PMCID: PMC6585894 DOI: 10.1590/s0102-865020190030000003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/10/2019] [Indexed: 01/13/2023] Open
Abstract
Purpose To evaluate whether there is a relationship between renal artery vasospasm
related low glomerular density or degeneration and neurogenic lung edema
(NLE) following subarachnoid hemorrhage. Methods This study was conducted on 26 rabbits. A control group was formed of five
animals, a SHAM group of 5 to which saline and a study group (n=16) injected
with homologous blood into the sylvian cisterna. Numbers of degenerated
axons of renal branches of vagal nerves, atrophic glomerulus numbers and NLE
scores were recorded. Results Important vagal degeneration, severe renal artery vasospasm, intrarenal
hemorrhage and glomerular atrophy observed in high score NLE detected
animals. The mean degenerated axon density of vagal nerves
(n/mm2), atrophic glomerulus density (n/mm3) and NLE
scores of control, SHAM and study groups were estimated as 2.40±1.82,
2.20±1.30, 1.80±1.10, 8.00±2.24, 8.80±2.39, 4.40±1.14 and 154.38±13.61,
34.69±2.68 and 12.19±1.97 consecutively. Degenerated vagal axon, atrophic
glomerulus and NLE scores are higher in study group than other groups and
the differences are statistically meaningful (p<0.001). Conclusion Vagal complex degeneration based glomerular atrophy have important roles on
NLE following SAH which has not been extensively mentioned in the
literature.
Collapse
Affiliation(s)
- Celaleddin Soyalp
- MD, Department of Anesthesiology, Medical Faculty, Yil University, Van, Turkey. Conception and design of the study, acquisition of data, manuscript writing
| | - Mehmet Nuri Kocak
- MD, Department of Neurology, Medical Faculty, Ataturk University, Erzurum, Turkey. Technical procedures, manuscript preparation
| | - Ali Ahiskalioglu
- Assistant Prof., Department of Anesthesiology and Reanimation, Medical Faculty, Ataturk University, Erzurum, Turkey. Acquisition, analysis and interpretation of data; manuscript preparation; critical revision
| | - Mehmet Aksoy
- Assistant Prof., Department of Anesthesiology and Reanimation, Medical Faculty, Ataturk University, Erzurum, Turkey. Acquisition, analysis and interpretation of data; manuscript preparation; critical revision
| | - Canan Atalay
- Assistant Prof., Department of Anesthesiology and Reanimation, Medical Faculty, Ataturk University, Erzurum, Turkey. Acquisition, analysis and interpretation of data; manuscript preparation; critical revision
| | - Mehmet Dumlu Aydin
- Prof., Department of Neurosurgery, Medical Faculty, Ataturk University, Erzurum, Turkey. Histopathological examinations, manuscript writing, critical revision, final approval
| | - Murteza Cakir
- Prof., Department of Neurosurgery, Medical Faculty, Ataturk University, Erzurum, Turkey. Histopathological examinations, manuscript writing, critical revision, final approval
| | - Cagatay Calikoglu
- Prof., Department of Neurosurgery, Medical Faculty, Ataturk University, Erzurum, Turkey. Histopathological examinations, manuscript writing, critical revision, final approval
| | - Sevilay Ozmen
- MD, Department of Pathology, Medical Faculty, Ataturk University, Erzurum, Turkey. Histopathological examinations
| |
Collapse
|
2
|
Kashihara K. Roles of arterial baroreceptor reflex during bezold-jarisch reflex. Curr Cardiol Rev 2011; 5:263-7. [PMID: 21037842 PMCID: PMC2842957 DOI: 10.2174/157340309789317805] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 04/21/2009] [Accepted: 05/05/2009] [Indexed: 11/22/2022] Open
Abstract
Among the many cardiopulmonary reflexes, this review specifically examines the roles of the arterial baroreflex during the Bezold-Jarisch reflex (BJR). Activation of cardiopulmonary vagal afferent C-fibers induces hypotension, bradycardia, and apnea, which are known collectively as the BJR; myocardial ischemia and infarction might induce the BJR. Arterial baroreflex has been established as an important negative feedback system that stabilizes arterial blood pressure against exogenous pressure perturbations. Therefore, understanding the functions of the arterial baroreflex during the BJR is crucial for elucidating its pathophysiological implications. The main central pathways of the BJR and the baroreflex are outlined herein, particularly addressing the common pathway between the reflexes. Furthermore, the pathophysiological roles of the arterial baroreflex during the BJR are described along with a brief discussion of pathophysiological merits and shortcomings of the reflexes.
Collapse
|
3
|
Ditting T, Hilgers KF, Scrogin KE, Stetter A, Linz P, Veelken R. Mechanosensitive cardiac C-fiber response to changes in left ventricular filling, coronary perfusion pressure, hemorrhage, and volume expansion in rats. Am J Physiol Heart Circ Physiol 2005; 288:H541-52. [PMID: 15471986 DOI: 10.1152/ajpheart.00131.2004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Left ventricular (LV) end-diastolic pressure (LVEDP) increase due to volume expansion (VExp) enhances mechanosensitive vagal cardiac afferent C-fiber activity (CNFA), thus decreasing renal sympathetic nerve activity (RSNA). Hypotensive hemorrhage (hHem) attenuates RSNA despite decreased LVEDP. We hypothesized that CNFA increases with any change in LVEDP. Coronary perfusion pressure (CPP), supposedly affected in both conditions, might also be a stimulus of CNFA. VExp and hHem were performed in anesthetized male Sprague-Dawley rats while blood pressure, heart rate, and RSNA were measured. Cervical vagotomy abolished RSNA response in both reflex responses. Single-unit CNFA was recorded while LVEDP was changed. Rapid changes (± 4, ±6, ±8 mmHg) were obtained by graded occlusion of the caval vein and descending aorta. Prolonged changes were obtained by VExp and hHem. Furthermore, CNFA was recorded in a modified Langendorff heart while CPP was changed (70, 100, 40 mmHg). Rapid LVEDP changes increased CNFA [caval vein occlusion: +16 ± 3 Hz (approximately +602%); aortic occlusion: +15 ± 3 Hz (approximately +553%); 70 units; P < 0.05]. VExp and hHem ( n = 6) increased CNFA [VExp: +10 ± 4 Hz (approximately +1,033%); hHem: +10 ± 2 Hz (approximately +1,225%); P < 0.05]. An increase in CPP increased CNFA [+2 ± 1 Hz (approximately +225%); P < 0.05], whereas a decrease in CPP decreased CNFA [−0.8 ± 0.4 Hz (approximately −50%); P < 0.05]. All C fibers recorded originated from the LV. CNFA increased with any LVEDP change but changed equidirectionally with CPP. Thus neither LVEDP nor CPP fully accounts directly for afferent C-fiber and reflex sympathetic responses. The intrinsic afferent stimuli and receptive fields accounting for reflex sympathoinhibition still remain cryptic.
Collapse
Affiliation(s)
- Tilmann Ditting
- Department of Nephrology, Johann Wolfgang University, Frankfurt, Germany
| | | | | | | | | | | |
Collapse
|
4
|
Verberne AJM, Sartor DM. CCK-induced inhibition of presympathetic vasomotor neurons: dependence on subdiaphragmatic vagal afferents and central NMDA receptors in the rat. Am J Physiol Regul Integr Comp Physiol 2004; 287:R809-16. [PMID: 15155283 DOI: 10.1152/ajpregu.00258.2004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Systemic administration of cholecystokinin (CCK) inhibits a subpopulation of rostral ventrolateral medulla (RVLM) presympathetic vasomotor neurons. This study was designed to determine whether this effect involved subdiaphragmatic vagal afferents and/or central N-methyl-d-aspartic acid (NMDA) receptors. Recordings were made from CCK-sensitive RVLM presympathetic vasomotor neurons in halothane-anesthetized, paralyzed male Sprague-Dawley rats. The responses of the neurons to CCK (2 and 4 μg/kg iv), phenylephrine (PE; 5 μg/kg iv), and phenylbiguanide (PBG; 5 μg/kg iv) were tested before and after application of the local anesthetic lidocaine (2% wt/vol gel; 1 ml) to the subdiaphragmatic vagi at the level of the esophagus. In seven separate experiments, lidocaine markedly reduced the inhibitory effects of CCK on RVLM presympathetic neuronal discharge rate. In other experiments, the effect of systemic administration of dizocilpine (1 mg/kg iv), a noncompetitive antagonist at NMDA receptor ion channels, on the RVLM presympathetic neuronal responses to CCK, PBG, and PE was tested. In all cases ( n = 6 neurons in 6 individual rats), dizocilpine inhibited the effects of CCK, PBG, and PE on RVLM presympathetic neuronal discharge. These results suggest that the effects of systemic CCK on the discharge of RVLM presympathetic neurons is mediated via an action on receptors located on subdiaphragmatic vagal afferents. Furthermore, the data suggest that CCK activates a central pathway involving NMDA receptors to produce inhibition of RVLM presympathetic neuronal discharge.
Collapse
MESH Headings
- Adrenergic alpha-Agonists/pharmacology
- Anesthetics, Local/pharmacology
- Animals
- Biguanides/pharmacology
- Cholecystokinin/pharmacology
- Depression, Chemical
- Diaphragm/innervation
- Diaphragm/physiology
- Dizocilpine Maleate/pharmacology
- Excitatory Amino Acid Antagonists/pharmacology
- Extracellular Space/drug effects
- Extracellular Space/physiology
- Male
- Medulla Oblongata/cytology
- Medulla Oblongata/drug effects
- Medulla Oblongata/physiology
- Motor Neurons/drug effects
- Muscle, Smooth, Vascular/drug effects
- Muscle, Smooth, Vascular/innervation
- Neurons, Afferent/physiology
- Parasympathetic Nervous System/drug effects
- Parasympathetic Nervous System/physiology
- Phenylephrine/pharmacology
- Rats
- Rats, Sprague-Dawley
- Receptors, N-Methyl-D-Aspartate/drug effects
- Receptors, N-Methyl-D-Aspartate/physiology
- Synaptic Transmission/drug effects
- Vagus Nerve/physiology
Collapse
Affiliation(s)
- Anthony J M Verberne
- Clinical Pharmacology and Therapeutics Unit, Dept. of Medicine, Austin Health, Heidelberg, Victoria 3084, Australia.
| | | |
Collapse
|
5
|
Kashihara K, Kawada T, Yanagiya Y, Uemura K, Inagaki M, Takaki H, Sugimachi M, Sunagawa K. Bezold-Jarisch reflex attenuates dynamic gain of baroreflex neural arc. Am J Physiol Heart Circ Physiol 2003; 285:H833-40. [PMID: 12714325 DOI: 10.1152/ajpheart.01082.2002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Although acute myocardial ischemia or infarction may induce the Bezold-Jarisch (BJ) reflex through the activation of serotonin receptors on vagal afferent nerves, the mechanism by which the BJ reflex modulates the dynamic characteristics of arterial pressure (AP) regulation is unknown. The purpose of this study was to examine the effects of the BJ reflex induced by intravenous phenylbiguanide (PBG) on the dynamic characteristics of the arterial baroreflex. In seven anesthetized rabbits, we perturbed intracarotid sinus pressure (CSP) according to a white noise sequence while renal sympathetic nerve activity (RSNA), AP, and heart rate (HR) were recorded. We estimated the transfer function from CSP to RSNA (neural arc) and from RSNA to AP (peripheral arc) before and after 10 min of intravenous administration of PBG (100 microg. kg-1. min-1). The intravenous PBG decreased mean AP from 84.5 +/- 4.0 to 68.2 +/- 4.7 mmHg (P < 0.01), mean RSNA to 76.2 +/- 7.0% (P < 0.05), and mean HR from 301.6 +/- 7.7 to 288.4 +/- 9.0 beats/min (P < 0.01). The intravenous PBG significantly decreased neural arc dynamic gain at 0.01 Hz (1.06 +/- 0.08 vs. 0.59 +/- 0.17, P < 0.05), whereas it did not affect that of the peripheral arc (1.20 +/- 0.12 vs. 1.18 +/- 0.41). In six different rabbits without intravenous PBG, the neural arc transfer function did not change between two experimental runs with intervening interval of 10 min, excluding the possibility that the cumulative effects of anesthetics had altered the neural arc transfer function. In conclusion, excessive activation of the BJ reflex during acute myocardial ischemia may exert an adverse effect on AP regulation, not only by sympathetic suppression, but also by attenuating baroreflex dynamic gain.
Collapse
Affiliation(s)
- Koji Kashihara
- Department of Cardiovascular Dynamics, National Cardiovascular Center Research Institute, 5-7-1 Fujishirodai, Suita-shi, Osaka 565-8565, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Veelken R, Stetter A, Dickel T, Hilgers KF. Bimodality of cardiac vagal afferent C-fibres in the rat. Pflugers Arch 2003; 446:516-22. [PMID: 12695915 DOI: 10.1007/s00424-003-1078-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2002] [Accepted: 03/17/2003] [Indexed: 10/26/2022]
Abstract
Vagal afferent C-fibres from the heart constitute an important input to the neurogenic cardiovascular regulation. These fibres respond to altered cardiac filling pressures and to chemical stimuli. In rats, we tested whether cardiac vagal afferent C-fibres react exclusively to one stimulus (chemical or mechanical) or whether the fibres are bimodal, i.e. responsive to either kind of stimulus. As a mechanical stimulus, an indwelling balloon was inflated in the aorta to increase left ventricular end-diastolic pressure. The serotonin 5HT(3) receptor agonist phenylbiguanide was injected into the pericardial sac as a chemical stimulus. An increase of fibre activity by more than two standard deviations compared with control was considered a response to a stimulus. Most fibres (42 out of 57) responded to both stimuli and were categorized as bimodal, 9 fibres were solely mechanosensitive and 6 were solely chemosensitive. Hence, the majority of cardiac vagal C-fibres are likely to be bimodal, responding to both cardiac filling pressure and serotonin 5HT(3) receptor stimulation. Our results emphasize the potential role of endogenous mediators in the afferent limb of cardiac reflexes.
Collapse
Affiliation(s)
- Roland Veelken
- Nephrologisches Labor, Department of Medicine IV, University of Erlangen-Nürnberg, Loschgestrasse 8, 91054 Erlangen, Germany.
| | | | | | | |
Collapse
|
7
|
Wang Y, Soukhova G, Proctor M, Walker J, Yu J. Bradykinin causes hypotension by activating pulmonary sympathetic afferents in the rabbit. J Appl Physiol (1985) 2003; 95:233-40. [PMID: 12679362 DOI: 10.1152/japplphysiol.00584.2002] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Bradykinin (BK) activates sympathetic afferents in the heart, intestine, and kidney, and it alters hemodynamics. However, we know little about the influence of pulmonary sympathetic afferents on circulation. Activation of pulmonary afferents by directly injecting stimulants into the lung parenchyma permits examination of reflexes that originate in the lung without confounding effects from the systemic circulation. In the present study, we tested the hypothesis that pulmonary sympathetic afferents exert a significant influence on hemodynamics. We examined reflex effects of injecting BK (1 microg/kg in 0.1 ml) into the lung parenchyma on circulation in anesthetized, open-chest, artificially ventilated rabbits. BK significantly decreased mean arterial blood pressure (BP) (27 +/- 3 mmHg) and heart rate (19 +/- 4 beats/min). Both effects remained after bilateral vagotomy. To rule out possible direct systemic vasodilation by BK, we examined renal sympathetic nerve activity (RSNA) in response to BK injection and examined BP responses to injection of ACh (0.1 ml of 10-4 M). BK suppressed the RSNA before and after vagotomy. ACh did not change BP when injected into the lung parenchyma, but it decreased BP (31 +/- 3 mmHg) when injected into the right atrium. Our data indicate that activating pulmonary sympathetic afferents reflexly suppresses hemodynamics.
Collapse
Affiliation(s)
- Y Wang
- Department of Medicine, University of Louisville, Louisville, KY 40292, USA
| | | | | | | | | |
Collapse
|
8
|
Saita M, Verberne AJM. Roles for CCK1 and 5-HT3 receptors in the effects of CCK on presympathetic vasomotor neuronal discharge in the rat. Br J Pharmacol 2003; 139:415-23. [PMID: 12770947 PMCID: PMC1573844 DOI: 10.1038/sj.bjp.0705245] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
1 The role of peripheral 5-hydroxytryptamine (5-HT(3)) receptors and cholecystokinin type 1 (CCK(1)) receptors in the inhibitory effects of phenylbiguanide (PBG) and CCK on arterial blood pressure, heart rate and the discharge of presympathetic vasomotor neurones of the rostral ventrolateral medulla (RVLM) was studied in alpha-chloralose-anaesthetized rats. 2 CCK (1 and 4 micro g kg(-1), i.v.) and PBG (2 and 10 micro g kg(-1), i.v.) reduced arterial blood pressure and heart rate, and inhibited the discharge of single RVLM presympathetic vasomotor neurones in a dose-related manner. 3 Devazepide (0.5 mg kg(-1), i.v.), a selective CCK(1) receptor antagonist, blocked the effects of CCK on arterial blood pressure, heart rate and neuronal discharge but did not significantly alter these responses to PBG. MDL72222 (0.1 mg kg(-1), i.v.), a selective 5-HT(3) receptor antagonist, blocked the effects of PBG on arterial blood pressure, heart rate and presympathetic neuronal discharge. MDL72222 attenuated the effects of CCK on arterial blood pressure, heart rate and RVLM presympathetic neuronal discharge. Vehicle did not significantly alter any of the responses to CCK or PBG. 4 These experiments suggest that systemically administered CCK acts directly through CCK(1) receptors to modulate sympathetic vasomotor function. In addition, the actions of CCK also are partly dependent on activation of 5-HT(3) receptors. CCK may release 5-HT which then acts at 5-HT(3) receptors to produce sympathetic vasomotor inhibition. In contrast, the actions of PBG are entirely dependent on 5-HT(3) receptors and are independent of any actions at the CCK(1) receptor.
Collapse
Affiliation(s)
- Mitsuhiko Saita
- Department of Medicine, Clinical Pharmacology and Therapeutics Unit, Austin and Repatriation Medical Centre, University of Melbourne, Heidelberg, Victoria 3084, Australia.
| | | |
Collapse
|
9
|
Linz P, Veelken R. Serotonin 5-HT(3) receptors on mechanosensitive neurons with cardiac afferents. Am J Physiol Heart Circ Physiol 2002; 282:H1828-35. [PMID: 11959649 DOI: 10.1152/ajpheart.00708.2000] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In rats, the mechanosensitive cardiorenal baroreflex influencing renal excretory function might be impaired by serotonin occurring in coronary arteries, e.g., in hypertension. Because the afferent limb of this reflex could be affected, we investigated the responses of nodose ganglion cells (one neuron of reflex) to osmotic, mechanical stress in presence or absence of the serotonin 5-HT(3) receptor agonist phenylbiguanide (PBG). Current-voltage relationships (from -100 to +50 mV) were obtained using cell patch recordings while the cells were exposed to control or hypoosmotic solutions to induce mechanical stress. This protocol was repeated after low doses of PBG (10 microM), angiotensin II (10 nM), or the stretch-activated channel blocker gadolinium (20 microM) were added to the extracellular medium (EM). Hypoosmotic EM induced significant changes in cellular conductance. The full-range current-voltage relationship allowed for the calculation of a mean reversal potential of -13 +/- 1.2 mV with respect to this change in cellular conductance (n = 44). This increase in conductance was impaired after addition of either PBG or gadolinium to the EM,which was statistically evaluated at a voltage of -80 mV, where influences of voltage-gated channels are not likely to interfere with the responses recorded. The serotonin 5-HT(3) receptor antagonist tropisetron (10 nM) prevented the PBG effect on conductance responses. Angiotensin II had no influence. Hence, serotonin might decrease the mechanical sensitivity of afferent cardiac nerves controlling renal sympathetic nerve activity.
Collapse
Affiliation(s)
- Peter Linz
- Department of Internal Medicine, University of Erlangen-Nürnberg, 91054 Erlangen, Germany
| | | |
Collapse
|
10
|
Cunningham JT, Bruno SB, Higgs KAN, Sullivan MJ. Intrapericardial procaine affects volume expansion-induced fos immunoreactivity in unanesthetized rats. Exp Neurol 2002; 174:181-92. [PMID: 11922660 DOI: 10.1006/exnr.2002.7863] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Acute volume expansion is associated with a specific pattern of Fos expression and the goal of the present study was to evaluate the contribution of cardiac receptors to this response. Adult male rats were instrumented with pericardial catheters introduced at the level of the thymus. Rats were also catheterized for measuring blood pressure, heart rate, central venous pressure, and intravenous infusion. Each rat received a 200-microl intrapericardial (i.p.c) injection of 2% procaine or 0.9% NaCl. Rats were then volume expanded with isotonic saline (10% body weight in 10 min) or given a control infusion (0.01 ml/min for 10 min). Ninety minutes after the start of the infusion, the rats were anesthetized and perfused transcardially. Their brains were sectioned and processed for Fos, dopamine-beta-hydroxylase, and oxytocin immunocytochemistry. Volume expansion plus i.p.c. saline produced a significant increase in Fos expression in the nucleus of the solitary tract, the ventrolateral medulla, the area postrema, the locus coeruleus, the paraventricular nucleus of the hypothalamus, the perinuclear zone of the supraoptic nucleus, and oxytocin neurons in the supraoptic nucleus. The i.p.c. procaine significantly blocked Fos expression produced by the volume expansion in the all of the regions examined except for the area postrema and the SON oxytocin neurons.
Collapse
Affiliation(s)
- J Thomas Cunningham
- Department of Physiology & the Dalton Cardiovascular Research Center, Research Park, Columbia, Missouri 65211, USA
| | | | | | | |
Collapse
|