Advanced Biomedical Research 2277-9175 2017 May 2017 05 01 Comparing the Efficacy of Three Different Nano-scale Bone Substitutes: In vivo Study 1 6 28061 EN Sayed Mohammad Razavi Dental Implants Research Center, Department of Oral Pathology, School of Dentitry, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0002-3504-9424 Mansour Rismanchian Dental Implants Research Center, Department of Prosthodontics, School of Dentitry, Isfahan University of Medical Sciences, Isfahan, Iran Nasim Jafari-pozve Department of Oral and Maxillofacial Radiology, School of Dentitry, Isfahan University of Medical Sciences, Isfahan; Department of Oral and Maxillofacial Radiology, School of Dentitry, Islamic Azad University, Khorasgan Branch, Isfahan, Iran Saied Nosouhian Dental Implants Research Center, Department of Prosthodontics, School of Dentitry, Isfahan University of Medical Sciences, Isfahan, Iran Journal Article 2023 02 20 Background: Synthetic biocompatible bone substitutions have been used widely for bone tissue regeneration as they are safe and effective. The aim of this animal study is to compare the effectiveness of three different biocompatible bone substitutes, including nano-hydroxyapatite (nano-HA) nano-bioglass (nano-BG) and forstrite scaffolds. Materials and Methods: In this interventional and experimental study, four healthy dogs were anesthetized, and the first to fourth premolars were extracted in each quadrant. After healing, the linear incision on the crestal ridge from molar to anterior segment prepared in each quadrant and 16 defects in each dog were prepared. Nano-HA, nano-BG, and forstrite scaffold was prepared according to the size of defects and placed in the 12 defects randomly, four defects remained as a control group. The dogs were sacrificed in four time intervals (15, 30, 45, and 60 days after) and the percentage of different types of regenerated bones (lamellar and woven) and connective tissue were recorded in histological process. The data were analyzed using Mann–Whitney test (α = 0.05). Results: The difference in nano-HA and nano-BG with the control group was significant in three-time intervals regarding the amount of bone formation (P < 0.01). After 15 days, the nano-HA showed the highest amount of woven and lamellar bone regeneration (18.37 ± 1.06 and 30.44 ± 0.54). Conclusion: Nano-HA and nano-BG groups showed a significant amount of bone regeneration, especially after 30 days, but paying more surveys and observation to these materials as bone substitutes seem to be needed.

https://advbiores.mui.ac.ir/article_28061_30875cf3491d376f2b9815c231b3e1a5.pdf

Advanced Biomedical Research 2277-9175 2017 May 2017 05 01 Relationship between Self-efficacy and Physical Activity, Medication Adherence in Chronic Disease Patients 1 7 28062 EN Seyde Shahrbanoo Daniali Department of Health, Student Research Center, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran Firooze Mostafavi Darani Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran Ahmad Ali Eslami Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran Mohammad Mazaheri Department of Traditional Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Journal Article 2023 02 20 Background: The global epidemic of unhealthy lifestyle causes to increase chronic disease. It has been proven that psychological factors such as self-efficacy are responsible to success in the process of lifestyle change. Low self-efficacy is usually related to low level of physical activity and medication adherence. Objective of the study was to investigate the effects of self-efficacy, other physical symptoms on physical activity and medication adherence in patients with chronic illness in public health centers. Materials and Methods: A cross-sectional study was conducted on 483 patients with chronic diseases attended to governmental health care centers in Isfahan. Participants were chosen by systematic random sampling. Inclusion criteria were having a chronic illness at least 6-month ago while prescription of medication and willing to take part in the survey. The parts of Stanford Self-management Questionnaire were used. Data were analyzed by SPSS 18 software using the descriptive and analytic statistics. P <0.05 was considered significant. Results: Mean age of participants was 54.8 (7.22) years. The half of participants had low self-efficacy and 87.2% had low physical activity. Nearly 80% of patients had a good medication adherence. There was a significant relationship between self-efficacy and physical activity (P = 0.336, β = 1.01, P< 0.001). Conclusion: Although chronic disease patients had a good medication adherence, other self-care behaviors such as physical activity has been neglected. It is seemed that concentration on psychological factors such as self-efficacy should be considered as a proximal factor to improve self-care.

https://advbiores.mui.ac.ir/article_28062_0a6ad41f086b7d5700c2cc9e937bd348.pdf

Advanced Biomedical Research 2277-9175 2017 May 2017 05 01 Antioxidant Capability of Ultra-high Temperature Milk and Ultra-high Temperature Soy Milk and their Fermented Products Determined by Four Distinct Spectrophotometric Methods 1 7 28064 EN Sahar Torki Baghbadorani Department of Food Science and Technology, Faculty of Agriculture and Natural Resources, Islamic Azad University, Science and Research Branch, Tehran, Iran Mohammad Reza Ehsani Department of Food Science and Technology, Faculty of Agriculture and Natural Resources, Islamic Azad University, Science and Research Branch, Tehran, Iran Maryam Mirlohi Department of Food Technology, Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran Hamid Ezzatpanah Department of Food Science and Technology, Faculty of Agriculture and Natural Resources, Islamic Azad University, Science and Research Branch, Tehran, Iran Leila Azadbakht Department of Community Nutrition, Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran Mina Babashahi Department of Food Technology, Food Security Research Center, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran Journal Article 2023 02 20 Background: Due to the recent emerging information on the antioxidant properties of soy products, substitution of soy milk for milk in the diet has been proposed by some nutritionists. We aimed to compare four distinct antioxidant measuring methods in the evaluation of antioxidant properties of industrial ultra-high temperature (UHT) milk, UHT soy milk, and their fermented products by Lactobacillus plantarum A7. Materials and Methods: Ascorbate auto-oxidation inhibition assay, 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) free radical scavenging method, hydrogen peroxide neutralization assay and reducing activity test were compared for the homogeneity and accuracy of the results. Results: The results obtained by the four tested methods did not completely match with each other. The results of the DPPH assay and the reducing activity were more coordinated than the other methods. By the use of these methods, the antioxidant capability of UHT soy milk was measured more than UHT milk (33.51 ± 6.00% and 945 ± 56 μM cysteine compared to 8.70 ± 3.20% and 795 ± 82 μM cysteine). The negative effect of fermentation on the antioxidant potential of UHT soy milk was revealed as ascorbate auto-oxidation inhibition assay, DPPH method and reducing activity tests ended to approximately 52%, 58%, and 80% reduction in antioxidant potential of UHT soy milk, respectively. Conclusions: The antioxidative properties of UHT soy milk could not be solely due to its phenolic components. Peptides and amino acids derived from thermal processing in soy milk probably have a main role in its antioxidant activity, which should be studied in the future.

https://advbiores.mui.ac.ir/article_28064_b9c317d06906da03e3d4798fe5824e31.pdf

Advanced Biomedical Research 2277-9175 2017 May 2017 05 01 Comparison the Effect of Extra Corporeal Shockwave Therapy with Low Dosage Versus High Dosage in Treatment of the Patients with Lateral Epicondylitis 1 4 28066 EN Parisa Taheri Department of Physical Medicine and Rehabilitation, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0002-8335-8862 Masoud Emadi Department of Physical Medicine and Rehabilitation, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran Jafar Poorghasemian Department of Physical Medicine and Rehabilitation, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran Journal Article 2023 02 20 Background: One of the most common reasons of elbow and forearm pain is lateral epicondylitis diagnosed based on clinical examination. The extracorporeal shock wave therapy is applied for less invasive treatments with different dosages. This study aimed to investigate the effects of high- and low-dose ESW in treating the lateral epicondylitis. Materials and Methods: This clinical trial was done in Al Zahra medical center on 40 patients who were selected randomly and divided into two groups. After VAS, the first group was treated by Duolith SD1 shock wave, energy of 0.25 mj/mm2, 1000 shocks; the second was treated by focus with the energy of 0.10 mj/mm2, 1000 shocks per session for 15 minutes with weekly intervals in three sessions. The patients were also treated with drugs (NSAIDs) and the visual analog scale (VAS) was reassessed 1 week after the last session and 12 weeks after finishing the treatment. Results: The mean of pain intensity during study was decreased in the two groups but reduction of pain intensity in the low-dose groups was higher than the high-dose groups (P = 0.001). Changes in other parameters including wrist extension test, middle finger extension test and PG was also similar. Conclusion: Extra corporeal shockwave therapy can be effective in treating lateral epicondylitis, but its effects usually appear in after 2 or 3 months and using the low dose of this treating method has more desirable therapeutic effects.

https://advbiores.mui.ac.ir/article_28066_e5f69a36d50c3cb60dc35e49a62f4f24.pdf

Advanced Biomedical Research 2277-9175 2017 May 2017 05 01 A Comparison of Intravenous Ephedrine or Phenylephrine, for Prevention of Postspinal Hypotension during Elective Lower Abdominal Surgery: A Randomized, Double-blind Case–control Study 1 5 28068 EN Khosrou Naghibi Department of Anesthesia and Intensive Care, Alzahra University Hospital, Isfahan, Iran Mojtaba Rahimi Department of Anesthesia and Intensive Care, Alzahra University Hospital, Isfahan, Iran Zahra Mashayekhi Anesthesiology and Critical Care Research Center, Department of Anesthesiology and Intensive Care, Isfahan University of Medical Sciences, Isfahan, Iran Journal Article 2023 02 20 Background: In this randomized, double-blinded case–control study, we investigated the intravenous effects of ephedrine or phenylephrine on prevention of post–spinal hypotension in elective lower abdominal surgery under spinal anesthesia. Materials and Methods: One hundred and thirty-five patients, American Society of Anesthesiologists physical status I or II candidate for elective lower abdominal surgery under spinal anesthesia were randomized to three groups (45 each). According to their allocated group, patients received either ephedrine 2.5 mg (E group), phenylephrine (P group) 25 mic as vasopressor or the same volume of saline normal as placebo (S group) immediately after the spinal anesthesia. hemodynamic parameters, and complications were recorded. Results: Patients' demographics were similar in all the groups. The mean systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP and also heart rate were similar over time for groups E and P (P > 0.05). The incidence of reactive hypertension was more in group E than group P and placebo (P < 0.05). The incidence of nausea and vomiting were significantly lower in groups E and P in comparison with placebo (P < 0.05). Conclusion: Although the mean fall of SBP and DBP were significantly less in groups E and P compared with placebo but we did not find significant differences in prophylactic use of ephedrine or phenylephrine for prevention of post–spinal hypotension in elective lower abdominal surgery. Vasopressors infusion have added benefit of lower incidence of nausea and vomiting.

https://advbiores.mui.ac.ir/article_28068_c5a49fecbf7846824c273eff3c8513ee.pdf

Advanced Biomedical Research 2277-9175 2017 May 2017 05 01 Upper Eyelid Silicone Oil Migration After Sutureless 23-Gauge Vitrectomy 1 3 28073 EN Alireza Dehghani Isfahan Eye Research Center, Isfahan University of Medical Sciences, Isfahan, Iran Leila Rezaei Emam Khomeini Eye Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran Ali Tavallali Vitreous-Retina-Macula Consultants of New York, 460 Park Ave, Fifth Floor, New York, NY 10022, United States Zahra Dastborhan Eye Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Journal Article 2023 02 20 To report a case of upper eyelid swelling and ptosis caused by silicone oil migration in a patient after sutureless 23-gauge pars plana vitrectomy and silicone oil injection. A 36-year-old female was referred to eye clinic with total retinal detachment (RD) and superotemporal giant dialysis secondary to trauma in the left eye. Transconjunctival sutureless 23-gauge pars plana vitrectomy and intraocular silicone oil (1300 centistokes) injection were performed. After about 5 months, she came back with the left upper eyelid and periorbital swelling. Palpation of the eyelid revealed soft and mobile subcutaneous small lumps that were not attached to the skin. Computed tomography scan of the orbit showed an 11 mm × 8 mm soft tissue density mass in lateral aspect of the left orbit. Transcutaneously surgical exploration was performed. The patient was seen after 1 week postoperatively and there was a significant improvement of the ptosis. Eyelid swelling and ptosis caused by silicone oil migration after RD surgery are very rare and this is one of the few reports in literature.

https://advbiores.mui.ac.ir/article_28073_95d2e07a0caa3ad6abc065d1ac24ab25.pdf

Advanced Biomedical Research 2277-9175 2017 May 2017 05 01 Erratum: Assessment of a 2D Electronic Portal Imaging Devices-based Dosimetry Algorithm for Pretreatment and In-vivo Midplane Dose Verification 1 1 28076 EN Journal Article 2023 02 20 https://advbiores.mui.ac.ir/article_28076_163e836b057fa98808f41048cba1195f.pdf

Advanced Biomedical Research 2277-9175 2017 May 2017 05 01 EPCAM Expression in Colon Adenocarcinoma and its Relationship with TNM Staging 1 4 28077 EN Mojhgan Mokhtari Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Zeinab Zakerzade Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Journal Article 2023 02 20 Background: Since epithelial cell adhesion molecule glycoprotein (EPCAM) is associated with the development and metastasis of colon adenocarcinoma, it can be helpful in predicting the tumor stage before surgery. In this study, we investigated EPCAM glycoprotein expression in colon adenocarcinoma and its relationship with tumor staging. Materials and Methods: This study was done on formalin-fixed and paraffin-embedded tissues of 71 patients diagnosed with colon adenocarcinoma, together with normal tissues around them, which were available at the archive of pathology lab of Al-Zahra hospital, Isfahan. Hematoxylin and eosin (HandE) and immunohistochemistry (IHC) staining methods for EPCAM marker were performed on paraffin-embedded blocks. Results: The percentage of staining of EPCAM glycoprotein in the tumoral and normal tissues of 71 patients with colon adenocarcinoma was studied and compared. In normal tissue, 84.5% showed strong staining, 15.5% showed moderate to strong, and none of the patients showed moderate, weak, or no staining at all. In the tumoral tissue, 25.4% had strong, 25.4% had moderate to strong, 26.8% showed moderate, 16.9% showed weak and 5.6% had no staining at all. EPCAM expression was significantly less in tumoral tissue than in normal. Conclusion: There was an inverse relationship between tumor staging and the percentage of staining in EPCAM glycoprotein so this marker can be used for predicting the tumor stage.

https://advbiores.mui.ac.ir/article_28077_1271475706211e282089b789f5f73b24.pdf

Advanced Biomedical Research 2277-9175 2017 May 2017 05 01 The Comparison between Effects of 12 weeks Combined Training and Vitamin D Supplement on Improvement of Sensory-motor Neuropathy in type 2 Diabetic Women 1 6 28078 EN Maryam Nadi Department of Exercise Physiology, University of Isfahan, Isfahan, Iran Seyyed Mohammad Marandi Department of Exercise Physiology, University of Isfahan, Isfahan, Iran Fahimeh Esfarjani Department of Exercise Physiology, University of Isfahan, Isfahan, Iran Mohammad Saleki Department of Exercise Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Mahboobeh Mohammadi General Physician, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Journal Article 2023 02 20 Background: Peripheral neuropathy is a common complaint of diabetes. This study aimed to determine the effects of 12 weeks combined training with Vitamin D supplement on improvement of sensory-motor neuropathy in women with diabetic neuropathy. Materials and Methods: This clinical trial study conducted on 90 patients were selected and randomly divided into two groups. Finally, 81 adult females with diabetes type II (20–55 years old) were interred in this study. The control group had no training, but received Vitamin D. The experimental group received Vitamin D and 12 weeks training program (3 days a week, 60 min/session) including aerobic exercises, strength, and flexibility. Aerobic exercise intensity was set at 60–70% maximum heart rate and resistance training intensity was determined by 10 R.M. Michigan neuropathy questionnaire, reflex hammer and tuning fork 128 Hz used to screening tense of neuropathy (Michigan Neuropathy Screening Instrument) that were used for pretest and posttest. Results: Following 3 months combined training and supplementation with Vitamin D, had observed a significant reduction in numbness (P = 0.001), pain (0.002), tingling (P = 0.001), and weakness (P = 0.002) in the lower limb and also increases in sense of touch intervention (P = 0.005), detects the position of the fingers (P = 0.001) and vibration perception (P = 0.001) in tissues. Knee reflexes (P = 0.77) and ankles reflexes (P = 0.47) did not significantly change after interventions. Conclusion: It seems that taking part in combined training and supplementation with Vitamin D can improve the symptoms of sensory-motor neuropathy.

https://advbiores.mui.ac.ir/article_28078_97ac043e24f12ce6b09bb8817efce982.pdf

Advanced Biomedical Research 2277-9175 2017 May 2017 05 01 Nosocomial Infections in Intensive Care Unit: Pattern of Antibiotic-resistance in Iranian Community 1 5 28079 EN Bahram Nasr Esfahani Department of Microbiology, Isfahan University of Medical Sciences, Isfahan, Iran Rozita Basiri Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Seyed Mohammad Mahdy Mirhosseini Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Sharareh Moghim Department of Microbiology, Isfahan University of Medical Sciences, Isfahan, Iran Shahaboddin Dolatkhah Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Journal Article 2023 02 20 Background: Bacterial infections are responsible for great number of mortality in Intensive Care Unit (ICU). Knowledge about prevalence of bacterial infections and their antibiotic-resistance pattern would be a great step for their treatment and management. Materials and Methods: Data about nosocomial infections in ICUs of Alzahra Hospital (referral hospital in Isfahan, center of Iran) were gathered during the years 2007–2010. A questionnaire was fulfilled for any specific patient with nosocomial infection containing demographic data of patient and also characteristics of the infection. Results: Out of all patients, 707 individuals (65.6%) were male and 370 (34.4%) were female. Our data revealed that Pseudomonas aeruginosa (13.9%), Klebsiella (11%), and Escherichia coli (6.4%) were the most prevalent bacterial infections. The most common sites of nosocomial infections in the ICU were respiratory system (399 cases, 37%), urinary system (230 cases, 21.4%), and blood (102 cases, 9.5%). The antibiotic-resistance of each bacteria in ICU ward was assessed and data were categorized in a table. There were less documentary about bacterial cultures in the year 2007 when compared with the next years. Conclusion: We found some differences (such as bacterial prevalence in ICU wards which caused nosocomial infections) in our local prevalence of nosocomial infections and also in their resistance pattern compared to other centers. Knowing about our data will help physicians to administer the most suitable antibiotics for treatment of nosocomial infections in our area.

https://advbiores.mui.ac.ir/article_28079_7cf67a2def04352826be6914e1bb5405.pdf

Advanced Biomedical Research 2277-9175 2017 May 2017 05 01 Insecticide Activity of Ageratina jahnii and Ageratina pichinchensis (Asteraceae) against Lutzomyia migonei (Diptera: Psychodidae) 1 5 28080 EN Lizzeth Torres Department of Biology, Faculty of Science, LAPEX-Experimental Parasitology Laboratory, Mérida; Organic Biomolecular Research Group, Research Institute, Faculty of Pharmacy and Bioanalysis, University of Los Andes, Mérida, Venezuela Janne Rojas Organic Biomolecular Research Group, Research Institute, Faculty of Pharmacy and Bioanalysis, University of Los Andes, Mérida, Venezuela Maritza Rondón Department of Biology, Faculty of Science, LAPEX-Experimental Parasitology Laboratory, Mérida, Venezuela Antonio Morales Organic Biomolecular Research Group, Research Institute, Faculty of Pharmacy and Bioanalysis, University of Los Andes, Mérida, Venezuela Elsa Nieves Department of Biology, Faculty of Science, LAPEX-Experimental Parasitology Laboratory, Mérida, Venezuela Journal Article 2023 02 20 Background: Insects are mostly pathogens transmitters, thus the necessity of finding effective bioinsecticides to combat them. In the present investigation, the insecticide activity of Ageratina jahnii and Ageratina pichinchensis (Asteraceae) essential oils, methanol, and aqueous extracts was evaluated against Lutzomyia migonei (Diptera: Psychodidae) females, Leishmania transmitters, a wide distributed parasitosis in Latin America. Materials and Methods: All extracts were prepared by maceration at room temperature, and essential oils were obtained by hydrodistillation process. Females of L. migonei were used in the bioassays using the adulticide test in pots. Results: Essential oils from both assayed plant species showed 100% of L. migonei mortality at 48 h of exposure at the concentration of 10 mg/ml. A. jahnii essential oil exhibited the following values, LD50 = 0.39 mg/ml, LD90 = 1.57 mg/ml, LD95 = 2.31 mg/ml, and LD99 = 4.80 mg/ml while for A. pichinchensis essential oil values were LD50 = 0.31 mg/ml, LD90 = 0.99 mg/ml, LD95 = 1.38 mg/ml, and LD99 = 2.55 mg/ml. Conclusion: Higher toxicity was observed with A. pichinchensis essential oil against L. migonei, comparing to A. jahnii oil. Two new plant species are being reported, showing bioactive properties against common tropical disease vectors such as L. migonei, hence, opening possibilities to a more environmental friendly control.

https://advbiores.mui.ac.ir/article_28080_c596cd46b0e3eac0e2fa9b23590a60ab.pdf

Advanced Biomedical Research 2277-9175 2017 May 2017 05 01 The Comparison Effects of Two Methods of (Adaptive Support Ventilation Minute Ventilation: 110% and Adaptive Support Ventilation Minute Ventilation: 120%) on Mechanical Ventilation and Hemodynamic Changes and Length of being in Recovery in Intensive Care Units 1 7 28083 EN Babak Ali Kiaei Anesthesiology and Critical Care Research Center, Isfahan, Iran Parviz Kashefi Anesthesiology and Critical Care Research Center, Isfahan, Iran Seyed Taghi Hashemi Anesthesiology and Critical Care Research Center, Isfahan, Iran Ahmad Mobasheri Medical School, Isfahan University of Medical Sciences, Isfahan, Iran Journal Article 2023 02 20 Background: The conventional method for ventilation is supported by accommodative or adaptive support ventilation (ASV) that the latter method is done with two methods: ASV minute ventilation (mv): 110% and ASV mv: 120%. Regarding these methods this study compared the differences in duration of mechanical ventilation and hemodynamic changes during recovery and length of stay in Intensive Care Units (ICU). Materials and Methods: In a clinical trial study, forty patients candidate for ventilation were selected and randomly divided into two groups of A and B. All patients were ventilated by Rafael ventilator. Ventilator parameters were set on ASV mv: 110% or ASV mv: 120% and patients were monitored on pulse oximetry, electrocardiography monitoring, central vein pressure and arterial pressure. Finally, the data entered to computer and analyzed by SPSS software. Results: The time average of connection to ventilator in two groups in modes of ASV mv: 110% and 120% was 12.3 ± 3.66 and 10.8 ± 2.07 days respectively, and according to t-test, there was no significant difference between two groups (P = 0.11). The average of length of stay in ICU in two groups of 110% and 120% was 16.35 ± 3.51 and 15.5 ± 2.62 days respectively, and according to t-test, there found to be no significant difference between two groups (P = 0.41). Conclusion: Using ASV mv: 120% can decrease extubation time compared with ASV mv: 110%. Furthermore, there is not a considerable side effect on hemodynamic of patients.

https://advbiores.mui.ac.ir/article_28083_f3678d7c62c8fb66cf6b7946dc16a20e.pdf