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JBMR：母乳喂养可终身影响胎儿骨骼健康

2020-07-25 Fu Yuang MedSci原创

胎儿出生体重母乳喂养骨峰值胎儿骨骼孕期吸烟
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骨峰值是骨骼健康的重要指标，同时也是骨折预测的重要因素。一些早期暴露因素，例如母乳喂养、孕期吸烟、出生体重等，可在个体生长期间对骨骼造成不同程度的影响。

     骨峰值（peak bone mass，PBM）是骨骼健康的重要指标，同时也是骨折预测的重要因素。一些早期暴露因素，例如母乳喂养、孕期吸烟、出生体重等，可在个体生长期间对骨骼造成不同程度的影响并最终导致PBM降低。此外，是否足月生产也是影响PBM的因素之一。近日，来自澳大利亚塔斯马尼亚大学的研究团队在《Journal of Bone and Mineral Research》上发表了一篇关于母亲早期暴露行为对胎儿成年后骨骼健康影响的文章，该团队前期研究已证实早期暴露因素对胎儿生长至8岁和16岁时的面积骨密度（aBMD）具有影响，本次研究在此基础上将观察终点增加至25周岁，同时纳入以高分辨率外周定量CT（HRpQCT）技术测定的骨微结构为最终指标。

     研究初始纳入1500人，最终有196人符合分析条件。研究将母乳喂养、孕期吸烟史及出生体重纳入早期暴露因素，试验个体25岁时的部分差异（性别差异、体重、身高、蔬菜摄入量、水果摄入量、钙摄入量）被定义为混杂因素。依据是否早产分为两个观察组。分别用双能X线吸收法（DXA）和HRpQCT测量aBMD及骨微结构。通过t检验和卡方检验比较组间数据差异，利用线性回归模型和多元log-binomial回归确定暴露因素的相关系数及相对危险度（RR）。

     结果显示，早产儿组具有更高的母乳喂养率及喂养时长，母乳喂养对于早产儿组的面积骨密度、皮质骨密度及小梁骨密度等具有正向影响，同时降低两组研究个体54%的下肢骨折风险；孕期吸烟史对于足月产个体的骨小梁数目及内过渡带孔隙度具有影响，并增加了两组研究个体75%的上肢骨折风险。出生体重则与骨折风险无显著相关性。

     研究得出：母亲围产期行为或影响胎儿一生，母乳喂养和孕期吸烟史可能会影响子代骨微结构及骨峰值，而出生体重的影响会在随后的生长期中逐渐减退。

原始出处：Associations of Breastfeeding, Maternal Smoking, and Birth Weight With Bone Density and Microarchitecture in Young Adulthood: a 25-Year Birth-Cohort Study, Journal of Bone and Mineral Research, July 8, 2020. DOI: 10.1002/jbmr.4044.

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    2021-03-21 悠悠sunny

    谢谢分享

    0

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    2021-01-20 ms1948154235210413

    #喂养#

    0

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    2020-09-18 lovetcm

    #母乳喂养#可终身影响#胎儿##骨骼#健康，其中秘密仍然未知

    0

  4. 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createdTime=Wed Jan 20 13:43:10 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=886371, encodeId=fc018863e17a, content=<a href='/topic/show?id=37e863495b0' target=_blank style='color:#2F92EE;'>#母乳喂养#</a>可终身影响<a href='/topic/show?id=fde48358e24' target=_blank style='color:#2F92EE;'>#胎儿#</a><a href='/topic/show?id=2de4101909c9' target=_blank style='color:#2F92EE;'>#骨骼#</a>健康，其中秘密仍然未知 , beContent=null, objectType=article, channel=null, level=null, likeNumber=198, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63495, encryptionId=37e863495b0, topicName=母乳喂养), TopicDto(id=83587, encryptionId=fde48358e24, topicName=胎儿), TopicDto(id=101909, encryptionId=2de4101909c9, topicName=骨骼)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Fri Sep 18 12:59:33 CST 2020, 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804551, encodeId=5fca80455171, content=比较专业, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d495401973, createdName=ms5000001081399896, createdTime=Sat Jul 25 21:43:08 CST 2020, time=2020-07-25, status=1, ipAttribution=)]
    2020-08-26 GUNDAMW1

    谢谢分享

    0

  5. 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createdName=meichuangyi, createdTime=Mon Jul 27 11:43:10 CST 2020, time=2020-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804581, encodeId=d117804581d8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/B0E2439972CE8FFE31DAD756C2A72E8F/100, createdBy=d7fe2049696, createdName=Belle姑娘, createdTime=Sun Jul 26 09:35:08 CST 2020, time=2020-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804556, encodeId=3e28804556e8, content=足月儿呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b972455532, createdName=1240394fm61暂无昵称, createdTime=Sat Jul 25 22:57:34 CST 2020, time=2020-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804551, encodeId=5fca80455171, content=比较专业, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d495401973, createdName=ms5000001081399896, createdTime=Sat Jul 25 21:43:08 CST 2020, time=2020-07-25, status=1, ipAttribution=)]
    2020-08-18 147918575

    这么好

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=949851, encodeId=b1f394985191, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210225/1f3a8e64c4dc4559af4d21a37afef10a/3632634089c24e5c807a83138e2529ce.jpg, createdBy=c3d35445259, createdName=悠悠sunny, createdTime=Sun Mar 21 08:44:17 CST 2021, time=2021-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1665101, encodeId=260c1665101fc, content=<a href='/topic/show?id=c8664008e1a' target=_blank style='color:#2F92EE;'>#喂养#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40087, encryptionId=c8664008e1a, topicName=喂养)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ed425881542, createdName=ms1948154235210413, 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createdName=meichuangyi, createdTime=Mon Jul 27 11:43:10 CST 2020, time=2020-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804581, encodeId=d117804581d8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/B0E2439972CE8FFE31DAD756C2A72E8F/100, createdBy=d7fe2049696, createdName=Belle姑娘, createdTime=Sun Jul 26 09:35:08 CST 2020, time=2020-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804556, encodeId=3e28804556e8, content=足月儿呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b972455532, createdName=1240394fm61暂无昵称, createdTime=Sat Jul 25 22:57:34 CST 2020, time=2020-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804551, encodeId=5fca80455171, content=比较专业, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d495401973, createdName=ms5000001081399896, createdTime=Sat Jul 25 21:43:08 CST 2020, time=2020-07-25, status=1, ipAttribution=)]
    2020-07-27 villahu

    #母乳#

    0

  7. 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time=2020-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813575, encodeId=45618135e5ee, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d3091399869, createdName=GUNDAMW1, createdTime=Wed Aug 26 22:03:46 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809971, encodeId=371b8099e139, content=这么好, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200818/5cc1dcb5c2d443a599f8e02ba00b5096/52827aa840b1482188777c3e86c64e52.jpg, createdBy=d5763030654, createdName=147918575, createdTime=Tue Aug 18 08:09:02 CST 2020, time=2020-08-18, status=1, ipAttribution=), 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createdName=meichuangyi, createdTime=Mon Jul 27 11:43:10 CST 2020, time=2020-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804581, encodeId=d117804581d8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/B0E2439972CE8FFE31DAD756C2A72E8F/100, createdBy=d7fe2049696, createdName=Belle姑娘, createdTime=Sun Jul 26 09:35:08 CST 2020, time=2020-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804556, encodeId=3e28804556e8, content=足月儿呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b972455532, createdName=1240394fm61暂无昵称, createdTime=Sat Jul 25 22:57:34 CST 2020, time=2020-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804551, encodeId=5fca80455171, content=比较专业, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d495401973, createdName=ms5000001081399896, createdTime=Sat Jul 25 21:43:08 CST 2020, time=2020-07-25, status=1, ipAttribution=)]
    2020-07-27 meichuangyi

    #骨骼健康#

    0

  8. 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time=2020-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813575, encodeId=45618135e5ee, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d3091399869, createdName=GUNDAMW1, createdTime=Wed Aug 26 22:03:46 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809971, encodeId=371b8099e139, content=这么好, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200818/5cc1dcb5c2d443a599f8e02ba00b5096/52827aa840b1482188777c3e86c64e52.jpg, createdBy=d5763030654, createdName=147918575, createdTime=Tue Aug 18 08:09:02 CST 2020, time=2020-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1299630, encodeId=4b1a129963097, content=<a href='/topic/show?id=7a056349485' target=_blank style='color:#2F92EE;'>#母乳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63494, encryptionId=7a056349485, topicName=母乳)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf1b289, createdName=villahu, createdTime=Mon Jul 27 11:43:10 CST 2020, time=2020-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555714, encodeId=980c1555e1461, content=<a href='/topic/show?id=9cac10191188' target=_blank style='color:#2F92EE;'>#骨骼健康#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101911, encryptionId=9cac10191188, topicName=骨骼健康)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b9814658686, createdName=meichuangyi, createdTime=Mon Jul 27 11:43:10 CST 2020, time=2020-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804581, encodeId=d117804581d8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/B0E2439972CE8FFE31DAD756C2A72E8F/100, createdBy=d7fe2049696, createdName=Belle姑娘, createdTime=Sun Jul 26 09:35:08 CST 2020, time=2020-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804556, encodeId=3e28804556e8, content=足月儿呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b972455532, createdName=1240394fm61暂无昵称, createdTime=Sat Jul 25 22:57:34 CST 2020, time=2020-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804551, encodeId=5fca80455171, content=比较专业, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d495401973, createdName=ms5000001081399896, createdTime=Sat Jul 25 21:43:08 CST 2020, time=2020-07-25, status=1, ipAttribution=)]
    2020-07-26 Belle姑娘

    学习

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=949851, encodeId=b1f394985191, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20210225/1f3a8e64c4dc4559af4d21a37afef10a/3632634089c24e5c807a83138e2529ce.jpg, createdBy=c3d35445259, createdName=悠悠sunny, createdTime=Sun Mar 21 08:44:17 CST 2021, time=2021-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1665101, encodeId=260c1665101fc, content=<a href='/topic/show?id=c8664008e1a' target=_blank style='color:#2F92EE;'>#喂养#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=40087, encryptionId=c8664008e1a, topicName=喂养)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0ed425881542, createdName=ms1948154235210413, createdTime=Wed Jan 20 13:43:10 CST 2021, time=2021-01-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=886371, encodeId=fc018863e17a, content=<a href='/topic/show?id=37e863495b0' target=_blank style='color:#2F92EE;'>#母乳喂养#</a>可终身影响<a href='/topic/show?id=fde48358e24' target=_blank style='color:#2F92EE;'>#胎儿#</a><a href='/topic/show?id=2de4101909c9' target=_blank style='color:#2F92EE;'>#骨骼#</a>健康，其中秘密仍然未知 , beContent=null, objectType=article, channel=null, level=null, likeNumber=198, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63495, encryptionId=37e863495b0, topicName=母乳喂养), TopicDto(id=83587, encryptionId=fde48358e24, topicName=胎儿), TopicDto(id=101909, encryptionId=2de4101909c9, topicName=骨骼)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Fri Sep 18 12:59:33 CST 2020, time=2020-09-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=813575, encodeId=45618135e5ee, content=谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d3091399869, createdName=GUNDAMW1, createdTime=Wed Aug 26 22:03:46 CST 2020, time=2020-08-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=809971, encodeId=371b8099e139, content=这么好, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200818/5cc1dcb5c2d443a599f8e02ba00b5096/52827aa840b1482188777c3e86c64e52.jpg, createdBy=d5763030654, createdName=147918575, createdTime=Tue Aug 18 08:09:02 CST 2020, time=2020-08-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1299630, encodeId=4b1a129963097, content=<a href='/topic/show?id=7a056349485' target=_blank style='color:#2F92EE;'>#母乳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63494, encryptionId=7a056349485, topicName=母乳)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf1b289, createdName=villahu, createdTime=Mon Jul 27 11:43:10 CST 2020, time=2020-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1555714, encodeId=980c1555e1461, content=<a href='/topic/show?id=9cac10191188' target=_blank style='color:#2F92EE;'>#骨骼健康#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=101911, encryptionId=9cac10191188, topicName=骨骼健康)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3b9814658686, createdName=meichuangyi, createdTime=Mon Jul 27 11:43:10 CST 2020, time=2020-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804581, encodeId=d117804581d8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/B0E2439972CE8FFE31DAD756C2A72E8F/100, createdBy=d7fe2049696, createdName=Belle姑娘, createdTime=Sun Jul 26 09:35:08 CST 2020, time=2020-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804556, encodeId=3e28804556e8, content=足月儿呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b972455532, createdName=1240394fm61暂无昵称, createdTime=Sat Jul 25 22:57:34 CST 2020, time=2020-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804551, encodeId=5fca80455171, content=比较专业, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d495401973, createdName=ms5000001081399896, createdTime=Sat Jul 25 21:43:08 CST 2020, time=2020-07-25, status=1, ipAttribution=)]
    2020-07-25 1240394fm61暂无昵称

    足月儿呢

    0

  10. 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createdName=meichuangyi, createdTime=Mon Jul 27 11:43:10 CST 2020, time=2020-07-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804581, encodeId=d117804581d8, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/B0E2439972CE8FFE31DAD756C2A72E8F/100, createdBy=d7fe2049696, createdName=Belle姑娘, createdTime=Sun Jul 26 09:35:08 CST 2020, time=2020-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804556, encodeId=3e28804556e8, content=足月儿呢, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4b972455532, createdName=1240394fm61暂无昵称, createdTime=Sat Jul 25 22:57:34 CST 2020, time=2020-07-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=804551, encodeId=5fca80455171, content=比较专业, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7d495401973, createdName=ms5000001081399896, createdTime=Sat Jul 25 21:43:08 CST 2020, time=2020-07-25, status=1, ipAttribution=)]
    2020-07-25 ms5000001081399896

    比较专业

    0

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