242:. The tube is then marked at this level to ensure that the tube has been inserted far enough into the patient's stomach. Many commercially available stomach and duodenal tubes have several standard depth markings, for example 46 cm (18 in), 56 cm (22 in), 66 cm (26 in) and 76 cm (30 in) from distal end; infant feeding tubes often come with 1 cm depth markings. The end of a plastic tube is lubricated (local anesthetic, such as 2% xylocaine gel, may be used; in addition, nasal vasoconstrictor and/or anesthetic spray may be applied before the insertion) and inserted into one of the patient's anterior nares. Treatment with 2.0 mg of IV midazolam greatly reduces patient stress. The tube should be directed straight towards the back of the patient as it moves through the nasal cavity and down into the throat. When the tube enters the
255:
Otolaryngology, is performed by a physician to pull a material through the nares and then tied with the ends shortened to prevent removal of the tube. The other method is a device called the
Applied Medical Technology, or AMT, bridle. This device uses a magnet inserted into both nares that connects at the nasal septum and then pulled through to one side and tied. This technology allows nurses to safely apply bridles. Several studies have proven the use of a nasal bridle prevents the loss of the NG placement that provides necessary nutrients or suctioning. A study conducted in the UK from 2014 through 2017, determined that 50% of feeding tubes secured with tape were lost inadvertently. The use of bridle securement decreased the percentage of NGs lost from 53% to 9%.
40:
163:
227:
251:, it is easily inserted down into the stomach. The tube must then be secured in place to prevent it from moving. There are several ways to secure an NG placement. One method and the least invasive is tape. Tape is positioned and wrapped around the NG tube onto the patients nose to prevent dislodgement.
299:
to confirm the correct placement of the NG tube. As enzyme testing becomes more practical, allowing measurements to be taken quickly and cheaply at the bedside, this technique may be used in combination with pH testing as an effective, less harmful replacement of X-ray confirmation. If the tube is to
286:
of the chest/abdomen. This is the most reliable means of ensuring proper placement of an NG tube. The use of a chest x-ray to confirm position is the expected standard in the UK, with Dr/ physician review and confirmation. Future techniques may include measuring the concentration of enzymes such as
145:
If the tube is to be used for continuous drainage, it is usually appended to a collector bag placed below the level of the patient's stomach; gravity empties the stomach's contents. It can also be appended to a suction system, however this method is often restricted to emergency situations, as the
121:
into the tube. For continuous feeding, a gravity based system is employed, with the solution placed higher than the patient's stomach. If accrued supervision is required for the feeding, the tube is often connected to an electronic pump which can control and measure the patient's intake and signal
315:
Function of an NG tube properly placed and used for suction is maintained by flushing. This may be done by flushing small amounts of saline and air using a syringe or by flushing larger amounts of saline or water, and air, and then assessing for the air to circulate through one lumen of the tube,
508:
Mulholland, Michael W., Lillemoe, Keith D., Doherty, Gerard M., Upchurch, Gilbert R., Alam, Hasan B., Pawlik, Timothy M. eds. Greenfield's
Surgery: Scientific Principles and Practice. 6th Edition. Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103:Lippincott Williams & Wilkins;
349:
Complications with nasogastric intubation can occur due to incorrect initial placement of the nasogastric tube or due to changes in tube position that go unrecognized. Nasogastric tubes mistakenly placed in the trachea or lungs can lead to aspiration of enteral feeds or medications administered
246:
and glides down the posterior pharyngeal wall, the patient may gag; in this situation the patient, if awake and alert, is asked to mimic swallowing or is given some water to sip through a straw, and the tube continues to be inserted as the patient swallows. Once the tube is past the pharynx and
122:
any interruption in the feeding. Nasogastric tubes may also be used as an aid in the treatment of life-threatening eating disorders, especially if the patient is not compliant with eating. In such cases, a nasogastric tube may be inserted by force for feeding against the patient's will under
254:
Another securement device is a nasal bridle, or a device that enters one nare, around the nasal septum, and then to the other nare where it is secured in place around the nasogastric tube. There are two ways a bridle is put into place. One method, according to the
Australian Journal of
307:
or less in adults) nasogastric tubes are appropriate for long-term feeding, so as to avoid irritation and erosion of the nasal mucosa. These tubes often have guidewires to facilitate insertion. If feeding is required for a longer period of time, other options, such as placement of a
211:- These tubes tend to be thicker and can be difficult to place without proper lubrication. Latex tends to break down at faster rates compared to other materials. Allergies to latex are relatively common and latex tubes are more likely to be recognized as a foreign object by the body.
177:, which is a single lumen, small bore NG tube. It is more appropriate for administration of medication or nutrition. This type of catheter tends to be more prone to suctioning against the stomach lining, which can cause damage and interfere with future function of the tube.
328:
in patients with moderate-to-severe neck and facial fractures due to the increased risk of airway obstruction or improper tube placement. Special attention is necessary during insertion under these circumstances in order to avoid undue trauma to the
340:
Alternative measures, such as an orogastric intubation, should be considered under these circumstances, or if the patient will be incapable of meeting their nutritional and caloric needs for an extended time period (usually >24 hours).
189:, which is a small bore NG tube with a weight at the end intended to pull it by gravity during insertion. The name "Dobhoff" refers to its inventors, surgeons Dr. Robert Dobbie and Dr. James Hoffmeister, who invented the tube in 1975.
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constant suction can easily damage the stomach's lining. In non-emergency situations, intermittent suction is often applied giving the benefits of suction without the untoward effects of damage to the stomach lining.
129:
Nasogastric aspiration (suction) is the process of draining the stomach's contents via the tube. Nasogastric aspiration is mainly used to remove gastrointestinal secretions and swallowed air in patients with
183:, which is a large bore NG tube with double lumen. This avails for aspiration in one lumen, and venting in the other to reduce negative pressure and prevent gastric mucosa from being drawn into the catheter.
153:
in order to prevent anesthesia-related vomiting and possible aspiration of any stomach contents. Such aspiration would represent a serious risk of complications to patients recovering from this surgery.
217:- Especially useful in patients with known latex allergies. Silicone tubes tend to be thinner and more pliable. This can be useful in some situations but can also be more prone to rupture under stress.
282:) to determine the acidity of the fluid. If the pH is 4 or below then the tube is in the correct position. If this is not possible then correct verification of tube position is obtained with an
964:
362:
to drain. Nasogastric tubes can also be mistakenly placed within the intracranial space; this is more likely to occur in patient who already have specific types of skull fractures.
609:
Manning, Chelsea Taylor; Buinewicz, Jacob Dillon; Sewatsky, Thomas
Patrick; Zgonis, Evangelia; Gutierrez, Kathy; O'Keefe, Michael F.; Freeman, Kalev; Bird, Steven B. (July 2016).
333:. There is also a greater risk to patients with bleeding disorders, particularly those resulting from the distended sub-mucosal veins in the lower third of the esophagus known as
205:- This material is most common. It is less likely to kink, which can be beneficial for placement, but its rigidity makes it less suitable to be used for long term feeding.
238:
Before an NG tube is inserted, it must be measured from the tip of the patient's nose, loop around their ear and then down to roughly 3–5 cm (1–2 in) below the
829:"A breath of fresh air: a quality-improvement study comparing an air-circulating technique versus conventional technique to prevent nasogastric tube dysfunction"
1007:
383:
reported about a voluntary field correction notice dated March 21, 2022, referenced 60 injuries and 23 deaths related to misplacement of a nasogastric tube.
582:
Betsy H. Allbee; Lisa
Marcucci; Jeannie S. Garber; Monty Gross; Sheila Lambert; Ricky J. McCraw; Anthony D. Slonim; Teresa A. Slonim (28 March 2012).
1908:
881:
Motta, Ana Paula Gobbo; Rigobello, Mayara
Carvalho Godinho; Silveira, Renata Cristina de Campos Pereira; Gimenes, Fernanda Raphael Escobar (2021).
611:"Does Routine Midazolam Administration Prior to Nasogastric Tube Insertion in the Emergency Department Decrease Patients' Pain? (A Pilot Study)"
1679:
365:
Other complications include clogged or nonfunctional tubes, premature removal of the tube, erosion of the nasal mucosa, esophageal perforation
1640:
456:"Nursing assistants' experiences of administering manual restraint for compulsory nasogastric feeding of young persons with anorexia nervosa"
802:
Perry, AG; Potter, PA (2010). "Skill 34-4: Inserting and maintaining a nasogastric tube for gastric decompression". In
Ostendorf, W (ed.).
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A man with a nasogastric feeding tube through which feed and medicine can be delivered to the stomach using either a pump or gravity
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into the stomach, and out the other lumen. When these two techniques of flushing were compared, the latter was more effective.
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Polyurethane NG tube (Viasys Corflo), 8 Fr Ă— 36 in (91 cm). This fine bore tube is appropriate for longer use (up to 4 weeks).
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655:"A systematic review of the effectiveness and complications of using nasal bridles to secure nasoenteral feeding tubes"
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965:"Avanos Medical Recalls Cortrak*2 Enteral Access System for Risk of Misplaced Enteral Tubes Could Cause Patient Harm"
17:
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Nasogastric tubes are available in a variety of different materials, each with their own unique properties.
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134:. Nasogastric aspiration can also be used in poisoning situations when a potentially toxic liquid has been
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which may be easily ruptured due to their friability and also in GERD(Gastro
Esophageal Reflux Disease).
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remain in place then a tube position check is recommended before each feed and at least once per day.
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430:"Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition"
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Taylor, Stephen J; Allan, Kaylee; Clemente, Rowan; Marsh, Aidan; Toher, Deirdre (2018-10-04).
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A nasogastric tube is used for feeding and administering drugs and other oral agents such as
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Lynch, Angelica; Tang, Cheryl S.; Jeganathan, Luxmana S.; Rockey, Jason G. (2018-01-30).
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Bani Hani, Murad; Ihim, Ikenna; Harps, Joyce; Cunningham, Steven C. (27 November 2015).
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940:"Health tech company in talks with FDA about device that may have caused injury, death"
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Such a practice may be highly distressing for both patients and healthcare staff.
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883:"Nasogastric/nasoenteric tube-related adverse events: an integrative review"
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Great care must be taken to ensure that the tube has not passed through the
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Roberts, James R.; Custalow, Catherine B.; Thomsen, Todd W., eds. (2019).
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691:"Feeding tube securement in critical illness: implications for safety"
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270:. The reliable method is to aspirate some fluid from the tube with a
248:
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Thomas, Bruce; Cummin, David; Falcone, Robert E. (24 October 1996).
580:, Ensure Appropriate Position of the Dubhoff Tube Prior To Feeding.
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791:. Cincinnati Children's Hospital Medical Center. August 22, 2011.
789:"Confirmation of Nasogastric/Orogastric Tube (NGT/OGT) Placement"
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Suction drainage is also used for patients who have undergone a
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is a similar process involving the insertion of a plastic tube (
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is a medical process involving the insertion of a plastic tube (
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27:
Feeding tube going into the stomach through the nose and throat
608:
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540:
Roberts and Hedges' clinical procedures in emergency medicine
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and nasogastric tube as seen on CXR. Both in good position.
454:
Kodua, Michael; Mackenzie, Jay-Marie; Smyth, Nina (2020).
652:
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142:, and to extract samples of gastric liquid for analysis.
688:
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invented the NG tube. Nasogastric tube is also known as
820:
537:
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113:. For drugs and for minimal quantities of liquid, a
746:
453:
806:(7th ed.). Mosby Elsevier. pp. 914–920.
749:"Accidental Pneumothorax from a Nasogastric Tube"
391:, has been classified as a Class I recall by the
1936:
460:International Journal of Mental Health Nursing
1641:Transjugular intrahepatic portosystemic shunt
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1001:
561:
559:
542:(Seventh ed.). Philadelphia: Elsevier.
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350:through the NG tube. This can also lead to
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568:. Last authored: Dec 2009, David LaPierre
1447:Transanal hemorrhoidal dearterialization
804:Clinical Nursing Skills & Techniques
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77:, down the esophagus, and down into the
1604:Artificial extracorporeal liver support
138:, for preparation before surgery under
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1937:
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887:Revista Latino-Americana de Enfermagem
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588:. Lippincott Williams & Wilkins.
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324:The use of nasogastric intubation is
1159:Vertical banded gastroplasty surgery
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659:Australian Journal of Otolaryngology
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449:
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170:Types of nasogastric tubes include:
1208:Percutaneous endoscopic gastrostomy
1016:Tests and procedures involving the
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24:
1646:Distal splenorenal shunt procedure
512:
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1966:
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274:. This fluid is then tested with
97:in Commonwealth countries, after
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1437:Lateral internal sphincterotomy
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938:Aitken, Peter (29 April 2022).
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753:New England Journal of Medicine
1144:Endoscopic sleeve gastroplasty
1095:Functional Lumen Imaging Probe
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585:Avoiding Common Nursing Errors
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1526:Lower gastrointestinal series
1270:Upper gastrointestinal series
710:10.12968/bjon.2018.27.18.1036
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132:gastrointestinal obstructions
1792:Diagnostic peritoneal lavage
1511:Double-contrast barium enema
1338:Partial ileal bypass surgery
1215:Esophagogastric dissociation
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1609:Bioartificial liver devices
1536:Transrectal ultrasonography
899:10.1590/1518-8345.3355.3400
766:10.1056/NEJM199610243351717
615:Academic Emergency Medicine
398:
395:, following these reports.
377:, sore throat and gagging.
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1971:
1531:Small-bowel follow-through
1399:Abdominoperineal resection
1258:Esophagogastroduodenoscopy
698:British Journal of Nursing
303:Only smaller diameter (12
1891:Clinical prediction rules
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1409:Total mesorectal excision
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1328:Intestine transplantation
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1118:Sengstaken–Blakemore tube
1108:
1100:High resolution manometry
1090:Esophageal motility study
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846:10.1186/s12912-015-0111-9
358:, which often requires a
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37:
32:
1746:Pancreas transplantation
1404:Lower anterior resection
1085:Esophageal pH monitoring
1027:Digestive system surgery
312:, should be considered.
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1840:Inguinal hernia surgery
1756:Pancreaticoduodenectomy
1139:Adjustable gastric band
1080:Impedance–pH monitoring
672:10.21037/ajo.2018.01.01
104:
1870:Exploratory laparotomy
1685:Hepatoportoenterostomy
1149:Gastric bypass surgery
1018:human digestive system
235:
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63:Nasogastric intubation
33:Nasogastric intubation
1845:Femoral hernia repair
1631:Liver transplantation
1225:Nissen fundoplication
229:
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89:) through the mouth.
83:Orogastric intubation
1442:Rubber band ligation
1381:Hartmann's operation
1817:Peritoneal dialysis
1636:Portal hypertension
1541:Virtual colonoscopy
1516:Endoanal ultrasound
1432:Anorectal manometry
1427:Anal sphincterotomy
1371:Colonic polypectomy
1166:Collis gastroplasty
432:. NICE. August 2017
389:Cortrak2 EAS recall
181:Salem Sump catheter
91:Abraham Louis Levin
1955:Medical treatments
1311:Jejunoileal bypass
1154:Sleeve gastrectomy
628:10.1111/acem.12961
335:esophageal varices
266:and down into the
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111:activated charcoal
1945:Medical equipment
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1301:Bariatric surgery
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1193:Gastroenterostomy
1134:Bariatric surgery
813:978-0-323-06805-5
759:(17): 1325–1326.
704:(18): 1036–1041.
595:978-1-4511-5324-8
549:978-0-323-35478-3
472:10.1111/inm.12758
367:esophageal reflux
320:Contraindications
232:endotracheal tube
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16:(Redirected from
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1235:Schilling test
1232:
1227:
1222:
1217:
1212:
1211:
1210:
1200:
1195:
1190:
1189:
1188:
1183:
1178:
1168:
1163:
1162:
1161:
1156:
1151:
1146:
1141:
1131:
1129:Gastric lavage
1126:
1121:
1114:
1112:
1106:
1105:
1103:
1102:
1097:
1092:
1087:
1082:
1077:
1072:
1070:Heller myotomy
1067:
1061:
1059:
1046:
1044:Upper GI tract
1037:
1031:
1030:
1025:
1022:
1021:
1013:
1012:
1005:
998:
990:
982:
981:
956:
930:
870:
819:
812:
794:
780:
739:
678:
642:
621:(7): 766–771.
601:
594:
570:
555:
548:
511:
501:
443:
420:
419:
417:
414:
413:
412:
407:
400:
397:
385:Avanos Medical
346:
343:
321:
318:
223:
220:
219:
218:
212:
206:
195:
192:
191:
190:
184:
178:
175:Levin catheter
159:
156:
106:
103:
73:) through the
58:
57:
50:
47:
46:
43:
35:
34:
26:
9:
6:
4:
3:
2:
1967:
1956:
1953:
1951:
1948:
1946:
1943:
1942:
1940:
1925:
1922:
1920:
1917:
1915:
1912:
1910:
1907:
1905:
1902:
1900:
1897:
1896:
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1888:
1882:
1878:
1875:
1871:
1868:
1867:
1866:
1863:
1862:
1860:
1856:
1846:
1843:
1841:
1838:
1836:
1835:Hernia repair
1833:
1832:
1830:
1828:
1824:
1818:
1815:
1813:
1810:
1808:
1805:
1803:
1800:
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1789:
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1778:
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1759:
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1699:
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1678:
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1668:
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1634:
1632:
1629:
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1624:
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1619:
1615:
1612:
1610:
1607:
1606:
1605:
1602:
1601:
1599:
1597:
1593:
1590:
1588:
1584:
1570:
1567:
1565:
1564:Fecal pH test
1562:
1560:
1557:
1556:
1554:
1552:
1548:
1542:
1539:
1537:
1534:
1532:
1529:
1527:
1524:
1522:
1519:
1517:
1514:
1512:
1509:
1507:
1504:
1502:
1499:
1498:
1495:
1494:Sigmoidoscopy
1492:
1490:
1487:
1485:
1482:
1480:
1477:
1475:
1472:
1470:
1466:
1463:
1462:
1460:
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1454:
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1440:
1438:
1435:
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1425:
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1420:
1416:
1410:
1407:
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1402:
1400:
1397:
1396:
1394:
1392:
1388:
1382:
1379:
1377:
1374:
1372:
1369:
1367:
1364:
1362:
1359:
1358:
1356:
1354:
1350:
1344:
1341:
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1336:
1334:
1331:
1329:
1326:
1324:
1321:
1319:
1316:
1312:
1309:
1307:
1304:
1303:
1302:
1299:
1298:
1296:
1294:
1290:
1287:
1285:
1281:
1271:
1268:
1266:
1263:
1259:
1256:
1255:
1254:
1251:
1250:
1248:
1246:
1242:
1236:
1233:
1231:
1230:Pyloromyotomy
1228:
1226:
1223:
1221:
1218:
1216:
1213:
1209:
1206:
1205:
1204:
1201:
1199:
1196:
1194:
1191:
1187:
1184:
1182:
1179:
1177:
1174:
1173:
1172:
1169:
1167:
1164:
1160:
1157:
1155:
1152:
1150:
1147:
1145:
1142:
1140:
1137:
1136:
1135:
1132:
1130:
1127:
1125:
1122:
1119:
1116:
1115:
1113:
1111:
1107:
1101:
1098:
1096:
1093:
1091:
1088:
1086:
1083:
1081:
1078:
1076:
1073:
1071:
1068:
1066:
1065:Esophagectomy
1063:
1062:
1060:
1058:
1054:
1050:
1047:
1045:
1041:
1038:
1036:
1032:
1028:
1023:
1019:
1011:
1006:
1004:
999:
997:
992:
991:
988:
970:
966:
960:
945:
941:
934:
926:
922:
917:
912:
908:
904:
900:
896:
892:
888:
884:
877:
875:
866:
862:
857:
852:
847:
842:
838:
834:
830:
823:
815:
809:
805:
798:
790:
784:
776:
772:
767:
762:
758:
754:
750:
743:
735:
731:
727:
723:
719:
715:
711:
707:
703:
699:
692:
685:
683:
673:
668:
664:
660:
656:
649:
647:
638:
634:
629:
624:
620:
616:
612:
605:
597:
591:
587:
586:
579:
574:
567:
562:
560:
551:
545:
541:
534:
532:
530:
528:
526:
524:
522:
520:
518:
516:
505:
497:
493:
489:
485:
481:
477:
473:
469:
465:
461:
457:
450:
448:
431:
425:
421:
411:
408:
406:
405:Force feeding
403:
402:
396:
394:
390:
386:
382:
378:
376:
372:
368:
363:
361:
357:
353:
345:Complications
342:
338:
336:
332:
327:
317:
313:
311:
306:
301:
298:
294:
290:
285:
281:
277:
273:
269:
265:
261:
256:
252:
250:
245:
241:
233:
228:
216:
213:
210:
207:
204:
203:Polypropylene
201:
200:
199:
188:
185:
182:
179:
176:
173:
172:
171:
164:
155:
152:
151:pneumonectomy
147:
143:
141:
137:
133:
127:
125:
120:
116:
112:
102:
100:
96:
92:
88:
84:
80:
76:
72:
68:
64:
54:
48:
41:
36:
31:
19:
1812:Paracentesis
1626:Liver biopsy
1521:Enteroclysis
1506:Defecography
1361:Appendectomy
972:. Retrieved
968:
959:
947:. Retrieved
943:
933:
890:
886:
836:
832:
822:
803:
797:
783:
756:
752:
742:
701:
697:
662:
658:
618:
614:
604:
584:
573:
539:
504:
463:
459:
434:. Retrieved
424:
410:Feeding tube
388:
379:
364:
352:pneumothorax
348:
339:
323:
314:
302:
280:litmus paper
257:
253:
237:
214:
208:
202:
197:
187:Dobhoff tube
186:
180:
174:
169:
148:
144:
128:
117:is used for
108:
94:
86:
82:
70:
66:
62:
61:
1802:Laparoscopy
1658:Gallbladder
1621:Hepatectomy
1551:Stool tests
1489:Proctoscopy
1484:Enteroscopy
1469:Colonoscopy
1353:Large bowel
1333:Jejunostomy
1293:Small bowel
1220:Hill repair
1203:Gastrostomy
1181:Billroth II
1171:Gastrectomy
1075:Sialography
974:28 November
949:28 November
944:foxnews.com
833:BMC Nursing
371:nose bleeds
247:enters the
95:Ryle's tube
1939:Categories
1865:Laparotomy
1807:Omentopexy
1784:Peritoneum
1419:Anal canal
1198:Gastropexy
1176:Billroth I
578:Section 82
436:30 January
416:References
360:chest tube
278:(note not
244:oropharynx
140:anesthesia
124:restraint.
1662:bile duct
1587:Accessory
1465:Endoscopy
1376:Colostomy
1366:Colectomy
1323:Ileostomy
1253:Endoscopy
1186:Roux-en-Y
1057:Esophagus
907:1518-8345
893:: e3400.
839:(1): 63.
718:0966-0461
496:220046454
480:1447-0349
375:sinusitis
331:esophagus
297:bilirubin
262:into the
249:esophagus
222:Technique
194:Materials
119:injection
1733:Pancreas
1474:Anoscopy
925:33439952
865:26617465
734:52917586
726:30281347
665:(1): 8.
637:26990304
488:32578949
399:See also
310:PEG tube
276:pH paper
215:Silicone
136:ingested
1110:Stomach
969:fda.gov
916:7798396
856:4661948
775:8992337
289:trypsin
272:syringe
268:bronchi
264:trachea
115:syringe
79:stomach
71:NG tube
1827:Hernia
1391:Rectum
923:
913:
905:
863:
853:
810:
773:
732:
724:
716:
635:
592:
546:
494:
486:
478:
295:, and
293:pepsin
260:larynx
1909:UKELD
1858:Other
1596:Liver
730:S2CID
694:(PDF)
509:2017.
492:S2CID
284:X-ray
209:Latex
158:Types
51:[
1904:PELD
1899:MELD
1706:MRCP
1680:ERCP
976:2022
951:2022
921:PMID
903:ISSN
861:PMID
808:ISBN
771:PMID
722:PMID
714:ISSN
633:PMID
590:ISBN
544:ISBN
484:PMID
476:ISSN
438:2018
105:Uses
75:nose
1711:PTC
1053:SGs
911:PMC
895:doi
851:PMC
841:doi
761:doi
757:335
706:doi
667:doi
623:doi
468:doi
393:FDA
387:'s
354:or
230:An
69:or
1941::
1879:/
1701:IV
1694::
1660:,
1467::
1055:/
967:.
942:.
919:.
909:.
901:.
891:29
889:.
885:.
873:^
859:.
849:.
837:14
835:.
831:.
769:.
755:.
751:.
728:.
720:.
712:.
702:27
700:.
696:.
681:^
661:.
657:.
645:^
631:.
619:23
617:.
613:.
558:^
514:^
490:.
482:.
474:.
464:29
462:.
458:.
446:^
373:,
369:,
305:Fr
291:,
101:.
81:.
1120:)
1009:e
1002:t
995:v
978:.
953:.
927:.
897::
867:.
843::
816:.
777:.
763::
736:.
708::
675:.
669::
663:1
639:.
625::
598:.
552:.
498:.
470::
440:.
55:]
20:)
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