Search Results
Results 1 - 50 of 1368
1 2 3 4 5 6 7 8 9 10 >
Khasawneh Mohammad A MA Division of Trauma Critical Care and General Surgery, Department of Surgery, St. Mary's Hospital, Mayo Clinic, Mary Brigh 2-810, 1216 Second Street SW, Rochester, MN, 55902, USA, - - 2014
Tissue O2 saturation (StO2) is a measure of tissue perfusion and should decrease during active hemorrhage. An initial StO2 value upon trauma center arrival measured concurrently with or prior to vitals, may predict hemorrhagic shock, requiring early blood product transfusion. Our aim was to identify the early StO2 threshold associated ...
Feinman Marcie M aDepartment of Surgery, Johns Hopkins Medicine, Baltimore, Maryland bDepartment of Surgery and The Center for Translational Injury Research, The University of Texas Health Science Center at Houston, Houston, Texas, - - 2014
This review article explores the recent literature regarding the optimal type and amount of intravenous fluids for the trauma patient from the time of injury through their ICU stay. It discusses damage control principles as well as targeted resuscitation utilizing new technology. In the prehospital arena, intravenous fluids have been ...
Mudge Margaret C MC Department of Veterinary Clinical Sciences, The Ohio State University, 601 Vernon L. Tharp Street, Columbus, OH 43210, USA. Electronic address: - - 2014
Treatment of acute hemorrhage in the horse involves targeted medical management and also may involve surgical stabilization. This article provides an approach to the initial stabilization and information on available topical hemostats. The practice of blood collection and transfusion is also described, with attention to new information on viability of ...
Tennent-Brown Brett B Faculty of Veterinary Science, Equine Centre, The University of Melbourne, 250 Princess Highway, Werribee, Victoria 3030, Australia. Electronic address: - - 2014
Admission blood lactate concentration is widely used as a prognostic indicator in equine medicine and can be a useful indicator of disease severity but typically fails to completely discriminate survivors from nonsurvivors. Increased admission lactate concentrations in adult horses typically return to normal within 12 to 24 hours. Lactate concentrations in ...
Kirkman E E Biomedical Sciences Department, Defence Science and Technology Laboratory, Porton Down, Salisbury, UK - - 2014
Trauma is the leading cause of death during the first four decades of life in the developed countries. Its haemodynamic response underpins the patient's initial ability to survive, and the response to treatment and subsequent morbidity and resolution. Trauma causes a number of insults including haemorrhage, tissue injury (nociception) and, ...
Starr Anna A Pharmacology and Therapeutics Group, Institute of Pharmaceutical Science, School of Biomedical Sciences, King's College London, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH; † British Heart Foundation Centre of Research Excellence, Division of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU. *MRC Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W12 0NN, - - 2014
Overproduction of nitric oxide (NO) by inducible NO synthase (iNOS) contributes towards refractory hypotension, impaired microvascular perfusion and end organ damage in septic shock patients. Tetrahydrobiopterin (BH4) is an essential NOS cofactor. GTP cyclohydrolase 1 (GCH1) is the rate-limiting enzyme for BH4 biosynthesis. Under inflammatory conditions, GCH1 activity and hence ...
Dowling Matthew B MB Fischell Department of Bioengineering, University of Maryland, College Park, - - 2014
Trauma represents a significant public health burden, and hemorrhage alone is responsible for 40% of deaths within the first 24 h after injury. Noncompressible hemorrhage accounts for the majority of hemorrhage-related deaths. Thus, materials which can arrest bleeding rapidly are necessary for improved clinical outcomes. This preliminary study evaluated several ...
Mracsko Eva E From the Department of Neurology, University Heidelberg, Heidelberg, Germany (E.M., E.J., S.-Y.N., A.K., A.L.); Institute for Stroke and Dementia Research, University Hospital Munich, Munich, Germany (A.L.); Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (A.L.); and Division of Brain Sciences, Imperial College, London, United Kingdom - - 2014
Neuroinflammatory processes contribute to secondary neuronal damage after intracerebral hemorrhage. We aimed to characterize the time course of brain immigration of different leukocyte subsets after striatal injection of either autologous blood or collagenase in mice. Intracerebral hemorrhage was induced by injection of either autologous blood (20 μL) or collagenase (0.03 ...
Remizova M I MI Department of Blood Substitutes and Components, Russian Research Institute of Hematology and Transfusiology, Federal Medical and Biological Agency, St. Petersburg, Russia, - - 2014
Effects of a NO donor L-arginine and a non-selective NO-synthase inhibitor N(G)-nitro-Larginine methyl ester on BP, microcirculation, acid-base balance, and gas content of blood were examined on rat model of hemorrhagic shock; the substances were administered without infusion media before blood loss. Bloodletting was stopped after manifestation of marked microcirculation ...
Brinton Mark R - - 2014
Noncompressible hemorrhage is currently the most common cause of preventable death in battlefield and in civilian trauma injuries. Tourniquets, specialized wound dressings, and hemorrhage-inhibiting biomaterials are not sufficiently effective in arrest of noncompressible hemorrhage and often cause collateral tissue damage. An effective, easy-to-use, portable device is needed to reduce blood ...
Semple-Hess Janet - - 2014
Drowning and submersion injuries are highly prevalent, yet preventable, causes of childhood mortality and morbidity. Although much of the resuscitation of the drowning pediatric victim is basic to all respiratory and cardiac arrest situations, there are some caveats for treatment of this type of injury. Risk factors for drowning victims ...
Williams Kristopher Burton KB Kristopher Burton Williams, Ashley Britton Christmas, Brant Todd Heniford, Ronald Fong Sing, Joseph Messick, Department of Surgery, Carolinas HealthCare System, Charlotte, NC 28204, United - - 2014
To characterize differences of arterial (ABG) and venous (VBG) blood gas analysis in a rabbit model of hemorrhagic shock. Following baseline arterial and venous blood gas analysis, fifty anesthetized, ventilated New Zealand white rabbits were hemorrhaged to and maintained at a mean arterial pressure of 40 mmHg until a state ...
Kaafarani H M A HM Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital & Harvard Medical School, Boston, MA, - - 2014
Most preventable trauma deaths are due to uncontrolled hemorrhage. In this article, we briefly describe the pathophysiology of the classical triad of death in trauma, namely, acidosis, hypothermia, and coagulopathy, and then suggest damage control resuscitation strategies to prevent and/or mitigate the effects of each in the bleeding patient. Damage ...
Schorn Mavis N - - 2014
Severe postpartum hemorrhage (PPH) can be defined as a blood loss of more than 1500 mL to 2500 mL. While rare, severe PPH is a significant contributor to maternal mortality and morbidity in the United States and throughout the world. Due to the maternal hematologic adaptation to pregnancy, the hypovolemia ...
Toksvang Linea N LN Department of Infectious Diseases M7641, Centre of Inflammation and Metabolism, University Hospital Rigshospitalet, Copenhagen Ø, - - 2014
Continuous monitoring of cerebral blood flow (CBF) may be valuable in critically ill patients with sepsis. In this study, we compared spatially resolved near-infrared spectroscopy (NIRS) to transcranial Doppler ultrasound (TCD)-derived estimates of noradrenaline-associated changes in CBF in such patients. Mean arterial blood pressure (MAP) was elevated by increasing the ...
Islam Nahidul N Research Unit, Avon Orthopedic Centre, Southmead Hospital, University of Bristol, United Kingdom; National Centre for Biomedical Engineering Science, National University of Ireland, Galway, Ireland; Shannon Applied Biotechnology Centre, Institute of Technology Tralee, Tralee, County Kerry, - - 2014
Major trauma increases vulnerability to systemic infections due to poorly defined immunosuppressive mechanisms. It confers no evolutionary advantage. Our objective was to develop better biomarkers of post-traumatic immunosuppression (PTI); and to extend our observation that PTI was reversed by anti-coagulated salvaged blood transfusion, in the knowledge that others had shown ...
Stefaniotou Antonia A MSc Program Cardiopulmonary Resuscitation, University of Athens, Medical School, Greece, 75 Mikras Asias street, 11527, Athens, - - 2014
The outcome for both in-hospital and out-of hospital cardiac arrest remains dismal. Vasopressors are used to increase coronary perfusion pressure and thus facilitate return of spontaneous circulation during cardiopulmonary resuscitation. However, they are associated with a number of potential adverse effects and may decrease endocardial and cerebral organ blood flow. ...
Guerci Philippe P School of Surgery, Faculty of Medicine, Vandoeuvre-Les-Nancy, - - 2014
The choice of volume expander for fluid resuscitation in hemorrhagic shock is still debated. Changes in plasma viscosity (PV) are barely investigated while PV modulates functional capillary density, microcirculation and organ function. The present study evaluated the impact of 2 strategies of fluid resuscitation in hemorrhagic shock in pigs. Ten ...
Smith Jason W JW Department of Surgery, University of Louisville, Louisville, KY; Department of Physiology and Biophysics, University of Louisville, Louisville, KY. Electronic address: - - 2014
Brain death in organ donors alters central hemodynamic performance, impairs physiology, exaggerates inflammation, and causes end-organ microcirculatory dysfunction and hypoxia. A new treatment, direct peritoneal resuscitation (DPR), might improve these derangements in acute brain death (ABD). We studied a standardized rodent model of brain death with matched controls to assess ...
Whyte Robin K - - 2014
Red blood cell transfusion is an important and frequent component of neonatal intensive care. The present position statement addresses the methods and indications for red blood cell transfusion of the newborn, based on a review of the current literature. The most frequent indications for blood transfusion in the newborn are ...
Del Pilar Huby Maria M Department of Surgery and Center for Translational Injury Research, University of Texas Health Science Center, Houston, - - 2014
Rodent models of hemorrhagic shock are paramount to our understanding of the pathophysiology of this disease, effects on coagulation, and exploring the utility of resuscitative methods for managing patients in shock. These models usually require serial blood sampling during experimentation. The lack of standardized practices for these experimental models has ...
Kelm Robert F RF 1Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany. 2Department of Neuropathology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany. 3Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center of the Johannes Gutenberg-University, Mainz, - - 2014
Despite advances in cardiac arrest treatment, high mortality and morbidity rates after successful cardiopulmonary resuscitation are still a major clinical relevant problem. The post cardiac arrest syndrome subsumes myocardial dysfunction, impaired microcirculation, systemic inflammatory response, and neurological impairment. The calcium-sensitizer levosimendan was able to improve myocardial function and initial resuscitation ...
Mallat Jihad J From the Intensive Care Unit, Centre Hospitalier du Dr Schaffner de Lens, Lens (JM, FP, ML, GG, NV, LT, DT), Department of Anaesthesiology and Critical Care Medicine, University Hospital of Lille, Univ Nord de France, Lille, France - - 2014
Central venous-to-arterial carbon dioxide partial pressure difference (ΔPCO2) can be used as a marker for the efficacy of venous blood in removing the total CO2 produced by the tissues. To date, this role of ΔPCO2 has been assessed only in patients after resuscitation from septic shock with already normalised central ...
Wang Dong D Critical Care Medicine Department, Clinical Center, NIH, Bethesda, - - 2014
In experimental pneumonia we found that transfused older blood increased mortality and lung injury that was associated with increased in vivo hemolysis and elevated plasma cell-free hemoglobin (CFH), non-transferrin-bound iron (NTBI), and plasma labile iron (PLI) levels. In this study, we additionally analyze identically treated animals that received lower or ...
Qian Jie J Weil Institute of Critical Care Medicine, Rancho Mirage, CA; Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. Electronic address: - - 2014
Post-resuscitation syndrome has been recognized as one of the major causes of the poor outcomes of cardiopulmonary resuscitation. The aims of this study were to investigate the intestinal microcirculatory changes following cardiopulmonary resuscitation and relate those changes to sublingual microcirculation and the severity of post-resuscitation syndrome as measured by myocardial ...
Hopper Kate K Department of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California at Davis, Davis, CA, - - 2014
To report acid base, electrolyte, glucose, and lactate values collected during or immediately after cardiopulmonary resuscitation (CPR) in dogs and cats. Retrospective study. University Teaching Hospital. Thirty-two dogs and 10 cats. None. Blood gas, electrolyte, glucose, and lactate values measured during CPR or within 5 minutes of return of spontaneous ...
Al Yazidi Ghalia G Division of Pediatric Neurology, Department of Pediatrics, Montreal Children's Hospital, McGill University, Montreal, - - 2014
Intraventricular hemorrhage is rare in term newborns. Severe asphyxia is recognized as one of the risk factors of intraventricular hemorrhage in these newborns. Therapeutic hypothermia, which is the only available treatment for the limitation of brain injury in term asphyxiated newborns, may cause fluctuations of cerebral blood flow, possibly placing ...
Sun Nannan N Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, Hubei, PR China; Department of Biomedical Engineering, Key Laboratory of Biomedical Photonics of Ministry of Education, Huazhong University of Science and Technology, 1037 Luoyu Road, Wuhan, Hubei 430074, PR China; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Biochemistry and Biophysics, Britton Chance Laboratory of Redox Imaging, Johnson Research Foundation, Perelman School of Medicine, University of Pennsylvania, Philadelphia, - - 2014
Our long-term goals are to identify imaging biomarkers for hemorrhagic shock and to understand how the preservation of cerebral microcirculation works. We also seek to understand how the damage occurs to the cerebral hemodynamics and the mitochondrial metabolism during severe hemorrhagic shock. We used a multimodal cerebral cortex optical imaging ...
Rivera-Chávez Fernando A FA Division of Burn/Trauma/Critical Care, UT Southwestern Medical Center , Dallas, Texas , - - 2014
ABSTRACT Objective: To evaluate neutrophil activation after exposure to standard HBC-201 (suspended in lactate Ringer's solution) versus HBOC-201 suspended in hypertonic 7.5% saline solution. Methods: We use plasma and tissue obtained from pigs subjected to controlled hemorrhagic shock and an ex vivo model of stimulated human whole blood. The pigs ...
Ball Chad G CG From the University of Calgary and Foothills Medical Centre, Calgary, - - 2014
Damage control resuscitation (DCR) represents the natural evolution of the initial concept of damage control surgery. It currently includes early blood product transfusion, immediate arrest and/or temporization of ongoing hemorrhage (i.e., temporary intravascular shunts and/or balloon tamponade) as well as restoration of blood volume and physiologic/hematologic stability. As a result, ...
Peruski Ann M AM Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, - - 2014
Objective-To determine whether increasing the viscosity of a standard hemoglobin-based oxygen-carrying solution (HBOC) would offset its associated vasoconstrictive effects and result in improved microvascular perfusion in healthy splenectomized dogs with experimentally induced hemorrhagic shock. Animals-12 male American Foxhounds. Procedures-Each dog underwent anesthesia and splenectomy. Shock was induced by controlled hemorrhage ...
Pereira Flávia Helena FH Instituto Federal de Educação, Ciência e Tecnologia do Sul de Minas Gerais, MachadoMG, Brazil, MSc, Professor, Instituto Federal de Educação, Ciência e Tecnologia do Sul de Minas Gerais, Machado, MG, - - 2014
to investigate whether there is a relationship between plasmatic levels of nitrate, body temperature, and blood pressure values in patients with sepsis, severe sepsis and septic shock. prospective observational study performed in a Brazilian hospital; data were collected from July to December 2009. Thirty blood samples were obtained from a ...
Skorup Paul P Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, - - 2014
This study aimed to determine whether the addition of an aminoglycoside to a ß-lactam antibiotic increases the antimicrobial effect during the early phase of Gram-negative severe sepsis/septic shock. A porcine model was selected that considered each animal's individual blood bactericidal capacity. Escherichia coli, susceptible to both antibiotics, was given to ...
Tara Shuhei S Division of Cardiology and Regenerative Medicine, Department of Internal Medicine, Nippon Medical - - 2014
Background: Because direct application of low-energy shock waves induces angiogenesis, we investigated the safety and efficacy of this new therapy to develop a noninvasive method of repeatable therapeutic angiogenesis for treating peripheral arterial disease (PAD). Subjects and Methods: The subjects were 10 patients who had symptomatic PAD and limited ischemia ...
Sun Nannan N Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, 430074, P. R. China, - - 2014
Understanding the biological mechanism and identifying biomarkers of hemorrhagic shock is important for diagnosis and treatment. We aim to use optical imaging to study how the cerebral blood circulation and metabolism change during the progression of severe hemorrhagic shock, especially the decompensatory stage. We used a multi-parameter (blood pressure (BP), ...
Mehrabadi Azar A Department of Obstetrics and Gynaecology, and the School of Population and Public Health, University of British Columbia, and the Children's and Women's Hospital and Health Centre of British Columbia, Vancouver - - 2014
Increases in postpartum hemorrhage have been reported from several countries. We assessed temporal trends in postpartum hemorrhage and severe postpartum hemorrhage in Canada between 2003 and 2010. We carried out a population-based cohort study of all hospital deliveries in Canada (excluding Quebec) from 2003 to 2010 (n = 2 193 ...
Idris Azam Che AC Faculty of Engineering, National Defence University of Malaysia, Kem Sungai Besi, Kuala Lumpur 57000, Malaysia. - - 2014
Scramjets have become a main focus of study for many researchers, due to their application as propulsive devices in hypersonic flight. This entails a detailed understanding of the fluid mechanics involved to be able to design and operate these engines with maximum efficiency even at their off-design conditions. It is ...
Keep Richard F RF Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan 48109-2200, USA ; Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, - - 2014
This article reviews current knowledge of the mechanisms underlying the initial hemorrhage and secondary blood-brain barrier (BBB) dysfunction in primary spontaneous intracerebral hemorrhage (ICH) in adults. Multiple etiologies are associated with ICH, for example, hypertension, Alzheimer's disease, vascular malformations and coagulopathies (genetic or drug-induced). After the initial bleed, there can ...
Jansen J O JO 144 Parachute Medical Squadron, 16 (Air Assault) Medical Regiment, and Aberdeen Royal Infirmary, Aberdeen, - - 2013
To document blood component usage in the UK medical treatment facility, Afghanistan, over a period of 4 years; and to examine the relationship with transfusion capability, injury pattern and survival. Haemostatic resuscitation is now firmly established in military medical practice, despite the challenges of providing such therapy in austere settings. ...
Cortés-Puch Irene I Critical Care Medicine Department, Clinical Center, NIH, Bethesda, MD, United - - 2013
In a randomized controlled blinded trial, two-year-old purpose-bred beagles (n=24) with S. aureus pneumonia, were exchanged-transfused with either 7- or 42-day-old washed or unwashed canine universal donor blood (80 ml/kg in 4 divided doses). Washing red cells (RBC) before transfusion had a significantly different effect on canine survival, multiple organ ...
Strandenes G G 1Norwegian Naval Special Operation Commando, Bergen, Norway 2Dept. of Immunology and Transfusion Medicine, Haukeland University Hospital, and Institute of Clinical Science, University of Bergen, Bergen, Norway 3Deployment Medicine International, P.O. Box 1264Gig Harbor, WA 98335 4U.S. Army Institute of Surgical Research, FT Sam Houston, TX, USA 5Naval Special Warfare Development Group Virginia Beach, Virginia 23461-2299 USA 6Specialist Corps, U.S. Army, Keller Army Community Hospital, West Point, New York 10996 USA 7Department of Transfusion Medicine, Örebro University Hospital, Orebro, Sweden 8NSWDG US Navy Virginia Beach, VA, USA 9Medical Operations Royal Caribbean Cruises Ltd. 305-982-2890 / ext. 32890 10Department of Pediatrics, Division of Critical Care, Washington University in St Louis, St. Louis, MO, - - 2013
Military experience and recent in-vitro laboratory data provide a biological rationale for whole blood use in the treatment of exsanguinating hemorrhage and have renewed interest in the re-introduction of fresh whole blood(FWB) and cold stored Whole Blood(WB) to patient care in austere environments. There is scant evidence to support, in ...
Ploen Robert R Department of Neurology, Ruprecht-Karls-University Heidelberg, Heidelberg, - - 2013
The management of acute ischemic stroke during anticoagulation with a novel oral anticoagulant (NOAC) is challenging because intravenous thrombolysis is contraindicated because of a putative increased risk of intracerebral hemorrhagic complications. We examined the risk of secondary postischemic hemorrhage after thrombolysis in rodents pretreated with rivaroxaban or warfarin. Mice were ...
Ballabh Praveen P Department of Pediatrics, Cell Biology and Anatomy, Regional Neonatal Center, New York Medical College, Maria Fareri Children's Hospital, Westchester Medical Center, 100 Woods Road, Valhalla, NY 10595, USA. Electronic address: - - 2014
Intraventricular hemorrhage (IVH) is a major neurologic complication of prematurity. Pathogenesis of IVH is attributed to intrinsic fragility of germinal matrix vasculature and to the fluctuation in the cerebral blood flow. Germinal matrix exhibits rapid angiogenesis orchestrating formation of immature vessels. Prenatal glucocorticoid exposure remains the most effective means of ...
Martini Wenjun Z - - 2013
Ongoing improvements in trauma care now recommend earlier use of blood products as part of damage control resuscitation, but generally these products are not available at far forward battlefield locations. For the military, questions continue to arise regarding efficacy of normal saline (NS) vs. lactated Ringer's (LR). Thus, this study ...
Ortiz Daniel D Department of Bioengineering, University of California, San Diego, La Jolla, CA 92093-0412, USA. Electronic address: - - 2014
The development of an alternative to blood transfusion to treat severe hemorrhage remains a challenge, especially in far forward scenarios when blood is not available. Hemoglobin level (Hb)-based oxygen (O2) carriers (HBOCs) were developed to address this need. Hemopure (HBOC-201, bovine Hb glutamer-250; OPK Biotech, Cambridge, MA), one such HBOC, ...
Schiraldi R - - 2013
Massive postpartum haemorrhage is a major worldwide cause of maternal mortality. Management requires intensive fluid resuscitation and blood transfusion. Although fluid therapy is often directed by the results of a full blood count and clotting screen, recent technological advances allow monitoring of haemodynamic function and cardiac output. Transoesophageal Doppler technology ...
Le Bas Abigail A Department of Obstetrics and Gynaecology, St George's Healthcare NHS Trust, London, UK. Electronic address: - - 2013
To establish the normal range for the "obstetric shock index" (OSI) after birth and to determine its usefulness as an aid to estimate blood loss in postpartum hemorrhage (PPH). A retrospective case-control analysis was conducted involving pregnant women admitted to St Georges Hospital for delivery: 50 with no PPH (control ...
Keene Damian D - - 2013
Haemorrhage from major trauma is a significant cause of death worldwide. The UK Defence Medical Service (UK-DMS) has had significant experience in managing severely injured and shocked trauma casualties over the last decade. This has led to the integration of rotational thromboelastometry (ROTEM) into damage control resuscitation delivered at Camp ...
Spinella Philip C - - 2013
The philosophy of DCR and RDCR can be summarized by stating that the goal is to prevent death from hemorrhagic shock by 'staying out of trouble instead of getting out of trouble'. In other words, it is preferred to arrest the progression of shock, rather than also having to reverse ...
Mallat J - - 2013
Determining the venous-to-arterial PCO2 difference (PCO2gap) during resuscitation of septic shock patients might be useful when deciding when to continue resuscitation despite a ScvO2 >70% associated with hyperlacticemia. Because hyperlacticemia is not a discriminatory factor in defining the cause of that stress, a PCO2gap >6 mmHg could be used to ...
1 2 3 4 5 6 7 8 9 10 >