blood cancer: 2008

Sunday, June 22, 2008

Blood and tissue concentration of cesium after exposure to cesium chloride

Abstract Context: Complementary alternative medicine therapies based on the use of cesium chloride preparations for the treatment of cancer and radiation poisoning, have generated therapeutic interest; but oral or intravenous administration of cesium chloride (CsCl) to cancer patients as an alternative mode of cancer therapy have not been approved by the U.S. Food and Drug Administration (FDA). Objective: Cesium (Cs) levels from human tissue were measured to determine exposure to an alternative medical treatment. Cesium levels are reported from two patients who were administered cesium chloride in conjunction with aloe vera as part of an alternative cancer treatment.

Trends in Hepatitis B and Hepatitis C Virus among Blood Donors over 16?Years in Turkey

Abstract Background: We document in the present study the trends over the sixteen years in HBV and HCV seroprevalence among blood donors in Turkish populations. Methods: In this study, serologic test results of whole blood (n = 6.240.130) donors at 22 Red Crescent Centers between 1989 and 2004 were evaluated retrospectively. Results and conclusion: The overall prevalence was 4.19% for HBsAg and 0.38% for HCV antibody during the study period. The annual prevalence of HBsAg gradually increased from 4.92% in 1989 to 5.23% in 1991 (p=0.001, t=21.00, CI95, 17237–22490) and gradually decreased from that to 2.10% in 2004 (p=0.001, t=17.27, CI95, 12869–21342). The seroprevalence of HCV antibody gradually increased from 18 per 10.000 in 1996, to 56 per 10.000 in 1998 (p=0.073, t=3.81, CI95, 459.62–5721.23), while that decreased to 34 per 10.000 in 2004 (p=0.021, t=7.49, CI95, 743.98–3980.11). The seroprevalence of hepatitis B and C has decreased markedly between 1989 and 2004 in Turkey. This could be related to the significant increase in the number of volunteer blood donors that increased from 135,779 to 197,815.

Temporal and venepuncture-related decline in circulating endothelial cell capture from mixed venous blood

Abstract Background: The quantification of circulating endothelial cells (CECs) in whole blood has evolved as a novel method for the assessment of endothelial function, although major methodological issues remain. We hypothesized that there is a temporal decline in CEC counts in static venesected blood and that venepuncture itself may lead to increased CEC detachment. Methods: CEC isolation was performed using the immunobead method. For the temporal decline experiment, we included 52 patients presenting with acute coronary syndrome (ACS). We performed CEC counts immediately and at 4 and 24 h later. For the venepuncture decline experiment, we studied 40 patients with stable cardiovascular disease (CVD). CEC counts were determined from the first 4 mL of aspirated venous blood and compared with counts obtained from a subsequent 4 mL sample of blood after at least 7.5 mL of blood had been collected.

Effects of porta-systemic shunting and ammonia infusion on cerebral blood flow autoregulation in the rat

Abstract Background: Portacaval shunting of blood, hyperammonemia, and impaired cerebral blood flow (CBF) autoregulation are assumed to be involved in the development of high intracranial pressure (ICP) in liver failure. In this study, we determined whether CBF autoregulation is impaired by portacaval anastomosis and hyperammonemia. Methods: Four groups of pentobarbital-sedated and mechanically ventilated rats were investigated after construction of a portacaval anastomosis or following sham operation. Half of the rats received either infusion of ammonia (55 μmol/kg/minute) or saline for 180 minutes. Arterial pressure and ICP was monitored, and lower limit of CBF autoregulation was determined.

Brief report: How well do clinic-based blood pressure measurements agree with the mercury standard?

Abstract BACKGROUND: Obtaining accurate blood pressure (BP) readings is a challenge faced by health professionals. Clinical trials implement strict protocols, whereas clinical practices and studies that assess quality of care utilize a less rigorous protocol for BP measurement. OBJECTIVE: To examine agreement between real-time clinic-based assessment of BP and the standard mercury assessment of BP.

Neuropsychological characteristics of adolescent boys differing in risk for high blood pressure

Abstract Background: Individuals with established hypertension have been found to display deficits in a number of neuropsychological abilities. In general, these are probably due to structural changes in the brain produced by sustained high blood pressure. However, a potentially important line of research suggests that some of these deficits may extend to younger individuals with less severe elevations of blood pressure, perhaps even children, and thus be related more to risk for hypertension than hypertension per se.Purpose: The objective was to examine the relationships between neuropsychological function and risk for hypertension in children.Methods: Measurements of blood pressure and parental history of hypertension were obtained in 88 French-Canadian 14-year-old boys and used to predict performance on a neuropsychological battery.Results: Boys at greater risk of hypertension by virtue of having a parental history of high blood pressure and normatively elevated systolic blood pressure had significantly lower scores on a verbal learning factor score compared to boys at lower risk. Boys with normatively elevated systolic blood pressure also had significantly lower scores on a spatial learning and memory factor score compared to boys with lower blood pressure. The results could not be attributed to differences in family socioeconomic status.Conclusions: Using a younger sample than typically employed in the area, the results support previous suggestions that some of the neuropsychological characteristics displayed by hypertensive individuals may predate the development of clinically elevated blood pressure and could be associated with risk for the disorder.

Blunted cardiovascular responses to daytime activities as related to reduced nocturnal blood pressure decline

Abstract Background: Individuals showing less than a 10% decline in blood pressure at night (“nondippers ”) are known to be at increased risk for hypertension and other cardiovascular conditions.Purpose: This research tested the assertion by R?ikk?nen et al. (1) that nondippers show blunted cardiovascular responses to activities during daytime hours.Methods: Ambulatory blood pressure and impedance monitoring was performed with 149 young adults in Singapore. At each daytime blood pressure reading, participants completed a computerized questionnaire indicating location, posture, physical activities, feelings, and social interactions.Results: Significant interactions between dipper status and feeling tired, location, posture, and physical activity provided qualified support for the blunting hypothesis. However, blunting of BP responses was not attributable to blunting of either cardiac output or total peripheral resistance responses.Conclusion: Nondippers appear to show blunted daytime responses to certain types of daytime activities. However, these effects are limited and appear to be the result of different mechanisms than those responsible for reduced nighttime blood pressure decline.

Chronic stress influences ambulatory blood pressure in adolescents

Abstract Background: High ambulatory blood pressure (ABP) predicts cardiovascular events, even after controlling for clinic BP and other established risk factors.Purpose: This study examined whether chronic or discrete stress in the past year was associated with greater ABP in adolescents.Method: Participants were 217 male and female Black and White adolescents who wore ABP monitors on 2 consecutive school days and completed a survey of life events.Results: Report of discrete, negative events was not associated with ABP. Adolescents experiencing greater numbers of chronic, negative life events exhibited greater systolic blood pressure (SBP), independent of ethnicity; sex; body mass index; and location, position, physical activity, and consumption of food/caffeine/nicotine at time of measurement. Greater numbers of chronic, negative events were associated with greater diastolic blood pressure (DBP) among boys. When resting clinic BP was introduced into the model, the main effect of chronic, negative life events on ambulatory SBP became nonsignificant, whereas the effect of chronic, negative life events on male adolescents’ DBP persisted.Conclusions: Chronic stress is associated with greater ambulatory SBP among male and female adolescents and with greater ambulatory DBP among male adolescents. The latter association persisted after controlling for clinic BP, suggesting that males may be more vulnerable to chronic stress as a determinant of BP regulation than females early in life.

Developmental, gender, and ethnic group differences in moods and ambulatory blood pressure in adolescents

Abstract Background: Adolescence is characterized by profound changes in physical, psychological, and social functioning thought to be accompanied by intense and varying moods.Purpose: Within a psychophysiological framework, this study examined the prevalence of 12 self-reported mood states of adolescents; investigated associations between specific mood states and ambulatory blood pressure readings; and explored effects of interactions among moods, gender, ethnic group, and maturation on ambulatory blood pressures.Methods: The sample included 371 African American, European American, and Hispanic American adolescents 11 to 16 years old. Systolic (SBP) and diastolic (DBP) blood pressures were measured every 30 min with an ambulatory monitor and were synchronized with electronic activity monitoring and moods self-recorded during waking hours in a checklist diary.Results: Moods differed significantly by gender, ethnic group, and maturation. Controlling for height, maturation, gender, ethnic group, mother’s education, position, location, activity, other moods, and interactions of moods with other variables in a multilevel, random coefficients regression model, both positive and negative mood states were associated with higher levels of SBP and DBP; being relaxed or bored, or having a feeling of accomplishing things were associated with lower SBP and DBP. There were significant interaction effects of moods with physical maturity, gender, and ethnic group on ambulatory SBP and DBP.Conclusions: Further study of the modifying effects of gender, ethnic group, and stage of development on reports of moods, and their associations with cardiovascular responses is recommended.

Validation of a noninvasive blood pressure monitoring device in normotensive and hypertensive pediatric intensive care patients

Abstract Objective. To evaluate the performance and to define limitations of a noninvasive blood pressure monitoring device in the critically ill pediatric population. Method. Patients were included in the study if they were admitted to the Pediatric Intensive Care Unit, were between the ages of 1 month and 18 years with wrist circumferences of ≥ 10 cm, and had an indwelling arterial line. Patients were excluded if their systolic blood pressure differed by ≥ 7.5% between their upper extremities. The measurements were collected simultaneously with those from an arterial line by a computer interfaced with the noninvasive blood pressure monitoring system and the patient’s monitor. Heart rates were calculated from the recorded pulse waveforms of the arterial lines. Comparison analyses were performed via bias and precision plots of the blood pressure and heart rate data in addition to calculation of Pearson’s correlation coefficients and concordance correlation coefficients. As a nonparametric method of comparison, the proportion of measurements that differed by greater than 10% was calculated. Results. Blood pressures and heart rates of 20 patients between the ages of 12 months and 17 years were monitored by a noninvasive blood pressure monitor for 30 min per patient. This data collection resulted in 2015 data points for each blood pressure and heart rate for comparison of methods. Concordance correlation coefficients were the following: systolic blood pressure, 0.93; diastolic blood pressure, 0.93; mean blood pressure, 0.94; and heart rate, 0.85. Conclusions. The noninvasive blood pressure monitor is capable of producing an accurate blood pressure measurement every 12–15 heartbeats in addition to providing a pulse waveform and digital display of the heart rate. Our study showed good agreement between the methods in the normotensive and hypertensive critically ill pediatric population with a wrist circumference limitation defined at ≥ 11 cm.

Autologous Blood Donation Before Elective Off-Pump Coronary Artery Bypass Grafting

Abstract Purpose. Preoperative autologous blood donation reduces exposure to homologous blood transfusions in cardiac surgery. The purpose of this study was to ascertain the volume of predonated autologous blood needed to avoid homologous blood transfusion in scheduled off-pump coronary artery bypass grafting (off-pump CABG). Methods. Fifty-six patients underwent scheduled off-pump CABG between January 1999 and December 2000. These patients all donated either 400ml (group 1, n = 33) or 800ml (group 2, n = 23) of autologous blood before operation. These patients donated at a rate of 400ml per week. All patients were given an equal volume of saline solution at the time of autologous donation.

Blood flow alterations in TNBS-induced colitis: Role of endothelin receptors

Abstract Objectives:The aim of the present study was to investigate the time dependent changes in hemodynamic parameters and to assess the role of endothelin (ET) receptors in trinitrobenzene sulfonic acid (TNBS) induced colitis. Materials:Inferior mesenteric artery (IMA) hemodynamics, myeloperoxidase activity (MPO) and damage scores were measured immediately or 1, 3, 5 and 14 days after colitis. Treatments: Another group of rats received a nonselective ET receptor antagonist bosentan (30 mg/kg/day), ET-A receptor antagonist BQ485 (60 g/rat/day) or ET-B receptor antagonist BQ788 (60 g/rat/day) prior to and on the 1st, 2nd and 3rd days after TNBS administration.

Acute blood neutrophilia induced by short-term compost dust exposure in previously unexposed healthy individuals

Abstract Objectives: Systemic effects of organic dust inhalation have been described in farming environments. The purpose of this study was to examine whether a single exposure at a biowaste composting facility could also exert systemic effects in healthy volunteers not previously exposed to organic dust from such facilities. Methods: Seventeen subjects (age 20–35 years) were exposed to organic dust for 2 h (exposure day) during moderate exercise; 12 of these subjects also took part in a control experiment (control day). Spirometry was performed before and immediately after the exposure. White blood cell counts and levels of tumor-necrosis factor-α (TNF-α), interleukin-1β (IL-1β) and interleukin-6 (IL-6) in peripheral blood were determined before and 3 h after exposure. Results: Exposures did not result in significant changes in lung function or blood cytokine levels. In contrast, the number and percentage of neutrophils increased during the exposure day [median (range) percent change of percentages 14 (−2; 67) %; P=0.002], but not during the control day [5 (−22; 35) %; P=0.66). Furthermore, there was a decrease in the number and percentage of eosinophils during the exposure day [−47 (−57; 0.0) %; P=0.002], whereas the change during the control day was smaller [−8 (−56; 71) %; P=0.68]. Conclusion: Short-term exposure of healthy, young subjects to organic dust from composting facilities had opposite effects on the numbers of blood neutrophils and blood eosinophils. These effects, though mild, suggest that even during a limited period of moderate work a sufficient amount of bioactive material can be deposited in the lung to elicit acute systemic alterations.

Prediction of HELLP syndrome with assessment of maternal dual hepatic blood supply by using Doppler ultrasound

Abstract Objective: Early structural and functional changes in the systemic vasculature have been proposed to play a major pathogenetic role in HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. Our objective was to assess whether the evaluation of maternal hepatic blood supply is instructive to the prediction of onset of HELLP syndrome. Design: Prospective observation study. Population: Fifty-eight women with severe preeclampsia and 60 healthy pregnant controls at 25–36 weeks gestation. Methods: Angle-corrected time-averaged flow velocity and the cross-sectional area of common hepatic artery and portal vein were measured by using Doppler ultrasonography in 58 women with severe preeclampsia and in 60 healthy pregnant controls at 25–36 weeks gestation. Intravascular flow volumes were calculated from the product of the time-averaged velocity and the cross-sectional area. The total liver blood flow was taken as the sum of flow volumes in the hepatic artery and portal vein. Results: The total liver blood flow decreased significantly to about 40% of control in 9 women with severe preeclampsia who developed HELLP syndrome within 4 days after the examination, but not in 49 women with severe preeclampsia without HELLP syndrome. Conclusion: The results indicated that the decrease in dual hepatic blood supply preceded the onset of HELLP syndrome.

The production of anti-inflammatory cytokines in whole blood by physico-chemical induction

Abstract Objective and design: Cytokines such as interleukin-1 (IL-1) play an important role in degenerative musculo-skeletal diseases, including osteoarthritis, and a multitude of inflammatory disorders. Agents that inhibit the action of such cytokines have a high therapeutic potential in such diseases. Here we describe a new method for enhancing the production of the interleukin-l receptor antagonist (IL-1Ra) and other anti-inflammatory cytokines in whole blood. Material and methods: Human venous blood was incubated in the presence of CrSO4-treated glass beads. Serum was recovered and the concentrations of IL-1Ra and other relevant cytokines were measured by ELISA.

Evaluation of peripheral blood neutrophil leucocytes in lead-exposed workers

Abstract Background: Inorganic lead can interfere with humoral and especially cell-mediated immunity even at frequently occurring (<50 μg/dl) blood lead (Pb-B) levels. Occupational exposure to lead causes a primary impairment of the chemotactic and phagocytic activities of neutrophil leucocytes. Objective: To verify whether, after taking into account the main confounding factors, occupational lead exposure is shown to induce changes in the number of blood neutrophil leucocytes, and to assess a possible dose-response relationship between Pb-B and the circulating neutrophil count in exposed workers. Subjects and methods: The study included 68 male lead-exposed (E) workers and 59 male workers in a food plant, recruited as controls (NE). A standardized questionnaire probing work, social, familial and personal medical history was administered to all the subjects. Blood and urine samples were collected to determine the dose and effect biological indices of lead and the total white blood cell and neutrophil counts. Results: Pb-B levels were significantly higher in E (geometric mean (GM): 20.5 μg/dl; 3.2–120 μg/dl) than in NE workers (GM: 3.5 μg/dl; 1–11 μg/dl). The mean absolute neutrophil count (ANC) was significantly higher in E workers with respect to NE workers. ANC correlated significantly with the biological lead dose and effect indices. Moreover, there was a dose-dependent increase of ANC with increasing Pb-B levels. The linear relationship between ANC and Pb-B was confirmed even after correction for age, body mass index and smoking habit. We also found an interaction between Pb-B level and smoking habit in increasing the number of blood neutrophils in lead-exposed workers. Conclusion: Our study is the first to describe a dose-dependent effect of lead on ANC in exposed workers. Our results underline the importance of promoting a further reduction of occupational lead exposure levels, adopting adequate individual protection means, as well as conducting medical campaigns against smoking, at the workplace.

Doppler Flow Wire Evaluation of Renal Blood Flow Reserve in Hypertensive Patients with Normal Renal Arteries

Abstract Purpose: To study the vasomotor responses of the renal microcirculation in patients with essential hypertension.

Linking nucleus accumbens dopamine and blood oxygenation

Abstract Rationale Animal research suggests that anticipation of reward can elicit dopamine release in the nucleus accumbens (NAcc). Human functional magnetic resonance imaging (FMRI) research further suggests that reward anticipation can increase local blood oxygen level dependent (BOLD) signal in the NAcc. However, the physiological relationship between dopamine release and BOLD signal increases in the NAcc has not yet been established.

Effects of Acupressure on Lower Limb Blood Flow for the Treatment of Peripheral Arterial Occlusive Diseases

Abstract Purpose To investigate the effects of acupressure on lower limb blood flow for the treatment of peripheral arterial occlusive diseases (PAOD).

Automated Bedside Measurement of Penile Blood Flow Using Pulse-Volume Plethysmography

Abstract Purpose To evaluate the efficiency of the form PWV/ABI (pulse wave velocity/ankle brachial pressure index) for measuring penile blood pressure (PBP) and the penile brachial pressure index (PBI).

Light and electron microscopic studies on human retinal blood vessels of patients with sclerosis and hypertension

Abstract Purpose To correlate the ophthalmoscopic and histological findings on human retinal blood vessels of patients with sclerosis and hypertension, respectively.

Measurement of renal blood flow in human subjects using the ultrasound velocity profiling technique

Abstract Purpose To (1) assess the accuracy of the ultrasound velocity profiling (USVP) technique of renal blood flow (RBF) measurement in normal subjects and (2) compare renal blood flow measurements obtained using USVP and renal clearance rate in patients with renal diseases.

Effects of MDMA on blood glucose levels and brain glucose metabolism

Abstract Purpose This study was designed to assess changes in glucose metabolism in rats administered single or repeated doses of MDMA.

Magnetic resonance quantitative myocardial perfusion reserve demonstrates improved myocardial blood flow after angiogenic implant therapy

Abstract Purpose The purpose of this study is to follow myocardial angiogenesis temporally using quantitative magnetic resonance first pass perfusion imaging and compare this with the “gold standard“ of radioactive microspheres in a random subset of animals.

Quantification of myocardial blood flow with 82Rb dynamic PET imaging

Abstract Purpose The PET tracer 82Rb is commonly used to evaluate regional perfusion defects for the diagnosis of coronary artery disease. There is limited information on the quantification of myocardial blood flow and flow reserve with this tracer. The goal of this study was to investigate the use of a one-compartment model of 82Rb kinetics for the quantification of myocardial blood flow.

Determinants of myocardial blood flow response to cold pressor testing and pharmacologic vasodilation in healthy humans

Abstract Purpose Response of myocardial blood flow (MBF) to sympathetic stimulation with cold is modulated by endothelium-related factors and is typically altered in the presence of coronary risk factors. Determinants of flow response to cold pressor testing (CPT) in normal volunteers at low risk for CAD remain less well defined, especially relative to baseline conditions such as hemodynamics and MBF, plasma substrate and lipid levels, and total pharmacologically stimulated vasodilator capacity.

Effect of hyperosmolality and cations on iodinated contrast medium-induced potassium release from human blood cells

Abstract Purpose Potassium release from blood cells is a contrast medium-induced phenomenon. The purposes of the study were to (1) assess the effect of hyperosmolality and of adding sodium ions and calcium ions to a solution on potassium release from human blood cells and (2) reevaluate the possibility of hemolysis as a cause of potassium elevation.

Changes in polymorphonuclear leukocyte elastase concentrations and hemolysis parameters in patients transfused with different blood preparations, and in the blood preparations themselves

Abstract Purpose Massive blood transfusion induces hemolysis and increases polymorphonuclear leukocyte elastase (PMNE) concentration. The purpose of this study was to compare hemolysis and PMNE concentrations in massive blood transfusions with three different preparations.

Proposal of blood volume-corrected model for quantification of regional cerebral blood flow with H215O-PET and its application to AVF

Abstract Purpose It is generally assumed that vascular tracer activity is negligible in the quantification of regional cerebral blood flow (rCBF) with H215O and positron emission tomography (PET) under normal conditions. We attempted to surpass the assumption of abnormal vascular conditions where the vascular tracer activity is significant by introducing the vascular component into the model.

Association Between Recurrence of Hepatocellular Carcinoma and α-Fetoprotein Messenger RNA Levels in Peripheral Blood

Abstract Purpose Intra- and extrahepatic recurrence is common, even after curative resection for hepatocellular carcinoma (HCC), suggesting preoperative or intraoperative tumor cell dissemination. Reverse transcription — polymerase chain reaction (RT-PCR) for α-fetoprotein (AFP) is used to detect circulating liver cancer cells. We previously developed a quantitative method that allows estimation of the AFP mRNA level by real-time PCR. In the present study, we used this method to measure the AFP mRNA level before and after resection of HCC, then correlated the findings with various clinicopathological characteristics and prognosis.

Influence of carboplatin infusion on osteosarcoma blood flow

Abstract Purpose Herein we report that carboplatin infusion influenced tumor blood flow signal independent of the mechanical decompression induced by the artificial lymphatics system technology that was being evaluated as part of a randomized veterinary clinical trial, treating spontaneously occurring canine appendicular osteosarcoma, a tumor very similar to its human counterpart.

Electrostatic field can preserve red blood cells in stored blood preparations

Abstract Purpose During the storage of red blood cell concentrates (CRCs), red blood cells are progressively destroyed and free hemoglobin and potassium concentrations increase. In this study, we focused on an electrostatic field that maintains food freshness without freezing, even at less than the freezing point. We hypothesized that the storage of CRCs under an electrostatic field could keep red blood cells in better condition than conventional storage.

The relationship between arteriovenous fistula blood flow rate and pulmonary artery pressure in hemodialysis patients

Abstract Purpose Although there is an increased prevalence of pulmonary hypertension in hemodialysis patients, the relationship between arteriovenous (AV) fistula blood flow and pulmonary hemodynamics is not known. The aim of this study was to evaluate the relationshipship between blood flow rate of AV fistula and pulmonary artery pressure (PAP) in hemodialysis patients.

Multi-Channel Electrical Bioimpedance: A New Noninvasive Method To Simultaneously Measure Cardiac And Peripheral Blood Flow

Abstract Objectives We sought to assess the ability of a new multi-channel electrical bioimpedance (MEB) methodology to accurately measure both cardiac blood flow and peripheral limb blood flow.

Adverse events of blood-pressure-lowering drugs: evidence of high incidence in a clinical setting

Abstract Objectives Our primary objective was to determine the incidence of AEs of antihypertensive drugs in a cohort of outpatients attending a specialized clinic. The secondary objectives were to determine the incidence of AEs by classes of blood-pressure-lowering drugs used in monotherapy and to identify risk factors for the occurrence of AEs.

Differences between Hospital- and Community-Acquired Blood Exposure Incidents Revealed by a Regional Expert Counseling Center

Abstract Objective: One year (2003) regional analysis of all blood exposure incidents from hospitals as well as from the community.

Usefulness of perioperative blood glucose control in patients undergoing off-pump coronary artery bypass grafting

Abstract Objective We investigated the usefulness of perioperative blood glucose control in patients undergoing coronary artery bypass grafting (CABG).

Intra-operative Blood Loss Predicts Complications After a Second Hepatectomy for Malignant Neoplasms

Abstract Objective We investigated the risk of morbidity after repeat resections for liver recurrence of hepatocellular carcinoma or for colorectal liver metastases.

Ex vivo expansion of CD34+ cells and immunocytes from umbilical cord blood

Abstract Objective Umbilical cord blood stem cell transplantation (CBSCT) has approached significant success in leukemia treatment, but it is associated with higher rates of delayed or failed engraftment and relapse. This may be caused by immature immune cells of umbilical cord blood. We try to expand stem/progenitor cells and T, NK, DC immunocytes from umbilical cord blood for transplantation and immunotherapy.

Sunday, June 22, 2008

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