{"id":21295,"date":"2023-04-21T19:19:26","date_gmt":"2023-04-21T12:19:26","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=21295"},"modified":"2023-04-21T19:19:26","modified_gmt":"2023-04-21T12:19:26","slug":"so-luoc-ve-khau-noi-chi-dut-lia-trong-chan-thuong","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/21\/so-luoc-ve-khau-noi-chi-dut-lia-trong-chan-thuong\/","title":{"rendered":"S\u01a1 l\u01b0\u1ee3c v\u1ec1 kh\u00e2u n\u1ed1i chi \u0111\u1ee9t l\u00eca trong ch\u1ea5n th\u01b0\u01a1ng"},"content":{"rendered":"<p><strong>\u0110\u1ee9t l\u00eca chi l\u00e0 tai n\u1ea1n l\u00e0m \u0111\u1ee9t m\u1ed9t ph\u1ea7n hay to\u00e0n b\u1ed9 chi th\u1ec3, chi tr\u00ean ho\u1eb7c chi d\u01b0\u1edbi, \u0111\u00f4i khi c\u1ee5t h\u1eb3n c\u1ea3 hai tay ho\u1eb7c 2 ch\u00e2n, trong \u0111\u00f3 nguy\u00ean nh\u00e2n \u0111\u1ee9ng \u0111\u1ea7u l\u00e0 tai n\u1ea1n lao \u0111\u1ed9ng, tai n\u1ea1n sinh ho\u1ea1t. <\/strong><strong>\u0110\u1ec3 kh\u00e2u n\u1ed1i chi \u0111\u1ee9t l\u00eca \u0111\u01b0\u1ee3c th\u00e0nh c\u00f4ng, t\u1ef7 l\u1ec7 s\u1ed1ng cao v\u00e0 h\u1eadu ph\u1eabu t\u1ed1t, ph\u1ee5c ch\u1ee9c n\u0103ng \u0111\u01b0\u1ee3c h\u1ed3i ph\u1ee5c t\u1ed1t, c\u00f9ng t\u00ecm hi\u1ec3u b\u00e0i vi\u1ebft sau \u0111\u00e2y.<\/strong><\/p>\n<h2>1. Th\u1eddi gian thi\u1ebfu m\u00e1u c\u00f3 h\u1ed3i ph\u1ee5c c\u1ee7a c\u00e1c m\u00f4 chi \u0111\u1ee9t l\u00eca:<\/h2>\n<ul>\n<li>Th\u1eddi gian thi\u1ebfu m\u00e1u c\u00f3 h\u1ed3i ph\u1ee5c: l\u00e0 th\u1eddi gian t\u1eeb l\u00fac m\u1ed9t ph\u1ea7n m\u00f4 hay t\u1ed5 ch\u1ee9c b\u1ecb c\u1eaft cung c\u1ea5p m\u00e1u cho \u0111\u1ebfn khi s\u1ef1 l\u01b0u th\u00f4ng m\u00e1u \u0111\u01b0\u1ee3c t\u00e1i l\u1eadp v\u00e0 t\u1ed5 ch\u1ee9c tr\u1edf l\u1ea1i ch\u1ee9c n\u0103ng b\u00ecnh th\u01b0\u1eddng. Qu\u00e1 th\u1eddi gian n\u00e0y d\u00f9 c\u00f3 t\u00e1i l\u1eadp tu\u1ea7n ho\u00e0n nh\u01b0ng t\u1ed5 ch\u1ee9c kh\u00f4ng ti\u1ebfp nh\u1eadn \u0111\u01b0\u1ee3c m\u00e1u v\u00e0 kh\u00f4ng c\u00f3 ch\u1ee9c n\u0103ng hay n\u00f3i c\u00e1ch kh\u00e1c m\u00f4 b\u1ecb ch\u1ebft \u1edf m\u1ee9c \u0111\u1ed9 t\u1ebf b\u00e0o.<\/li>\n<li>Th\u1eddi gian thi\u1ebfu m\u00e1u n\u00f3ng: l\u00e0 th\u1eddi gian thi\u1ebfu m\u00e1u c\u00f3 h\u1ed3i ph\u1ee5c khi ph\u1ea7n \u0111\u1ee9t r\u1eddi \u0111\u01b0\u1ee3c \u0111\u1ec3 trong \u0111i\u1ec1u ki\u1ec7n nhi\u1ec7t \u0111\u1ed9 th\u01b0\u1eddng c\u1ee7a m\u00f4i tr\u01b0\u1eddng.<\/li>\n<li>Th\u1eddi gian thi\u1ebfu m\u00e1u l\u1ea1nh : l\u00e0 th\u1eddi gian thi\u1ebfu m\u00e1u c\u00f3<a href=\"https:\/\/www.vinmec.com\/vi\/co-xuong-khop\/suc-khoe-thuong-thuc\/so-cuu-va-bao-quan-chi-bi-dut-lia-trong-cap-cuu\/\"> h\u1ed3i ph\u1ee5c<\/a> khi ph\u1ea7n \u0111\u1ee9t l\u00eca \u0111\u01b0\u1ee3c b\u1ea3o qu\u1ea3n \u1edf nhi\u1ec7t \u0111\u1ed9 t\u1eeb 0 &#8211; 4 \u0111\u1ed9 C.<\/li>\n<\/ul>\n<h4>Th\u1eddi gian thi\u1ebfu m\u00e1u c\u00f3 h\u1ed3i ph\u1ee5c m\u1ed9t s\u1ed1 m\u00f4 nh\u01b0 sau:<\/h4>\n<table style=\"height: 244px;\" width=\"823\">\n<tbody>\n<tr>\n<td>\n<p style=\"text-align: center;\"><strong>M\u00f4<\/strong><\/p>\n<\/td>\n<td style=\"text-align: center;\"><strong>Th\u1eddi gian thi\u1ebfu m\u00e1u n\u00f3ng<\/strong><\/td>\n<td>\n<p style=\"text-align: center;\"><strong>Th\u1eddi gian thi\u1ebfu m\u00e1u l\u1ea1nh<\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">Da v\u00e0 m\u00f4 d\u01b0\u1edbi da<\/p>\n<\/td>\n<td style=\"text-align: center;\">4 \u2013 6 gi\u1edd<\/td>\n<td>\n<p style=\"text-align: center;\">\u0111\u1ebfn 12 gi\u1edd<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td>\n<p style=\"padding-left: 80px;\">C\u01a1<\/p>\n<\/td>\n<td style=\"padding-left: 80px;\">\n<p style=\"padding-left: 80px;\">2 gi\u1edd<\/p>\n<\/td>\n<td style=\"padding-left: 80px;\">\n<p style=\"padding-left: 80px;\">\u0111\u1ebfn 08 gi\u1edd<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td>\n<p style=\"text-align: center;\">X\u01b0\u01a1ng<\/p>\n<\/td>\n<td style=\"text-align: center;\">3 gi\u1edd<\/td>\n<td>\n<p style=\"text-align: center;\">\u0111\u1ebfn 24 gi\u1edd<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>2. Ch\u1ec9 \u0111\u1ecbnh v\u00e0 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh kh\u00e2u n\u1ed1i chi \u0111\u1ee9t l\u00eca:<\/h2>\n<h3>2.1. Ch\u1ec9 \u0111\u1ecbnh kh\u00e2u n\u1ed1i chi \u0111\u1ee9t l\u00eca d\u1ef1a tr\u00ean 3 y\u1ebfu t\u1ed1:<\/h3>\n<ul>\n<li>T\u1ed5ng tr\u1ea1ng b\u1ec7nh nh\u00e2n: T\u1ed5ng tr\u1ea1ng ng\u01b0\u1eddi b\u1ec7nh c\u00f3 th\u1ec3 ch\u1ecbu \u0111\u1ef1ng ph\u1eabu thu\u1eadt l\u1edbn, k\u00e9o d\u00e0i nhi\u1ec1u gi\u1edd. Ch\u1ee9c n\u0103ng tu\u1ea7n ho\u00e0n, h\u00f4 h\u1ea5p, gan th\u1eadn cho ph\u00e9p.<\/li>\n<li>Ph\u1ea7n m\u1ecfm c\u1ee5t n\u01a1i \u0111\u1ee9t l\u00eca: kh\u00f4ng b\u1ecb b\u1ea7m d\u1eadp n\u1eb7ng, m\u1ea5t m\u00f4 r\u1ed9ng kh\u00f4ng c\u00f2n m\u00f4 m\u1ec1m \u0111\u1ec3 kh\u00e2u n\u1ed1i.<\/li>\n<li>Ph\u1ea7n \u0111\u1ee9t l\u00eca c\u00f2n t\u1ed1t kh\u00f4ng b\u1ecb b\u1ea7m d\u1eadp hay \u0111\u1ee9t nhi\u1ec1u \u0111o\u1ea1n.<\/li>\n<\/ul>\n<h4>C\u1ea7n ch\u00fa \u00fd c\u00e1c \u0111i\u1ec3m sau:<\/h4>\n<ul>\n<li>\u0110\u1ee9t l\u00eca ng\u00f3n tay c\u00e1i c\u00f3 ch\u1ec9 \u0111\u1ecbnh kh\u00e2u n\u1ed1i tuy\u1ec7t \u0111\u1ed1i v\u00ec ch\u1ee9c n\u0103ng chi\u1ebfm 40-60% ch\u1ee9c n\u0103ng b\u00e0n tay.<\/li>\n<li>\u0110\u1ee9t l\u00eca chi \u1edf tr\u1ebb em c\u0169ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh kh\u00e2u n\u1ed1i tuy\u1ec7t \u0111\u1ed1i.<\/li>\n<\/ul>\n<h3>2.2 Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh kh\u00e2u n\u1ed1i :<\/h3>\n<p>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh kh\u00e2u n\u1ed1i c\u0169ng c\u00f2n c\u00f3 t\u00ednh t\u01b0\u01a1ng \u0111\u1ed1i t\u00f9y thu\u1ed9c v\u00e0o t\u00ecnh tr\u1ea1ng n\u1ea1n nh\u00e2n, \u0111\u1ed9i ng\u0169 ph\u1eabu thu\u1eadt vi\u00ean v\u00e0 b\u00e1c s\u0129 h\u1ed3i s\u1ee9c, can thi\u1ec7p \u00a0n\u1ed9i khoa, c\u01a1 s\u1edf v\u1eadt ch\u1ea5t c\u1ee7a ph\u00f2ng ph\u1eabu thu\u1eadt.<\/p>\n<p>Theo Biemer v\u00e0 Daniel c\u00f3 c\u00e1c ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh nh\u01b0 sau:<\/p>\n<ul>\n<li>B\u1ec7nh h\u1ec7 th\u1ed1ng n\u1eb7ng.<\/li>\n<li>Nguy c\u01a1 do t\u00ea m\u00ea.<\/li>\n<li>Th\u1eddi gian thi\u1ebfu m\u00e1u n\u00f3ng.<\/li>\n<li>Chi l\u1edbn \u0111\u1ee9t l\u00eca th\u1eddi gian qu\u00e1 6 gi\u1edd.<\/li>\n<li>Ng\u00f3n tay \u0111\u1ee9t l\u00eca th\u1eddi gian qu\u00e1 10gi\u1edd.<\/li>\n<li>Lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng:\n<ul>\n<li>B\u1ea7m d\u1eadp, \u0111\u1ee5ng d\u1eadp v\u1ebft th\u01b0\u01a1ng n\u1eb7ng.<\/li>\n<li>\u0110\u1ee9t l\u00eca do v\u1eb7n xo\u1eafn, k\u00e9o \u0111\u1ee9t k\u00e8m theo t\u1ed5n th\u01b0\u01a1ng m\u1ea1ch m\u00e1u \u1edf xa. Lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng n\u00e0y r\u1ea5t tr\u1ea7m tr\u1ecdng, kh\u00f3 kh\u00e2u n\u1ed1i, t\u1ef7 l\u1ec7 s\u1ed1ng th\u1ea5p v\u00e0 ph\u1ee5c h\u1ed3i ch\u1ee9c n\u0103ng k\u00e9m.<\/li>\n<\/ul>\n<\/li>\n<li>\u0110\u1ee9t l\u00eca b\u00fap ng\u00f3n.<\/li>\n<li>\u0110\u1ee9t l\u00eca 1 ng\u00f3n duy nh\u1ea5t tr\u1eeb ng\u00f3n 1 hay c\u00e1c tr\u01b0\u1eddng h\u1ee3p \u0111\u1eb7c bi\u1ec7t kh\u00e1c.<\/li>\n<li>Ti\u1ec1n s\u1eed b\u1ec7nh:\n<ul>\n<li>T\u00e2m th\u1ea7n<\/li>\n<li>Ti\u1ec3u \u0111\u01b0\u1eddng<\/li>\n<li>X\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch<\/li>\n<li>Nh\u1ed3i m\u00e1u c\u01a1 tim<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<figure id=\"attachment_21303\" aria-describedby=\"caption-attachment-21303\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-medium wp-image-21303\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/th-7-300x200.jpg\" alt=\"H\u00ecnh \u1ea3nh minh h\u1ecda \u0111\u1ee9t l\u00eca chi\" width=\"300\" height=\"200\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/th-7-300x200.jpg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/th-7.jpg 470w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-21303\" class=\"wp-caption-text\">H\u00ecnh \u1ea3nh minh h\u1ecda \u0111\u1ee9t l\u00eca chi<\/figcaption><\/figure>\n<h2>3. Quy tr\u00ecnh kh\u00e2u n\u1ed1i chi:<\/h2>\n<h3>Th\u00f4ng th\u01b0\u1eddng n\u1ed1i chi ti\u1ebfn h\u00e0nh theo qui tr\u00ecnh sau:<\/h3>\n<ul>\n<li>B\u01b0\u1edbc 1: C\u1eaft l\u1ecdc v\u1ebft th\u01b0\u01a1ng \u1edf ph\u1ea7n \u0111\u1ee9t l\u00eca v\u00e0 m\u1ecfm c\u1ee5t: l\u1ea5y b\u1ecf d\u1ecb v\u1eadt, m\u00f4 ch\u1ebft, m\u00f4 d\u1eadp n\u00e1t. Vi\u1ec7c c\u1eaft l\u1ecdc g\u1ea7n c\u00e1c c\u1ea5u tr\u00fac m\u1ea1ch m\u00e1u hay th\u1ea7n kinh ph\u1ea3i th\u1ef1c hi\u1ec7n d\u01b0\u1edbi k\u00ednh l\u00fap \u0111\u1ec3 b\u1ea3o v\u1ec7 c\u00e1c c\u1ea5u tr\u00fac n\u00e0y.<\/li>\n<li>B\u01b0\u1edbc 2: \u0110\u00e1nh d\u1ea5u c\u00e1c c\u1ea5u tr\u00fac m\u1ea1ch m\u00e1u, th\u1ea7n kinh, g\u00e2n. Vi\u1ec7c t\u00ecm v\u00e0 \u0111\u00e1nh d\u1ea5u c\u00e1c c\u1ea5u tr\u00fac n\u00e0y gi\u00fap cho qu\u00e1 tr\u00ecnh kh\u00e2u n\u1ed1i thu\u1eadn l\u1ee3i v\u00e0 nhanh h\u01a1n. Trong qu\u00e1 tr\u00ecnh t\u00ecm v\u00e0 \u0111\u00e1nh d\u1ea5u, ch\u00fang ta x\u00e1c \u0111\u1ecbnh \u0111\u01b0\u1ee3c ph\u1ea7n m\u1ea1ch m\u00e1u th\u1ea7n kinh c\u00f2n t\u1ed1t \u0111\u1ec3 kh\u00e2u n\u1ed1i. Vi\u1ec7c n\u00e0y r\u1ea5t c\u1ea7n thi\u1ebft cho quy\u1ebft \u0111\u1ecbnh c\u1eaft ng\u1eafn xu\u01a1ng bao nhi\u00eau hay c\u00f3 gh\u00e9p m\u1ea1ch m\u00e1u kh\u00f4ng.<\/li>\n<\/ul>\n<p style=\"padding-left: 40px;\">C\u00e1c g\u00e2n c\u01a1 th\u01b0\u1eddng kh\u00f4ng c\u1ea7n ph\u1ea3i \u0111\u00e1nh d\u1ea5u, tuy nhi\u00ean \u0111\u1ec3 vi\u1ec7c kh\u00e2u n\u1ed1i g\u00e2n nhanh ch\u00f3ng trong th\u00ec n\u00e0y ch\u00fang ta \u00e1p d\u1ee5ng kh\u00e2u n\u1ed1i g\u00e2n ki\u1ec3u Tajima. T\u1ee9c l\u00e0 kh\u00e2u chu\u1ea9n b\u1ecb s\u1eb5n \u1edf 2 \u0111\u1ea7u g\u00e2n tr\u01b0\u1edbc.<\/p>\n<ul>\n<li>B\u01b0\u1edbc 3: C\u1eaft ng\u1eafn v\u00e0 k\u1ebft h\u1ee3p x\u01b0\u01a1ng. Ngo\u1ea1i tr\u1eeb c\u00e1c tr\u01b0\u1eddng h\u1ee3p v\u1ebft c\u1eaft s\u1eafc g\u1ecdn kh\u00f4ng g\u00e2y b\u1ea7m d\u1eadp m\u00f4 m\u1ec1m kh\u00f4ng c\u1ea7n ph\u1ea3i c\u1eaft ng\u1eafn x\u01b0\u01a1ng. \u0110a s\u1ed1 c\u00e1c tr\u01b0\u1eddng h\u1ee3p ch\u00fang ta ph\u1ea3i c\u1eaft ng\u1eafn x\u01b0\u01a1ng \u0111\u1ec3 thu\u1eadn l\u1ee3i kh\u00e2u n\u1ed1i m\u1ea1ch m\u00e1u th\u1ea7n kinh kh\u00f4ng b\u1ecb c\u0103ng. Tuy nhi\u00ean \u1edf m\u1ed9t v\u00e0i tr\u01b0\u1eddng h\u1ee3p ch\u00fang ta c\u00f3 th\u1ec3 kh\u00f4ng c\u1eaft ng\u1eafn x\u01b0\u01a1ng nh\u01b0 v\u00f9ng g\u1ea7n kh\u1edbp, l\u00fac n\u00e0y ph\u1ea3i gh\u00e9p m\u1ea1ch m\u00e1u.<\/li>\n<li>B\u01b0\u1edbc 4: Kh\u00e2u g\u00e2n.<\/li>\n<li>B\u01b0\u1edbc 5: Kh\u00e2u \u0111\u1ed9ng m\u1ea1ch.<\/li>\n<li>B\u01b0\u1edbc 6: Kh\u00e2u t\u0129nh m\u1ea1ch.<\/li>\n<li>B\u01b0\u1edbc 7: Kh\u00e2u th\u1ea7n kinh.<\/li>\n<li>B\u01b0\u1edbc 8: \u0110\u00f3ng da.<\/li>\n<\/ul>\n<p>Tr\u00ecnh t\u1ef1 tr\u00ean \u0111\u00e2y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c thay \u0111\u1ed5i theo t\u1eebng tr\u01b0\u1eddng h\u1ee3p b\u1ec7nh nh\u00e2n. Trong tr\u01b0\u1eddng h\u1ee3p \u00a0n\u1ea1n nh\u00e2n v\u00e0o b\u1ec7nh vi\u1ec7n s\u1edbm ngay sau tai n\u1ea1n, ch\u00fang ta c\u00f3 th\u1ec3 kh\u00e2u t\u0129nh m\u1ea1ch tr\u01b0\u1edbc khi kh\u00e2u \u0111\u1ed9ng m\u1ea1ch \u0111\u1ec3 tr\u00e1nh m\u1ea5t m\u00e1u. V\u00e0 n\u1ebfu tr\u01b0\u1eddng h\u1ee3p \u00a0n\u1ea1n nh\u00e2n \u0111\u1ebfn mu\u1ed9n th\u00ec \u01b0u ti\u00ean kh\u00e2u \u0111\u1ed9ng m\u1ea1ch \u0111\u1ec3 t\u01b0\u1edbi m\u00e1u m\u00f4 tr\u01b0\u1edbc khi kh\u00e2u c\u00e1c c\u1ea5u tr\u00fac kh\u00e1c.<\/p>\n<h2>4. Ch\u0103m s\u00f3c theo d\u00f5i h\u1eadu ph\u1eabu:<\/h2>\n<ul>\n<li>Di chuy\u1ec3n b\u1ec7nh nh\u00e2n.<\/li>\n<li>B\u0103ng, n\u1eb9p b\u1ed9t c\u1ed1 \u0111\u1ecbnh t\u01b0 th\u1ebf ch\u00f9ng m\u1ea1ch m\u00e1u \u0111\u01b0\u1ee3c kh\u00e2u n\u1ed1i.<\/li>\n<li>S\u1eed d\u1ee5ng thu\u1ed1c theo ch\u1ec9 \u0111\u1ecbnh: D\u1ecbch truy\u1ec1n, kh\u00e1ng sinh, gi\u00e3n m\u1ea1ch, ch\u1ed1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u.<\/li>\n<li>C\u00e1c ph\u01b0\u01a1ng ph\u00e1p v\u1eadt l\u00fd tr\u1ecb li\u1ec7u h\u1ed7 tr\u1ee3 qu\u00e1 tr\u00ecnh ph\u1ee5c h\u1ed3i sau ph\u1eabu thu\u1eadt.<\/li>\n<li>Theo d\u00f5i chi: m\u00e0u s\u1eafc chi, nhi\u1ec7t \u0111\u1ed9 chi, nh\u1ea5p nh\u00e1y m\u00f3ng, \u0111\u1ed9 chun gi\u00e3n c\u1ee7a da.<\/li>\n<\/ul>\n<p>Ngu\u1ed3n: B\u1ed9 Y T\u1ebf<\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0110\u1ee9t l\u00eca chi l\u00e0 tai n\u1ea1n l\u00e0m \u0111\u1ee9t m\u1ed9t ph\u1ea7n hay to\u00e0n b\u1ed9 chi th\u1ec3, chi tr\u00ean ho\u1eb7c chi d\u01b0\u1edbi, \u0111\u00f4i khi c\u1ee5t h\u1eb3n c\u1ea3 hai tay ho\u1eb7c 2 ch\u00e2n, trong \u0111\u00f3 nguy\u00ean nh\u00e2n \u0111\u1ee9ng \u0111\u1ea7u l\u00e0 tai n\u1ea1n lao \u0111\u1ed9ng, tai n\u1ea1n sinh ho\u1ea1t. \u0110\u1ec3 kh\u00e2u n\u1ed1i chi \u0111\u1ee9t l\u00eca \u0111\u01b0\u1ee3c th\u00e0nh c\u00f4ng, t\u1ef7 [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[75,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - 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