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Author response to: Comment on: Evolution of transoral endoscopic thyroidectomy vestibular approach according to the IDEAL framework

Lee SH, Moorthy R, Nagala S

Br J Surg, 2022 Oct 14;109(11):e118.
PMID: 35891610 DOI: 10.1093/bjs/znac236
Fulltext Self-reported symptom study of COVID-19 chemosensory dysfunction in Malaysia

Lee SH, Yeoh ZX, Sachlin IS, Gazali N, Soelar SA, Foo CY, et al.

Sci Rep, 2022 02 08;12(1):2111.
PMID: 35136124 DOI: 10.1038/s41598-022-06029-6

Alterations in the three chemosensory modalities-smell, taste, and chemesthesis-have been implicated in Coronavirus Disease 2019 (COVID-19), yet emerging data suggest a wide geographic and ethnic variation in the prevalence of these symptoms. Studies on chemosensory disorders in COVID-19 have predominantly focused on Caucasian populations whereas Asians remain understudied. We conducted a nationwide, multicentre cross-sectional study using an online questionnaire on a cohort of RT-PCR-confirmed adult COVID-19 patients in Malaysia between 6 June and 30 November 2020. The aim of our study was to investigate their presenting symptoms and assess their chemosensory function using self-ratings of perceived smell, taste, chemesthesis, and nasal blockage. In this cohort of 498 patients, 41.4% reported smell and/or taste loss when diagnosed with COVID-19, which was the commonest symptom. Blocked nose, loss of appetite, and gastrointestinal disturbances were independent predictors of smell and/or taste loss on multivariate analysis. Self-ratings of chemosensory function revealed a reduction in smell, taste, and chemesthesis across the entire cohort of patients that was more profound among those reporting smell and/or taste loss as their presenting symptom. Perceived nasal obstruction accounted for only a small proportion of changes in smell and taste, but not for chemesthesis, supporting viral disruption of sensorineural mechanisms as the dominant aetiology of chemosensory dysfunction. Our study suggests that chemosensory dysfunction in COVID-19 is more widespread than previously reported among Asians and may be related to the infectivity of viral strains.Study Registration: NMRR-20-934-54803 and NCT04390165.
Fulltext The association between lower educational attainment and depression owing to shared genetic effects? Results in ~25,000 subjects

Peyrot WJ, Lee SH, Milaneschi Y, Abdellaoui A, Byrne EM, Esko T, et al.

Mol Psychiatry, 2015 Jun;20(6):735-43.
PMID: 25917368 DOI: 10.1038/mp.2015.50

An association between lower educational attainment (EA) and an increased risk for depression has been confirmed in various western countries. This study examines whether pleiotropic genetic effects contribute to this association. Therefore, data were analyzed from a total of 9662 major depressive disorder (MDD) cases and 14,949 controls (with no lifetime MDD diagnosis) from the Psychiatric Genomics Consortium with additional Dutch and Estonian data. The association of EA and MDD was assessed with logistic regression in 15,138 individuals indicating a significantly negative association in our sample with an odds ratio for MDD 0.78 (0.75-0.82) per standard deviation increase in EA. With data of 884,105 autosomal common single-nucleotide polymorphisms (SNPs), three methods were applied to test for pleiotropy between MDD and EA: (i) genetic profile risk scores (GPRS) derived from training data for EA (independent meta-analysis on ~120,000 subjects) and MDD (using a 10-fold leave-one-out procedure in the current sample), (ii) bivariate genomic-relationship-matrix restricted maximum likelihood (GREML) and (iii) SNP effect concordance analysis (SECA). With these methods, we found (i) that the EA-GPRS did not predict MDD status, and MDD-GPRS did not predict EA, (ii) a weak negative genetic correlation with bivariate GREML analyses, but this correlation was not consistently significant, (iii) no evidence for concordance of MDD and EA SNP effects with SECA analysis. To conclude, our study confirms an association of lower EA and MDD risk, but this association was not because of measurable pleiotropic genetic effects, which suggests that environmental factors could be involved, for example, socioeconomic status.
Fulltext Amivantamab plus chemotherapy with and without lazertinib in EGFR-mutant advanced NSCLC after disease progression on osimertinib: primary results from the phase III MARIPOSA-2 study

Passaro A, Wang J, Wang Y, Lee SH, Melosky B, Shih JY, et al.

Ann Oncol, 2024 Jan;35(1):77-90.
PMID: 37879444 DOI: 10.1016/j.annonc.2023.10.117

BACKGROUND: Amivantamab plus carboplatin-pemetrexed (chemotherapy) with and without lazertinib demonstrated antitumor activity in patients with refractory epidermal growth factor receptor (EGFR)-mutated advanced non-small-cell lung cancer (NSCLC) in phase I studies. These combinations were evaluated in a global phase III trial.
PATIENTS AND METHODS: A total of 657 patients with EGFR-mutated (exon 19 deletions or L858R) locally advanced or metastatic NSCLC after disease progression on osimertinib were randomized 2 : 2 : 1 to receive amivantamab-lazertinib-chemotherapy, chemotherapy, or amivantamab-chemotherapy. The dual primary endpoints were progression-free survival (PFS) of amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy. During the study, hematologic toxicities observed in the amivantamab-lazertinib-chemotherapy arm necessitated a regimen change to start lazertinib after carboplatin completion.
RESULTS: All baseline characteristics were well balanced across the three arms, including by history of brain metastases and prior brain radiation. PFS was significantly longer for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy [hazard ratio (HR) for disease progression or death 0.48 and 0.44, respectively; P < 0.001 for both; median of 6.3 and 8.3 versus 4.2 months, respectively]. Consistent PFS results were seen by investigator assessment (HR for disease progression or death 0.41 and 0.38 for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy, respectively; P < 0.001 for both; median of 8.2 and 8.3 versus 4.2 months, respectively). Objective response rate was significantly higher for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy (64% and 63% versus 36%, respectively; P < 0.001 for both). Median intracranial PFS was 12.5 and 12.8 versus 8.3 months for amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy versus chemotherapy (HR for intracranial disease progression or death 0.55 and 0.58, respectively). Predominant adverse events (AEs) in the amivantamab-containing regimens were hematologic, EGFR-, and MET-related toxicities. Amivantamab-chemotherapy had lower rates of hematologic AEs than amivantamab-lazertinib-chemotherapy.
CONCLUSIONS: Amivantamab-chemotherapy and amivantamab-lazertinib-chemotherapy improved PFS and intracranial PFS versus chemotherapy in a population with limited options after disease progression on osimertinib. Longer follow-up is needed for the modified amivantamab-lazertinib-chemotherapy regimen.
Response of Coptotermes curvignathus (Isoptera: Rhinotermitidae) to formaldehyde catcher-treated particleboard

Lee SH, H'ng PS, Peng TL, Lum WC

Pak J Biol Sci, 2013 Nov 01;16(21):1415-8.
PMID: 24511759

The objective of this study is to investigate the feasibility of formaldehyde catcher as termites repellent. Single-layered UF-bonded particleboard was post-treated with formaldehyde catcher and heat respectively. Besides that, some boards were also produced with the formaldehyde catcher was added into the resin during the blending process, called add-in method. Particleboard post-treated with formaldehyde catcher reported the most severe attack. Heat-treated particleboard showed slightly better durability than the control blocks while the add-in catcher showed the best durability among three methods. A valid test was obtained as the termites survived the first week of the test. However, all the termites were found dead at the end of the test.
Morphological re-description of Cochlochila bullita (Stål) (Heteroptera: Tingidae), a potential pest of Orthosiphon aristatus Blume Miq. (Lamiales: Lamiaceae) in Malaysia

Peng TL, Sajap AS, Jeen LH, Lee SH, Lum WC

Pak J Biol Sci, 2013 Dec 01;16(23):1786-90.
PMID: 24506049

One species of lace bug Cochlochila bullita Stål (Heteroptera: Tingidae) was found heavily infested Orthosiphon aristatus Blume Miq., an important medicinal plant in Malaysia. A morphological re-description of C. bullita was done in order to facilitate the identification of this oligophagous insect pest. Five variables, body length and width, antenna length, tibia length and head width were measured from 15 samples from each stage. Among these variables, body length and width were used to construct the ratio for species identification; while body lengths with the other three variables were used to distinguish the nymphs from each developmental stage. The measurements of four traits except the antenna length showed significant differences between the development stages. And thus suggest the body width, tibia length and head width were suitable parameters used to distinguish the nymphal stages. However, the result on the growth factor showed only the sizes of the head followed a more constant growth rate with growth ratios (1.21-1.39) lie between the Dyar's ratio. Body length and width ratio for the adult female and male was 1.51 +/- 0.00 and 1.59 +/- 0.01, respectively. These data are pertinent for identifying developmental stages and to distinguish the species of the lace bug.
Fulltext Isolation and Characterization of Cellulose Nanocrystals from Oil Palm Mesocarp Fiber

Chieng BW, Lee SH, Ibrahim NA, Then YY, Loo YY

Polymers (Basel), 2017 Aug 11;9(8).
PMID: 30971032 DOI: 10.3390/polym9080355

The aim was to explore the utilization of oil palm mesocarp fiber (OPMF) as a source for the production of cellulose nanocrystals (CNC). OPMF was first treated with alkali and then bleached before the production of CNC by acid hydrolysis (H₂SO₄). The produced materials were characterized using Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), thermogravimetric analysis (TGA), a scanning electron microscope (SEM) and a transmission electron microscope (TEM). It was proven that acid hydrolysis can increase the crystallinity of bleached OPMF and reduce the dimension of cellulose to nano scale. Changes in the peaks of the FTIR spectrum at 2852 (C-H stretching), 1732 (C=O stretching) and 1234 cm-1 (C-O stretching) indicated that the alkali treatment completely removed hemicelluloses and lignin from the fiber surface. This can be seen from the thermogram obtained from the TGA characterization. Morphological characterization clearly showed the formation of rod-shaped CNCs. The promising results prove that OPMF is a valuable source for the production of CNC.
Fulltext Peritoneal implantation of ureter in a cadaveric kidney transplant recipient

Tan SY, Lim CS, Teo SM, Lee SH, Razack A, Loh CS

Med J Malaysia, 2003 Dec;58(5):769-70.
PMID: 15190667

We report here a case of a kidney transplant recipient in whom the ureter was initially implanted into the peritoneum. Excessive ultrafiltration volume and reversal of serum vs dialysate creatinine ratio when the patient was recommenced on continuous ambulatory peritoneal dialysis first suggested the diagnosis which was subsequently confirmed by a plain abdominal x-ray demonstrating placement of ureteric stent in the peritoneum. This rare complication was successfully corrected with surgical re-implantation of ureter into the bladder and 5 years later, the patient remains well with good graft function.
Author Correction: Activation function 1 of progesterone receptor is required for progesterone antagonism of oestrogen action in the uterus

Lee SH, Lim CL, Shen W, Tan SMX, Woo ARE, Yap YHY, et al.

BMC Biol, 2023 Feb 16;21(1):34.
PMID: 36797738 DOI: 10.1186/s12915-023-01543-z
Change in gait after high tibial osteotomy: A systematic review and meta-analysis

Lee SH, Lee OS, Teo SH, Lee YS

Gait Posture, 2017 09;57:57-68.
PMID: 28577508 DOI: 10.1016/j.gaitpost.2017.05.023

We conducted a meta-analysis to analyze how high tibial osteotomy (HTO) changes gait and focused on the following questions: (1) How does HTO change basic gait variables? (2) How does HTO change the gait variables in the knee joint? Twelve articles were included in the final analysis. A total of 383 knees was evaluated. There were 237 open wedge (OW) and 143 closed wedge (CW) HTOs. There were 4 level II studies and 8 level III studies. All studies included gait analysis and compared pre- and postoperative values. One study compared CWHTO and unicompartmental knee arthroplasty (UKA), and another study compared CWHTO and OWHTO. Five studies compared gait variables with those of healthy controls. One study compared operated limb gait variables with those in the non-operated limb. Gait speed, stride length, knee adduction moment, and lateral thrust were major variables assessed in 2 or more studies. Walking speed increased and stride length was increased or similar after HTO compared to the preoperative value in basic gait variables. Knee adduction moment and lateral thrust were decreased after HTO compared to the preoperative knee joint gait variables. Change in co-contraction of the medial side muscle after surgery differed depending on the degree of frontal plane alignment. The relationship between change in knee adduction moment and change in mechanical axis angle was controversial. Based on our systematic review and meta-analysis, walking speed and stride length increased after HTO. Knee adduction moment and lateral thrust decreased after HTO compared to the preoperative values of gait variables in the knee joint.
Impact of deprescribing intervention on potentially inappropriate medications and clinical outcomes among hospitalized older adults in Malaysia: a randomized controlled trial (REVMED RCT) protocol

Chang CT, Teoh SL, Cheah WK, Lee PJ, Azman MA, Ling SH, et al.

J Pharm Policy Pract, 2023 Oct 03;16(1):113.
PMID: 37789376 DOI: 10.1186/s40545-023-00621-5

BACKGROUND: Polypharmacy and the use of potentially inappropriate medications (PIMs) are prevalent among older patients admitted to hospitals, posing a heightened risk of adverse drug events. This trial aims to evaluate the effectiveness of a pharmacist-led deprescribing intervention in reducing medications, PIM and improving clinical outcomes, using the locally developed Malaysian Potentially Inappropriate Prescribing Screening tool in Older Adults (MALPIP).
METHODS: This is an 18-month cluster-randomized, open-label, parallel-arm controlled trial conducted at 14 public hospitals in the Perak state of Malaysia. Patients aged 60 and above, who have at least one medication and one comorbidity are eligible. A stratified-cluster randomization design is employed, with 7 hospitals assigned to the control arm and 7 hospitals assigned to the intervention arm. The MALPIP screening tool will be used in the intervention group to review the medications. If PIM is detected, the pharmacists will discuss with doctors and decide whether to stop or reduce the dose. The primary outcomes of this trial are the total number of medications and number of PIM. The secondary outcomes include fall, emergency department visits, readmissions, quality of life and mortality. Outcomes will be measured during enrolment, discharge, 6, 12, and 18 months.
DISCUSSION: This REVMED trial aims to test the hypothesis that a pharmacist-led deprescribing intervention initiated in the hospital will reduce the total number of medications and PIM 18 months after hospital discharge, reducing fall, emergency department visits, readmissions, mortality and lead to improvement in quality of life. Trial findings will quantify the clinical outcomes associated with reducing medications and PIM for hospitalized older adults with polypharmacy.
TRIAL REGISTRATION NUMBER: This trial was prospectively registered at clinicaltrials.gov (NCT05875623) on the 25th of May 2023. NCT05875623 Clinicaltrials.gov URL: NCT05875623 registered on 25th July 2023.
Fulltext Psychiatric Sequelae of Former "Comfort Women," Survivors of the Japanese Military Sexual Slavery during World War II

Lee J, Kwak YS, Kim YJ, Kim EJ, Park EJ, Shin Y, et al.

Psychiatry Investig, 2018 Apr;15(4):336-343.
PMID: 29669407 DOI: 10.30773/pi.2017.11.08.2

"Comfort women" refers to young women and girls who were forced into sexual slavery by the Imperial Japanese military during World War II. They were abducted from their homes in countries under Imperial Japanese rule, mostly from Korea, and the rest from China, Philippines, Malaysia, Taiwan, Indonesia, the Netherlands, etc. "Comfort women" endured extreme trauma involving rape, sexual torture, physical abuse, starvation, threats of death, and witnessed many others being tortured and killed. This article reviews all the studies that have investigated the psychiatric or psychosocial sequelae of the survivors of the Japanese military sexual slavery. Most importantly, a recent study which conducted a psychiatric evaluation on the former "comfort women" currently alive in South Korea is introduced. The participants' unmarried rate was relatively high and their total fertility rate was relatively low. Majority of the participants reported having no education and being the low economic status. They showed high current and lifetime prevalence of posttraumatic disorder, major depressive disorder, somatic symptom disorder, social anxiety disorder, panic disorder, and alcohol use disorder. Participants showed high suicidality and majority of the participants still reported being ashamed of being former "comfort women" after all these years. This article high-lights the fact that the trauma has affected the mental health and social functioning of former "comfort women" throughout their lives, and even to the present day.
Fulltext Cervical cord compression presenting with sciatica-like leg pain

Chan CK, Lee HY, Choi WC, Cho JY, Lee SH

Eur Spine J, 2011 Jul;20 Suppl 2:S217-21.
PMID: 20938789 DOI: 10.1007/s00586-010-1585-5

Sciatica-like leg pain can be the main presenting symptom in patients with cervical cord compression. It is a false localizing presentation, which may lead to missed or delayed diagnosis, resulting in the wrong plan of management, especially in the presence of concurrent lumbar lesions. Medical history, physical findings and the results of imaging studies were reviewed in two cases of cervical cord compressions, which presented with sciatica-like leg pain. There was multi-level cervical spondylosis with cord compression in the first patient and the second patient had two levels of cervical disc herniation with cord compression. In both cases, there were co-existing lumbar lesions, which could be responsible for the presentation of the leg pain. Cervical blocks were diagnostic in identifying the level responsible for the leg pain and it was confirmed so after cervical decompressive surgery in both cases, which brought significant pain relief. Funicular leg pain is a rare presentation of cervical cord compression. It is a referred pain due to the irritation of the ascending spinothalamic tract. Cervical blocks were successful in identifying the cause of funicular pain in our cases and this may pave the way for further studies to establish the role of cervical blocks as a diagnostic tool for funicular pain caused by cord compression.
Acute cholecystitis caused by Clonorchis sinensis

Rohela M, Johari S, Jamaiah I, Init I, Lee SH

Southeast Asian J. Trop. Med. Public Health, 2006 Jul;37(4):648-51.
PMID: 17121288

We are reporting a case of a 43-year-old Chinese male from Hong Kong, who came to see a doctor complaining of acute onset of severe upper abdominal pain. A diagnosis of acute cholecystitis was made and an emergency cholecystectomy was carried out. On opening the common bile duct, lancet-shaped worms were seen emerging from it. About 45 adult worms were collected and sent to the Department of Parasitology University of Malaya for identification. The worms were identified as Clonorchis sinensis. After the operation the patient was treated with praziquantel and he had an uneventful recovery.
Emphysematous pyelonephritis: drainage or nephrectomy?

Koh KB, Lam HS, Lee SH

Br J Urol, 1993 May;71(5):609-11.
PMID: 8518872

Four cases of emphysematous pyelonephritis are reported and the pathogenesis, surgical implications and preferred mode of management are discussed. We have not found percutaneous drainage to be useful, but feel there is an important place for surgical drainage alone because of the potential for renal recovery and the risks of emergency nephrectomy.
The abdominal cocoon

Yip FW, Lee SH

Aust N Z J Surg, 1992 Aug;62(8):638-42.
PMID: 1642584

Since it was first described in 1978 the abdominal cocoon continues to be a rare cause of intestinal obstruction. So far this rare condition where the small intestine is encased in a fibrous membrane has been reported only in females. Diagnosis is usually made at laparotomy and the treatment of choice is lysis of adhesions. Proper recognition of this benign condition will result in the correct management of it and prevent unnecessary bowel resections. Five new cases including one male patient, together with a review of previous reports in the English literature, are presented.
Amblyomma cordiferum Neumann, 1899 (Acari: Ixodidae) parasitizing reticulated pythons, Malayopython reticulatus (Schneider, 1801) (Reptilia: Pythonidae) in Peninsular Malaysia

Tan LP, Choong SS, Samsuddin AS, Lee SH

Ticks Tick Borne Dis, 2019 10;10(6):101285.
PMID: 31494069 DOI: 10.1016/j.ttbdis.2019.101285

Two ticks were collected from a reticulated python (Malayopython reticulatus) caught in Tumpat District, Kelantan, Peninsular Malaysia. The ticks were first identified as Ambylomma sp. through morphological comparison with identification keys. Determination of the tick species was made through PCR and sequencing. However, BLAST analysis revealed 85-88% sequence nucleotide identity with Amblyomma nitidum and Amblyomma geoemydae. Additionally, the morphological features of the ticks collected in this study did not match either A. nitidum or A. geoemydae. Further examination of the ticks confirmed the species as Amblyomma cordiferum. This is the first record of A. cordiferum DNA sequence with morphological support of colour illustrations for adult A. cordiferum. This is also the most recent record of this host association in Peninsular Malaysia. Information from this report can serve as a reference for species identification using the described morphology or molecular sequences.
Effects of degree of substitution and irradiation doses on the properties of hydrogel prepared from carboxymethyl-sago starch and polyethylene glycol

Zahib IR, Md Tahir P, Talib M, Mohamad R, Alias AH, Lee SH

Carbohydr Polym, 2021 Jan 15;252:117224.
PMID: 33183648 DOI: 10.1016/j.carbpol.2020.117224

Carboxymethyl starch (CMS) was produced from sago starch via carboxymethylation. The CMS with different degree of substitution (DS) ranges from 0.4 to 0.8 were mixed with polyethylene glycol (PEG) of different molecular weight and distilled water and the hydrogel was cured by electron beam irradiation with doses ranging from 25 to 35 kGy. The results revealed that CMS-PEG hydrogels with DS 0.4 give the optimum gel content when radiated at 30 kGy and with PEG 600. Thermogravimetric analysis (TGA) revealed that there are two phases exist in CMS with DS 0.4 in contrast to the three steps decomposition occurs in DS 0.6 and 0.8. It shows that the CMS with DS 0.4 is more thermally stable. Surface morphology revealed crosslinking among the blends when subjected into the radiation dose. The study shows both radiation and PEG addition improved most of the properties of CMS irrespective of the DS value.
The Potential Use of Anticancer Peptides (ACPs) in the Treatment of Hepatocellular Carcinoma

Ng CX, Lee SH

Curr Cancer Drug Targets, 2020;20(3):187-196.
PMID: 31713495 DOI: 10.2174/1568009619666191111141032

Peptides have acquired increasing interest as promising therapeutics, particularly as anticancer alternatives during recent years. They have been reported to demonstrate incredible anticancer potentials due to their low manufacturing cost, ease of synthesis and great specificity and selectivity. Hepatocellular carcinoma (HCC) is among the leading cause of cancer death globally, and the effectiveness of current liver treatment has turned out to be a critical issue in treating the disease efficiently. Hence, new interventions are being explored for the treatment of hepatocellular carcinoma. Anticancer peptides (ACPs) were first identified as part of the innate immune system of living organisms, demonstrating promising activity against infectious diseases. Differentiated beyond the traditional effort on endogenous human peptides, the discovery of peptide drugs has evolved to rely more on isolation from other natural sources or through the medicinal chemistry approach. Up to the present time, the pharmaceutical industry intends to conduct more clinical trials for the development of peptides as alternative therapy since peptides possess numerous advantages such as high selectivity and efficacy against cancers over normal tissues, as well as a broad spectrum of anticancer activity. In this review, we present an overview of the literature concerning peptide's physicochemical properties and describe the contemporary status of several anticancer peptides currently engaged in clinical trials for the treatment of hepatocellular carcinoma.
Fulltext Importance of Interfacial Adhesion Condition on Characterization of Plant-Fiber-Reinforced Polymer Composites: A Review

Lee CH, Khalina A, Lee SH

Polymers (Basel), 2021 Jan 29;13(3).
PMID: 33573036 DOI: 10.3390/polym13030438

Plant fibers have become a highly sought-after material in the recent days as a result of raising environmental awareness and the realization of harmful effects imposed by synthetic fibers. Natural plant fibers have been widely used as fillers in fabricating plant-fibers-reinforced polymer composites. However, owing to the completely opposite nature of the plant fibers and polymer matrix, treatment is often required to enhance the compatibility between these two materials. Interfacial adhesion mechanisms are among the most influential yet seldom discussed factors that affect the physical, mechanical, and thermal properties of the plant-fibers-reinforced polymer composites. Therefore, this review paper expounds the importance of interfacial adhesion condition on the properties of plant-fiber-reinforced polymer composites. The advantages and disadvantages of natural plant fibers are discussed. Four important interface mechanism, namely interdiffusion, electrostatic adhesion, chemical adhesion, and mechanical interlocking are highlighted. In addition, quantifying and analysis techniques of interfacial adhesion condition is demonstrated. Lastly, the importance of interfacial adhesion condition on the performances of the plant fiber polymer composites performances is discussed. It can be seen that the physical and thermal properties as well as flexural strength of the composites are highly dependent on the interfacial adhesion condition.

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