char = I;code = 73 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = o;code = 111 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = g;code = 103 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = a;code = 97 char = s;code = 115 char = s;code = 115 char = o;code = 111 char = c;code = 99 char = i;code = 105 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = c;code = 99 char = h;code = 104 char = a;code = 97 char = n;code = 110 char = g;code = 103 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = r;code = 114 char = u;code = 117 char = m;code = 109 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = .;code = 46 result sql = Intravenous contrast agents and associated changes in serum osmolality.
Intravenous contrast agents and associated changes in serum osmolality.char = <;code = 60 char = b;code = 98 char = >;code = 62 char = B;code = 66 char = A;code = 65 char = C;code = 67 char = K;code = 75 char = G;code = 71 char = R;code = 82 char = O;code = 79 char = U;code = 85 char = N;code = 78 char = D;code = 68 char = ;code = 32 char = :;code = 58 char = ;code = 32 char = <;code = 60 char = /;code = 47 char = b;code = 98 char = >;code = 62 char = A;code = 65 char = n;code = 110 char = e;code = 101 char = c;code = 99 char = d;code = 100 char = o;code = 111 char = t;code = 116 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = d;code = 100 char = a;code = 97 char = t;code = 116 char = a;code = 97 char = ;code = 32 char = s;code = 115 char = u;code = 117 char = g;code = 103 char = g;code = 103 char = e;code = 101 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = a;code = 97 char = t;code = 116 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = o;code = 111 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = g;code = 103 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = g;code = 103 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = e;code = 101 char = n;code = 110 char = h;code = 104 char = a;code = 97 char = n;code = 110 char = c;code = 99 char = e;code = 101 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = n;code = 110 char = s;code = 115 char = i;code = 105 char = t;code = 116 char = i;code = 105 char = v;code = 118 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = m;code = 109 char = p;code = 112 char = u;code = 117 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = m;code = 109 char = o;code = 111 char = g;code = 103 char = r;code = 114 char = a;code = 97 char = p;code = 112 char = h;code = 104 char = y;code = 121 char = ;code = 32 char = (;code = 40 char = C;code = 67 char = T;code = 84 char = );code = 41 char = ;code = 32 char = c;code = 99 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = d;code = 100 char = u;code = 117 char = c;code = 99 char = e;code = 101 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = c;code = 99 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = s;code = 115 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = r;code = 114 char = u;code = 117 char = m;code = 109 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ,;code = 44 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = d;code = 100 char = u;code = 117 char = c;code = 99 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = g;code = 103 char = a;code = 97 char = p;code = 112 char = .;code = 46 char = ;code = 32 char = A;code = 65 char = n;code = 110 char = ;code = 32 char = u;code = 117 char = n;code = 110 char = e;code = 101 char = x;code = 120 char = p;code = 112 char = l;code = 108 char = a;code = 97 char = i;code = 105 char = n;code = 110 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = g;code = 103 char = a;code = 97 char = p;code = 112 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = t;code = 116 char = e;code = 101 char = n;code = 110 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = m;code = 109 char = p;code = 112 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = e;code = 101 char = x;code = 120 char = t;code = 116 char = e;code = 101 char = n;code = 110 char = s;code = 115 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = e;code = 101 char = v;code = 118 char = a;code = 97 char = l;code = 108 char = u;code = 117 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = e;code = 101 char = n;code = 110 char = c;code = 99 char = e;code = 101 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = u;code = 117 char = n;code = 110 char = i;code = 105 char = d;code = 100 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = f;code = 102 char = i;code = 105 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = x;code = 120 char = i;code = 105 char = n;code = 110 char = s;code = 115 char = ,;code = 44 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = r;code = 114 char = t;code = 116 char = i;code = 105 char = c;code = 99 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = r;code = 114 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = x;code = 120 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = a;code = 97 char = l;code = 108 char = c;code = 99 char = o;code = 111 char = h;code = 104 char = o;code = 111 char = l;code = 108 char = s;code = 115 char = ;code = 32 char = (;code = 40 char = m;code = 109 char = e;code = 101 char = t;code = 116 char = h;code = 104 char = a;code = 97 char = n;code = 110 char = o;code = 111 char = l;code = 108 char = ,;code = 44 char = ;code = 32 char = e;code = 101 char = t;code = 116 char = h;code = 104 char = a;code = 97 char = n;code = 110 char = o;code = 111 char = l;code = 108 char = ,;code = 44 char = ;code = 32 char = i;code = 105 char = s;code = 115 char = o;code = 111 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = p;code = 112 char = y;code = 121 char = l;code = 108 char = ;code = 32 char = a;code = 97 char = l;code = 108 char = c;code = 99 char = o;code = 111 char = h;code = 104 char = o;code = 111 char = l;code = 108 char = ,;code = 44 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = e;code = 101 char = t;code = 116 char = h;code = 104 char = y;code = 121 char = l;code = 108 char = e;code = 101 char = n;code = 110 char = e;code = 101 char = ;code = 32 char = g;code = 103 char = l;code = 108 char = y;code = 121 char = c;code = 99 char = o;code = 111 char = l;code = 108 char = );code = 41 char = .;code = 46 char = ;code = 32 char = T;code = 84 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = b;code = 98 char = i;code = 105 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = o;code = 111 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = m;code = 109 char = e;code = 101 char = d;code = 100 char = i;code = 105 char = a;code = 97 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = r;code = 114 char = a;code = 97 char = i;code = 105 char = s;code = 115 char = e;code = 101 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = r;code = 114 char = u;code = 117 char = m;code = 109 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = u;code = 117 char = l;code = 108 char = t;code = 116 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = g;code = 103 char = a;code = 97 char = p;code = 112 char = ;code = 32 char = h;code = 104 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = t;code = 116 char = ;code = 32 char = b;code = 98 char = e;code = 101 char = e;code = 101 char = n;code = 110 char = ;code = 32 char = s;code = 115 char = y;code = 121 char = s;code = 115 char = t;code = 116 char = e;code = 101 char = m;code = 109 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = v;code = 118 char = e;code = 101 char = s;code = 115 char = t;code = 116 char = i;code = 105 char = g;code = 103 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = .;code = 46 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = >;code = 62 char = M;code = 77 char = E;code = 69 char = T;code = 84 char = H;code = 72 char = O;code = 79 char = D;code = 68 char = S;code = 83 char = ;code = 32 char = :;code = 58 char = ;code = 32 char = <;code = 60 char = /;code = 47 char = b;code = 98 char = >;code = 62 char = W;code = 87 char = e;code = 101 char = ;code = 32 char = e;code = 101 char = v;code = 118 char = a;code = 97 char = l;code = 108 char = u;code = 117 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = c;code = 99 char = h;code = 104 char = a;code = 97 char = n;code = 110 char = g;code = 103 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = r;code = 114 char = u;code = 117 char = m;code = 109 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = g;code = 103 char = a;code = 97 char = p;code = 112 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = h;code = 104 char = o;code = 111 char = r;code = 114 char = t;code = 116 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = p;code = 112 char = e;code = 101 char = d;code = 100 char = i;code = 105 char = a;code = 97 char = t;code = 116 char = r;code = 114 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = e;code = 101 char = m;code = 109 char = e;code = 101 char = r;code = 114 char = g;code = 103 char = e;code = 101 char = n;code = 110 char = c;code = 99 char = y;code = 121 char = ;code = 32 char = d;code = 100 char = e;code = 101 char = p;code = 112 char = a;code = 97 char = r;code = 114 char = t;code = 116 char = m;code = 109 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = w;code = 119 char = i;code = 105 char = t;code = 116 char = h;code = 104 char = ;code = 32 char = a;code = 97 char = b;code = 98 char = d;code = 100 char = o;code = 111 char = m;code = 109 char = i;code = 105 char = n;code = 110 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = w;code = 119 char = h;code = 104 char = o;code = 111 char = ;code = 32 char = n;code = 110 char = e;code = 101 char = c;code = 99 char = e;code = 101 char = s;code = 115 char = s;code = 115 char = i;code = 105 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = -;code = 45 char = e;code = 101 char = n;code = 110 char = h;code = 104 char = a;code = 97 char = n;code = 110 char = c;code = 99 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = C;code = 67 char = T;code = 84 char = ;code = 32 char = s;code = 115 char = c;code = 99 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = p;code = 112 char = a;code = 97 char = r;code = 114 char = t;code = 116 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = i;code = 105 char = r;code = 114 char = ;code = 32 char = d;code = 100 char = i;code = 105 char = a;code = 97 char = g;code = 103 char = n;code = 110 char = o;code = 111 char = s;code = 115 char = t;code = 116 char = i;code = 105 char = c;code = 99 char = ;code = 32 char = e;code = 101 char = v;code = 118 char = a;code = 97 char = l;code = 108 char = u;code = 117 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = .;code = 46 char = ;code = 32 char = I;code = 73 char = n;code = 110 char = c;code = 99 char = l;code = 108 char = u;code = 117 char = s;code = 115 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = c;code = 99 char = r;code = 114 char = i;code = 105 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = i;code = 105 char = a;code = 97 char = ;code = 32 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = g;code = 103 char = e;code = 101 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = 1;code = 49 char = 0;code = 48 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = 1;code = 49 char = 8;code = 56 char = ;code = 32 char = y;code = 121 char = e;code = 101 char = a;code = 97 char = r;code = 114 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = b;code = 98 char = i;code = 105 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = o;code = 111 char = b;code = 98 char = t;code = 116 char = a;code = 97 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = b;code = 98 char = l;code = 108 char = o;code = 111 char = o;code = 111 char = d;code = 100 char = ;code = 32 char = s;code = 115 char = a;code = 97 char = m;code = 109 char = p;code = 112 char = l;code = 108 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = 3;code = 51 char = 0;code = 48 char = ;code = 32 char = m;code = 109 char = i;code = 105 char = n;code = 110 char = u;code = 117 char = t;code = 116 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = f;code = 102 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = d;code = 100 char = m;code = 109 char = i;code = 105 char = n;code = 110 char = i;code = 105 char = s;code = 115 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = .;code = 46 char = ;code = 32 char = B;code = 66 char = e;code = 101 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = 3;code = 51 char = 0;code = 48 char = ;code = 32 char = m;code = 109 char = i;code = 105 char = n;code = 110 char = u;code = 117 char = t;code = 116 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = f;code = 102 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = d;code = 100 char = m;code = 109 char = i;code = 105 char = n;code = 110 char = i;code = 105 char = s;code = 115 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ,;code = 44 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = r;code = 114 char = u;code = 117 char = m;code = 109 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = N;code = 78 char = a;code = 97 char = ,;code = 44 char = ;code = 32 char = g;code = 103 char = l;code = 108 char = u;code = 117 char = c;code = 99 char = o;code = 111 char = s;code = 115 char = e;code = 101 char = ,;code = 44 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = r;code = 114 char = u;code = 117 char = m;code = 109 char = ;code = 32 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = ;code = 32 char = n;code = 110 char = i;code = 105 char = t;code = 116 char = r;code = 114 char = o;code = 111 char = g;code = 103 char = e;code = 101 char = n;code = 110 char = ;code = 32 char = l;code = 108 char = e;code = 101 char = v;code = 118 char = e;code = 101 char = l;code = 108 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = o;code = 111 char = b;code = 98 char = t;code = 116 char = a;code = 97 char = i;code = 105 char = n;code = 110 char = e;code = 101 char = d;code = 100 char = .;code = 46 char = ;code = 32 char = O;code = 79 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = g;code = 103 char = a;code = 97 char = p;code = 112 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = c;code = 99 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = u;code = 117 char = s;code = 115 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = m;code = 109 char = u;code = 117 char = l;code = 108 char = a;code = 97 char = ;code = 32 char = 2;code = 50 char = (;code = 40 char = N;code = 78 char = a;code = 97 char = );code = 41 char = ;code = 32 char = +;code = 43 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = r;code = 114 char = u;code = 117 char = m;code = 109 char = ;code = 32 char = u;code = 117 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = ;code = 32 char = n;code = 110 char = i;code = 105 char = t;code = 116 char = r;code = 114 char = o;code = 111 char = g;code = 103 char = e;code = 101 char = n;code = 110 char = /;code = 47 char = 2;code = 50 char = .;code = 46 char = 8;code = 56 char = ;code = 32 char = +;code = 43 char = ;code = 32 char = g;code = 103 char = l;code = 108 char = u;code = 117 char = c;code = 99 char = o;code = 111 char = s;code = 115 char = e;code = 101 char = /;code = 47 char = 1;code = 49 char = 8;code = 56 char = .;code = 46 char = ;code = 32 char = T;code = 84 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = g;code = 103 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = O;code = 79 char = p;code = 112 char = t;code = 116 char = i;code = 105 char = r;code = 114 char = a;code = 97 char = y;code = 121 char = ;code = 32 char = 3;code = 51 char = 2;code = 50 char = 0;code = 48 char = ;code = 32 char = (;code = 40 char = T;code = 84 char = y;code = 121 char = c;code = 99 char = o;code = 111 char = ;code = 32 char = h;code = 104 char = e;code = 101 char = a;code = 97 char = l;code = 108 char = t;code = 116 char = h;code = 104 char = c;code = 99 char = a;code = 97 char = r;code = 114 char = e;code = 101 char = ,;code = 44 char = ;code = 32 char = M;code = 77 char = a;code = 97 char = l;code = 108 char = l;code = 108 char = i;code = 105 char = n;code = 110 char = k;code = 107 char = r;code = 114 char = o;code = 111 char = d;code = 100 char = t;code = 116 char = ,;code = 44 char = ;code = 32 char = H;code = 72 char = a;code = 97 char = z;code = 122 char = e;code = 101 char = l;code = 108 char = w;code = 119 char = o;code = 111 char = o;code = 111 char = d;code = 100 char = ,;code = 44 char = ;code = 32 char = M;code = 77 char = o;code = 111 char = );code = 41 char = ;code = 32 char = (;code = 40 char = i;code = 105 char = o;code = 111 char = v;code = 118 char = e;code = 101 char = r;code = 114 char = s;code = 115 char = o;code = 111 char = l;code = 108 char = ,;code = 44 char = ;code = 32 char = 6;code = 54 char = 8;code = 56 char = %;code = 37 char = );code = 41 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = a;code = 97 char = d;code = 100 char = m;code = 109 char = i;code = 105 char = n;code = 110 char = i;code = 105 char = s;code = 115 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = a;code = 97 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = d;code = 100 char = o;code = 111 char = s;code = 115 char = e;code = 101 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = 2;code = 50 char = ;code = 32 char = m;code = 109 char = L;code = 76 char = /;code = 47 char = k;code = 107 char = g;code = 103 char = ;code = 32 char = (;code = 40 char = 1;code = 49 char = .;code = 46 char = 3;code = 51 char = 6;code = 54 char = ;code = 32 char = g;code = 103 char = /;code = 47 char = k;code = 107 char = g;code = 103 char = );code = 41 char = .;code = 46 char = ;code = 32 char = T;code = 84 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = m;code = 109 char = a;code = 97 char = i;code = 105 char = n;code = 110 char = ;code = 32 char = o;code = 111 char = u;code = 117 char = t;code = 116 char = c;code = 99 char = o;code = 111 char = m;code = 109 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = e;code = 101 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = v;code = 118 char = e;code = 101 char = r;code = 114 char = s;code = 115 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = p;code = 112 char = o;code = 111 char = s;code = 115 char = t;code = 116 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = r;code = 114 char = ;code = 32 char = g;code = 103 char = a;code = 97 char = p;code = 112 char = .;code = 46 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = >;code = 62 char = R;code = 82 char = E;code = 69 char = S;code = 83 char = U;code = 85 char = L;code = 76 char = T;code = 84 char = S;code = 83 char = ;code = 32 char = :;code = 58 char = ;code = 32 char = <;code = 60 char = /;code = 47 char = b;code = 98 char = >;code = 62 char = F;code = 70 char = o;code = 111 char = u;code = 117 char = r;code = 114 char = t;code = 116 char = e;code = 101 char = e;code = 101 char = n;code = 110 char = ;code = 32 char = s;code = 115 char = u;code = 117 char = b;code = 98 char = j;code = 106 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = e;code = 101 char = n;code = 110 char = r;code = 114 char = o;code = 111 char = l;code = 108 char = l;code = 108 char = e;code = 101 char = d;code = 100 char = .;code = 46 char = ;code = 32 char = T;code = 84 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = m;code = 109 char = e;code = 101 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = e;code = 101 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = p;code = 112 char = o;code = 111 char = s;code = 115 char = t;code = 116 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = r;code = 114 char = u;code = 117 char = m;code = 109 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = 2;code = 50 char = 9;code = 57 char = 2;code = 50 char = .;code = 46 char = 7;code = 55 char = 5;code = 53 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = 2;code = 50 char = 9;code = 57 char = 2;code = 50 char = .;code = 46 char = 8;code = 56 char = 7;code = 55 char = 5;code = 53 char = ;code = 32 char = m;code = 109 char = O;code = 79 char = s;code = 115 char = m;code = 109 char = /;code = 47 char = L;code = 76 char = ;code = 32 char = (;code = 40 char = P;code = 80 char = ;code = 32 char = =;code = 61 char = ;code = 32 char = 0;code = 48 char = .;code = 46 char = 9;code = 57 char = 3;code = 51 char = );code = 41 char = ,;code = 44 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = p;code = 112 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = l;code = 108 char = y;code = 121 char = .;code = 46 char = ;code = 32 char = T;code = 84 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = r;code = 114 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = p;code = 112 char = o;code = 111 char = n;code = 110 char = d;code = 100 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = m;code = 109 char = e;code = 101 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = v;code = 118 char = a;code = 97 char = l;code = 108 char = u;code = 117 char = e;code = 101 char = s;code = 115 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = e;code = 101 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = p;code = 112 char = o;code = 111 char = s;code = 115 char = t;code = 116 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = g;code = 103 char = a;code = 97 char = p;code = 112 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = 9;code = 57 char = .;code = 46 char = 1;code = 49 char = 7;code = 55 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = 1;code = 49 char = 2;code = 50 char = .;code = 46 char = 1;code = 49 char = 5;code = 53 char = ;code = 32 char = m;code = 109 char = O;code = 79 char = s;code = 115 char = m;code = 109 char = /;code = 47 char = L;code = 76 char = ,;code = 44 char = ;code = 32 char = r;code = 114 char = e;code = 101 char = s;code = 115 char = p;code = 112 char = e;code = 101 char = c;code = 99 char = t;code = 116 char = i;code = 105 char = v;code = 118 char = e;code = 101 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = (;code = 40 char = P;code = 80 char = ;code = 32 char = =;code = 61 char = ;code = 32 char = 0;code = 48 char = .;code = 46 char = 1;code = 49 char = 3;code = 51 char = 3;code = 51 char = );code = 41 char = .;code = 46 char = ;code = 32 char = T;code = 84 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = m;code = 109 char = e;code = 101 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = d;code = 100 char = i;code = 105 char = f;code = 102 char = f;code = 102 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = n;code = 110 char = c;code = 99 char = e;code = 101 char = ;code = 32 char = b;code = 98 char = e;code = 101 char = t;code = 116 char = w;code = 119 char = e;code = 101 char = e;code = 101 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = e;code = 101 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = p;code = 112 char = o;code = 111 char = s;code = 115 char = t;code = 116 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = g;code = 103 char = a;code = 97 char = p;code = 112 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = 0;code = 48 char = .;code = 46 char = 1;code = 49 char = 2;code = 50 char = 5;code = 53 char = ;code = 32 char = m;code = 109 char = O;code = 79 char = s;code = 115 char = m;code = 109 char = /;code = 47 char = L;code = 76 char = .;code = 46 char = ;code = 32 char = T;code = 84 char = h;code = 104 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = w;code = 119 char = a;code = 97 char = s;code = 115 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = ;code = 32 char = s;code = 115 char = t;code = 116 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = s;code = 115 char = t;code = 116 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = l;code = 108 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = s;code = 115 char = i;code = 105 char = g;code = 103 char = n;code = 110 char = i;code = 105 char = f;code = 102 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = r;code = 114 char = r;code = 114 char = e;code = 101 char = l;code = 108 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = b;code = 98 char = e;code = 101 char = t;code = 116 char = w;code = 119 char = e;code = 101 char = e;code = 101 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = d;code = 100 char = o;code = 111 char = s;code = 115 char = e;code = 101 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = g;code = 103 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = d;code = 100 char = m;code = 109 char = i;code = 105 char = n;code = 110 char = i;code = 105 char = s;code = 115 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = p;code = 112 char = o;code = 111 char = s;code = 115 char = t;code = 116 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = g;code = 103 char = a;code = 97 char = p;code = 112 char = .;code = 46 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = r;code = 114 char = /;code = 47 char = >;code = 62 char = <;code = 60 char = b;code = 98 char = >;code = 62 char = C;code = 67 char = O;code = 79 char = N;code = 78 char = C;code = 67 char = L;code = 76 char = U;code = 85 char = S;code = 83 char = I;code = 73 char = O;code = 79 char = N;code = 78 char = S;code = 83 char = ;code = 32 char = :;code = 58 char = ;code = 32 char = <;code = 60 char = /;code = 47 char = b;code = 98 char = >;code = 62 char = T;code = 84 char = h;code = 104 char = e;code = 101 char = s;code = 115 char = e;code = 101 char = ;code = 32 char = d;code = 100 char = a;code = 97 char = t;code = 116 char = a;code = 97 char = ;code = 32 char = s;code = 115 char = u;code = 117 char = g;code = 103 char = g;code = 103 char = e;code = 101 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = a;code = 97 char = t;code = 116 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = o;code = 111 char = u;code = 117 char = s;code = 115 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = g;code = 103 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ,;code = 44 char = ;code = 32 char = w;code = 119 char = h;code = 104 char = e;code = 101 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = d;code = 100 char = m;code = 109 char = i;code = 105 char = n;code = 110 char = i;code = 105 char = s;code = 115 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = a;code = 97 char = t;code = 116 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = v;code = 118 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = d;code = 100 char = o;code = 111 char = s;code = 115 char = e;code = 101 char = s;code = 115 char = ,;code = 44 char = ;code = 32 char = d;code = 100 char = o;code = 111 char = ;code = 32 char = n;code = 110 char = o;code = 111 char = t;code = 116 char = ;code = 32 char = s;code = 115 char = i;code = 105 char = g;code = 103 char = n;code = 110 char = i;code = 105 char = f;code = 102 char = i;code = 105 char = c;code = 99 char = a;code = 97 char = n;code = 110 char = t;code = 116 char = l;code = 108 char = y;code = 121 char = ;code = 32 char = i;code = 105 char = n;code = 110 char = c;code = 99 char = r;code = 114 char = e;code = 101 char = a;code = 97 char = s;code = 115 char = e;code = 101 char = ;code = 32 char = s;code = 115 char = e;code = 101 char = r;code = 114 char = u;code = 117 char = m;code = 109 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = i;code = 105 char = t;code = 116 char = y;code = 121 char = ;code = 32 char = o;code = 111 char = r;code = 114 char = ;code = 32 char = p;code = 112 char = r;code = 114 char = o;code = 111 char = d;code = 100 char = u;code = 117 char = c;code = 99 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = g;code = 103 char = a;code = 97 char = p;code = 112 char = .;code = 46 char = ;code = 32 char = P;code = 80 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = w;code = 119 char = h;code = 104 char = o;code = 111 char = ;code = 32 char = a;code = 97 char = r;code = 114 char = e;code = 101 char = ;code = 32 char = f;code = 102 char = o;code = 111 char = u;code = 117 char = n;code = 110 char = d;code = 100 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = h;code = 104 char = a;code = 97 char = v;code = 118 char = e;code = 101 char = ;code = 32 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = o;code = 111 char = s;code = 115 char = m;code = 109 char = o;code = 111 char = l;code = 108 char = a;code = 97 char = l;code = 108 char = ;code = 32 char = g;code = 103 char = a;code = 97 char = p;code = 112 char = ;code = 32 char = a;code = 97 char = f;code = 102 char = t;code = 116 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = p;code = 112 char = e;code = 101 char = r;code = 114 char = f;code = 102 char = o;code = 111 char = r;code = 114 char = m;code = 109 char = a;code = 97 char = n;code = 110 char = c;code = 99 char = e;code = 101 char = ;code = 32 char = o;code = 111 char = f;code = 102 char = ;code = 32 char = a;code = 97 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = -;code = 45 char = e;code = 101 char = n;code = 110 char = h;code = 104 char = a;code = 97 char = n;code = 110 char = c;code = 99 char = e;code = 101 char = d;code = 100 char = ;code = 32 char = C;code = 67 char = T;code = 84 char = ;code = 32 char = s;code = 115 char = c;code = 99 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = s;code = 115 char = h;code = 104 char = o;code = 111 char = u;code = 117 char = l;code = 108 char = d;code = 100 char = ;code = 32 char = u;code = 117 char = n;code = 110 char = d;code = 100 char = e;code = 101 char = r;code = 114 char = g;code = 103 char = o;code = 111 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = o;code = 111 char = r;code = 114 char = o;code = 111 char = u;code = 117 char = g;code = 103 char = h;code = 104 char = ;code = 32 char = e;code = 101 char = v;code = 118 char = a;code = 97 char = l;code = 108 char = u;code = 117 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = i;code = 105 char = d;code = 100 char = e;code = 101 char = n;code = 110 char = t;code = 116 char = i;code = 105 char = f;code = 102 char = y;code = 121 char = ;code = 32 char = i;code = 105 char = t;code = 116 char = s;code = 115 char = ;code = 32 char = e;code = 101 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = l;code = 108 char = o;code = 111 char = g;code = 103 char = y;code = 121 char = ;code = 32 char = r;code = 114 char = a;code = 97 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = r;code = 114 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = a;code = 97 char = n;code = 110 char = ;code = 32 char = a;code = 97 char = t;code = 116 char = t;code = 116 char = r;code = 114 char = i;code = 105 char = b;code = 98 char = u;code = 117 char = t;code = 116 char = i;code = 105 char = n;code = 110 char = g;code = 103 char = ;code = 32 char = t;code = 116 char = h;code = 104 char = e;code = 101 char = ;code = 32 char = g;code = 103 char = a;code = 97 char = p;code = 112 char = ;code = 32 char = t;code = 116 char = o;code = 111 char = ;code = 32 char = c;code = 99 char = o;code = 111 char = n;code = 110 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = s;code = 115 char = t;code = 116 char = ;code = 32 char = a;code = 97 char = d;code = 100 char = m;code = 109 char = i;code = 105 char = n;code = 110 char = i;code = 105 char = s;code = 115 char = t;code = 116 char = r;code = 114 char = a;code = 97 char = t;code = 116 char = i;code = 105 char = o;code = 111 char = n;code = 110 char = .;code = 46 result sql = BACKGROUND : Anecdotal data suggest that intravenous contrast agents given to enhance the sensitivity of computed tomography (CT) can produce increases in serum osmolality, producing an osmolal gap. An unexplained osmolal gap often prompts extensive evaluation for the presence of unidentified toxins, particularly the toxic alcohols (methanol, ethanol, isopropyl alcohol, and ethylene glycol). The ability of intravenous contrast media to raise serum osmolality with a resulting osmolal gap has not been systematically investigated.METHODS : We evaluated changes in serum osmolality and osmolal gap in a cohort of patients presenting to a pediatric emergency department with abdominal pain who necessitated a contrast-enhanced CT scan as part of their diagnostic evaluation. Inclusion criteria were age of 10 to 18 years and the ability to obtain blood samples 30 minutes after contrast administration. Before and 30 minutes after contrast administration, serum osmolality and Na, glucose, and serum urea nitrogen levels were obtained. Osmolal gap was calculated using the formula 2(Na) + serum urea nitrogen/2.8 + glucose/18. The contrast agent Optiray 320 (Tyco healthcare, Mallinkrodt, Hazelwood, Mo) (ioversol, 68%) was administered at a dose of 2 mL/kg (1.36 g/kg). The main outcomes of interest were precontrast versus postcontrast osmolality and osmolar gap.RESULTS : Fourteen subjects were enrolled. The mean precontrast and postcontrast serum osmolalities were 292.75 and 292.875 mOsm/L (P = 0.93), respectively. The corresponding mean values for the precontrast and postcontrast osmolal gaps were 9.17 and 12.15 mOsm/L, respectively (P = 0.133). The mean difference between the precontrast and the postcontrast osmolal gaps was 0.125 mOsm/L. There was no statistically significant correlation between the dose of the contrast agent administered and the postcontrast osmolality or osmolal gap.CONCLUSIONS : These data suggest that intravenous contrast agents, when administered at conventional doses, do not significantly increase serum osmolality or produce an osmolal gap. Patients who are found to have an osmolal gap after the performance of a contrast-enhanced CT scan should undergo thorough evaluation to identify its etiology rather than attributing the gap to contrast administration.
Publication: Pediatr Emerg Care 2009 Sep ;25(9)::555-7. :doi: 10.1097/PEC.0b013e3181b5b8ce.
Publication Date: 2009 Sep
Study Author(s): George, Mathew;Shannon, Michael;
Institution: Harvard Medical Toxicology Program, Division of Emergency Medicine, Children's Hospital Boston, Boston, MA, USA. drmg456@gmail.com
Shortcut link to this study:
BACKGROUND : Anecdotal data suggest that intravenous contrast agents given to enhance the sensitivity of computed tomography (CT) can produce increases in serum osmolality, producing an osmolal gap. An unexplained osmolal gap often prompts extensive evaluation for the presence of unidentified toxins, particularly the toxic alcohols (methanol, ethanol, isopropyl alcohol, and ethylene glycol). The ability of intravenous contrast media to raise serum osmolality with a resulting osmolal gap has not been systematically investigated.METHODS : We evaluated changes in serum osmolality and osmolal gap in a cohort of patients presenting to a pediatric emergency department with abdominal pain who necessitated a contrast-enhanced CT scan as part of their diagnostic evaluation. Inclusion criteria were age of 10 to 18 years and the ability to obtain blood samples 30 minutes after contrast administration. Before and 30 minutes after contrast administration, serum osmolality and Na, glucose, and serum urea nitrogen levels were obtained. Osmolal gap was calculated using the formula 2(Na) + serum urea nitrogen/2.8 + glucose/18. The contrast agent Optiray 320 (Tyco healthcare, Mallinkrodt, Hazelwood, Mo) (ioversol, 68%) was administered at a dose of 2 mL/kg (1.36 g/kg). The main outcomes of interest were precontrast versus postcontrast osmolality and osmolar gap.RESULTS : Fourteen subjects were enrolled. The mean precontrast and postcontrast serum osmolalities were 292.75 and 292.875 mOsm/L (P = 0.93), respectively. The corresponding mean values for the precontrast and postcontrast osmolal gaps were 9.17 and 12.15 mOsm/L, respectively (P = 0.133). The mean difference between the precontrast and the postcontrast osmolal gaps was 0.125 mOsm/L. There was no statistically significant correlation between the dose of the contrast agent administered and the postcontrast osmolality or osmolal gap.CONCLUSIONS : These data suggest that intravenous contrast agents, when administered at conventional doses, do not significantly increase serum osmolality or produce an osmolal gap. Patients who are found to have an osmolal gap after the performance of a contrast-enhanced CT scan should undergo thorough evaluation to identify its etiology rather than attributing the gap to contrast administration.
PMID: 19755886