403:(LPR) or extraesophegeal reflux disease (EERD). Distal esophageal pH monitoring has been used as an objective test to establish reflux as the cause of the atypical reflux symptoms, but its role in causally associating patients' symptoms to GERD is controversial. In an effort to improve diagnostic accuracy of testing, a catheter with two pH sensors has been used to measure the degree of esophageal acid exposure in both distal and proximal esophagus. The ideal location for pH measurement to confirm the diagnosis of the laryngopharyngeal reflux is the
29:
374:(PPI) by primary care physicians has resulted in a change in pattern of GERD in patients who use these medications. Quite often gastroenterologist and foregut surgeons receive consultations to assess patients with persistent reflux symptoms despite the fact that patients is on acid suppression medications. This is due to the fact that symptoms of these patients are the results of weak acid or non-acid reflux. In 1991
248:
172:
developed a dependable external reference electrode. Using this technique to monitor esophageal acid exposure patients for periods up to 24 hours, DeMeester and
Johnson were able to identify the most important parameters of esophageal acid exposure, and they developed a composite pH score to quantify
167:
probe to map the gastroesophageal pH gradient, and demonstrated a sharp gradient in normal subjects and a gradual, sloping gradient in patients with esophagitis. Four years later, Miller used an indwelling esophageal pH electrode to continuously measure esophageal and gastric pH for a period up to 12
378:
was the first investigator who described
Multichannel Intraluminal Impedance (MII), a technique which detects intraesophageal bolus transport. This method is based on measuring the resistance to alternating current (i.e., impedance) of the content of the esophageal lumen. MII- pH monitoring was then
312:
A reflux episode is defined as esophageal pH drops below four. Esophageal pH monitoring is performed for 24 or 48 hours and at the end of recording, a patient's tracing is analyzed and the results are expressed using six standard components. Of these 6 parameters, a pH score called
111:
and is the most objective method to document reflux disease, assess the severity of the disease and monitor the response of the disease to medical or surgical treatment. It can also be used in diagnosing
235:, patients may have limited their activity and become more sedentary during the monitored period. This may have resulted in less acid reflux and a false negative test. A catheter-free radio
168:
hours. This technique required that the patient keep their hands immersed in saline to serve as a reference. Prolonged monitoring became feasible in 1974 when
Johnson and
379:
developed by several clinical investigators. The clinical application of this technique is mainly in GERD patients who have persistent symptoms despite medical therapy.
691:
Tutuian R, Vela MF, Shay SS, Castell DO (September 2003). "Multichannel intraluminal impedance in esophageal function testing and gastroesophageal reflux monitoring".
524:
DeMeester TR, Peters JH, Bremner CG, Chandrasoma P (1999). "Biology of gastroesophageal reflux disease: pathophysiology relating to medical and surgical treatment".
204:
is not always a reliable guide to the presence of acid reflux in the esophagus. Further, only half of the patients with increased esophageal acid exposure will have
497:
Tefera L, Fein M, Ritter MP, et al. (October 1997). "Can the combination of symptoms and endoscopy confirm the presence of gastroesophageal reflux disease?".
786:
726:
Ayazi S, Lipham JC, Hagen JA, et al. (August 2009). "A new technique for measurement of pharyngeal pH: normal values and discriminating pH threshold".
219:
monitoring can provide data to guide further evaluation and treatment of patients with GERD-associated symptoms. In the past, an indwelling nasoesophageal
435:
Johnson LF, Demeester TR (October 1974). "Twenty-four-hour pH monitoring of the distal esophagus. A quantitative measure of gastroesophageal reflux".
1687:
272:
The duration of the test is 24 hours in the first and second techniques and 48 hours for the Bravo capsule or more (96 hours) for OMOM capsule.
1458:
1419:
300:. In transnasal placement, the capsule is placed 5 cm above the upper border of the LES, and in endoscopic placement 6 cm above
1484:
1062:
822:
407:
and new studies have focused on the development of a new pH sensor which can function in the challenging environment of the oropharynx.
1489:
779:
1225:
1382:
462:
Talley NJ, Zinsmeister AR, Schleck CD, Melton LJ (April 1992). "Dyspepsia and dyspepsia subgroups: a population-based study".
1723:
937:
772:
321:
has been calculated, which is a global measure of esophageal acid exposure. A Demeester score > 14.72 indicates reflux.
986:
1424:
1682:
1677:
1215:
560:
209:
185:
104:
922:
873:
1304:
1048:
896:
764:
611:"Bravo catheter-free pH monitoring: normal values, concordance, optimal diagnostic thresholds, and accuracy"
1570:
1289:
1116:
993:
813:
173:
gastroesophageal reflux. The initial 24-hour pH studies required hospitalization until the introduction of
387:
Retrograde flow of gastric contents to the upper aerodigestive tract causes a variety of symptoms such as
1728:
1479:
1314:
858:
296:(UES). The Bravo pH capsule is placed either transnasally based on manometric measurements, or following
1387:
1309:
1177:
1036:
293:
281:
1575:
1365:
1279:
1187:
1106:
878:
868:
301:
280:
In assessment of distal esophageal pH, the sensor is placed 5 cm above the upper border of the
1669:
1524:
1182:
805:
400:
113:
39:
1618:
1534:
1159:
917:
1648:
1463:
927:
796:
371:
1623:
1553:
1409:
1003:
964:
258:
Esophageal pH monitoring is currently performed using one of the following three techniques:
223:
was the only way to measure esophageal acid exposure. Because this method is associated with
200:
occurs when esophageal mucosa is exposed to the acidic gastric content, but the complaint of
1692:
1220:
285:
100:
8:
1595:
1519:
1414:
1319:
1294:
1210:
1205:
1149:
944:
215:
Although there remains no gold standard for the diagnosis of GERD, ambulatory esophageal
152:
292:
esophageal acid exposure, the second sensor is placed 1-5 below the lower border of the
1089:
932:
751:
591:
169:
561:"Effect of ambulatory 24-hour esophageal pH monitoring on reflux-provoking activities"
177:
in the 1980s that allowed portable esophageal pH monitoring in an outpatient setting.
1655:
1539:
1501:
1347:
1257:
1079:
971:
912:
743:
708:
704:
673:
632:
583:
541:
506:
479:
475:
444:
144:
595:
1659:
1496:
902:
755:
735:
700:
663:
622:
575:
533:
471:
92:
71:
1697:
1474:
1470:
1453:
1448:
1235:
1131:
1121:
1096:
1084:
1071:
1023:
537:
416:
45:
1702:
1529:
1392:
1337:
1043:
1013:
907:
848:
831:
28:
739:
627:
610:
579:
1717:
1613:
1342:
1272:
1008:
843:
794:
399:. These respiratory manifestations of the reflux disease are commonly called
189:
174:
58:
1590:
1404:
1299:
1284:
1139:
747:
712:
677:
636:
587:
545:
268:
Wireless pH monitoring using Bravo pH capsule or OMOM pH monitoring capsule
125:
668:
651:
510:
483:
448:
365:
1580:
1436:
1399:
1267:
1262:
1247:
1111:
998:
981:
959:
949:
853:
239:
system allows a longer period of monitoring and may be better tolerated.
205:
136:
65:
81:
1643:
1585:
1562:
1329:
1197:
976:
954:
396:
236:
232:
212:(GERD) on the basis of symptoms or endoscopic findings is problematic.
1440:
1243:
1154:
1144:
1101:
1031:
835:
297:
201:
197:
193:
160:
148:
140:
108:
1511:
1252:
289:
220:
107:(GERD). It provides direct physiologic measurement of acid in the
888:
523:
404:
228:
53:
247:
1605:
1169:
392:
133:
461:
1374:
388:
649:
382:
609:
Ayazi S, Lipham JC, Portale G, et al. (January 2009).
559:
Fass R, Hell R, Sampliner RE, et al. (November 1999).
224:
156:
129:
650:
Neto RL, Herbella FM, Schlottmann F, Patti MG (May 2019).
307:
275:
139:" and by Bernstein and Baker who reported the symptom of
188:(GERD) is a common disease in western countries. In the
33:
pH-probe for measuring acidity in gastrointestinal tract
366:
Multichannel intraluminal impedance (MII) pH monitoring
216:
164:
163:
was first described in 1960 by Tuttle. He used a glass
132:
was emphasized by
Winkelstein who introduced the term "
690:
16:
Method of diagnosing and measuring gastric acid reflux
254:
A sample of Bravo pH tracing recorded over 48 hours
124:The importance of refluxed gastric contents in the
608:
304:. The same applies to OMOM pH monitoring capsule.
558:
1715:
725:
496:
434:
262:Single sensor pH monitoring using a pH catheter
1420:Transjugular intrahepatic portosystemic shunt
821:
780:
265:Dual sensor pH monitoring using a pH catheter
643:
328:Components of 24-h Esophageal pH Monitoring
1070:
787:
773:
27:
1561:
667:
652:"Does DeMeester score still define GERD?"
626:
383:pH monitoring in laryngopharyngeal reflux
1226:Transanal hemorrhoidal dearterialization
246:
1383:Artificial extracorporeal liver support
180:
1716:
308:Components of esophageal pH monitoring
276:pH sensor location and probe placement
768:
196:daily and 44% at least once a month.
938:Vertical banded gastroplasty surgery
987:Percutaneous endoscopic gastrostomy
795:Tests and procedures involving the
192:, 7% of the population experiences
13:
1425:Distal splenorenal shunt procedure
354:Number of reflux episodes ≥ 5 min
14:
1740:
359:Longest reflux episode (minutes)
151:in what then became known as the
705:10.1097/00004836-200309000-00004
1216:Lateral internal sphincterotomy
370:The widespread prescription of
339:Percent Upright time pH < 4
210:gastroesophageal reflux disease
208:. Therefore, the diagnosis of
186:Gastroesophageal reflux disease
105:gastroesophageal reflux disease
923:Endoscopic sleeve gastroplasty
874:Functional Lumen Imaging Probe
719:
684:
602:
552:
517:
490:
455:
428:
344:Percent Supine time pH < 4
1:
1305:Lower gastrointestinal series
1049:Upper gastrointestinal series
422:
334:Percent total time pH < 4
302:the gastroesophageal junction
242:
119:
1571:Diagnostic peritoneal lavage
1290:Double-contrast barium enema
1117:Partial ileal bypass surgery
994:Esophagogastric dissociation
615:Clin. Gastroenterol. Hepatol
538:10.1146/annurev.med.50.1.469
476:10.1016/0016-5085(92)90764-P
7:
1724:Diagnostic gastroenterology
1388:Bioartificial liver devices
1315:Transrectal ultrasonography
410:
252:96 Hour Bravo pH monitoring
10:
1745:
1310:Small-bowel follow-through
1178:Abdominoperineal resection
1037:Esophagogastroduodenoscopy
349:Number of reflux episodes
294:upper esophageal sphincter
282:lower esophageal sphincter
143:following instillation of
1670:Clinical prediction rules
1668:
1636:
1604:
1576:Intraperitoneal injection
1552:
1510:
1435:
1373:
1364:
1328:
1280:Abdominal ultrasonography
1234:
1196:
1188:Total mesorectal excision
1168:
1130:
1107:Intestine transplantation
1061:
1022:
897:Sengstaken–Blakemore tube
887:
879:High resolution manometry
869:Esophageal motility study
830:
812:
803:
740:10.1007/s11605-009-0915-6
656:Diseases of the Esophagus
628:10.1016/j.cgh.2008.08.020
78:
64:
52:
38:
26:
21:
1525:Pancreas transplantation
1183:Lower anterior resection
864:Esophageal pH monitoring
806:Digestive system surgery
401:laryngopharyngeal reflux
155:. Formal measurement of
114:laryngopharyngeal reflux
97:esophageal pH monitoring
22:Esophageal pH monitoring
1619:Inguinal hernia surgery
1535:Pancreaticoduodenectomy
918:Adjustable gastric band
859:Impedance–pH monitoring
580:10.1023/A:1026608804938
1649:Exploratory laparotomy
1464:Hepatoportoenterostomy
928:Gastric bypass surgery
797:human digestive system
693:J. Clin. Gastroenterol
372:proton pump inhibitors
255:
1624:Femoral hernia repair
1410:Liver transplantation
1004:Nissen fundoplication
728:J. Gastrointest. Surg
250:
1221:Rubber band ligation
1160:Hartmann's operation
437:Am. J. Gastroenterol
286:esophageal manometry
284:(LES) determined by
181:Clinical application
1596:Peritoneal dialysis
1415:Portal hypertension
1320:Virtual colonoscopy
1295:Endoanal ultrasound
1211:Anorectal manometry
1206:Anal sphincterotomy
1150:Colonic polypectomy
945:Collis gastroplasty
669:10.1093/dote/doy118
470:(4 Pt 1): 1259–68.
153:acid perfusion test
1729:Medical monitoring
1090:Jejunoileal bypass
933:Sleeve gastrectomy
315:Composite pH Score
256:
1711:
1710:
1656:Rapid urease test
1632:
1631:
1548:
1547:
1540:Puestow procedure
1502:Cholescintigraphy
1360:
1359:
1356:
1355:
1348:Stool guaiac test
1258:Capsule endoscopy
1080:Bariatric surgery
1057:
1056:
972:Gastroenterostomy
913:Bariatric surgery
363:
362:
145:hydrochloric acid
103:for diagnosis of
89:
88:
54:OPS-301 code
1736:
1693:Child–Pugh score
1660:Urea breath test
1559:
1558:
1520:Frey's procedure
1497:Cholecystography
1371:
1370:
1068:
1067:
903:Nasogastric tube
828:
827:
819:
818:
789:
782:
775:
766:
765:
760:
759:
723:
717:
716:
688:
682:
681:
671:
647:
641:
640:
630:
606:
600:
599:
565:
556:
550:
549:
521:
515:
514:
494:
488:
487:
464:Gastroenterology
459:
453:
452:
432:
324:
323:
93:gastroenterology
82:edit on Wikidata
74:
48:
31:
19:
18:
1744:
1743:
1739:
1738:
1737:
1735:
1734:
1733:
1714:
1713:
1712:
1707:
1698:Ranson criteria
1664:
1628:
1600:
1544:
1506:
1475:Cholangiography
1471:Medical imaging
1454:Cholecystostomy
1449:Cholecystectomy
1431:
1352:
1324:
1236:Medical imaging
1230:
1192:
1164:
1126:
1122:Strictureplasty
1097:Bowel resection
1085:Duodenal switch
1053:
1024:Medical imaging
1018:
883:
814:Digestive tract
808:
799:
793:
763:
724:
720:
689:
685:
648:
644:
607:
603:
563:
557:
553:
522:
518:
495:
491:
460:
456:
433:
429:
425:
417:Heidelberg test
413:
385:
368:
319:DeMeester Score
310:
278:
245:
231:discomfort and
183:
122:
99:is the current
85:
70:
44:
34:
17:
12:
11:
5:
1742:
1732:
1731:
1726:
1709:
1708:
1706:
1705:
1703:Milan criteria
1700:
1695:
1690:
1685:
1680:
1674:
1672:
1666:
1665:
1663:
1662:
1653:
1652:
1651:
1640:
1638:
1634:
1633:
1630:
1629:
1627:
1626:
1621:
1616:
1610:
1608:
1602:
1601:
1599:
1598:
1593:
1588:
1583:
1578:
1573:
1567:
1565:
1556:
1554:Abdominopelvic
1550:
1549:
1546:
1545:
1543:
1542:
1537:
1532:
1530:Pancreatectomy
1527:
1522:
1516:
1514:
1508:
1507:
1505:
1504:
1499:
1494:
1493:
1492:
1487:
1482:
1467:
1466:
1461:
1456:
1451:
1445:
1443:
1433:
1432:
1430:
1429:
1428:
1427:
1422:
1412:
1407:
1402:
1397:
1396:
1395:
1393:Liver dialysis
1390:
1379:
1377:
1368:
1362:
1361:
1358:
1357:
1354:
1353:
1351:
1350:
1345:
1340:
1338:Fecal fat test
1334:
1332:
1326:
1325:
1323:
1322:
1317:
1312:
1307:
1302:
1297:
1292:
1287:
1282:
1276:
1275:
1270:
1265:
1260:
1255:
1250:
1240:
1238:
1232:
1231:
1229:
1228:
1223:
1218:
1213:
1208:
1202:
1200:
1194:
1193:
1191:
1190:
1185:
1180:
1174:
1172:
1166:
1165:
1163:
1162:
1157:
1152:
1147:
1142:
1136:
1134:
1128:
1127:
1125:
1124:
1119:
1114:
1109:
1104:
1099:
1094:
1093:
1092:
1087:
1076:
1074:
1065:
1063:Lower GI tract
1059:
1058:
1055:
1054:
1052:
1051:
1046:
1044:Barium swallow
1041:
1040:
1039:
1028:
1026:
1020:
1019:
1017:
1016:
1014:Schilling test
1011:
1006:
1001:
996:
991:
990:
989:
979:
974:
969:
968:
967:
962:
957:
947:
942:
941:
940:
935:
930:
925:
920:
910:
908:Gastric lavage
905:
900:
893:
891:
885:
884:
882:
881:
876:
871:
866:
861:
856:
851:
849:Heller myotomy
846:
840:
838:
825:
823:Upper GI tract
816:
810:
809:
804:
801:
800:
792:
791:
784:
777:
769:
762:
761:
718:
683:
642:
601:
574:(11): 2263–9.
551:
526:Annu. Rev. Med
516:
489:
454:
426:
424:
421:
420:
419:
412:
409:
384:
381:
367:
364:
361:
360:
356:
355:
351:
350:
346:
345:
341:
340:
336:
335:
331:
330:
309:
306:
277:
274:
270:
269:
266:
263:
244:
241:
182:
179:
147:in the distal
121:
118:
87:
86:
79:
76:
75:
68:
62:
61:
56:
50:
49:
42:
36:
35:
32:
24:
23:
15:
9:
6:
4:
3:
2:
1741:
1730:
1727:
1725:
1722:
1721:
1719:
1704:
1701:
1699:
1696:
1694:
1691:
1689:
1686:
1684:
1681:
1679:
1676:
1675:
1673:
1671:
1667:
1661:
1657:
1654:
1650:
1647:
1646:
1645:
1642:
1641:
1639:
1635:
1625:
1622:
1620:
1617:
1615:
1614:Hernia repair
1612:
1611:
1609:
1607:
1603:
1597:
1594:
1592:
1589:
1587:
1584:
1582:
1579:
1577:
1574:
1572:
1569:
1568:
1566:
1564:
1560:
1557:
1555:
1551:
1541:
1538:
1536:
1533:
1531:
1528:
1526:
1523:
1521:
1518:
1517:
1515:
1513:
1509:
1503:
1500:
1498:
1495:
1491:
1488:
1486:
1483:
1481:
1478:
1477:
1476:
1472:
1469:
1468:
1465:
1462:
1460:
1457:
1455:
1452:
1450:
1447:
1446:
1444:
1442:
1438:
1434:
1426:
1423:
1421:
1418:
1417:
1416:
1413:
1411:
1408:
1406:
1403:
1401:
1398:
1394:
1391:
1389:
1386:
1385:
1384:
1381:
1380:
1378:
1376:
1372:
1369:
1367:
1363:
1349:
1346:
1344:
1343:Fecal pH test
1341:
1339:
1336:
1335:
1333:
1331:
1327:
1321:
1318:
1316:
1313:
1311:
1308:
1306:
1303:
1301:
1298:
1296:
1293:
1291:
1288:
1286:
1283:
1281:
1278:
1277:
1274:
1273:Sigmoidoscopy
1271:
1269:
1266:
1264:
1261:
1259:
1256:
1254:
1251:
1249:
1245:
1242:
1241:
1239:
1237:
1233:
1227:
1224:
1222:
1219:
1217:
1214:
1212:
1209:
1207:
1204:
1203:
1201:
1199:
1195:
1189:
1186:
1184:
1181:
1179:
1176:
1175:
1173:
1171:
1167:
1161:
1158:
1156:
1153:
1151:
1148:
1146:
1143:
1141:
1138:
1137:
1135:
1133:
1129:
1123:
1120:
1118:
1115:
1113:
1110:
1108:
1105:
1103:
1100:
1098:
1095:
1091:
1088:
1086:
1083:
1082:
1081:
1078:
1077:
1075:
1073:
1069:
1066:
1064:
1060:
1050:
1047:
1045:
1042:
1038:
1035:
1034:
1033:
1030:
1029:
1027:
1025:
1021:
1015:
1012:
1010:
1009:Pyloromyotomy
1007:
1005:
1002:
1000:
997:
995:
992:
988:
985:
984:
983:
980:
978:
975:
973:
970:
966:
963:
961:
958:
956:
953:
952:
951:
948:
946:
943:
939:
936:
934:
931:
929:
926:
924:
921:
919:
916:
915:
914:
911:
909:
906:
904:
901:
898:
895:
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892:
890:
886:
880:
877:
875:
872:
870:
867:
865:
862:
860:
857:
855:
852:
850:
847:
845:
844:Esophagectomy
842:
841:
839:
837:
833:
829:
826:
824:
820:
817:
815:
811:
807:
802:
798:
790:
785:
783:
778:
776:
771:
770:
767:
757:
753:
749:
745:
741:
737:
734:(8): 1422–9.
733:
729:
722:
714:
710:
706:
702:
699:(3): 206–15.
698:
694:
687:
679:
675:
670:
665:
661:
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653:
646:
638:
634:
629:
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581:
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569:
568:Dig. Dis. Sci
562:
555:
547:
543:
539:
535:
531:
527:
520:
512:
508:
505:(10): 933–6.
504:
500:
493:
485:
481:
477:
473:
469:
465:
458:
450:
446:
443:(4): 325–32.
442:
438:
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408:
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305:
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288:. To measure
287:
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190:United States
187:
178:
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175:microcircuits
171:
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117:
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101:gold standard
98:
94:
83:
77:
73:
69:
67:
63:
60:
57:
55:
51:
47:
43:
41:
37:
30:
25:
20:
1591:Paracentesis
1405:Liver biopsy
1300:Enteroclysis
1285:Defecography
1140:Appendectomy
863:
731:
727:
721:
696:
692:
686:
659:
655:
645:
618:
614:
604:
571:
567:
554:
529:
525:
519:
502:
498:
492:
467:
463:
457:
440:
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386:
375:
369:
327:
318:
314:
311:
279:
271:
257:
251:
214:
184:
126:pathogenesis
123:
96:
90:
1581:Laparoscopy
1437:Gallbladder
1400:Hepatectomy
1330:Stool tests
1268:Proctoscopy
1263:Enteroscopy
1248:Colonoscopy
1132:Large bowel
1112:Jejunostomy
1072:Small bowel
999:Hill repair
982:Gastrostomy
960:Billroth II
950:Gastrectomy
854:Sialography
621:(1): 60–7.
532:: 469–506.
206:esophagitis
137:esophagitis
66:MedlinePlus
1718:Categories
1644:Laparotomy
1586:Omentopexy
1563:Peritoneum
1198:Anal canal
977:Gastropexy
955:Billroth I
423:References
397:hoarseness
243:Techniques
237:telemetric
233:rhinorrhea
229:pharyngeal
120:Background
1441:bile duct
1366:Accessory
1244:Endoscopy
1155:Colostomy
1145:Colectomy
1102:Ileostomy
1032:Endoscopy
965:Roux-en-Y
836:Esophagus
298:endoscopy
202:heartburn
198:Heartburn
194:heartburn
170:DeMeester
161:esophagus
149:esophagus
141:heartburn
109:esophagus
1512:Pancreas
1253:Anoscopy
748:19421822
713:12960718
678:30561585
637:18976965
596:20505417
588:10573372
546:10073290
411:See also
290:proximal
221:catheter
889:Stomach
756:8736410
511:9322676
499:Am Surg
484:1551533
449:4432845
405:pharynx
159:in the
46:D050782
1606:Hernia
1170:Rectum
754:
746:
711:
676:
635:
594:
586:
544:
509:
482:
447:
393:asthma
134:peptic
72:003401
1688:UKELD
1637:Other
1375:Liver
752:S2CID
662:(5).
592:S2CID
564:(PDF)
389:cough
376:Silny
225:nasal
80:[
59:1-316
1683:PELD
1678:MELD
1485:MRCP
1459:ERCP
744:PMID
709:PMID
674:PMID
633:PMID
584:PMID
542:PMID
507:PMID
480:PMID
445:PMID
395:and
227:and
157:acid
130:GERD
40:MeSH
1490:PTC
832:SGs
736:doi
701:doi
664:doi
623:doi
576:doi
534:doi
472:doi
468:102
317:or
128:of
91:In
1720::
1658:/
1480:IV
1473::
1439:,
1246::
834:/
750:.
742:.
732:13
730:.
707:.
697:37
695:.
672:.
660:32
658:.
654:.
631:.
617:.
613:.
590:.
582:.
572:44
570:.
566:.
540:.
530:50
528:.
503:63
501:.
478:.
466:.
441:62
439:.
391:,
217:pH
165:pH
116:.
95:,
899:)
788:e
781:t
774:v
758:.
738::
715:.
703::
680:.
666::
639:.
625::
619:7
598:.
578::
548:.
536::
513:.
486:.
474::
451:.
84:]
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