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Hiroshi Mitsumoto, MD
Publications (* as a senior author)
- Mitsumoto H, Conomy PJ, Regula G: Subdural hematoma: experience in a general hospital. Cleveland Clin Q 1977; 44:95-100.
- Mitsumoto H, Conomy, JP, Regular G: Ophthalmologic aspects of subdural hematoma. Cleveland Clin Q 1977; 44:101-106.
- Conomy JP, Regular G, Mitsumoto H: Age as a determinant in the neurology of subdural hematomas. Trans Amer Neuro Assoc 1976; 101-102.
- Mitsumoto H: McArdle disease: phosphorylase activity in regenerating fibers. Neurology 1979; 29:258-262.
- Streib EW, Wilbourn AJ, Mitsumoto H: Spontaneous electrical activity in polymyositis and dermatomyositis. Muscle Nerve ; 1979; 2:14-18.
- Mitsumoto H, Wilbourn AJ, Goren H: Perineurioma as the cause of localized hypertrophic neuropathy. Muscle Nerve 1980; 3:403-412.
- Sivak E, Salanga V, Wilbourn AJ, Mitsumoto H: Diaphragmatic palsies in adult-onset acid maltase deficiency myopathy. Ann Neurol 1981; 9:613-616.
- Verghese P, Bradley WG, Mitsumoto H, Chad D: A blind controlled trial of ACTH and cerebral gangliosides and nerve regeneration in the rat. Exp Neurol 1982; 77:455-458.
- Mitsumoto H, Bradley WG: The wobbler mouse: the murine motor neuron diseases: degeneration and regeneration of the lower motor neuron. Brain 1982; 105:811-834.
- Mitsumoto H, Bradley WG, Aprille JR, Nemni R, Wray SH: Chronic progressive external ophthalmoplegia (CPEO): clinical, morphologic, and biochemical studies. Neurology 1983; 33:452-461.
- Mitsumoto H: Axonal regeneration in murine motor neuron disease (the wobbler mouse). Muscle Nerve 1985; 8:44-51.
- Mitsumoto H, Sliman RJ, Schafer IA, Sternick CS, Wilbourn AJ, Kaufman B, Horwitz SJ; Motor neuron disease and adult hexosaminidase-A deficiency in two families: Evidence for multisystem degeneration. Ann Neurol 1985; 17:378-385.
- Mitsumoto H, Gambetti P: Impaired slow axonal transport in wobbler mouse motor neuron disease. Ann Neurol 1986; 19:64-68.
- Mitsumoto H, Salgado ED, Negroski D et al: Amyotrophic lateral sclerosis: Effects of acute intravenous and chronic subcutaneous administration of thyrotrophin-releasing hormone in controlled trials. Neurology 1986;36:152-159.
- Mitsumoto H, Boggs AL: Vacuolated anterior horn cells in wobbler mouse motor neuron disease: Peripheral axons and regenerative capacity. J Neuropathol Exp Neurol 1987; 46:214-222.
- Estes ML, Ewing-Wilson D, Chou SM, Mitsumoto H, Hanson MR, et al: Chloroquine neuromyotoxicity: A clinical and pathological prospective. Amer J Med 1987; 82:447-455.
- Sivak ED, Ahmad M, Hanson MR, Mitsumoto H, Wilbourn AJ: The spectrum and management of respiratory insufficiency in adult-onset acid maltase deficiency. Souther Med J 1987; 80:205-208.
- Calabrese LH, Mitsumoto H, Chou SM: Inclusion body myositis (IBM): Presenting as treatment-resistant polymyositis. Arthr Rhem 1987; 30:397-403.
- *Kozachuk W, Mitsumoto H, Salanga V, Wilbur J: Effects of daily TRH administration in murine motor neuron disease (wobbler mouse). J Neurol Sci 1987; 78:253-260.
- Mitsumoto H, Ferut AL, Kurahasi K, McQuarrie IG: Impairment of retrograde axonal transport in wobbler mouse motor neuron disease. Muscle Nerve 1990; 13:121-126.
- Mitsumoto H, Bunge G, Andrish JT, DeBoer GE, Tetzlaff JE, Cruse RP: Fiber-type-specific caffeine sensitivities in normal human skinned muscle fibers. Anesthesiology 1990; 72:50-54.
- Mitsumoto H, McQuarrie IG, Kurahashi K, Sunohara N: Histometric characteristics and regenerative capacity in wobbler mouse motor neuron disease. Brain 1990; 113:497-508.
- Navon R, Kolodny EH, Mitsumoto H, Thomas GH, Proia RL: Ashkenazi Jewish and non-Jewish adult GM 2 gangliosidosis patients share a common genetic defect. Am J Hum Genet 1990; 46:817-821.
- Sadig SA, Thomas FP, Kilidireas K, et al: The spectrum of neurological disease associated with anti-GM antibodies. Neurology 1990; 40:1067-1072.
- Mitsumoto H, Schwartzman MJ, Estes ML, et al: Paroxysmal autonomic dysfunction and sudden death in stiff-man syndrome. J Neurol 1991; 238: 91-96.
- Krieger C, Perry TL, Hansen S, Mitsumoto H: The wobbler mouse: amino acid contents in brain and spinal cord. Brain Res 1991; 551:142-144.
- Krieger C, Perry TL, Hanson S, Mitsumoto H, Honore T: Excitatory amino acid receptor antagonists in murine motor neuron disease. Can J Neurol Sci 19:462-465, 1992.
- Mitsumoto H, Kurahashi K, Jacob JM, McQuarrie IG: Retardation of fast axonal transport in wobbler mice. Muscle Nerve 1993; 16:542-547.
- *Sawada K, Malchesky PS, Koo AP, Mitsumoto H: Myasthenia gravis therapy. A new immunoadsorbent technique can eliminate acetylcholine receptor antibodies. Cleveland Clin J Med 1993; 60: 60-64.
- Krieger C, Lai R, Mitsumoto H, Shaw C: The wobbler mouse: quantitative autoradiography of glutamatergic ligand binding sites in spinal cord. Neurodegeneration 1993; 2:9-17.
- *Ikeda K, Mitsumoto, H: In vivo and in vitro muscle tensions in wobbler mouse motor neuron disease. Muscle Nerve . 1993; 16: 979-981.
- Hirano M, Silbestri G, Blake DM (Mitsumoto H, one of 15 authors): Mitochondrial neurogastrointerstinal encephalomyopathy (MNGIE): clinical biochemical, and genetic features of an autosomal recessive mitochondrial disorder. Neurology 1994;44:721-7.
- Mitsumoto H, Ikeda K, Holmlund TH, Greene T, Cedarbaum JM, Wong V, Lindsay RM: The effects of ciliary neurotrophic factor on motor dysfunction in wobbler mouse motor neuron disease. Ann Neurol 1994;36:142-8.
- Mitsumoto H, Ikeda K, Klinkosz B, Cedarbaum JM, Wong V, Lindsay RM: Arrest of motor neuron disease in wobbler mice cotreated with CNTF and BDNF. Science 1994;265:1107-10.
- *Ikeda K, Wong V, Holmlund TH, Greene T, Cedarbaum JM, Lindsay RM, Mitsumoto H: Histometric effects of ciliary neurotrophic factor in wobbler mouse motor neuron disease. Ann Neurol 1995;47:47-54.
- Grob D, Simpson D, Mitsumoto H, et al.: Treatment of myasthenia gravis by immunoadsorption of plasma. Neurology 1995;45:338-344.
- *Ikeda K, Klinkosz B, Greene T, Cedarbaum JM, Wong V, Lindsay RM, Mitsumoto H: Effects of brain-derived neurotrophic factor (BDNF) on motor dysfunction in wobbler mouse motor neuron disease. Ann Neurol 1995; 37:505-511.
- Sato N, Brum JM, Mitsumoto H, DeBoer GE: Effect of cocaine on the contracture response to 1% halothane in patients undergoing diagnostic muscle biopsy for malignant hyperthermia. Can J Anaesth 1995; 42:158-62.
- Den H-X, Tainer JA, Mitsumoto H, et al.: Two novel SOD 1 mutation in patients with familial amyotrophic lateral sclerosis. Hum Molec Genet 1995;4:113-116.
- The ALS CNTF Treatment Study (ACTS) Phase I-II Study Group: The pharmacokinetics of subcutaneously administered recombinant human ciliary neurotrophic factor (rHCNTF) in patients with amyotrophic lateral sclerosis: relation to parameters of the acute-phase response. Clin Neuropharmacol 1995; 18:500-514.
- The ALS CNTF Treatment Study (ACTS) Phase I-II Study Group: A phase I study of human ciliary neurotrophic factor (rHCNTF) in patients with amyotrophic lateral sclerosis. Clin Neuropharmacol 1995; 6:515-532.
- Mitsumoto H, Saito T: Treatment trials in ALS. Prog Br Res ( Tokyo) 1996; 40:132-144.
- The ALS CNTF Treatment Study (ACTS) Phase I-II Study Group. The amyotrophic lateral sclerosis functional rating scale. Assessment of activities of daily living in patients with amyotrophic lateral sclerosis. Arch Neurol 1996;53:141-147.
- The ALS CNTF Treatment Study (ACTS) Phase III Study Group. A double-blind placebo-controlled trial of subcutaneous recombinant human ciliary neurotrophic factor (rHCNTF) in amyotrophic lateral sclerosis. Neurology 1996; 46:1244-1249.
- Mitsumoto H, Olney, RK: Drug combination treatment in patients with ALS: current status and future direction. Neurology 1996;47 (Suppl 2): S103-107.
- Zu JS, Deng H-X, Lo, TP, Mitsumoto H, et al.: Exon 5 encoded domain is not required for the toxic function of mutant SOD1 but essential for the dismutase activity: identification and characterization of two new SOD1 mutations associated with familial amyotrophic lateral sclerosis. Neurogenetics 1997; 1:65-71.
- Mitsumoto H, Kumar S, Levin KH, Tan M, Desai RG: Intravenous immunoglobulin treatment for amyotrophic lateral sclerosis. Indian J Hematol Blood Transf 1997; 15:14-17.
- *Aboussaouan LS, Khan SU, Meeker DP, Stelmack K, Mitsumoto H: The effect of non-invasive positive pressure ventilation on survival in amyotrophic lateral sclerosis. Ann Int Med 1997; 127: 450-453.
- *Krivickas LS, Shockley L, Mitsumoto H: Home care of patients with amyotrophic lateral sclerosis (ALS). J Neurol Sci 1997; 152 (Suppl. 1): S82-89.
- *Ishiyama T, Pioro EP, Klinkosz B, Mitsumoto H: Genetic transfer of the wobbler gene to C57/6J x NZB hybrid stock: natural history and response to CNTF and BDNF cotreatment. J Exp Neurol 1997; 148:247-255.
- Mitsumoto H, Shockley L: Amyotrophic lateral sclerosis: continuum of care from diagnosis through hospice. Home HealthCare Consultant 1998; 5:20-29.
- *Pioro EP, Wang Y, Moore JK, Ng TC, Trapp BD, Klinkosz, Mitsumoto H: Neuronal pathology in the wobbler mouse brain revealed by in vivo proton magnetic resonance spectroscopy and immunocytochemistry. NeuroReport 1998; 9:3041-3046.
- *Dal Bello-Haas V, Kloos AD, Mitsumoto H: Physical therapy for a patient through six stages of amyotrophic lateral sclerosis. Physical Therapy 1998;78:1312-1324.
- *Pioro EP, Major T, Mitsumoto H, Ng T: Short TE 1H‑MRSI of medulla in ALS: In vivo evidence of neurodegeneration and excess glutamate+glutamine. Neurology 1999; 53: 71-79.
- Miller RG, Rosenber JA, Gelinas DF, Mitsumoto H, et al, and the ALS practice Parameters Task Force. Practice parameter: an evidence-based review. Neurology 1999; 52:1311-1323. BDNF Study Group (Phase III). A controlled trial of recombinant methinyl human BDNF in ALS. Neurology 1999; 52:1427-1433.
- Esposito SJ, Mitsumoto H, Shanks M. Use of palatal lift and palatal augmentation prostheses to improve dysarthria in patients with amyotrophic lateral sclerosis: A cases series. J Prosthet Dent 2000; 83:90-98.
- Miller RG, Anderson FA, Bradley WG, Mitsumoto H, Munsat TL, Ringel SP, and the ALS C.A.R.E. Study Group. The ALS patient care database. Goals, design, and early results. Neurology 2000; 54:53-57.
- *Tsuzaka K, Ishiyama,T, Pioro EP, Mitsumoto H. Role of Brain-Derived Neurotrophic Factor in Wobbler MouseMotor Neuron Disease. Muscle Nerve 2001; 24:474-480.
- Mitsumoto H, DelBene M. Improving the quality of life for people with ALS: The challenge ahead. ALS 2000; 1:329-336.
- *Dal Bello-Haas V, Andrews-Hinders D, Bocian J, Mascha E, Wheeler T, Mitsumoto H. Spiritual well-being of the individual with ALS. ALS 2000; 1:337-341.
- Hentati A, Deng H-X, Zhai H, et al (13 th of 18 authors). Novel mutations in spastin gene and absence of correlation with age at onset of symptoms. Neurology 2000; 55:1388-1390.
- Aboussouan LS, Khan SU, Arroliga AC, Banerjee M, Mitsumoto H. Effect of noninvasive positive-pressure ventilation on pulmonary function, respiratory muscle strength and arterial blood gases in amyotrophic lateral sclerosis. Muscle Nerve 2001;24:403-409.
- Mitsumoto H, Klinkosz B, Pioro EP, Tsuzaka K, Ishiyama T, O'Leary RM, Pennica D. The effects of cardiotrophin-1 (CT-1) in a mouse motor neuron disease. Muscle Nerve 2001; 24:769-777..
- *Dal Bello-Haas V, Andrews-Hinders D, Balsdon Richer C, Blakely-Adams C, Hanson J, Hammel J, Kelly D, Kloos, A, Pioro EP, Powazki RD, Wheeler T, Mitsumoto H. Development, analysis, refinement, and utility of an interdisciplinary ALS 2001; 2:39-46.
- Sivak ED, Shefner JM, MitsumotoH, Taft IM. The use of non-invasive positive pressure ventilation (NIPPV) in ALS patients. A need for improved determination of ternvention timing. ALS 2001;2: 139-146.
- *Albert SM, Murphy PL, Del Bene M, Rowland LP, Mitsumoto H. Incidence and predictors of PEG placement in ALS/MND. J Neurol Sci 2001;191115-120.
- *Ishiyama T, Ogo H, Wong V, Klinkosz B, Nogushi, Nakayama C, Mitsumoto H. Methionine-free brain-derived neurotrophic factor in wobbler mouser motor neuron disease: dose-related effects and comparison with the methionyl form. Brain Research 2002; 944: 195-199.
- Mitsumoto H. Caregiver assessment: summary. ALS and Other MND 2002 (Suppl 1): S31-34.
- Mitsumoto H. Biochemical markers: con. Amyotroph Lateral Scler Other Motor Neuron Disord 2002; 3(Suppl 1): S83.
- Naini A, Musumeci O, Hayes L, Pallotti F, Del Bene M, Mitsumoto H. Identification of a novel mutation in Cu/Zn superoxide dismutase gene associated with familial amyotrophic lateral sclerosis J Neurol Sci. 2002;198:17-9.
- Chan S, Kaufmann P, Shungu DC, Mitsumoto H. Amyotrophic lateral sclerosis and primary lateral sclerosis: evidence-based diagnostic evaluation of the upper motor neuron. Neuroimag Clin N Am 2003; 13:307-326.
- Horner RD, Makins KG, Feussner JR, Grambow SC, Hoo-lindquist J, Harati Y, Mitsumoto H, et al. Occurrence of amyotrophic lateral sclerosis among Gulf War veterans. Neurology 2003;61:742-749.
- Parton M, Mitsumoto H, Leigh P. Amino acids for amyotrophic lateral sclerosis / motor neuron disease. Cochrane Database Syst Rev 2003; 4:CD003457.
- Mitsumoto H, Davidson M, Moore DH, et al. Percutaneous endoscopic gastrostomy (PEG) in patients with ALS and bulbar dysfunction. ALS Other MND 2003; 4: 177-185.
- Kloos AD, Dal Bello-Haas V, Thome R, Cassidy J, Lewis L, Cusma T, Mitsumoto H. Interrator and intrarater reliability of the Tinetti balance test for individuals with amyotrophic lateral sclerosis. J Neurol Phys Ther 2004; 28:12-19.
- * Kaufmann P, Pullman SL, Shungu DC, et al, and H. Mitsumoto. Objective Tests for Upper Motor Neuron Involvement in Amyotrophic Lateral Sclerosis (ALS). Neurology 2004; 62:1753-1757.
Book Chapters
- Mitsumoto H, Munsat TL: Neuromuscular diseases and spinal cord and root problems. In: Fundamentals of Internal Medicine, edited by D. Kaye, and L. Rose, Mosby Company, St. Louis, 1982, pp. 1169-1178.
- Mitsumoto H, Bradley WG: Axonal pathology in the murine motor neuron disease. In: Current Trends in Neuroscience Vol. 3, edited by M. Adachi, A. Hirano, and G. Aronson, Igaku-Shoin Med. Publisher, Tokyo- New York, 1985, pp 126-149.
- Mitsumoto H. Bradley WG: Chapter 1. Development and structure of nerves. In: Vinkin and Bruyn (eds): Neuropathies. Handbook of Clinical Neurology, Vol. 7. North-Holland, Amsterdam, 1987, pp 1-22.
- Mitsumoto H: Motor Neuron Disease. In: Current Clinical Practice. F.H. Messerli: (ed). W. B. Saunders 1987, pp 700-702.
- Mitsumoto H: Study of motor neuron disease. An approach with an animal model (the wobbler mouse) In: Contributions to Contemporary Neurology: A Tribute to Joseph M. Foley, M.D. Daroff RB, Conomy JP (eds). Butterworth, Stoneham, 1988, pp. 127-142.
- Mitsumoto H: Therapeutic trials in ALS (Discussion). T. Tsubaki and Y. Yase (Eds.). International Conference of Amyotrophic Lateral Sclerosis. Simul International. Osaka, 1988, pp. 117-138.
- Mitsumoto H, Munsat TL: Problems of Nerve and Muscle. In: Internal Medicine for Dentistry 2nd edition, edited by D. Kaye and L. Kose Mosby Company, St. Louis. 1990, pp.746-755.
- Bosch EP, Mitsumoto H: Disorders of peripheral nerves. In: Neurology in Clinical Practice. Bradley WG, Daroff RB, Fenichel GM, Marsden CD (eds). Butterworth Publishers. 1990, pp.1719-1792.
- Breuer AC, Mitsumoto H, Atkinson MB: Axonal transport abnormalities in motor neuron disease: A possible role of endogenous or exogenous chemical agents. In: Neurotoxicology and Epidemiology on Motor Neuron Disease. F.C. Rose (ed). Demos, New York. 1991, pp. 243-246.
- Mitsumoto H. Amyotrophic lateral sclerosis (ALS). A study of an animal model (The Wobbler Mouse). Proceedings of the XIth International Congress of Neuropathology. The Japanese Society of Neuropathology. Kyoto. 1991, pp. 601-604.
- *Cwik V, Mitsumoto H: Post-polio syndrome. In: Handbook of Amyotrophic Lateral Sclerosis. R.A. Smith (ed). Marcel-Dekker, New York. 1992, pp.77-91.
- Mitsumoto H, Lopez CL: Peripheral Neuropathy. In Conn's Current Therapy. R.E. Rakel (ed). Saunders, Philadelphia. 1992, pp.886-896.
- Mitsumoto H, Ikeda K, Wong V, Cedarbaum JM, Lindsay RM. Wobbler Mouse Motor Neuron Disease and Neurotrophic Factors. The Forbes H. Norris Memorial Volume . Smith-Gordon, London, 1994, pp. 211-223.
- Mitsumoto H. Classification and clinical features of ALS. In Mitsumoto H, Norris FT, Jr (eds). Amyotrophic Lateral Sclerosis: Comprehensive Management and Treatment. Demos Publisher, New York, 1994; pp. 1-20.
- Mitsumoto, H: Motor Neuron Disease: The Path to Clinical Trials. Syllabus for the American Academy of Neurology Postgraduate Course. In M. Brooke (Director): Recent Advances in Neuromuscular Diseases. Published by AAN, New York, 1993.
- Mitsumoto, H: New therapeutic approaches. In: Motor Neuron Disease (Amyotrophic Lateral Sclerosis ). Leigh N., Swash M (eds). Springer-Verlag, London, 1995, pp. 419-441.
- Mitsumoto, H, Wilbourn AJ: Spectrum of acquired sensory neuropathies: clinical, electrodiagnostic, and pathologic studies. In Asbury AK, Budka H, Sluga E (eds): Sensory neuropathies. Wien/ New York; Spring-Verlag, 1995, pp. 91-104.
- Bosch EP, Mitsumoto H: Disorders of peripheral nerves. In: Neurology in Clinical Practice. 2nd edition, Bradley WG, Daroff RB, Fenichel GM, Marsden CD (eds). Butterworth Publishers. 1995;1881-1952.
- *King PH, Mitsumoto H: Neuropathology of Amyotrophic Lateral Sclerosis. In J. Belsh & P Schiffman (eds): ALS: Diagnosis and Management for the Clinician . Futura, New York, 1996, pp. 203-218.
- Mitsumoto H, Pioro, EP: Animal Models of Motor Neuron Disease. In Serratrice G, Munsat TL, eds: Pathogenesis and Treatment of Amyotrophic Lateral Sclerosis. Lippincott-Raven Publishers, Philadelphia. 1995, pp.73-87.
- Mitsumoto H: A new approach for treatment of ALS (in Japanese). In: Tashiro K, Mizuno, Y, Kurihara T (eds): Modern Concept of Neurology. Igakushoin, Tokyo. 1995, pp. 146-152.
- Mitsumoto H: Advances in ALS clinical trials. In Nakano I, Hirano A (eds): Amyotrophic Lateral Sclerosis. Amsterdam: Elsevier, 1996, pp. 374-384.Mitsumoto H: ALS: Hypotheses of pathogenesis and clinical trials. Excerpta Medica International Congress Series 1101 (Xth International Congress of EMG and Clinical Neurophysiology ), Elsevier, Amsterdam. 1996, pp. 355-361.
- Mitsumoto H (as an author): Introduction (pp8-9), Adult spinal muscular atrophy (pp33-40), Kennedy disease (pp 41-46), Benign focal amyotrophy (pp 111-115), Disorders of motor neurons manifested by hyperactivity (pp 121128), Trends (pp 129), and Patient Management Problem (pp137-156). In: Continuum. Motor Neuron Disease (ed. Mitsumoto, H). Williams and Wilkins, Baltimore. 1997.
- Mitsumoto H: Amyotrophic lateral sclerosis. In: Adelman A, Smith B (eds): Encyclopedia of Neuroscience in CD-Rom. Elsevier, New York, 1998.
- H, Mitsumoto H. Muscle Physiology and Pathophysiology. Levin K, Lüder HO (eds). Comprehensive Clinical neurophysiology. W S Saunders, Philadelphia. 2000; 81-88.
- Cole B, Mitsumoto H. Amyotrophic Lateral Sclerosis. In 2000 Baker’s Clinicl Neurology on CD Rom (edited by Joynt R and Griggs RC). Lippincott, Williams & Wilkins, Baltimore, 2000 and 2002 (new edition).
- Murray B, Mitsumoto H. Drug therapy in Amyotrophic Lateral Sclerosis. In Pourmand R and Haratic Y (eds). Advances in Neurology. Vol 88. Neuromuscular Disorders. Philadelphia: Lippincott Williams & Wilkins. 2001; pp 63-82.
- Murray B, Mitsumoto H. Amyotrophic Lateral Sclerosis. In Katerji B, Kaminski H Preston D, Ruff R, Shapiro B (eds): Neuromuscular Disorders in Clinical Practice. Boston: Butterworth-Heimann. 2002, pp. 417-444.
- Mitsumoto H: Section Editor for Motor Neuron Diseases. In Brown WR, Bolton CP, Aminoff MJ (eds). Neuromuscular Function and Disease, Saunders, 2002; pp.1263-1326.
- Gooch CL, Mitsumoto H. Infectious, syndromic, and systemic disorders. In Brown WR, Bolton CP, Aminoff MJ (eds). Neuromuscular Function and Disease, Saunders, 2002; pp. 1281-1294.
- Murray B, Hitsumoto H. Drug therapy in amyotrophic lateral sclerosis. In Pourmand R and Harati Y (eds). Neuromuscular Disorders. Lippincotte Williams and Wilkins. New York. Advances in Neurology 2002;88 63-82.
- Mitsumoto H. Nutritional management for patients with amyotrophic lateral sclerosis. In Miller RG (ed). Continuum. Amyotrophic Lateral Sclerosis, AAN. 2002: 95-109.
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