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BACKGROUND/AIM: Photodynamic therapy (PDT) is a relatively non-invasive anti-cancer therapy that employs a photosensitizer with a specific wavelength of light, causing a photochemical reaction that releases free radicals, thereby inducing tumor cell necrosis via oxidative stress. The oxygen molecule reaches the singlet excited state through efficient energy transfer from an excited triplet state of the photosensitizer. Heavy atoms are frequently introduced in photosensitizers for efficiently generating reactive oxygen species (ROS) in PDT, known as the heavy atom effect. However, metal-complexed photosensitizers often show low water-solubility. To overcome this limitation and produce ROS effectively, we focused on the better solubility of photosensitizers with heavy metals bound within the chlorin skeleton and conjugated with glucose in this study. MATERIALS AND METHODS: We established maltotriose (Mal3)-conjugation with heavy metallochlorins [M (Mal3-chlorin), M=Pt or Pd)] and evaluated its anti-tumor effect. RESULTS: M (Mal3-chlorin) showed effective ROS production and singlet oxygen induction. Consequently, these cytotoxic factors caused effective anti-tumor effects and induced morphological changes, followed by cell death in vitro. In a xenograft tumor mouse model, PDT with M (Mal3-chlorin) showed tumor growth suppression. CONCLUSION: M (Mal3-Chlorin) might be an excellent glucose-conjugated chlorin because of its strong anti-tumor PDT effect.
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Fotoquimioterapia , Porfirinas , Trissacarídeos , Humanos , Animais , Camundongos , Fármacos Fotossensibilizantes/farmacologia , Espécies Reativas de Oxigênio , Metais , Porfirinas/farmacologia , Modelos Animais de Doenças , GlucoseRESUMO
PURPOSE: This study aimed to compare the outcomes of patients with ground-grass opacity (GGO)-dominant non-small cell lung cancer (NSCLC) who were treated with carbon ion radiotherapy (CIRT) versus segmentectomy. METHODS: A retrospective review of medical records was conducted. The study included 123 cases of clinical stage 0/IA peripheral NSCLC treated with single-fraction CIRT from 2003 to 2012, 14 of which were determined to be GGO-dominant and were assigned to CIRT group. As a control, 48 consecutive patients who underwent segmentectomy for peripheral GGO-dominant clinical stage IA NSCLC were assigned to segmentectomy group. RESULTS: The patients in CIRT group, compared with segmentectomy group, were significantly older (75 ± 7.2 vs. 65 ± 8.2 years, P = 0.000660), more likely to be male (13/14 vs. 22/48, P = 0.00179), and had a lower forced vital capacity (91 ± 19% vs. 110 ± 13%, P = 0.0173). There was a significant difference in the 5-years overall survival rate (86% vs. 96%, P = 0.000860), but not in the 5-years disease-specific survival rate (93% vs. 98%, P = 0.368). DISCUSSION: Compared with segmentectomy, CIRT may be an alternative option for patients with early GGO-dominant NSCLC who are poor candidates for, or who refuse, surgery.
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Carcinoma Pulmonar de Células não Pequenas , Radioterapia com Íons Pesados , Neoplasias Pulmonares , Humanos , Masculino , Feminino , Carcinoma Pulmonar de Células não Pequenas/radioterapia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/cirurgia , Pneumonectomia , Pulmão/patologia , Estudos Retrospectivos , Estadiamento de NeoplasiasRESUMO
The dinuclear oxidovanadium(IV/V) complex, [V2(HS2O8)O3(C18H24N2)2]·CH3CN or [V2O2(µ-O)(µ-H(SO4)2)(4,4'-tBubpy)2]·CH3CN (4,4'-tBubpy = 4,4'-di-tert-butyl-2,2'-bi-pyridine), has crystallographic C 2 symmetry and exhibits a distorted octa-hedral geometry around the vanadium center, where the two 4,4'-tBubpy ligands are nearly orthogonal to each other. The two vanadium ions are linked by an oxo anion and a unique protonated sulfate anion [H(SO4)2 3-]. In the crystal, inter-molecular C-Hâ¯π and π-π inter-actions between the 4,4'-tBubpy ligands are present, leading to a three-dimensional network.
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Membrane-permeable fluorescent dyes that stain DNA are useful reagents for microscopic imaging, as they can be introduced into living cells to label DNA. However, the number of these dyes, such as Hoechst 33342, is limited. Here, we show that the icosahedral dodecaborate B12Br122-, a superchaotropic carrier that delivers different types of molecules into cells, functions as an excellent carrier for membrane-impermeable fluorescent dyes. Propidium iodide (PI) and 4',6-diamidino-2-phenylindole (DAPI), dicationic membrane-impermeable fluorescent dyes that stain DNA, can permeate cell membranes in the presence of boron clusters. Methyl green (MG), a dicationic dye used in the histological and fluorescent staining of DNA, permeated cell membranes in the presence of boron clusters. In contrast, monocationic membrane-permeable fluorescent dyes, such as acridine orange and pyronin Y, exhibited reduced fluorescence in cells in the presence of boron clusters. Boron clusters do not quench dicationic fluorescent dyes in water in vitro but have quenching effects on monocationic fluorescent dyes. We have demonstrated that the addition of B12Br122- to impermeable dicationic fluorescent DNA-staining dyes, such as DAPI, PI, and MG, which have been widely used for numerous years, imparts membrane permeability to introduce these dyes into living cells.
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BACKGROUND: Photodynamic therapy (PDT) using photosensitisers is a minimally invasive treatment for malignant tumours. However, ideal photosensitisers are not yet established. Recently, we developed a new photosensitiser, glucose-conjugated chlorin e6 (G-Ce6). OBJECTIVES: To evaluate the clinical efficacy of vascular-targeted PDT (VTP), a type of PDT utilising a short drug-light interval, using G-Ce6 to treat spontaneously occurring tumours in dogs. METHODS: Five dogs with spontaneously occurring tumours (malignant melanoma: three; haemangiopericytoma: two; and squamous cell carcinoma: one) were subjected to VTP. These dogs were intravenously injected with G-Ce6 at doses of 1-3 mg/kg 5 min before laser irradiation. Tumours were superficially or interstitially irradiated using a 677-nm diode laser. RESULTS: Repeated VTP decreased tumour size, yielding complete remission in three dogs. Complications such as oedema surrounding normal tissues and fistulae were observed, and the oedema was self-limiting. The fistula was cured by debriding the necrotic tissues formed after VTP. CONCLUSIONS: Our findings demonstrate that VTP using G-Ce6 had antitumour effects in dogs with spontaneously occurring tumours.
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Doenças do Cão , Melanoma , Fotoquimioterapia , Cães , Animais , Glucose/uso terapêutico , Fotoquimioterapia/veterinária , Melanoma/veterinária , Edema/tratamento farmacológico , Edema/veterinária , Doenças do Cão/tratamento farmacológicoRESUMO
Metal-organic frameworks (MOFs)âcrystalline coordination polymersâwith unique characteristics such as structural designability accompanied by tunable electronic properties and intrinsic uniform nanopores have become the platform for applications in diverse scientific areas ranging from nanotechnology to energy/environmental sciences. To utilize the superior features of MOF in potential applications, the fabrication and integration of thin films are of importance and have been actively sought. Especially, downsized MOFs into nanosheets can act as ultimately thin functional components in nanodevices and potentially display unique chemical/physical properties rarely seen in bulk MOFs. Assembling nanosheets by aligning amphiphilic molecules at the air/liquid interface has been known as the Langmuir technique. By utilizing the air/liquid interface as a reaction field between metal ions and organic ligands, MOFs are readily formed into the nanosheet state. The expected features in MOF nanosheets including electrical conduction largely depend on the nanosheet characteristics such as lateral size, thickness, morphology, crystallinity, and orientation. However, their control has not been achieved as yet. Here, we demonstrate how changing the concentration of a ligand spread solution can modify the assembly of MOF nanosheets, composed of 2,3,6,7,10,11-hexaiminotriphenylene (HITP) and Ni2+ ions (HITP-Ni-NS), at the air/liquid interface. A systematic increase in the concentration of the ligand spread solution leads to the enlargement of both the lateral size and the thickness of the nanosheets while retaining their perfect alignment and preferred orientation. On the other hand, at much higher concentrations, we find that unreacted ligand molecules are included in HITP-Ni-NS, introducing disorder in HITP-Ni-NS. These findings can develop further sophisticated control of MOF nanosheet features, accelerating fundamental and applied studies on MOFs.
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The air/liquid interface is a superior platform to create nanosheets of materials by promoting spontaneous two-dimensional growth of components. Metal-organic frameworks (MOFs)-intrinsically porous crystals-with π-conjugated triphenylene-based ligands show high electrical conductivities. Forming nanosheets of such conductive MOFs should enable their use in electronic devices. Although highly conductive MOF nanosheets have been created at the air/liquid interface, direct control of their continuity, morphology, thickness, crystallinity, and orientation directly influencing device performance remains as an issue to be addressed. Here, we present detailed insights into the formation process of electrically conductive MOF nanosheets composed of 2,3,6,7,10,11-hexaiminotriphenylene (HITP) and Ni2+ ions (HITP-Ni-NS) at the air/liquid interface. The morphological and structural features of HITP-Ni-NS strongly depend on the standing time-the time without any external actions involved, but leaving the interface undisturbed after setting the ligand solution onto the metal-ion solution. We find that the fundamental features of HITP-Ni-NS are determined by the standing time with conductivity sensitively influenced by such pre-determined HITP-Ni-NS characteristics. These findings will lead towards the establishment of a rational strategy for creating MOF nanosheets at the air/liquid interface with desired properties, thereby accelerating their use in diverse potential applications.
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Japanese national oncological experts convened to evaluate the efficacy and safety of particle beam therapy (PT) for pulmonary, liver and lymph node oligometastases (P-OM, L-OM and LN-OM, respectively) and to conduct a statistically comparative analysis of the local control (LC) rate and overall survival (OS) rate of PT versus those of X-ray stereotactic body radiotherapy (X-SBRT) and X-ray intensity-modulated radiotherapy (X-IMRT). They conducted [1] an analysis of the efficacy and safety of metastasis-directed therapy with PT for P-OM, L-OM and LN-OM using a Japanese nationwide multi-institutional cohort study data set; [2] a systematic review of X-ray high-precision radiotherapy (i.e. X-SBRT/X-IMRT) and PT for P-OM, L-OM and LN-OM; and [3] a statistical comparison between LC and OS of the cohort data set in PT and that of the extracted historical data set in X-SBRT/X-IMRT from the preceding systematic review. Safety was evaluated as the incidence of grade ≥ 3 adverse events, while statistical comparisons of LC and OS were conducted by estimating the incidence rate ratios (IRR) for local progression and mortality, respectively. This study demonstrated that PT provided durable LC (3-year LC rate: 72.8-83.2%) with acceptable OS (3-year OS rate: 38.5-68.1%) and risk of severe toxicity incidence of 0.8-3.5% in radical metastasis-directed therapy for P-OM, L-OM and LN-OM. Compared to LC with X-SBRT or X-IMRT, LC with PT was potentially superior for P-OM; superior for L-OM; and equivalent for LN-OM. In particular, this study demonstrated that PT may be a new treatment option for L-OM tumors measuring > 5 cm.
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Metástase Neoplásica , Radiocirurgia , Humanos , Estudos de Coortes , População do Leste Asiático , Fígado , Estudos Retrospectivos , Resultado do Tratamento , Raios X , Metástase Neoplásica/radioterapiaRESUMO
We compared the dose distributions of carbon-ion pencil beam scanning (C-PBS), proton pencil beam scanning (P-PBS) and Volumetric Modulated Arc Therapy (VMAT) for locally recurrent rectal cancer. The C-PBS treatment planning computed tomography (CT) data sets of 10 locally recurrent rectal cancer cases were randomly selected. Three treatment plans were created using identical prescribed doses. The beam angles for C-PBS and P-PBS were identical. Dosimetry, including the dose received by 95% of the planning target volume (PTV) (D95%), dose to the 2 cc receiving the maximum dose (D2cc), organ at risk (OAR) volume receiving > 15Gy (V15) and > 30Gy (V30), was evaluated. Statistical significance was assessed using the Wilcoxon signed-rank test. Mean PTV-D95% values were > 95% of the volume for P-PBS and C-PBS, whereas that for VMAT was 94.3%. However, PTV-D95% values in P-PBS and VMAT were < 95% in five and two cases, respectively, due to the OAR dose reduction. V30 and V15 to the rectum/intestine for C-PBS (V30 = 4.2 ± 3.2 cc, V15 = 13.8 ± 10.6 cc) and P-PBS (V30 = 7.3 ± 5.6 cc, V15 = 21.3 ± 13.5 cc) were significantly lower than those for VMAT (V30 = 17.1 ± 10.6 cc, V15 = 55.2 ± 28.6 cc). Bladder-V30 values with P-PBS/C-PBS (3.9 ± 4.8 Gy(RBE)/3.0 ± 4.0 Gy(RBE)) were significantly lower than those with VMAT (7.9 ± 8.1 Gy). C-PBS provided superior dose conformation and lower OAR doses compared with P-PBS and VMAT. C-PBS may be the best choice for cases in which VMAT and P-PBS cannot satisfy dose constraints. C-PBS could be another choice for cases in which VMAT and P-PBS cannot satisfy dose constraints, thereby avoiding surgical resection.
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Radioterapia de Intensidade Modulada , Neoplasias Retais , Humanos , Prótons , Reto , Radioterapia de Intensidade Modulada/métodos , Planejamento da Radioterapia Assistida por Computador/métodos , Dosagem Radioterapêutica , Recidiva Local de Neoplasia/radioterapia , Neoplasias Retais/radioterapia , Doença CrônicaRESUMO
In recent years, the development of environmentally benign molecular construction methods has been of great importance, and especially, resource recycling, high atomic efficiency, and low environmental impact are in high demand. From this point of view, attention has also been focused on the development of one-pot synthesis of pharmaceuticals and functional molecules. Imines are excellent synthetic intermediates of these useful molecules, and the environmentally friendly oxidative synthesis of imines from amines has been energetically developed using oxygen (or air), which is abundantly available on the Earth, as an oxidant. This review focuses on the latest innovative and green oxidation systems of amines to imines under atmospheric oxygen, and their application to one-pot/eco-friendly and sustainable synthesis of pharmaceuticals and functional molecules. In particular, catalytic systems that activate molecular oxygen are categorized and described in detail as transition metal catalytic systems, photoirradiated catalytic systems, and organocatalytic systems.
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Aminas , Iminas , Oxigênio , Estrutura Molecular , Catálise , Preparações FarmacêuticasRESUMO
Photodynamic therapy (PDT) damages cancer cells via photosensitization using harmless laser irradiation. We synthesized a new photosensitizer, mannose-conjugated-chlorin e6 (M-chlorin e6), which targets mannose receptors that are highly expressed on M2-like tumor-associated macrophages (M2-TAMs) and cancer cells. In our previous study, we demonstrated that M-chlorin e6 PDT reduces tumor volume and decreases the proportion of M2-TAMs. Whether M-chlorin e6 PDT-treated cancer cells activate tumor immunity remains unclear, although the decrease in M2-TAMs is thought to be a direct injurious effect of M-chlorin e6 PDT. Calreticulin (CRT) is exposed at the surface of the membrane of cancer cells in response to treatment with chemotherapeutic agents such as anthracycline and oxaliplatin. Surface-exposed CRT induces phagocytosis of CRT receptor-positive cells, including macrophages, inducing anticancer immune responses. In the present study, we found that M-chlorin e6 PDT increases CRT on the surface of cancer cells, leading to macrophage phagocytosis of cancer cells. Furthermore, M-chlorin e6 PDT increases CD80+CD86+ macrophages. These results suggest that M-chlorin e6 PDT exerts anti-tumor effects by both enhancing the phagocytosis of cancer cells and strengthening the anti-tumor phenotype of macrophages.
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Clorofilídeos , Neoplasias , Fotoquimioterapia , Calreticulina , Clorofilídeos/uso terapêutico , Humanos , Macrófagos , Manose/farmacologia , Manose/uso terapêutico , Neoplasias/tratamento farmacológico , Fagocitose , Fotoquimioterapia/métodosRESUMO
BACKGROUND: Pancreatic cancer is a disease of the elderly; patients >65 years are 60% of the cases. Due to multiple comorbidities, treating these patients is challenging. We report the efficacy and safety of carbon ion radiotherapy (C-ion RT) in octogenarians. METHODS: We retrospectively analyzed the cases of 46 pancreatic cancer patients aged ≥80 years (median 83, range 80-97) treated with definitive C-ion RT in 2007-2018 at our institute. RESULTS: Twenty-five patients (54%) had resectable or borderline-resectable disease; none underwent surgery (because of medical reasons, e.g., age, multiple comorbidities). C-ion RT was delivered with a median dose of 55.2 Gy (RBE) in 12 fractions. The survivors' median follow-up period was 43 (range 19-76) months. The entire cohort's median overall survival (OS) was 15 (95%CI: 14-22) months with a 3-year OS of 20% (95%CI: 11%-35%). On both univariate and multivariate analyses, baseline CA19-9 remained the significant independent OS prognostic factor (p = 0.032). The 3-year local control rate for all patients was 34% (95%CI: 19%-53%). Local failure (n = 25, 54%) was as common as distant relapse (n = 26, 57%); 33% of the patients experienced both local and systemic failure. About 15% underwent re-C-ion RT for infield recurrence; they achieved a median 22-month OS. No patients exhibited grade ≥3 severe acute or late toxicities (including those who received re-C-ion RT). CONCLUSIONS: C-ion RT in octogenarians with pancreatic cancer showed promising outcomes with acceptable acute and late toxicities and can be considered a reasonable alternative to radical surgery.
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Radioterapia com Íons Pesados , Neoplasias Pancreáticas , Idoso , Idoso de 80 Anos ou mais , Radioterapia com Íons Pesados/efeitos adversos , Humanos , Recidiva Local de Neoplasia , Octogenários , Neoplasias Pancreáticas/etiologia , Neoplasias Pancreáticas/radioterapia , Estudos Retrospectivos , Neoplasias PancreáticasRESUMO
The addition of interelement compounds with heteroatom-heteroatom single bonds to carbon-carbon unsaturated bonds under light irradiation is believed to be an atomically efficient method to procure materials with carbon-heteroatom bonds. In this study, we achieved the photoinduced bisphosphination of alkynes using the phosphorus interelement compound, tetraphenyldiphosphine monosulfide (1), to stereoselectively obtain the corresponding (E)-vic-1,2-bisphosphinoalkenes, which are important transition-metal ligands. The bisphosphination reaction was performed by mixing 1 and various alkynes and then exposing the mixture to light irradiation. Optimization of the conditions for the bisphosphination reaction resulted in a wide substrate range and excellent trans-selectivity. Moreover, the completely regioselective introduction of pentavalent and trivalent phosphorus groups to the terminal and internal positions of the alkynes, respectively, was achieved. We also found that the novel double-bond isomerization reaction of the synthesized bisphosphinated products occurred with a catalytic amount of a base under mild conditions. Our method for the photoinduced bisphosphination of carbon-carbon unsaturated compounds may have strong implications for both organic synthesis and organometallic and catalyst chemistry.
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Although diaryl tellurides are parent organotellurium compounds, their synthesis methods, especially for unsymmetrical ones, are limited. This may be due to the instability of diaryl tellurides and their synthesis intermediates under reaction conditions. Radical reactions are known to exhibit excellent functional group selectivity; therefore, we focused on a bimolecular homolytic substitution (SH2) reaction between the aryl radical and diaryl ditelluride. Aryl radicals are generated from arylhydrazines in air and captured by diaryl ditellurides, resulting in a selective formation of unsymmetrical diaryl tellurides with high yields. The electronic effects of the substituents on both arylhydrazines and diaryl ditellurides on the SH2 reaction of tellurium are also discussed in detail.
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This technical report introduces the utility of iodine paste markers using endodontic materials for the accurate contouring of mucosal lesions of oral mucosal melanoma, which are difficult to delineate on imaging during the planning of carbon-ion radiation therapy (CIRT). The patient had a primary oral mucosal melanoma located in the palatal mucosa without palatal or maxillary bone invasion. A dental root canal filling material, which is a calcium hydroxide/iodoform nonhardenable paste, was used as a marker. We first performed treatment-planning computed tomography (CT) without an iodine paste marker for mucosal lesions. Subsequently, we placed an iodine paste marker on the palatal mucosal lesion to accurately delineate the mucosal lesions of the palate. Finally, we obtained a reference CT image with an iodine paste marker. Computed tomography without the marker was fused to the reference CT with markers during treatment planning, and the gross tumor volume was contoured. Thereafter, CIRT was delivered without markers. During CIRT, expected acute mucositis was observed in the area of the planning target volume, including melanosis, in accordance with the dose distribution. The use of iodine paste markers for localized mucosal lesions, which are difficult to delineate on CT and magnetic resonance imaging, may be useful for accurately contouring gross tumor volumes on treatment-planning CT.
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Iodo , Melanoma , Humanos , Imageamento por Ressonância Magnética/métodos , Melanoma/diagnóstico por imagem , Melanoma/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
A simple and efficient method for α-brominating lactones that affords α-bromolactones under mild conditions using tetraalkylammonium hydroxide (R4N+OH-) as a base was developed. Lactones are ring-opened with Br2 and a substoichiometric amount of PBr3, leading to good yields of the corresponding α-bromocarboxylic acids. Subsequent intramolecular cyclization over 1 h using a two-phase system (H2O/CHCl3) containing R4N+OH- afforded α-bromo lactones in good yields. This method can be applied at the 10 mmol scale using simple operations. α-Bromo-δ-valerolactone, which is extremely reactive and difficult to isolate, could be isolated and stored in a freezer for about one week using the developed method. Optimizing the solvent for environmentally friendly large-scale syntheses revealed that methyl ethyl ketone (MEK) was as effective. In addition, in situ-generated α-bromo-δ-valerolactone was directly converted into a sulfur-substituted functional lactone without difficulty by reacting it with a sulfur nucleophile in one pot without isolation. This new bromination system is expected to facilitate the industrial use of α-bromolactones as important intermediates.
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A green method of the oxidation of benzylamines to imines was developed using a novel binary system of Au/C-CuO. This system was evaluated under atmospheric oxygen, and the corresponding imines were obtained in up to 100% yields by loading 0.006 mol % of Au/C and 1.25 mol % of CuO under mild conditions. This system was also successfully applied to the syntheses of N-containing functional molecules, as well as that of imines on the scale of several grams. Furthermore, the turnover number of the system (more than 8000 times on a gold basis) as well as its ability to be reused more than 10 times for benzylamine oxidation demonstrates the excellent durability and recyclability of the developed system.
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In this study, the reactivity of organochalcogen compounds toward a representative alkyl-lead bond compound under light was investigated in detail. Under light irradiation, the Cy-Pb bond of Cy6Pb2 (Cy = cyclohexyl) undergoes homolytic cleavage to generate a cyclohexyl radical (Cyâ¢). This radical can be successfully captured by diphenyl diselenide, which exhibits excellent carbon-radical-capturing ability. In the case of (PhS)2 and (PhTe)2, the yields of the corresponding cyclohexyl sulfides and tellurides were lower than that of (PhSe)2. This probably occurred due to the low carbon-radical-capturing ability of (PhS)2 and the high photosensitivity of the cyclohexyl-tellurium bond.
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Although most metal-organic frameworks (MOFs)âhighly porous crystalline metal complex networks with structural and functional varietiesâare electrically insulating, high electrical conduction has been recently demonstrated in MOFs while retaining permanent porosity. Usability of electronically active MOFs effectively emerges when they are created in a thin-film state as required in major potential applications such as chemiresistive sensors, supercapacitors, and electrode catalysts. Thin-film morphology including crystallinity, thickness, density, roughness, and orientation sensitively influences device performance. Fine control of such morphological parameters still remains as a main issue to be addressed. Here, we report a bottom-up procedure of assembling a conductive MOF nanosheet composed of 2,3,6,7,10,11-hexaiminotriphenylene molecules and nickel ions (HITP-Ni-NS). Creation of HITP-Ni-NS is achieved by applying air/liquid (A/L) interfacial bottom-up synthesis. HITP-Ni-NS has a multilayered structure with 14 nm thickness and is endowed with high crystallinity and uniaxial orientation, demonstrated by synchrotron X-ray crystallography. Facile transferability of HITP-Ni-NS assembled at air/liquid interfaces to any desired substrate enables us to measure its electrical conductivity, recorded as 0.6 S cm-1âhighest among those of triphenylene-based MOF nanosheets with a thickness lower than 100 nm.