Kusabereka uye kusabereka kuri kuwedzera, mune vese vakadzi nevarume, pasirese.
Kushaya mbereko kutadza, semurume nemukadzi, kubata pamuviri mushure memwedzi mitanhatu - 12 yekuedza.Kusabereka (Subfertility) zvinoreva kuva nemukana wakadzikira wekuva nepamuviri, maererano nevamwe vakaroorana.
Inofungidzirwa kuti 12-15% yevakaroorana vanoda, asi havakwanisi, kubata pamuviri.Nekuda kweizvi, marapirwo ekuzvara akadai seIVF, IUI, mahormone kana madhiragi nzira, mavhiya, nezvimwe, zviri kukurumidza kuwedzera mukurumbira.
Light therapy (dzimwe nguva inozivikanwa sephotobiomodulation, LLLT, red light therapy, inotonhora laser, nezvimwe.) inoratidza vimbiso yekuvandudza hutano hwenhengo dzakawanda dzemuviri dzakasiyana, uye yakadzidzwa kune zvese kuzvara kwemukadzi nekubereka kwemurume.Kurapa kwakareruka kurapwa kwakakodzera here?Muchikamu chino tichakurukura kuti sei chiedza chingave chese chaunoda…
Nhanganyaya
Kushaya mbereko idambudziko repasi rose revarume nevakadzi, uye huwandu hwembereko huchidzikira nekukurumidza, mune dzimwe nyika zvakanyanya kupfuura dzimwe.10% yevacheche vese vakaberekerwa muDenmark parizvino vakanambwa kuburikidza nerubatsiro rweIVF uye matekinoroji akafanana ekubereka.Muroora mumwe chete pavatanhatu muJapan haabereki, uye munguva pfupi yapfuura hurumende yeJapan yakapindira kuti ibhadhare mari yeIVF yevaviri kuti vamise dambudziko rehuwandu hwevanhu.Hurumende muHungary, ichishuvira kuwedzera mbereko dzakaderera, yaita kuti vakadzi vane vana vana kana kupfuura vasunungurwe kweupenyu hwose kubva pakubhadhara mutero wemari.Kuberekwa kwemukadzi kune dzimwe nyika dzeEurope kwakaderera se 1.2, uye kunyange kuderera se0,8 muSingapore.
Nhamba yekuzvarwa yave kuderera pasi rose, kubvira kuma1950 uye mune mamwe matunhu zvisati zvaitika.Hakusi kushaya mbereko kwevanhu chete kuri kuramba kuchiwedzera, marudzi akasiyana emhuka ari kuitawo matambudziko akadai semapurazi nezvipfuwo.Chikamu chekuderera kwehuwandu hwekuberekwa kunokonzerwa nemagariro evanhu - vakaroorana vari kusarudza kuedza vana gare gare, apo kubereka kwepanyama kwakatoderera.Chimwe chikamu chekuderera ndeyezvakatipoteredza, zvekudya uye mahomoni.Semuenzaniso huwandu hwembeu muavhareji yevarume hwadzikira ne50% mumakore makumi mana apfuura.Saka varume nhasi vari kungo gadzira hafu yemasero embeu sezvaiitwa namadzibaba avo nanasekuru kare muhuduku hwavo.Matambudziko ekubereka echikadzi akadai sepolycystic ovarian syndrome (PCOS) zvino akanganisa kusvika 10% yevakadzi.Endometriosis (chimiro chinokura matishu echibereko mune dzimwe nzvimbo dzekuberekesa) zvakare chinokanganisa mumwe muvakadzi gumi, saka vakadzi vangangoita mamirioni mazana maviri pasi rese.
Chiedza chekurapa ipfungwa nyowani yekurapa yekushaya mbereko, uye nyangwe ichiwira pasi peiyo 'ART' (tekinoroji inobatsira pakuzvara) seIVF, yakachipa zvakanyanya, isingapindire, uye iri nyore kuwana kurapwa.Chiedza chechiedza chakanyatsogadziriswa kurapwa kwehutano hwemaziso, matambudziko ekurwadziwa, kuporesa, nezvimwewo, uye iri kudzidzwa nesimba pasi rose nekuda kwemamiriro akasiyana-siyana uye nhengo dzemuviri.Mazhinji emazuva ano ekurapa kwechiedza chekutsvagisa mbereko ari kubuda munyika mbiri - Japan neDenmark - kunyanya kutsvagiro pamusoro pembereko yevakadzi.
Kubereka Kwemukadzi
50%, inenge hafu, yevose vakaroorana vasina mbereko imhaka yezvikonzero zvevakadzi chete, uye imwe 20% iri musanganiswa wevose vakadzi nevarume vasina mbereko.Saka vanenge 7 kubva pagumi rega reganyaya yekubata pamuviri inogona kuvandudzwa nekugadzirisa hutano hwevakadzi.
Zvinetso zveThyroid uye PCOS ndezvimwe zvezvikonzero zvinokonzera kusabereka, zvose zviri kunyanya kuongororwa (Verenga zvakawanda nezvehutano hwehutano uye chiedza chekurapa pano).Endometriosis, fibroids uye kumwe kukura kwemukati kusingadiwe kunopa imwe chikamu chikuru chenyaya dzekushaya mbereko.Kana mukadzi asingabereki, 30%+ yenguva pachange paine imwe nhanho yeendometriosis.Zvimwe zvinowanzokonzera kushaya mbereko ndezvi;fallopian tube blockages, mukati mavanga kubva pakuvhiyiwa (kusanganisira C-sections), uye mamwe matambudziko ovulation kunze kwepcos (anovulation, irregular, etc.).Kazhinji chikonzero chekushaya mbereko hachitsananguriki - hazvizivikanwe kuti sei.Mune zvimwe zviitiko kubata uye kuiswa kwezai kunoitika, asi pane imwe nguva mukutanga pamuviri pane kuparara.
Nekukurumidza kusimuka kwematambudziko ekuzvara, kwave nekukwira kwakafanana kwekurapa kwekushaya mbereko netsvagiridzo.Japan senyika ine imwe yematambudziko akaipisisa pasi rose, ine imwe yepamusoro-soro yekushandiswa kweIVF.Ivo zvakare mapiyona mukudzidza mhedzisiro yechiedza chekurapa pakuvandudza kubereka kwevakadzi….
Chiedza chekurapa uye kubereka kwevakadzi
Chiedza chekurapa chinoshandisa mwenje dzvuku, pedyo nechiedza che infrared, kana musanganiswa wezvose.Rudzi rwakanaka rwechiedza chechinangwa chinosiyana zvichienderana nechikamu chemuviri.
Kana uchitarisa kubereka kwevakadzi zvakananga, zvinonyanya kutariswa ichibereko, mazai, fallopian tubes uye general hormonal system (thyroid, brain, etc.).Matishu ose aya ari mukati memuviri (kusiyana nenhengo dzechirume dzekuberekana), uye saka rudzi rwechiedza nekupinda kwakanakisa runodikanwa, sezvo chikamu chidiki chechiedza chinorova ganda chichapinda pasi mumatumbu semaovari.Kunyangwe nehurefu hwemasaisai hunopa kupinza kwakaringana, huwandu hunopinda huchiri hudiki, uye saka kukwirira kwakanyanya kwechiedza kunodiwa zvakare.
Pedyo infrared mwenje pawavelengths pakati pe720nm ne840nm vane yakanakisa kupinda mukati mebiological tissue..Rudzi urwu rwechiedza rwunozivikanwa se'Near Infrared Window (mubiological tissue)' nekuda kwehumwe humwe hunoita hwekupfuura mukati memuviri.Vatsvagiri vari kutarisa kuvandudza kusabereka kwevakadzi nechiedza vakanyanya kusarudza iyo 830nm padyo neinfrared wavelength yekudzidza.Iyi 830nm wavelength haingopindi zvakanaka chete, asiwo ine simba rekuita pamasero edu, inovandudza basa ravo.
Chiedza pamutsipa
Imwe yetsvagiridzo yekutanga kubva kuJapan yaive yakavakirwa pa'The Proximal Priority Theory'.Pfungwa huru ndeyekuti uropi inhengo huru yemuviri uye dzimwe nhengo dzese nemahomoni masisitimu ari pasi kubva kuhuropi.Ingave kana kwete iyi pfungwa ndeyechokwadi, pane chimwe chokwadi kwairi.Vatsvagiri vakashandisa 830nm padhuze nemwenje infrared pamutsipa wevakadzi vekuJapan vasina mbereko, vachitarisira kuti iyo yakananga uye isina kunanga (kuburikidza neropa) mhedzisiro pahuropi zvinozotungamira kune zvirinani mahomoni uye metabolic mamiriro mumuviri wese, kunyanya kubereka.Mhedzisiro yacho yaive yakanaka, nechikamu chepamusoro chevakadzi vaimbonzi 'havachabereki zvakanyanya' kwete kubata pamuviri chete, asiwo kuwana vana vapenyu - vachigamuchira mwana wavo munyika.
Kutevera kubva kuzvidzidzo vachishandisa chiedza pamutsipa, vatsvakurudzi vaifarira kuti kana kwete kurapwa kwechiedza kunogona kuvandudza kubudirira kwehutano hwepamuviri uye IVF.
In vitro fertilization inozivikanwa senzira yekupedzisira kana nzira dzechinyakare dzekubata pamuviri dzatadza.Mutengo wega wega unogona kunge wakakwira zvakanyanya, kunyangwe zvisingaite kune vakaroora vazhinji, vamwe vachitora zvikwereti sekubheja kuti vazvipe mari.Huwandu hwekubudirira kweIVF hunogona kunge hwakaderera, kunyanya muvakadzi vane makore makumi matatu nemashanu kana kupfuura.Tichifunga nezve mutengo wakakwira uye yakaderera budiriro mwero, kuvandudza mikana yeIVF kutenderera kwakakosha kuzadzisa chinangwa chekuzvitakura.Kubvisa kudiwa kweIVF uye kubata pamuviri pachako mushure mekutadza kutenderera kunotonyanya kufadza.
Miyero yekuisirwa yezai rakagadzirwa (yakakosha kune ese ari maviri IVF uye yenguva dzose kubata pamuviri) inofungidzirwa kuti ine chekuita nemitochondrial basa.Kuita pasi mitochondria kunotadzisa kushanda kwezai sero.Iyo mitochondria inowanikwa mumasero ezai inogarwa nhaka kubva kuna amai, uye inogona kuve nekuchinja kweDNA mune vamwe vakadzi, kunyanya nekufambira mberi kwezera.Tsvuku uye padhuze infrared light therapy inoshanda zvakananga pamitochondria, kuvandudza basa uye kuderedza nyaya senge DNA shanduko.Izvi zvinotsanangura kuti nei imwe ongororo yakaitwa kuDenmark yakaratidza kuti zvikamu zviviri muzvitatu zvevakadzi vakambotadza kutenderera kweIVF vakawana nhumbu yakabudirira (kunyangwe nhumbu chaidzo) nekurapa kwakareruka.Paitove nenyaya yekuti mukadzi ane 50 years aita nhumbu.
Chiedza padumbu
Iyo protocol yakashandiswa muchidzidzo ichi kubva kuDenmark yaisanganisira pedyo ne infrared light therapy sessions pasvondo, chiedza chichiiswa zvakananga kudumbu, pamwero mukuru.Kana mukadzi asina kubata pamuviri panguva yazvino yekuenda kumwedzi, marapirwo akaenderera mberi mune inotevera.Kubva mumuenzaniso wevakadzi mazana mana vaimbove vasina mbereko, mazana maviri nemakumi matanhatu vavo vakakwanisa kubata pamuviri vachitevera pedyo ne infrared light treatments.Kuderera kwehutano hwezai haisi nzira isingagadziriswi, zvingaita sokuti.Tsvagiridzo iyi inomutsa mibvunzo pamusoro pechirongwa cheART chekubvisa nucleus yezai remukadzi nekuripinza mumasero ezai remunhu anopa mari (inozivikanwa semitochondrial transfer, orperson/mubereki vacheche) - zvinonyatsodiwa here kana masero ezai remukadzi achikwanisa kudzoreredzwa ne-non-invasive therapy.
Kushandisa chiedza chekurapa zvakananga padumbu (kunangisa mazai, chibereko, fallopian tubes, mazai evha, nezvimwewo) inofungidzirwa kushanda nenzira mbiri.Chekutanga optimizes nharaunda yokuberekana hurongwa, kuona kuti zai masero asunungurwa panguva ovulation, anogona kufamba pasi fallopian chubhu, uye anogona kudyara muine utano chibereko rusvingo uye zvakanaka kubuda ropa, ane utano placenta anogona kuumba, etc. Imwe nzira inosanganisira. kuvandudza hutano hwezai sero zvakananga.Oocyte masero, kana masero ezai, anoda huwandu hukuru hwesimba zvichienzaniswa nemamwe maseru kune maitiro ane chekuita nekupatsanurwa kwesero uye kukura.Iri simba rinopihwa nemitochondria - chikamu chesero chinobatwa nechiedza chekurapa.Kudzikira mitochondrial basa rinogona kuonekwa seyakakosha cellular chikonzero chekushaya mbereko.Iyi inogona kunge iri tsananguro yakakosha yezvakawanda zvembereko 'zvisingatsananguriki' uye nei mbereko ichidzikira nekukura - masero ezai haakwanise kuita simba rakakwana.Uchapupu hwekuti vanoda uye kushandisa simba rakawanda kudaro hunowanikwa nekuti kune 200 times more mitochondria mumasero ezai kana ichienzaniswa nemamwe masero enguva dzose.Ndiwo mukana wakapetwa ka200 wemhedzisiro uye mabhenefiti kubva kuchiedza kurapa maererano nemamwe maseru ari mumuviri.Pasero rega rega riri mumuviri wese wemunhu, murume kana mukadzi, sero rezai rinogona kunge riri iro rudzi rwunogamuchira zvakanyanya kuwedzeredzwa kubva kune tsvuku uye pedyo ne infrared light therapy.Dambudziko chete nderekuwana mwenje kuti upinde pasi kusvika kumaovari (zvimwe pane izvo pazasi).
Ose ari maviri aya kurapa kwechiedza kana 'photobiomodulation' magadzirirwo pamwe chete anoumba hutano uye hudiki nharaunda, yakakodzera kutsigira iri kukura embryo.
Kubereka Kwemurume
Vanhurume ndivo vanokonzeresa vanenge makumi matatu muzana yevakaroora vasina mbereko, nemusanganiswa wevarume nevakadzi zvinhu zvinoverengera imwe 20% pamusoro pazvo.Saka hafu yenguva, kuvandudza hutano hwemurume huchagadzirisa nyaya dzembereko dzevakaroorana.Matambudziko ekuzvara muvarume anowanzoenderana nekudzikira kwe testicular function, zvichikonzera dambudziko nesperm.Kune zvimwe zvikonzero zvakasiyana zvakare, senge;retrograde ejaculation, yakaoma ejaculate, masoja ekudzivirira chirwere anorwisa urume, uye zviuru nezviuru zvemajini uye zvakatipoteredza.Zvirwere zvegomarara uye utachiona hunogona kukanganisa zvachose kukwanisa kwema testes kugadzira urume.
Zvinhu zvakaita sekuputa fodya uye kunwa doro nguva dzose zvine mhedzisiro yakaipa pahuwandu hwembeu uye kunaka kwembeu.Kusvuta kwababa kunotoderedza mwero wekubudirira weIVF mitsetse nehafu.
Nekudaro, kune zvakatipoteredza uye zvekudya zvinogona kuvandudza kugadzirwa kwembeu uye mhando, senge yakagadziridzwa zinc chimiro uye tsvuku mwenje kurapa.
Chiedza chekurapa hachizivikanwe pakurapa nyaya dzekuzvara, asi kutsvaga nekukurumidza papubmed kunoratidza mazana ezvidzidzo.
Chiedza Therapy uye kubereka kwemurume
Chiedza chekurapa (aka photobiomodulation) chinosanganisira kushandiswa kwechitsvuku chinooneka, kana chisingaonekwe pedyo ne infrared, chiedza kumuviri uye chinonyatso dzidza nezvehutano hwembeu.
Saka ndeipi rudzi rwechiedza rwakanyanya uye ndeupi chaiwo wavelength?Tsvuku, kana pedyo ne infrared?
Chiedza dzvuku pa670nm parizvino ndiyo yakanyatso tsvagurudzwa uye inoshanda renji yekuvandudza hutano hwemurume wekubereka uye mhando yembeu.
Inokurumidza, yakasimba masero embeu
Zvidzidzo zvinoratidza kuti kunyangwe mushure mechikamu chimwe chete chered light therapy, sperm motility (kushambira kumhanya) inovandudza zvakanyanya:
Kufamba kana kumhanya kwemasero embeu kwakakosha pakuzvara, sezvo pasina kumhanya kwakakwana, urume hahumbofa hwakaita rwendo kusvika pasero rezai remukadzi nekurisanganisa.Nehumbowo hwakasimba, hwakajeka hwekuti kurapwa kwechiedza kunonatsiridza kufamba, kushandisa mudziyo wakakodzera wekurapa wemwenje unoratidzika kunge wakakosha kune chero murume nemukadzi vasina mbereko.Iyo yakagadziridzwa motility kubva pachiedza kurapa inogona kutokunda nyaya iyo yakaderera sperm kuverenga, nekuti iyo yakaderera chiyero chembeu ichiri kukwanisa kusvika uye (imwe yacho) inobatanidza zai sero.
Mamirioni mamwe masero embeu
Chiedza chekurapa hachingonatsiridze kufamba, zvidzidzo zvakasiyana-siyana zvinoratidza kuti zvinogona sei kuvandudza huwandu hwesperm / concentration, kupa kwete kukurumidza kukurumidza urume, asi akawanda acho.
Anenge esero ese mumuviri wedu ane mitochondria - chinangwa chered light therapy - kusanganisira Sertoli Masero.Aya ndiwo macells anogadzira urume ema testes - nzvimbo inogadzirwa urume.Kushanda zvakanaka kwemaseru aya kwakakosha pazvinhu zvese zvekubereka kwemurume, kusanganisira kuverenga kwembeu.
Zvidzidzo zvinonongedza kurapwa kwakareruka kunatsiridza huwandu hweSertoli Masero mumachende echirume, kushanda kwawo (uye saka huwandu hwemasero embeu/kuverengeka kwaanogadzira), uye zvakare kudzikisira kuburitswa kwemaseru asina kujairika.Huwandu hwesperm hwakaonekwa huchivandudzika neka2-5 muvarume vane huwandu hwaive hwakaderera.Mune imwe ongororo yakaitwa kuDenmark, huwandu hwemasperms hwakakwira kubva pamamiriyoni maviri pamill kusvika pamamiriyoni makumi mana paml nekurapwa kumwe chete kumachende.
Kuwanda kwembeu, kukurumidza kufamba kwembeu, uye kushomeka kwembeu ndizvo zvimwe zvezvikonzero zvakakosha nei kurapwa kwechiedza chiri chikamu chakakosha chekuvandudza chero nyaya yembereko.
Dzivisa kupisa zvachose
Mucherechedzo wakakosha pachiedza chekurapa kwema testes:
Testes dzevanhu dzinodzika kubva mumuviri dzichipinda muscrotum nechikonzero chakakosha - dzinoda tembiricha yakaderera kuti ishande pairi.Pakupisa kwemuviri kwe37°C (98.6°F) havakwanise kuburitsa urume.Kuita kwespermatogenesis kunoda kudonha kwetembiricha pakati pe2 ne5 madhigirii kubva pakati pekushisa kwemuviri.Zvakakosha kufunga nezve tembiricha inodiwa kana uchisarudza mudziyo wekurapa mwenje wekubereka kwemurume - iyo inonyanya kushandisa simba rudzi rwemwenje inofanira kushandiswa - maLED.Kunyangwe ne LEDs, kune hunyoro hwekudziya hunoita hunonzwa mushure menguva refu.Kuisa muyero wakakodzera nehurefu hwakakodzera hwemwenje dzvuku inobata simba ndicho chinhu chakakosha pakuvandudza kubereka kwemurume.Mamwe mashoko pazasi.
Iyo meshini - izvo zvitsvuku / infrared mwenje zvinoita
Kuti tinyatsonzwisisa kuti sei dzvuku / IR mwenje uchibatsira nekubereka kwemurume nemukadzi, isu tinofanirwa kuziva kuti inoshanda sei pamaserura.
Mechanism
Migumisiro yetsvuku uye pedyo infrared light therapyZvinofungidzirwa kuti zvinobva mukudyidzana nemasero edu mitochondria.Izvi'photobiomodulation' zvinoitika kana mafungu akakodzera echiedza, ari pakati pe600nm ne850nm, akatorwa nemitochondrion, uye pakupedzisira achitungamira mukugadzirwa kwesimba kuri nani uye kushomeka kuzvimba muchitokisi.
Chimwe chezvinangwa zvakakosha zvechiedza chekurapa enzyme inonzi Cytochrome C Oxidase - chikamu chemagetsi ekufambisa cheni maitiro emagetsi metabolism.Zvinonzwisiswa kuti kune zvimwe zvikamu zvakati wandei zvemitochondria zvinokanganiswawo.Aya mitochondria akanyanya kuwanda muzai nemasero embeu.
Nguva pfupi mushure mechikamu chekurapa kwechiedza, zvinokwanisika kuona kuburitswa kwemorekuru inonzi Nitric Oxide kubva kumaseru.Iyi HAPANA molecule inoshingairira kufema, ichivharira kugadzirwa kwesimba uye kushandiswa kweokisijeni.Saka, kuibvisa kubva musero kunodzorera yakajairika hutano basa.Tsvuku uye pedyo nechiedza che infrared inofungidzirwa kuti inoparadzanisa molecule iyi inoshungurudza kubva kuCytochrome C Oxidase enzyme, kudzorera hutano hwehutano hwekushandiswa kweokisijeni nekugadzirwa kwesimba.
Chiedza chechiedza chinewo mhedzisiro pamvura mukati memasero edu, ichiigadzira nenzvimbo yakawanda pakati pemorekuru rimwe nerimwe.Izvi zvinoshandura chimiro chemakemikari uye chemuviri chesero, zvichireva kuti kudya uye zviwanikwa zvinogona kupinda nyore nyore, chepfu inogona kudzingwa nekushomeka kushoma, ma enzymes uye mapuroteni anoshanda zvakanyanya.Izvi pamvura yemaserura zvinoshanda kwete zvakananga mukati memasero, asiwo kunze kwayo, munzvimbo yekunze uye matishu seropa.
Iyi ingori pfupiso inokurumidza ye2 nzira dzekuita.Panogona kunge paine zvimwe, zvisinganzwisisike zvizere, zvinobatsira zvinoitika padanho remaserura kutsanangura mhedzisiro kubva muchiedza chekurapa.
Upenyu hwose hunopindirana nechiedza - zvinomera zvinoda chiedza chekudya, vanhu vanoda ultraviolet chiedza chevhitamini D, uye sezvinoratidzwa nezvidzidzo zvose, tsvuku uye pedyo nechiedza che infrared chakakosha kuvanhu uye mhuka dzakasiyana-siyana kune utano hwakanaka hwemetabolism uye kunyange kubereka.
Migumisiro yechiedza chechiedza haisi kungoonekwa munzvimbo inotarirwa yemusangano, asiwo systemically.Semuyenzaniso chikamu chechiedza chekurapa paruoko rwako chinogona kupa mabhenefiti kumoyo.Chikamu chechirapa chakareruka pamutsipa chinogona kupa mabhenefiti kuhuropi, izvo zvinogona kuvandudza kugadzirwa kwehomoni / chimiro uye zvinotungamira kune zvinoshamisa hutano hwemuviri wese.Kurapa kwechiedza kwakakosha pakubvisa kushushikana kweserura uye kuita kuti masero ako ashande zvakajairika zvakare uye maseru ehurongwa hwekubereka haana kusiyana.
Summary
Kurapa kwechiedza kwakadzidziswa kubereka kwevanhu / mhuka kwemakumi emakore
Pedyo nechiedza cheInfrared chakadzidzwa kuvandudza chimiro chembereko muvakadzi
Inovandudza kugadzirwa kwesimba mumasero ezai - zvakakosha pakubata pamuviri
Red Light therapy inoratidzwa kuvandudza kugadzirwa kwesimba muSertoli maseru uye sperm masero, izvo zvinotungamira mukuwedzera huwandu hwesperm uye mhando.
Zvese zvinhu zvekubereka (murume nemukadzi) zvinoda huwandu hukuru hwesimba remagetsi
Kurapa kwechiedza kunobatsira maseru kuti asangane nezvinodiwa zvesimba
LEDs uye lasers ndiyo chete michina yakanyatsodzidza.
Red wavelengths pakati pe620nm ne670nm akanakira vanhurume.
Pedyo neInfrared mwenje yakatenderedza 830nm renji inoita seyakanakira kubereka kwevakadzi.
Nguva yekutumira: Sep-28-2022