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J Cardiothorac Vasc Anesth 2018 02 7;32(1):290-296. Epub 2017 Oct 7.

Department of Anesthesiology and Pain Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea. Electronic address:

Objective: To compare GlideScope and lighted stylet for double-lumen endobronchial tube (DLT) intubation in terms of intubation time, success rate of first attempt at intubation, difficulty in DLT advancement toward the glottis, and postoperative sore throat and hoarseness.

Design: A prospective, randomized study.

Setting: Medical center governed by a university hostpial. Read More

Ann Otol Rhinol Laryngol 2016 Nov 23;125(11):943-946. Epub 2016 Aug 23.

Department of Otolaryngology-Head & Neck Surgery, Loyola University Medical Center, Maywood, IL, USA.

Objective: To describe a technique for tracheostomy in heterotopic ossification that has not yet been described in the literature.

Methods: We report a case of difficult tracheostomy while using conventional techniques in a 68-year-old patient who underwent mitral valve replacement requiring warfarin therapy three months prior. Imaging revealed heterotopic ossification overlying the trachea. Read More

Anesthesiology 2016 10;125(4):656-66

From the Department of Anesthesiology, Oregon Health & Science University, Portland, Oregon (M.F.A., A.M.B.); Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan (D.W.H., A.S., T.T., J. Ragheb, S.K.); Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut (A.W.W.); Department of Anesthesiology, University of Colorado, Aurora, Colorado (L.J.); Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (D.A.B.); Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont (W.C.P.); Department of Anesthesiology, Washington University, St. Louis, Missouri (J. Rao); Department of Anesthesiology, University of Tennessee Graduate School of Medicine, Knoxville, Tennessee (J.L.E.); Department of Anesthesiology, University of Virginia, Charlottesville, Virginia (D.A.C.); and Department of Anesthesiology, University of Utah, Salt Lake City, Utah (P.B.).

Background: Multiple attempts at tracheal intubation are associated with mortality, and successful rescue requires a structured plan. However, there remains a paucity of data to guide the choice of intubation rescue technique after failed initial direct laryngoscopy. The authors studied a large perioperative database to determine success rates for commonly used intubation rescue techniques. Read More

J Emerg Med 2016 Sep 2;51(3):262-4. Epub 2016 Jul 2.

Intensive Care Unit, Hôpital d'instruction des armées PERCY, Clamart, France.

Background: Out-of-hospital endotracheal intubation is a frequent procedure for trauma care. Nevertheless, in warm climates, sunlight and heat can interfere with the flow of the usual procedure. They can affect the equipment and hinder the operator. Read More

Masui 2015 Oct;64(10):1045-7

Videolaryngoscope is useful in patients with difficult airways, but it may not be in some patients. We report the use of a lighted stylet to facilitate tracheal intubation in 2 patients in whom laryngoscopy with a videolaryngoscope was difficult. Case 1: A 52-year-old female with loose teeth and lockjaw presented for a scoliosis surgery under general anesthesia. Read More

Can J Anaesth 2013 May 1;60(5):444-9. Epub 2013 Feb 1.

School of Electrical Engineering, University of Ulsan, Ulsan, South Korea.

Purpose: This study is a feasibility assessment to determine the ability of novice users to utilize an infrared (IR) sensor stylet as a guide to position the tip of the endotracheal tube (ETT) 40 mm proximal to the carina in the swine trachea.

Methods: We developed a stylet system using an IR sensor attached to the tip of a stylet to facilitate measuring the distance of the ETT from the carina. The indicator lamp of the IR sensor system turns on through calibration when the ETT tip arrives at a point 20 mm proximal to the carina. Read More

Rev Esp Anestesiol Reanim 2013 Feb 15;60(2):74-8. Epub 2012 Nov 15.

Servicio de Anestesiología, Instituto Venezolano Seguro Social, Hospital Dr. Montezuma Ginnari, Valera, Venezuela.

Objectives: To evaluate the difficulty of intubation with a lighted stylet by correlating the body mass index (BMI) with the neck or cervical circumference (CC), and to establish the values of BMI and CC that could help identify a possible difficult intubation with this device.

Patients And Methods: An observational and correlational study was performed on selected patients by consecutive sampling who were intubated using the lighted stylet. Variables such as age, gender, ASA physical status, BMI, CC, transillumination intensity, Cormack-Lehane grade, and Mallampati scores, were recorded. Read More

J Int Med Res 2012 ;40(4):1519-31

Department of Anaesthesiology, Southwest Hospital, Third Military Medical University, 19 Gaotanyan Street, Shapingba, Chongqing 400038, China.

Objective: To evaluate the effect on intubation success of different bent lengths of a lightwand (a malleable illuminating stylet used for intubation), based on the patient's thyroid prominence-to-mandibular angle distance (TMD), thyroid prominence-to-incisor distance (TID) and gender.

Methods: This prospective, randomized, blinded study included patients undergoing elective surgery. In group A, the bent length was determined based on the patient's gender. Read More

Vet J 2013 Feb 25;195(2):254-6. Epub 2012 Jul 25.

Department of Anesthesiology, Yuan's General Hospital, No. 162, Cheng-Kung 1st Road, Kaohsiung City 80249, Taiwan.

Efficient oral endotracheal intubation of laboratory animals is a challenging technique in veterinary research. This study introduces a miniaturized lighted stylet for rabbit intubation. An experiment with repeated measures on two factors was used to assess the feasibility and efficacy of this method. Read More

Laryngoscope 2011 Nov 24;121(11):2391-3. Epub 2011 Aug 24.

Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, The University of Washington School of Medicine, Seattle, Washington 98195, USA.

Objectives: Video-assisted endoscopic intubation (VAEI) has gained wide use in anesthesiology when difficult intubation is encountered. Even when excellent visualization of the larynx is achieved with VAEI, successful intubation can be difficult and/or traumatic due to awkward angles and rigid stylets. Presented is a modification of standard VAEI procedure that allows for minimization of intubation trauma. Read More

Rev Bras Anestesiol 2011 Jul-Aug;61(4):447-55

Universidade Federal de Juiz de Fora, Brazil.

Background And Objectives: Anesthesiologists are responsible for airway management whenever they assume the anesthesia of a patient. In this study, we compare the hemodynamic parameters of rigid laryngoscopy and lighted stylet in patients with coronariopathies.

Patients And Methods: This randomized clinical trial included 40 patients undergoing myocardial revascularization assigned into two groups: lighted stylet and rigid laryngoscope. Read More

Spine (Phila Pa 1976) 2012 Mar;37(6):476-81

University of Rochester/Strong Memorial Hospital, Rochester, NY, USA.

Study Design: Human cadaveric study using various intubation devices in a cervical spine instability model.

Objective: We sought to evaluate various intubation techniques and determine which device results in the least cervical motion in the setting of a global ligamentous instability model.

Summary Of Background Data: Many patients presenting with a cervical spine injury have other injuries that may require rapid airway management with endotracheal intubation. Read More

J Anesth 2011 Apr 2;25(2):294-7. Epub 2011 Feb 2.

Department of Anesthesiology, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Suntoh-gun, Shizuoka 411-8777, Japan.

We report a case of epiglottic prolapse induced by lighted stylet tracheal intubation perceived by following upper gastrointestinal endoscopy. A 68-year-old male was to undergo endoscopic mucosal resection (EMR) under general anesthesia for a superficial orolarynx cancer spreading over the root of the tongue. Because the mucosal change was so minimal, intubation was performed with a lighted stylet instead of a direct laryngoscope, to prevent its metal blade spoiling the delicate endoscopic findings. Read More

Anaesthesist 2010 Sep 13;59(9):806-11. Epub 2010 Aug 13.

Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der J W Goethe-Universität Frankfurt am Main.

Background: Previous studies have shown that video laryngoscopy enhances laryngeal view in patients with apparently normal and difficult airways. The utility of the novel, portable, battery-powered C-MAC video laryngoscope is as yet unproven. It was hypothesized that in routine patients undergoing ENT surgery, the rate of glottic views considered unsatisfactory, i. Read More

J Anesth 2010 Oct 7;24(5):811-4. Epub 2010 Aug 7.

VA Western New York Healthcare System, Division of Critical Care and Pain Medicine, Department of Anesthesiology, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Rm 203C, 3495 Bailey Ave, Buffalo, NY 14215, USA.

We have surveyed the availability of equipment, content of difficult-airway carts (DAC), and training in the use of such equipment in intensive-care units (ICU). We devised a set of proposals regarding what constitutes the ideal DAC. We surveyed 300 ICU in the United States. Read More

Rev Bras Anestesiol 2010 Mar-Apr;60(2):138-43, 79-82

Hospital Santa Cruz.

Background And Objectives: Approaching the airways with a laryngoscope can cause different types of injuries. The objective of the present study was to determine whether lighted stylet tracheal intubation can be a less traumatic alternative for patients when compared to direct laryngoscopy.

Methods: Ninety-eight patients between 16 and 88 years and physical status ASA I and II participated in the present study. Read More

Middle East J Anaesthesiol 2009 Oct;20(3):447-50

Anaesthesiology & Critical care Deptt, NSCB Subharti Medical College, Meerut (UP), India.

Anesth Analg 2010 Feb 21;110(2):508-14. Epub 2009 Nov 21.

Department of Anaesthesiology, West China Hospital, Sichuan University, State Key Laboratory of Biotherapy of Cancer, Chengdu, Sichuan, People's Republic of China.

Background: In this study, we evaluated the feasibility and accuracy of Univent tube (Fuji Systems, Tokyo, Japan) placement with the aid of auscultation (AUS) or as guided by a lighted stylet (LS) compared with placement guided by the fiberoptic bronchoscope (FOB) or the blind intubation technique as recommended by the manufacturer's guidelines.

Methods: Eighty ASA physical status I-II adult patients requiring single-lung ventilation for elective thoracic surgery were randomly allocated into 4 groups according to the method used for Univent tube positioning: manufacturer-recommended (MR) group (n = 20); FOB group (n = 20); AUS group (n = 20); and LS group (n = 20). Tracheal placement of the Univent tube was accomplished with direct rigid laryngoscopy after anesthetic induction and was positioned by the same anesthesiologist using 1 of the above-described methods. Read More

J Clin Anesth 2009 Jun 6;21(4):258-63. Epub 2009 Jun 6.

Department of Anesthesiology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University Hospital, Kaohsiung, 807, Taiwan.

Study Objective: To investigate the efficiency of a double curve nasotracheal tube on lightwand-guided nasotracheal intubation.

Design: Prospective, randomized, controlled trial.

Setting: University medical center hospital. Read More

Minerva Anestesiol 2009 May;75(5):307-11

Department of Anesthesiology and Resuscitation, Pitié-Salpétrière Hospital, Paris, France.

Maintenance of a patent and prevention of aspiration are essential for the management of the trauma patient, that requires experienced physicians in airway control techniques. Difficulties of the airway control in the trauma setting are increased by the vital failures, the risk of aspiration, the potential cervical spine injury, the combative patient, and the obvious risk of difficult tracheal intubation related to specific injury related to the trauma. Endotracheal intubation remains the gold standard in trauma patient airway management and should be performed via the oral route with a rapid sequence induction and a manual in-line stabilization maneuver, to decrease the risks previously mentioned. Read More

Anesth Analg 2009 May;108(5):1638-43

Departement of Anesthesiology, Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Montreal, Canada.

Background: Tracheal intubation of an unstable cervical spine (c-spine) patient with the flexible fiberoptic bronchoscope (FOB) is thought to minimize c-spine movement but may be technically difficult in certain patients. Intubation using a luminous stylet, such as the Trachlight(R) (TL), also produces minimal motion of the c-spine and may be an interesting alternative technique for patients with an unstable c-spine. In this study, we compared the cervical motion caused by the TL and the FOB during intubation. Read More

Anesth Analg 2009 Apr;108(4):1215-9

Department of Anesthesiology and Pain Medicine, School of Medicine, Konkuk University, Seoul, Korea.

Background: A lighted stylet is an effective alternative to a direct laryngoscope and has been reported to be particularly useful in patients with difficult airways. A high Mallampati class indicates poor visibility of the oropharyngeal structures. Because a lighted stylet does not require direct oropharyngeal visualization, we hypothesized that the lighted stylet would be easier to use than a direct laryngoscope in patients with a high Mallampati score. Read More

Can J Anaesth 2009 Feb 31;56(2):147-50. Epub 2008 Dec 31.

Department of Anesthesia, Toronto Western Hospital, University of Toronto, MC2-405, Toronto, ON, Canada, M5T 2S8.

Purpose: Hallermann-Streiff syndrome is a congenital syndrome associated with oculomandibulofacial abnormalities and potentially difficult airways. This case report describes the novel use of a lighted stylet-guided tracheal tube insertion through a new supraglottic airway, the intubating laryngeal airway (ILA), in a patient with Hallermann-Streiff syndrome who had anticipated difficult airway.

Clinical Features: A 26-year-old male with Hallermann-Streiff syndrome was scheduled for a vitrectomy. Read More

Anesth Analg 2008 Dec;107(6):2095-6

J Cardiothorac Vasc Anesth 2007 Oct 6;21(5):774-5. Epub 2007 Apr 6.

Masui 2006 Aug;55(8):999-1001

Department of Anesthesia, Kansai Rosai Hospital, Amagasaki 660-8511.

Background: Trachlight is a light-tipped stylet designed to guide tracheal intubation. It obviates the need for direct laryngoscopy and is reported to be particularly useful for managing difficult tracheal intubation. Its clinical application, however, is not limited to difficult airway management. Read More

Anesth Analg 2005 Sep;101(3):910-5, table of contents

Department of Anesthesia and Perioperative Medicine, University of Western Ontario, 339 Windermere Road, London, Ontario, Canada N6A 5A5. [corrected]

The question of which is the optimum technique to intubate the trachea in a patient who may have a cervical(C)-spine injury remains unresolved. We compared, using fluoroscopic video, C-spine motion during intubation for Macintosh 3 blade, GlideScope, and Intubating Lighted Stylet, popularly known as the Lightwand or Trachlight. Thirty-six healthy patients were randomized to participate in a crossover trial of either Lightwand or GlideScope to Macintosh laryngoscopy, with in-line stabilization. Read More

Anesth Analg 2005 May;100(5):1439-46, table of contents

Department of Anesthesiology, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8.

The purpose of this study was to determine the preferences of Canadian anesthesiologists in difficult intubation and cannot intubate-cannot ventilate (CICV) situations. Using a mailed survey, we asked anesthesiologists their preferences for and comfort level in using (a) alternative airway devices in a difficult intubation scenario and (b) infraglottic airway in a CICV scenario. Chi-square analysis and Student's t-test were used for categorical and continuous variables. Read More

Contemp Top Lab Anim Sci 2005 Mar;44(2):52-5

Department of Imaging Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.

A safe and efficient method for endotracheal intubation was needed to mechanically ventilate mice and rats for various research projects. We developed an easy, reliable, and expeditious method for intubating these rodents. Inexpensive disposable Teflon intravenous catheters are used as endotracheal tubes. Read More

Rev Esp Anestesiol Reanim 2004 Oct;51(8):456-60

Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen de las Nieves, Granada.

Laryngoscopy and tracheal intubation produce intense noxious stimuli and are associated with an adrenergic response that can be deleterious in patients with concomitant diseases. Illuminating stylets effectively aid blind intubation by lighting the trachea, and using such devices has been associated with lower incidences of sore throat, dysphonia, and adverse hemodynamic events in comparison with rigid laryngoscopy. We report the case of a female patient with a catecholamine-secreting vagal paraganglioma. Read More

J Clin Anesth 2004 Sep;16(6):445-8

Department of Anesthesiology, Children's Hospital, Boston, MA 02115, USA.

A severe limb injury challenges an anesthesiologist's ability to provide care. We describe the difficulties encountered by an anesthesiology resident with a severely injured left arm and present solutions to overcoming an inability to perform traditional direct laryngoscopy. Airway management adjuncts explored include modified left-handed direct laryngoscopy, lighted stylet intubation, fiberoptic intubation, Laryngeal Mask Airway, Combitube, retrograde wire technique, and the eventual conversion to direct laryngoscopy with the right hand with the reversed Macintosh and the Cranwall modification of the Miller blade. Read More

Can J Anaesth 2003 May;50(5):511-3

Department of Anesthesiology, Changhua Christian Hospital, 135 Nanhsiao Street, Changhua 500, Taiwan.

Purpose: To evaluate, using an endotracheal tube mounted on a flexible lighted stylet, how the patient's head-neck position and inflation of the endotracheal cuff affect correct alignment of the tube tip with the glottis.

Methods: Eighty-two patients were enrolled. The course of the endotracheal tube in the pharynx was examined by observing the anterior neck for transillumination in each patient under four different intubating conditions. Read More

J Med Assoc Thai 2002 Sep;85 Suppl 3:S963-8

Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.

Transillumination of the soft tissue of the neck using a lighted stylet (lightwand) is an effective and safe intubating technique in experienced hands. The goal of this study was to determine the effectiveness and safety of this device in intubating the trachea of elective surgical patients by non-experienced hands. One hundred and fifty, paralysed, anesthetized, adult patients (ASA I-II, no known or potential problems with intubation) were studied. Read More

Anaesth Intensive Care 2002 Aug;30(4):462-6

Department of Anaesthesia, The Children's Hospital at Westmead, NSW, Australia.

The Shikani Seeing Stylet is a recently introduced reusable intubating stylet, produced in adult and paediatric versions. It combines features of a fibreoptic bronchoscope and a lightwand. Inside a malleable stainless steel sheath, the Shikani Seeing Stylet has a fibreoptic cable leading to a distal light source and high-resolution lens. Read More

Emerg Med J 2002 Jul;19(4):292-4

Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore.

Objective: To compare the ease of use of the direct vision laryngoscope and the lighted stylet (Trachlight) by novice staff.

Methods: Ten novice medical officers (MOs) performed orotracheal intubations using either the conventional direct vision laryngoscope (DL) or a lighted stylet device (Trachlight). They performed their DL intubations during the first phase of the study, followed by the Trachlight intubations in the subsequent phase. Read More

Masui 2001 Nov;50(11):1239-41

Department of Anesthesiology, Kudanzaka Hospital, Tokyo 102-0074.

A 28 year-old-woman with the first and second brancheal arch syndrome was scheduled for the lift of the inferior part of the right ear. Difficult intubation was expected because of the mandibular hypoplasia. We chose a lightwand stylet for tracheal intubation. Read More

Anesthesiology 2001 Nov;95(5):1304-5

Masui 2001 Mar;50(3):270-2

Department of Anesthesia, Yamaguchi Prefectural Central Hospital, Hofu 747-8511.

We report that Trachlight-guided nasotracheal intubation might be achieved successfully and traumatically without removal of a stiff internal stylet. Endotracheal tube was mounted on a Trachlight with the stylet in position and bent to form a less sharp curvature than a right angle, namely 40-60 degree, at 7 cm proximal to the endotracheal tube tip. Forty-six patients scheduled for nasal intubation were studied to measure the intubation time and the success rate with the use of Trachlight. Read More

Anaesthesia 2000 May;55(5):485-8

Accident and Emergency Department, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.

The need for tracheal intubation in the emergency department is often unpredictable and precipitous in nature. When compared with the operating room, a higher incidence of difficult intubation is observed. There are currently no accepted guidelines with respect to the stocking of difficult airway equipment in the emergency department. Read More

Anesth Analg 2000 Mar;90(3):745-56

Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.

Anesthesiology 1999 Dec;91(6):1628-32

Institute of Medical Science, Department of Anesthesiology, Faculty of Medicine, University of Tokyo, Japan.

Background: Failed or difficult tracheal intubation is an important cause of morbidity and mortality during anesthesia. Although a number of fiberoptic devices are available to circumvent this problem, many do not allow manual control of the flexion of the tip and necessitate time-consuming preparation, special training, or the use of an external light source. To improve these limitations, the authors designed a new fiberoptic stylet scope (FSS) that has a simple form of a standard stylet with the fiberoptic view and maneuverability of its tip. Read More

Anesthesiology 1999 Nov;91(5):1560-1

Masui 1999 Jun;48(6):672-7

Department of Anesthesiology, Moji Rosai Hospital, Kitakyushu.

We studied the reasons why tracheal intubation using a lighted stylet (Trachlight) was sometimes difficult for unexperienced intubators. We also examined light-guided intubation skill acquisition in inexperienced anesthesiologists. Two anesthesiologists, with no prior experience in using a Trachlight, performed orotracheal intubation using a Trachlight in 60 anesthetized patients (30 patients each). Read More

Masui 1999 Apr;48(4):419-20

Department of Anesthesiology, Kansai Medical University, Moriguchi.

The intubating laryngeal mask has a potential role for tracheal intubation in patients with difficult airways, but there have been only reports of the techniques of blind tracheal intubation through the intubating laryngeal mask. The success rate of blind intubation at the first attempt may be merely 50-60% even in patients with normal airways. We report the use of the intubating laryngeal mask for tracheal intubation in three patients with difficult airways, in whom a tube was easily inserted through the laryngeal mask into the trachea either blindly, using a fiberoptic bronchoscope or using a lighted stylet. Read More

Ann Emerg Med 1999 Jun;33(6):694-8

Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.

Study Objective: We conducted a national survey of emergency medicine residency program directors to determine which alternative devices were available in their emergency departments for difficult airway management. We also assessed the residency directors' experience in use of these devices.

Methods: After approval was received from the institutional review board at our institution, residency directors were contacted by mail, fax, or phone in October 1997. Read More

Anesth Analg 1999 Apr;88(4):766-70

Department of Internal Medicine I, University of Vienna, Austria.

Unlabelled: One of the most serious complications of conventional endotracheal intubation is unidentified placement of the tube in the esophagus. The aim of our study was to evaluate four different methods for immediate detection of the tube position: auscultation, capnographic determination of ETCO2, esophageal detection method (EDM) using a self-inflating bulb, and the transillumination method using a lighted stylet (Trachlight; Laerdal, Armonk, NY). Thirty-eight endotracheally intubated patients admitted to our medical intensive care unit were enrolled in the study. Read More

Anaesthesia 1998 Nov;53(11):1084-90

Department of Anaesthesia, Policlinico Universitario, Roma, Italy.

This study assesses the efficacy of the intubating laryngeal mask as a ventilation device and blind intubation guide. Following induction of anaesthesia with propofol, the device was successfully inserted at the first attempt in 110/110 (100%) patients. Placement took less than 10 s in all patients. Read More

Can J Anaesth 1998 Aug;45(8):757-76

Department of Anaesthesia, University of Ottawa, Ontario.

Purpose: To review the current literature and generate recommendations on the role of newer technology in the management of the unanticipated difficult airway.

Methods: A literature search using key words and filters of English language and English abstracted publications from 1990-96 contained in the Medline, Current Contents and Biological Abstracts databases was carried out. The literature was reviewed and condensed and a series of evidence-based recommendations were evolved. Read More

Anesth Analg 1998 Oct;87(4):979

J Clin Monit Comput 1998 May;14(4):271-4

Department of Anesthesiology University of Florida College of Medicine, Gaines 32610-0254, USA.

Objective: We set out to establish whether a novel plastic optical fiber incorporated into an endotracheal tube (ETT) stylet could be used for intubation of a dog. A secondary objective examined the need for a direct illumination source from a laryngoscope. Lastly, the fragility of the system was tested. Read More