Admin: Yeni sayfa: "{{Infobox medical condition| Name = Mongolian spot | synonyms = Mongolian blue spot, congenital dermal melanocytosis, dermal melanocytosis..."

2017-03-31T17:23:56Z

Yeni sayfa: "{{Infobox medical condition| Name = Mongolian spot | synonyms = Mongolian blue spot, congenital dermal melanocytosis,<ref name="Bolognia" /> dermal melanocytosis..."

Yeni sayfa

{{Infobox medical condition|
Name = Mongolian spot |
synonyms = Mongolian blue spot, congenital dermal melanocytosis,<ref name="Bolognia" /> dermal melanocytosis<ref name="Bolognia">{{cite book |author1=Rapini, Ronald P. |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L. |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |pages=1720 |isbn=1-4160-2999-0 |oclc= |doi= |accessdate=}}</ref>|
Image = Mongolianspotphoto.jpg|
Caption = Mongolian spot visible on six-month-old Taiwanese baby girl|
Field = [[Dermatology]]|
DiseasesDB = 8342 |
ICD10 = {{ICD10|D|22|5|d|10}} ([[ILDS]] D22.505) |
ICD9 = {{ICD9|757.33}} ([[CDC/BPA]] 757.386) |
ICDO = |
OMIM = |
MedlinePlus = 001472 |
eMedicineSubj = derm |
eMedicineTopic = 271 |
MeshID = D049328
}}
'''Mongolian spot (congenital dermal melanocytosis)''' is a [[benign]], flat, [[congenital disorder|congenital]] [[birthmark]] with wavy borders and irregular shape. In 1883 it was described and named after [[Mongols|Mongolians]] by [[Erwin Bälz]], a German anthropologist based in Japan.<ref>Die koerperlichen Eigenschaften der Japaner.(1885) Baelz.E. Mittheil.d.deusch Gesell.f.Natur-u-Voelkerheilkunde Ostasiens. Bd.4.H.32</ref><ref>Circumscribed dermal melanosis (Mongolian spot)(1981) Kikuchi I, Inoue S. in "Biology and Diseases of Dermal Pigmentation", University of Tokyo Press , p83</ref><ref>{{cite book|pages=6–17|edition=|year=1993|accessdate=May 17, 2014|publisher=Wolfe|author=Bernard Cohen|volume=|quote=|location=|title=Atlas of pediatric dermatology|url=https://books.google.com/books?id=grlsAAAAMAAJ&q=ines+mongolian+spot&dq=ines+mongolian+spot&hl=en&sa=X&ei=3pqdVaHIBIWS-wGP46H4BA&ved=0CCsQ6AEwAQ|isbn=1563750198}}</ref><ref>{{cite book|page=2262|edition=|pages=|year=1908|accessdate=May 17, 2014|publisher=American Medical Association|others=American Medical Association|volume=|quote=|location=|title=JAMA: The Journal of the American Medical Association, Volume 51|url=https://books.google.com/books?id=KUgcAQAAMAAJ&pg=PA2262&dq=ines+mongolian+spot&hl=en&sa=X&ei=3pqdVaHIBIWS-wGP46H4BA&ved=0CDQQ6AEwAw#v=onepage&q=ines%20mongolian%20spot&f=false|isbn=}}</ref> It normally disappears three to five years after birth and almost always by [[puberty]]. The most common color is blue, although they can be blue-gray, blue-black or deep brown.

== Cause ==
The Mongolian spot is a [[Congenital disorder|congenital]] developmental condition—that is, one existing from birth—exclusively involving the [[skin]]. The blue colour is caused by [[melanocyte]]s, [[melanin]]-containing cells, that are usually located in the surface of the skin (the [[epidermis (skin)|epidermis]]), but are in the deeper region (the [[dermis]]) in the location of the spot.<ref name=skin /> Usually, as multiple spots or one large patch, it covers one or more of the lumbosacral area (lower [[Human back|back]]), the [[buttock]]s, sides, and [[shoulder]]s.<ref name=skin /> It results from the entrapment of melanocytes in the lower half to two-thirds of the dermis during their migration from the [[neural crest]] to the epidermis during [[Human embryogenesis|embryonic development]].<ref name=skin />

Male and female infants are equally predisposed to Mongolian spot.{{citation needed|date=April 2013}}

People who are not aware of the background of the Mongolian spots may mistake them for bruises, possibly resulting in unfounded concerns about abuse.<ref>[http://www.tokyo-med.ac.jp/genet/msp/index.htm Mongolian Spot] - English information of Mongolian spot, written by Hironao NUMABE, M.D., Tokyo Medical University.</ref><ref>{{cite book|last=Empson|first=Rebecca M.|title=Harnessing fortune : personhood, memory and place in northeast Mongolia|year=2010|publisher=Oxford University Press|location=Oxford|isbn=9780197264737}}</ref><ref>{{cite book|page=180|edition=2, illustrated|pages=|year=2001|accessdate=May 17, 2014|publisher=Lippincott Williams & Wilkins|author=|editor1=Robert M. Reece|editor2=Stephen Ludwig|volume=|quote=|location=|title=Child Abuse: Medical Diagnosis and Management|url=https://books.google.com/books?id=3DZtAAAAMAAJ&q=spanish+mongolian+spot&dq=spanish+mongolian+spot&hl=en&sa=X&ei=6pqdVb6-Kozj-QG_xr2QBQ&ved=0CFUQ6AEwCQ|isbn=0781724449}}</ref>

== Prevalence ==
Infants may be born with one or more Mongolian spots ranging from small area on the buttocks to a larger area on the back.

The spot is prevalent among [[East Asia|East]], [[South Asia|South]], [[Southeast Asia|Southeast]], [[Turkic peoples|North and Central Asian peoples]], [[Uralic peoples|Uralic]] and [[Finno-Ugric peoples]], Indigenous [[Oceania]]ns (chiefly [[Micronesia]]ns and [[Polynesia]]ns), Sub-Saharan Africans,<ref>{{cite book|page=95|edition=illustrated|pages=|year=1997|accessdate=May 17, 2014|publisher=Edwin Mellen Press|author=Kevin C. Stuart|volume=|quote=|location=|title=Mongols in Western/American consciousness|url=https://books.google.com/books?id=tCRtAAAAMAAJ&q=white+spanish+mongolian+spot&dq=white+spanish+mongolian+spot&hl=en&sa=X&ei=95qdVfvHGoOr-QGb74agBQ&ved=0CDsQ6AEwBA|isbn=0773484434}}</ref> [[Indigenous peoples of the Americas|Amerindians]],<ref>{{cite book|page=90|edition=3, illustrated|pages=|year=1999|accessdate=May 17, 2014|publisher=Lippincott Williams & Wilkins|author=Miller|volume=|quote=|location=|title=Nursing Care of Older Adults: Theory and Practice|url=https://books.google.com/books?id=nJ3pBEh1osMC&q=ines+mongolian+spot&dq=ines+mongolian+spot&hl=en&sa=X&ei=3pqdVaHIBIWS-wGP46H4BA&ved=0CC8Q6AEwAg|isbn=0781720761}}</ref> non-European [[Latin Americans]], [[Caribbean people|Caribbeans]] of mixed-race descent, and [[Turkish people]].<ref name=skin>[http://skin-care.health-cares.net/Mongolian-blue-spots.php Mongolian blue spots] - Health care guide discussing the Mongolian blue spot.</ref><ref>{{cite journal | title = Frequency and characteristics of Mongolian spots among Turkish children in Aegean region | date = July 2006| pmid=17172067 | volume=48 |vauthors=Egemen A, Ikizoğlu T, Ergör S, Mete Asar G, Yilmaz O | journal=Turk J Pediatr | pages=232–6}}</ref><ref name=tokyo>{{cite web|url=http://www.tokyo-med.ac.jp/genet/msp/about.htm|title=About Mongolian Spot|work=tokyo-med.ac.jp|accessdate=1 October 2015}}</ref><ref>[https://books.google.com/books?id=hNx9BwAAQBAJ&pg=PT289&lpg=PT289&dq=#v=onepage&q&f=false Transcultural Medicine: Dealing with patients from different cultures]</ref>
They occur in about 90-95% of Asian and 80-85% [[Indigenous peoples of the Americas|Native American]] infants.<ref name="tokyo"/> Approximately 90% of Polynesians and Micronesians are born with Mongolian spots, as are about 46% of children in Latin America,<ref name=med>[http://emedicine.medscape.com/article/1068732-overview#a0199 Epidemiology of Mongolian spot on MedScape]</ref> where they are associated with non-European descent. These spots also appear on 5-10% of babies of full Caucasian descent; [[Coria del Río]] in Spain has a high incidence due to the presence of descendants of the [[Hasekura Tsunenaga|first Japanese official envoy to Spain]] in the early 17th century.<ref name="tokyo"/><ref>{{cite web|url=http://www.japantimes.co.jp/text/nn20031211b4.html|title=Spain's Japon clan has reunion to trace its 17th century roots - The Japan Times|work=The Japan Times|accessdate=1 October 2015}}</ref> Black babies have Mongolian spots at a frequency of 96%.<ref>{{cite book|page=34|edition=|pages=|year=2012|accessdate=May 17, 2014|publisher=Springer Science & Business Media|author=N Silverberg|volume=|quote=|location=|title=Atlas of Pediatric Cutaneous Biodiversity: Comparative Dermatologic Atlas of Pediatric Skin of All Colors|url=https://books.google.com/books?id=8ra2I3Vj8Y8C&pg=PA34&dq=white+spanish+mongolian+spot&hl=en&sa=X&ei=95qdVfvHGoOr-QGb74agBQ&ved=0CEQQ6AEwBg#v=onepage&q=white%20spanish%20mongolian%20spot&f=false|archiveurl=https://books.google.com/books?id=8ra2I3Vj8Y8C&pg=PA34&dq=spanish+mongolian+spot&hl=en&sa=X&ei=6pqdVb6-Kozj-QG_xr2QBQ&ved=0CEUQ6AEwBg#v=onepage&q=spanish%20mongolian%20spot&f=false|archivedate=2012|isbn=1461435641}}</ref>

Almost the entire [[Mestizos in Mexico|mestizo (mixed Spanish-Indian) people of Mexico]] have the Mongolian spot.<ref>{{cite book|page=197|edition=|pages=|year=2012|accessdate=May 17, 2014|publisher=Springer Science & Business Media|author=|editor1=Lawrence C. Parish|editor2=Larry E. Millikan|others=M. Amer, R.A.C. Graham-Brown, S.N. Klaus, J.L. Pace|volume=|quote=|location=|title=Global Dermatology: Diagnosis and Management According to Geography, Climate, and Culture|url=https://books.google.com/books?id=2JXwBwAAQBAJ&pg=PA197&dq=spanish+mongolian+spot&hl=en&sa=X&ei=6pqdVb6-Kozj-QG_xr2QBQ&ved=0CCsQ6AEwAQ#v=onepage&q=spanish%20mongolian%20spot&f=false|isbn=1461226147}}</ref>

Central Americans indigenous children were subjected to racism due to their Mongolian spots but progressive circles began to make having the Mongolian spot popular after the late 1960s.<ref>{{cite book|page=239|edition=|pages=|year=2007|accessdate=May 17, 2014|publisher=U of Minnesota Press|author=Arturo Arias|volume=|quote=|location=|title=Taking Their Word: Literature and the Signs of Central America|url=https://books.google.com/books?id=ofWsxAYhcLwC&pg=PA239&dq=spanish+mongolian+spot&hl=en&sa=X&ei=6pqdVb6-Kozj-QG_xr2QBQ&ved=0CDAQ6AEwAg#v=onepage&q=spanish%20mongolian%20spot&f=false|archiveurl=https://books.google.com/books?id=ofWsxAYhcLwC&pg=PA239&dq=ines+mongolian+spot&hl=en&sa=X&ei=3pqdVaHIBIWS-wGP46H4BA&ved=0CCYQ6AEwAA#v=onepage&q=ines%20mongolian%20spot&f=false|archivedate=2007|isbn=1452913161}}</ref>

Highland Peruvians have the Mongolian spot.<ref>{{cite book|page=105|edition=|pages=|year=2015|accessdate=May 17, 2014|publisher=Princeton University Press|author=Herbert Goldhamer|volume=|quote=|location=|title=The Foreign Powers in Latin America|series=Princeton Legacy Library, Rand Corporation research study|url=https://books.google.com/books?id=zHV9BgAAQBAJ&pg=PA105&dq=white+spanish+mongolian+spot&hl=en&sa=X&ei=95qdVfvHGoOr-QGb74agBQ&ved=0CDUQ6AEwAw#v=onepage&q=white%20spanish%20mongolian%20spot&f=false|archiveurl=https://books.google.com/books?id=zHV9BgAAQBAJ&pg=PA105&dq=spanish+mongolian+spot&hl=en&sa=X&ei=6pqdVb6-Kozj-QG_xr2QBQ&ved=0CDoQ6AEwBA#v=onepage&q=spanish%20mongolian%20spot&f=false|archivedate=2015|isbn=1400869153}}</ref>

==Anthropological description==
The French anthropologist [[:fr:Robert Gessain|Robert Gessain]] interested himself in what he called the ''tache pigmentaire congenitale'' or coloured birthmark, publishing multiple papers in the ''[[Journal de la Société des Américanistes]]'', an academic journal covering the cultural anthropology of the Americas. Gessain spent time with the [[Huehuetla Tepehua]] people in [[Hidalgo (state)|Hidalgo]], [[Mexico]], and wrote in 1947 about the spot's "location, shape, colour, histology, chemistry, genetic transmission, and racial distribution". He had previously spent several winters in Greenland, and wrote an overview in 1953 of what was known about the spot. He hypothesised that the age at which it faded in various populations might prove to be a distinguishing characteristic of those groups. Gessain claimed that the spot was first observed amongst the Eskimo.<ref name="auto">{{cite journal|last1=Gessain|first1=Robert|title=La tache pigmentaire congénitale chez les Eskimo d'Angmassalik|journal=Journal de la Société des Américanistes|date=1953|volume=42|pages=301–332|doi=10.3406/jsa.1953.2408}}</ref>

[[Hans Egede Saabye]], a Danish priest and botanist, spent 1770-1778 in Greenland. His diaries, published in 1816 and translated into several European languages, contained much ethnographic information. He described the spot on newborns, saying he had seen it often when the infants were presented naked for baptism. A second Danish observer was doctor and zoologist [[Daniel Frederik Eschricht]], mainly based in [[Copenhagen]]. In 1849 he wrote of the "mixed" babies he had delivered at the [[lying-in]] hospital. He also says that "the observation made for the first time by Saabye about Eskimo children has been completely confirmed by [[Carl Peter Holbøll|Captain Holbøll]]", who sent him a fetus pickled in alcohol.<ref name="auto"/>

Gessain goes on to state that it was only in 1883 that an anthropologist mentions the spot. It was [[Erwin Bälz]], a German working in Tokyo, who described a dark blue mark on Japanese infants. He presented his findings in 1901 in Berlin, and from that point on, Bälz's name was associated with certain skin cells containing pigment. Captain [[Gustav Frederik Holm]] wrote in 1887 that his Greenlandic interpreter Johannes Hansen (known as Hanserak) attested to the existence of the birthmark over the kidney region of newborns, which grows larger as they grow older. That year, the Danish anthropologist Soren Hansen drew the connection between the observations of Bälz in Japan and Saabye in Greenland. "This cannot be a coincidence. It is not the first time that the resemblance between the Japanese and the Eskimo has been pointed out." [[Fridtjof Nansen]], the Norwegian polar explorer, said that the spot was widespread in the mixed Danish-Eskimo population of West Greenland. Soren Hansen confirmed this, and further hypothesised that in both Japan and Greenland the spot might indicate an African connection ("a sign of direct descent from a black racial element"). (See [[Historical race concepts]].) A missionary in [[Bethel, Alaska]], a traditional gathering place of [[Central Alaskan Yup'ik language|Yup'ik people]], reported that the spots were common on children. [[:eu:Rudolf Trebitsh|Rudolf Trebitsh]], an Austrian linguist and ethnologist, spent the summer of 1906 on the West Coast of Greenland, and listed all the examples he came across. Gessain went to north [[Labrador]] in 1926, looking for children with these spots. In 1953 Dr Saxtorph, medical advisor to the Greenland department (part of the Danish government), wrote that the Greenlanders do not like outsiders to see or discuss these birthmarks; "they doubtless feel as a reminiscence of the time when they lived on a low cultural level".<ref name="auto"/>

The presence or absence of the Mongolian spot was used by racial theorists such as [[Joseph Deniker]] (1852-1918), the French anthropologist.<ref>{{cite journal|last1=Deniker|first1=Joseph|title=Les taches congénitales dans la région sacro-lombaire considérées comme caractère de race|journal=Bulletins et Mémoires de la Société d'Anthropologie de Paris|date=4 April 1901|volume=2|issue=2|pages=274–281}}</ref>

The ''Journal of Cutaneous Diseases Including Syphilis, Volume 23'' contained several accounts of the Mongolian spot on children in the Americas:

{{quote|[[Gustav Frederik Holm|Holm]] ("Ethnological Sketch. Communications on Greenland," X., Copenhagen, 1887) announced the presence of the spot in the east part of Greenland. Bartels ("The So-Called 'Mongolian' Spots on Infants of Esquimaux," Ethnologic Review, 1903) received letters regarding it from East Greenland and also from [[Alaska Natives|Esquimaux of Alaska]]. In half-breed European-Esquimaux, Hansen says he has encountered it. Among [[Indigenous peoples of the Pacific Northwest Coast|Indians of North Vancouver]], British Columbia, there are observations made by [[Erwin Bälz|Baelz]] as well as by [[Herman Frederik Carel ten Kate (anthropologist)|Tenkate]] (secondhand). In [[Maya peoples|the Mayas]] of Central America, [[Frederick Starr|Starr]]'s (Data on the Ethnography of Western Mexico, Part H., 1902) facts are corroborated by Herman (Aparecimiento de la Mancha Mongolica. Revista de Ethnologia, 1904). He cites [[Alexander Francis Chamberlain|A. F. Chamberlain]] (Pigmentary Spots, American Anthropologist, 1902,) and Starr (Sacral Spots of Mayan Indians, Science, New Series, xvii., 1903).}}

In Central America, according to these authorities, the spot is called ''Uits,'' "pan," and it is an insult to speak of it. It disappears in the tenth month. It is bluish-reddish (in these [[Redskin (slang)|red men]]), and is remarkable by its littleness. Mayan [[half-breed]] infants do not have it (red men and Spanish white). The [[Morus (plant)|mulberry colored]] spot is very well known in [[Afro-Brazilian|Negroid Brazil]]. Among individuals of mixed Indian blood (black and red) it is called "genipapo" from its resemblance in color (bluish-gray) to an indigenous fruit of Brazil, named [[Genipa americana|genipapo]] (an Indian word adopted into Portuguese).

''Tem genipapo'' means the same as "he is of colored (negro) race." Brazilians say that the spot has a great tendency to preserve itself through the generations by inheritance, and that "Indian blood" is never lost when entering a new. This is the explanation made by those in whose family it occurs. It is rather like the Minorcan blood of the [[Andrew Turnbull (colonist)|Dr. Trumbull]] negroes of [[St. Augustine, Florida]], among whom this same spot shows itself even to-day. Yet no one knows them to be black, except that a dark child is sometimes born and strangled by the beautiful women of that race descended from the old Negress of Spain, whom Dr. Trumbull married and brought to America with him. [[:es:Roberto Lehmann Nitsche|Dr. Lehmann-Nitsche]] (Mancha Morada de los recien Nacidos, La Semana Medico, 1904) has known of cases of the spot among very swarthy individuals of Europe. He believes that the religious Brazilians are wrong in their accusation that it is the "[[Curse and mark of Cain|Seal of Cain]]" ("Cain's seal was on the forehead. Besides, a tribal tattooing in all probability was Cain's seal, as every anthropologist might explain").<ref>{{cite book|title=The Journal of Cutaneous Diseases Including Syphilis ...|volume=23|url=https://books.google.com/books?id=trAhAQAAMAAJ&pg=PA210|year=1905|publisher=American Dermatological Association|pages=210–}}</ref>

A marriage between a Chinese man and a white Mexican woman was recorded in ''Current Anthropological Literature'', published in 1912, titled "Note on two children born to a Chinese and a Mexican white" (''Note sur deux enfants nés d'un chinois et d'une mexicaine de race blanche''). "Treats briefly of Chen Tean (of Hong Kong), his wife, Inez Mancha (a white Mexican), married in 1907, and their children, a boy (born April 14, 1908) and a girl (born September 24, 1909). The boy is of marked Chinese type, the girl much more European. No Mongolian spots were noticed at birth. Both children were born with red cheeks. Neither has ever been sick. The boy began to walk at ten months, the girl a little after a year."<ref>{{cite book|title=Current Anthropological Literature|volume=1|url=https://books.google.com/books?id=UeAqAAAAYAAJ&pg=PA257|year=1912|publisher=American Anthropological Association and the American Folklore Society|pages=257–}}</ref>

== Cultural terminology ==
The Mongolian spot is referred to in the [[Japanese language|Japanese]] idiom ''shiri ga aoi'' ({{lang|jp|尻が青い}}), meaning "to have a blue butt",<ref>[[:ja:尻|尻]] {{ja icon}}</ref><ref>[http://languagelog.ldc.upenn.edu/nll/?p=727 "The butt is blue": the untold story], [http://languagelog.ldc.upenn.edu/ Language Log], October 15, 2008 @ 3:14 pm; comment of October 16, 2008 @ 11:39 am</ref> which is a reference to immaturity or inexperience. In central [[Mexico]], The expression is used in the same way, being locally referred to as the "green butt" ({{lang-es|rabo verde}}). It is also referred to as ''la patada de Cuauhtémoc'', meaning "[[Cuauhtémoc]]'s kick".{{Citation needed|date=December 2016}} The mark is also common among Maya people of the [[Yucatan Peninsula]] <ref>Life Magazine - Ancient and Modern Maya (june 1947) [https://books.google.com.mx/books?id=f04EAAAAMBAJ&printsec=frontcover#v=onepage&q=mongolian%20spot&f=false]</ref> where is referred to as ''Wa'' in [[Yucatec_Maya_language|Maya]], which means "circle". [[Korean mythology]] explains the spot as a bruise formed when [[Samshin halmi]] ({{lang-ko|삼신할미}}), a shaman spirit to whom people pray around childbirth, slapped the baby's behind to hasten the baby to quickly get out from his or her mother's womb.

In [[Indigenous peoples in Ecuador|Ecuador, the native Indians]] of [[Colta Canton|Colta]] are insultingly referred to in Spanish by a number of terms which allude to the Mongolian spot.<ref>{{cite book|page=6|edition=|pages=|year=1966|accessdate=May 17, 2014|publisher=Department of Anthropology, Cornell University|author=Eileen Maynard|volume=|quote=|location=|title=The Indians of Colta: Essays on the Colta Lake Zone, Chimborazo (Ecuador)|url=https://books.google.com/books?id=n-5lAAAAMAAJ&q=white+spanish+mongolian+spot&dq=white+spanish+mongolian+spot&hl=en&sa=X&ei=95qdVfvHGoOr-QGb74agBQ&ved=0CEoQ6AEwBw|archiveurl=https://books.google.com/books?id=n-5lAAAAMAAJ&q=spanish+mongolian+spot&dq=spanish+mongolian+spot&hl=en&sa=X&ei=6pqdVb6-Kozj-QG_xr2QBQ&ved=0CCYQ6AEwAA|archivedate=May 30, 2008|isbn=}}</ref>

In Spanish it is called ''mancha mongólica'' and ''mancha de Baelz'' (see [[Erwin Bälz]]).<ref>{{cite book|pages=184, 121|edition=|year=2012|accessdate=May 17, 2014|publisher=McGraw Hill Professional|author=Vox|volume=|quote=|location=|title=Vox Super-Mini Medical Spanish and English Dictionary|series=Vox dicitonaries|url=https://books.google.com/books?id=64hk8Beb94EC&q=spanish+mongolian+spot&dq=spanish+mongolian+spot&hl=en&sa=X&ei=6pqdVb6-Kozj-QG_xr2QBQ&ved=0CEsQ6AEwBw|isbn=0071788638}}</ref>

== See also ==
* [[List of cutaneous conditions]]

== References ==
{{reflist}}

{{Gonadal tumors, paraganglioma, glomus, nevi and melanomas}}
{{Congenital malformations and deformations of integument}}

[[Category:Cutaneous congenital anomalies]]

Mongolian spot - Değişiklik geçmişi

Admin: Yeni sayfa: "{{Infobox medical condition| Name = Mongolian spot | synonyms = Mongolian blue spot, congenital dermal melanocytosis, dermal melanocytosis..."