Predictive Factors of Steatosis and Non-Alcoholic Steatohepatitis in Morbidly Obese Patients Undergoing Bariatric Surgery

Background and Objectives: Obesity is one of the most health-threatening phenomena. It is estimated that over 1 billion adults have overweight or obesity. The current study aimed at presenting a detailed account of the findings that attempted to predict the severity of fatty liver disease and its se...

Full description

Saved in:
Bibliographic Details
Published inHepatitis monthly Vol. 17; no. 11
Main Authors Kalidari, Behrooz, Mahmoudieh, Mohsen, Melali, Hamid, Nazari Moghadam, Mehdi, Kolahdouzan, Mohsen
Format Journal Article
LanguageEnglish
Published Tehran Tehran Hepatitis Center 01.11.2017
Subjects
Online AccessGet full text

Cover

Loading…
Abstract Background and Objectives: Obesity is one of the most health-threatening phenomena. It is estimated that over 1 billion adults have overweight or obesity. The current study aimed at presenting a detailed account of the findings that attempted to predict the severity of fatty liver disease and its sequelae, including non-alcoholic steatohepatitis (NASH), fibrosis, and cirrhosis, by correlating biopsy results with liver function tests and various metabolic markers of laboratory results in patients with morbid obesity. Methods: A total of 111 subjects participated in the study. The collected data included pathology study of liver biopsy, fasting blood glucose (FBS), liver function test (LFT), and lipid profile. Results: The correlation between fibrosis and steatosis was 0.493 (P = 0.001, 95% confidence interval (CI) and correlation between fibrosis and NASH grade was 0.531 (P = 0.001, 95%CI). There was a significant relationship between aspartate aminotransferase (AST) and triglyceride (TG) with steatosis intensity and a significant positive relationship between AST, cholesterol, and FBS with NASH intensity. Conclusions: Levels of serum AST and TG showed significant relationship with steatosis and fibrosis intensities; AST, FBS, and cholesterol had a significant correlation with NASH intensity. Cholesterol and low-density lipoprotein (LDL) levels had an inverse monotonic relationship with fibrosis intensity.
AbstractList Background and Objectives: Obesity is one of the most health-threatening phenomena. It is estimated that over 1 billion adults have overweight or obesity. The current study aimed at presenting a detailed account of the findings that attempted to predict the severity of fatty liver disease and its sequelae, including non-alcoholic steatohepatitis (NASH), fibrosis, and cirrhosis, by correlating biopsy results with liver function tests and various metabolic markers of laboratory results in patients with morbid obesity. Methods: A total of 111 subjects participated in the study. The collected data included pathology study of liver biopsy, fasting blood glucose (FBS), liver function test (LFT), and lipid profile. Results: The correlation between fibrosis and steatosis was 0.493 (P = 0.001, 95% confidence interval (CI) and correlation between fibrosis and NASH grade was 0.531 (P = 0.001, 95%CI). There was a significant relationship between aspartate aminotransferase (AST) and triglyceride (TG) with steatosis intensity and a significant positive relationship between AST, cholesterol, and FBS with NASH intensity. Conclusions: Levels of serum AST and TG showed significant relationship with steatosis and fibrosis intensities; AST, FBS, and cholesterol had a significant correlation with NASH intensity. Cholesterol and low-density lipoprotein (LDL) levels had an inverse monotonic relationship with fibrosis intensity.
Author Kolahdouzan, Mohsen
Kalidari, Behrooz
Melali, Hamid
Nazari Moghadam, Mehdi
Mahmoudieh, Mohsen
Author_xml – sequence: 1
  givenname: Behrooz
  surname: Kalidari
  fullname: Kalidari, Behrooz
– sequence: 2
  givenname: Mohsen
  surname: Mahmoudieh
  fullname: Mahmoudieh, Mohsen
– sequence: 3
  givenname: Hamid
  surname: Melali
  fullname: Melali, Hamid
– sequence: 4
  givenname: Mehdi
  surname: Nazari Moghadam
  fullname: Nazari Moghadam, Mehdi
– sequence: 5
  givenname: Mohsen
  surname: Kolahdouzan
  fullname: Kolahdouzan, Mohsen
BookMark eNo1kM1PAjEQxRuDiYBePTfxvDjdsrR7RCJqgkKiJN423e4slECLbTHZ_97lw9O8yfvNvOT1SMc6i4TcMxhkkqWPa9yruHN2wIYg5RXpMsGzhLdL56LZkH_fkF4IG4BMgki7pFl4rIyO5hfpVOnofKCupp8RVXTBBKpsRT-cTcZb7dZua_TFO6WZ2BLG0nfnS1NtGzovMSBdtA7aGOjSVuhXztgVfVLeqOiP9we_Qt_ckutabQPeXWafLKfPX5PXZDZ_eZuMZ4nmIGKCoDkKJdK8ZFJwXYKoq7JSCIpJNqqyHAFHqZQ1AEoUpdRc1TyVKWjAOud98nD-u_fu54AhFht38LaNLFieMyazVMiWGpwp7V0IHuti781O-aZgUBzrLf7rLU718j8G8XQp
CitedBy_id crossref_primary_10_1016_j_dsx_2019_05_030
Cites_doi 10.1159/000282102
10.1007/s11695-010-0204-1
10.1111/j.1440-1746.2007.04833.x
10.1016/j.cld.2007.02.011
10.1159/000087295
10.1381/096089206776116462
10.1097/MCG.0000000000000116
10.3904/kjim.2004.19.1.19
10.1179/acb.2009.084
10.1001/archsurg.138.11.1240
10.1381/096089206776944904
10.1111/j.1365-2036.2007.03483.x
10.1053/gast.2001.25540
10.1381/0960892055002347
10.1381/096089206775565159
10.1016/S1665-2681(19)31823-X
10.1381/096089203765887633
10.1381/0960892053576820
10.1381/0960892055002239
10.1016/j.soard.2007.11.007
10.4254/wjh.v3.i8.219
10.1111/j.1365-2036.2011.04724.x
10.1007/s11695-015-1696-5
10.1053/gast.2002.34168
10.1136/bmj.d3897
10.1053/j.gastro.2006.01.042
10.3748/wjg.14.2867
10.1177/000313481408000624
10.1381/096089206775565122
10.1007/s11695-012-0591-6
10.1111/j.1572-0241.2006.01041.x
10.1007/s11695-011-0559-y
10.1590/S0102-86502013001100008
10.1056/NEJMct067019
10.1056/NEJMra011775
10.1007/s11695-007-9086-2
10.1210/jc.2008-1598
10.1046/j.1365-2036.2003.01493.x
10.1016/j.jhep.2006.06.013
10.1381/0960892054222830
10.1038/sj.ijo.0800571
ContentType Journal Article
Copyright Copyright Tehran Hepatitis Center Nov 2017
Copyright_xml – notice: Copyright Tehran Hepatitis Center Nov 2017
DBID AAYXX
CITATION
3V.
7X7
7XB
8FI
8FJ
8FK
8G5
ABUWG
AFKRA
AZQEC
BENPR
CCPQU
CWDGH
DWQXO
FYUFA
GHDGH
GNUQQ
GUQSH
K9.
M0S
M2O
MBDVC
PQEST
PQQKQ
PQUKI
PRINS
Q9U
DOI 10.5812/hepatmon.14088
DatabaseName CrossRef
ProQuest Central (Corporate)
Health & Medical Complete (ProQuest Database)
ProQuest Central (purchase pre-March 2016)
Hospital Premium Collection
Hospital Premium Collection (Alumni Edition)
ProQuest Central (Alumni) (purchase pre-March 2016)
Research Library (Alumni Edition)
ProQuest Central (Alumni)
ProQuest Central
ProQuest Central Essentials
AUTh Library subscriptions: ProQuest Central
ProQuest One Community College
Middle East & Africa Database
ProQuest Central
Health Research Premium Collection
Health Research Premium Collection (Alumni)
ProQuest Central Student
Research Library Prep
ProQuest Health & Medical Complete (Alumni)
Health & Medical Collection (Alumni Edition)
ProQuest research library
Research Library (Corporate)
ProQuest One Academic Eastern Edition (DO NOT USE)
ProQuest One Academic
ProQuest One Academic UKI Edition
ProQuest Central China
ProQuest Central Basic
DatabaseTitle CrossRef
Research Library Prep
ProQuest Central Student
ProQuest Central Basic
ProQuest Central Essentials
ProQuest One Academic Eastern Edition
ProQuest Health & Medical Complete (Alumni)
ProQuest Central (Alumni Edition)
ProQuest One Community College
ProQuest Hospital Collection
Research Library (Alumni Edition)
Health Research Premium Collection (Alumni)
ProQuest Central China
ProQuest Hospital Collection (Alumni)
ProQuest Central
ProQuest Health & Medical Complete
Health Research Premium Collection
Middle East & Africa Database
ProQuest One Academic UKI Edition
Health and Medicine Complete (Alumni Edition)
ProQuest Central Korea
ProQuest Research Library
ProQuest One Academic
ProQuest Central (Alumni)
DatabaseTitleList Research Library Prep
Database_xml – sequence: 1
  dbid: BENPR
  name: ProQuest Central
  url: https://www.proquest.com/central
  sourceTypes: Aggregation Database
DeliveryMethod fulltext_linktorsrc
Discipline Medicine
EISSN 1735-3408
ExternalDocumentID 10_5812_hepatmon_14088
GeographicLocations Iran
GeographicLocations_xml – name: Iran
GroupedDBID ---
29I
2WC
3V.
53G
5GY
5VS
7X7
8FI
8FJ
8G5
8R4
8R5
AAWTL
AAYXX
ABDBF
ABUWG
ADBBV
AENEX
AFKRA
AHMBA
ALIPV
ALMA_UNASSIGNED_HOLDINGS
AZQEC
BAWUL
BENPR
BPHCQ
BVXVI
CCPQU
CITATION
CWDGH
DIK
DWQXO
E3Z
EBD
EOJEC
ESX
FYUFA
GNUQQ
GROUPED_DOAJ
GUQSH
HMCUK
HYE
KQ8
M2O
M~E
OBODZ
OK1
PQQKQ
PROAC
Q2X
RNS
RPM
TR2
TUS
UKHRP
~8M
7XB
8FK
K9.
MBDVC
PQEST
PQUKI
PRINS
Q9U
ID FETCH-LOGICAL-c307t-e0c3e7a729b1873cb07fdbdae0a1816d59e0e6288f00e8e7b8c3af32820c0ef93
IEDL.DBID BENPR
ISSN 1735-143X
IngestDate Thu Oct 10 20:41:10 EDT 2024
Wed Nov 06 13:19:30 EST 2024
IsDoiOpenAccess false
IsOpenAccess true
IsPeerReviewed false
IsScholarly true
Issue 11
Language English
LinkModel DirectLink
MergedId FETCHMERGED-LOGICAL-c307t-e0c3e7a729b1873cb07fdbdae0a1816d59e0e6288f00e8e7b8c3af32820c0ef93
OpenAccessLink https://hepatmon.kowsarpub.com/cdn/dl/2c792a3e-d731-11e7-98dc-43da2491a1d5
PQID 1991185278
PQPubID 105779
ParticipantIDs proquest_journals_1991185278
crossref_primary_10_5812_hepatmon_14088
PublicationCentury 2000
PublicationDate 2017-11-01
PublicationDateYYYYMMDD 2017-11-01
PublicationDate_xml – month: 11
  year: 2017
  text: 2017-11-01
  day: 01
PublicationDecade 2010
PublicationPlace Tehran
PublicationPlace_xml – name: Tehran
PublicationTitle Hepatitis monthly
PublicationYear 2017
Publisher Tehran Hepatitis Center
Publisher_xml – name: Tehran Hepatitis Center
References key-A14088REF19-19
key-A14088REF2-2
key-A14088REF1-1
key-A14088REF38-38
key-A14088REF11-11
key-A14088REF13-13
key-A14088REF17-17
Myers RP (key-A14088REF41-41) 2009; 8 Suppl 1
key-A14088REF20-20
key-A14088REF22-22
Jamali R (key-A14088REF15-15) 2008; 14
key-A14088REF23-23
Luyckx FH (key-A14088REF25-25) 1998; 22
key-A14088REF27-27
key-A14088REF29-29
key-A14088REF32-32
key-A14088REF34-34
key-A14088REF18-18
key-A14088REF10-10
key-A14088REF12-12
key-A14088REF14-14
key-A14088REF16-16
Bugianesi E (key-A14088REF7-7) 2002; 123
key-A14088REF21-21
key-A14088REF42-42
key-A14088REF9-9
Feijo SG (key-A14088REF30-30) 2013; 28
key-A14088REF24-24
Reha JL (key-A14088REF37-37) 2014; 80
key-A14088REF8-8
key-A14088REF26-26
key-A14088REF28-28
Dixon JB (key-A14088REF36-36) 2001; 121
key-A14088REF6-6
key-A14088REF31-31
Park KS (key-A14088REF39-39) 2004; 19
Shi JP (key-A14088REF40-40) 2009; 17
key-A14088REF33-33
key-A14088REF5-5
key-A14088REF35-35
Alba L (key-A14088REF4-4) 2003; 17
key-A14088REF3-3
References_xml – ident: key-A14088REF23-23
  doi: 10.1159/000282102
– ident: key-A14088REF32-32
  doi: 10.1007/s11695-010-0204-1
– ident: key-A14088REF21-21
  doi: 10.1111/j.1440-1746.2007.04833.x
– ident: key-A14088REF6-6
  doi: 10.1016/j.cld.2007.02.011
– ident: key-A14088REF13-13
  doi: 10.1159/000087295
– ident: key-A14088REF20-20
  doi: 10.1381/096089206776116462
– ident: key-A14088REF1-1
  doi: 10.1097/MCG.0000000000000116
– volume: 19
  start-page: 19
  issue: 1
  year: 2004
  ident: key-A14088REF39-39
  publication-title: Korean J Intern Med.
  doi: 10.3904/kjim.2004.19.1.19
  contributor:
    fullname: Park KS
– ident: key-A14088REF11-11
  doi: 10.1179/acb.2009.084
– ident: key-A14088REF14-14
  doi: 10.1001/archsurg.138.11.1240
– ident: key-A14088REF19-19
  doi: 10.1381/096089206776944904
– ident: key-A14088REF28-28
  doi: 10.1111/j.1365-2036.2007.03483.x
– volume: 121
  start-page: 91
  issue: 1
  year: 2001
  ident: key-A14088REF36-36
  publication-title: Gastroenterology.
  doi: 10.1053/gast.2001.25540
  contributor:
    fullname: Dixon JB
– ident: key-A14088REF10-10
  doi: 10.1381/0960892055002347
– ident: key-A14088REF27-27
  doi: 10.1381/096089206775565159
– volume: 8 Suppl 1
  start-page: S25
  year: 2009
  ident: key-A14088REF41-41
  publication-title: Ann Hepatol.
  doi: 10.1016/S1665-2681(19)31823-X
  contributor:
    fullname: Myers RP
– ident: key-A14088REF35-35
  doi: 10.1381/096089203765887633
– ident: key-A14088REF34-34
  doi: 10.1381/0960892053576820
– ident: key-A14088REF26-26
  doi: 10.1381/0960892055002239
– ident: key-A14088REF31-31
  doi: 10.1016/j.soard.2007.11.007
– ident: key-A14088REF38-38
  doi: 10.4254/wjh.v3.i8.219
– ident: key-A14088REF9-9
  doi: 10.1111/j.1365-2036.2011.04724.x
– ident: key-A14088REF33-33
  doi: 10.1007/s11695-015-1696-5
– volume: 123
  start-page: 134
  issue: 1
  year: 2002
  ident: key-A14088REF7-7
  publication-title: Gastroenterology.
  doi: 10.1053/gast.2002.34168
  contributor:
    fullname: Bugianesi E
– volume: 17
  start-page: 812
  issue: 11
  year: 2009
  ident: key-A14088REF40-40
  publication-title: Zhonghua Gan Zang Bing Za Zhi.
  contributor:
    fullname: Shi JP
– ident: key-A14088REF5-5
  doi: 10.1136/bmj.d3897
– ident: key-A14088REF17-17
  doi: 10.1053/j.gastro.2006.01.042
– volume: 14
  start-page: 2867
  issue: 18
  year: 2008
  ident: key-A14088REF15-15
  publication-title: World J Gastroenterol.
  doi: 10.3748/wjg.14.2867
  contributor:
    fullname: Jamali R
– volume: 80
  start-page: 595
  issue: 6
  year: 2014
  ident: key-A14088REF37-37
  publication-title: Am Surg.
  doi: 10.1177/000313481408000624
  contributor:
    fullname: Reha JL
– ident: key-A14088REF29-29
  doi: 10.1381/096089206775565122
– ident: key-A14088REF3-3
  doi: 10.1007/s11695-012-0591-6
– ident: key-A14088REF42-42
  doi: 10.1111/j.1572-0241.2006.01041.x
– ident: key-A14088REF24-24
  doi: 10.1007/s11695-011-0559-y
– volume: 28
  start-page: 788
  issue: 11
  year: 2013
  ident: key-A14088REF30-30
  publication-title: Acta Cir Bras.
  doi: 10.1590/S0102-86502013001100008
  contributor:
    fullname: Feijo SG
– ident: key-A14088REF2-2
  doi: 10.1056/NEJMct067019
– ident: key-A14088REF8-8
  doi: 10.1056/NEJMra011775
– ident: key-A14088REF22-22
  doi: 10.1007/s11695-007-9086-2
– ident: key-A14088REF18-18
  doi: 10.1210/jc.2008-1598
– volume: 17
  start-page: 977
  issue: 8
  year: 2003
  ident: key-A14088REF4-4
  publication-title: Aliment Pharmacol Ther.
  doi: 10.1046/j.1365-2036.2003.01493.x
  contributor:
    fullname: Alba L
– ident: key-A14088REF12-12
  doi: 10.1016/j.jhep.2006.06.013
– ident: key-A14088REF16-16
  doi: 10.1381/0960892054222830
– volume: 22
  start-page: 222
  issue: 3
  year: 1998
  ident: key-A14088REF25-25
  publication-title: Int J Obes Relat Metab Disord.
  doi: 10.1038/sj.ijo.0800571
  contributor:
    fullname: Luyckx FH
SSID ssj0058072
Score 2.1268914
Snippet Background and Objectives: Obesity is one of the most health-threatening phenomena. It is estimated that over 1 billion adults have overweight or obesity. The...
SourceID proquest
crossref
SourceType Aggregation Database
SubjectTerms Alcohol use
Body mass index
Gastrointestinal surgery
Heart surgery
Inflammation
Laparoscopy
Lipids
Liver cirrhosis
Liver diseases
Metabolism
Obesity
Pathology
Stomach
Studies
Weight control
Title Predictive Factors of Steatosis and Non-Alcoholic Steatohepatitis in Morbidly Obese Patients Undergoing Bariatric Surgery
URI https://www.proquest.com/docview/1991185278
Volume 17
hasFullText 1
inHoldings 1
isFullTextHit
isPrint
link http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwfV1LS8NAEB60BfEiPrE-yh4ET6Hb3aZJTtKqRQRLUQu9hX1FC5LUJh76753dbFAv3gJLkmVmd76Z3Zn5AK4sHQ2XrB-EWifBgDEZIIxgsDKgpq9DpsPMJchOhw_zweMiXPgDt9KnVTY20RlqXSh7Rt6zKTq20DeKb1afgWWNsrernkJjG9oMv05b0B7fT2fPjS0OY-rom_oRD_H3fFG3bQxxOr13NPeVVTW-6HhXfsHSX6vsoGayD3veRySjWqkHsGXyQ9h58rfgR7CZre2zNVRkUvPlkCIjNjW3KsplSUSuybTIg1HNf7tUfsxNxjYxIsucPBVrudQfG2K5AQyZ1Q1WS-KYkN4KhDQyxkDatfAnL3X19DHMJ_evtw-Bp1AIFG7eKjBUcRMJ9KBlP464kjTKtNTCUIHQPtRhYqixjMMZpSY2kYwVFxnHOIwqarKEn0ArL3JzCoRJxrNMYLykMAgzWg65UIJpKWzDniTpwHUjwXRVd8pIMcKwsk4bWadO1h24aASc-h1Tpj_6Pft_-Bx2mYVWVw94Aa1q_WUu0TGoZBe2o0XUhfZofDeedP1a-Aa9yb4m
link.rule.ids 315,783,787,12068,21400,27936,27937,31731,33756,43322,43817,74079,74636
linkProvider ProQuest
linkToHtml http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwfV07T8MwELagSMCCeIpCAQ9ITFaduGmSCRVEVaCtKtFK2SK_ApFQUpow9N_jcxIeC1skD7Hu7Lv77PP3IXQNcjRMuA7xlApJz3UFMWnEgJUe1Y7yXOUltkF22h8tek-RF9UHbkXdVtnERBuoVS7hjLwLLTrw0NcPbpcfBFSj4Ha1ltDYRFvAwwUKBn70Dbi8gFrxJsdnnvk5iyrSRs9Mpvtmgn0JjjaTsqorv5LS35hsE81wH-3VFSIeVC49QBs6O0Tbk_oO_AitZyv4hjCFh5VaDs4TDI25ZV6kBeaZwtM8I4NK_TaV9ZidDFAY4TTDk3wlUvW-xqAMoPGsolctsNVBes1NQsN3BkZbAn_8Ur2dPkaL4cP8fkRqAQUizdYtiaaSaZ-b-lk4gc-koH6ihOKacpPY-8oLNdWgN5xQqgPti0AynjCDwqikOgnZCWpleaZPEXaFy5KEG7QkDQTTSvQZl9xVggNdTxi20U1jwXhZ8WTEBl-ArePG1rG1dRt1GgPH9X4p4h_vnv0_fIV2RvPJOB4_Tp_P0a4LSda-DOygVrn61BemRCjFpV0HXzZrvVg
linkToPdf http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwfV1LS8NAEF60gngRn1ifexA8hW6zTZOcpD6Kz1JQobewTw1IUpt46L93ZrP1cfEW2MswMzszX3ZmPkJOkY6Gy7AbRFqnQS8MZQBpBMBKj5mujkIdWdcgO-rfvPTuJtHE9z9Vvq1yERNdoNalwn_kHWzRwUHfOOlY3xYxvhqeTz8CZJDCl1ZPp7FMVmJAKejh8eQbfEUJc0RO3ZhHIAifNAscIxCs8waBv0ajg4COgeVXgvobn13SGW6QdV8t0kFj3k2yZIotsvro38O3yXw8w28MWXTYMOfQ0lJs0q3LKq-oKDQdlUUwaJhwc-XPnDC4zojmBX0sZzLX73OKLAGGjptVqxV1nEivJSQ3egGQ2i3zp0_NHPUOeRleP1_eBJ5MIVBwjevAMMVNLKCWlt0k5kqy2GqphWECknxfR6lhBrmHLWMmMbFMFBeWAyJjihmb8l3SKsrC7BEaypBbKwA5KYBjRss-F0qEWgpc3ZOmbXK20GA2bXZmZIA1UNfZQteZ03WbHC4UnPm7U2U_lt7___iErIILZA-3o_sDshZivnVDgoekVc8-zRFUC7U8dm7wBcLBwZY
openUrl ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Predictive+Factors+of+Steatosis+and+Non-Alcoholic+Steatohepatitis+in+Morbidly+Obese+Patients+Undergoing+Bariatric+Surgery&rft.jtitle=Hepatitis+monthly&rft.au=Kalidari%2C+Behrooz&rft.au=Mahmoudieh%2C+Mohsen&rft.au=Melali%2C+Hamid&rft.au=Mehdi+Nazari+Moghadam&rft.date=2017-11-01&rft.pub=Tehran+Hepatitis+Center&rft.issn=1735-143X&rft.eissn=1735-3408&rft.volume=17&rft.issue=11&rft_id=info:doi/10.5812%2Fhepatmon.14088&rft.externalDBID=HAS_PDF_LINK
thumbnail_l http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1735-143X&client=summon
thumbnail_m http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1735-143X&client=summon
thumbnail_s http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1735-143X&client=summon