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Wang CK, Yen CC, Chen SY, Lo HY, Ng CJ, Chaou CH. Prognostic value of cardiac troponin in dialysis patients with paroxysmal supraventricular tachycardia. Medicine (Baltimore) 2022; 101:e30513. [PMID: 36086794 PMCID: PMC10980411 DOI: 10.1097/md.0000000000030513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 08/05/2022] [Indexed: 10/14/2022] Open
Abstract
A rise in cardiac troponin I (cTnI) is common in supraventricular tachycardia (SVT). While troponin elevation in SVT is thought to be a predictor of future adverse events in patients with prior coronary artery disease, the prognostic significance of cTnI in end-stage kidney disease (ESKD) patients with SVT are not known. We aimed to examine the prognostic significance of cTnI in ESKD patients presenting with SVT in the emergency department. This was a retrospective, multiple-center observational study utilizing regularly collected electronic medical records. We screened electronic medical records of all dialysis patients presenting to the emergency departments in 5 hospitals over 12 years with SVT. These patients were divided into whether cTnI was tested, and were further stratified into the cTnI-positive and cTnI-negative groups. The primary outcome of the study was the 3-year risk of major adverse cardiovascular events (MACE). Sixty-two patients were qualified for inclusion. Fifty-seven patients (91.9%) were tested for cTnI, and 5 patients were not. Patients with the cTnI test were older (P = .03) and had a longer length of hospital stay (P < .001). Forty-seven patients (82.5%) had a positive result, and 10 (17.5%) had a negative result. A history of hypertension (P = .013) and decreased left ventricular ejection fraction (P = .048) were the independent predictors of cTnI elevation. After a mean follow-up period of 20.6 ± 14.7 months, there were no differences in 3-year MACE between patients with or without elevated cTnI levels in Kaplan-Meier analysis (P = .34). A history of coronary artery disease was the only independent predictor of 3-year MACE (P = .017). Through the subgroup analysis, a history of coronary artery disease (HR 2.73; CI 1.01-7.41; P = .049) remained an independent risk factor for 3-year MACE in patients with elevated cTnI levels. A large proportion (82.5%) of troponin elevation was observed in ESKD patients with SVT, but it had a poor correlation with MACE.
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Affiliation(s)
- Chih-Kai Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chieh-Ching Yen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Chang Gung Medical Education Research Center, Taoyuan, Taiwan
| | - Hsiang-Yun Lo
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Chang Gung Medical Education Research Center, Taoyuan, Taiwan
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Kanjwal K, Kichloo A, Ali M, Berger RD. Narrow complex supraventricular tachycardia. What is the mechanism? HeartRhythm Case Rep 2021; 7:525-528. [PMID: 34434700 PMCID: PMC8377234 DOI: 10.1016/j.hrcr.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Khalil Kanjwal
- Department of Cardiology, McLaren Greater Lansing Hospital, Lansing, Michigan
| | - Asim Kichloo
- Department of Internal Medicine, Central Michigan University, Saginaw, Michigan
| | - Muzaffar Ali
- Department of Cardiology, Sher i Kashmir Institute of Medical Sciences, Srinagar, India
| | - Ronald D Berger
- Department of Cardiology, Johns Hopkins University, Baltimore, Maryland
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Kanjwal K, Kanjwal S, Haji AQ. A Case of Intermittent Preexcitation and Palpitations: More than Meets the Eye. J Innov Card Rhythm Manag 2020; 10:3892-3895. [PMID: 32477709 PMCID: PMC7252703 DOI: 10.19102/icrm.2019.101102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/11/2019] [Indexed: 12/04/2022] Open
Abstract
We discuss the case of a 22-year-old female who presented to the clinic experiencing recurrent palpitations. She was also found to have intermittent preexcitation on her electrocardiogram (ECG). Her palpitations were attributed to stress. Previously, she had gone to the emergency department a few times and was diagnosed with sinus tachycardia. Her ECG revealed a right-sided accessory pathway. Given her atypical finding of orthodromic reciprocating tachycardia, a 30-day event monitor was implanted, which revealed that one episode was correlated with sinus tachycardia, with a heart rate of 120 bpm. She mentioned experiencing other episodes that were severe, but she did not activate the monitor manually at the time of these incidents. After a long discussion with the patient about available management options for her symptoms, it was decided to proceed with long-term monitoring with an implantable loop recorder to gather better symptom–rhythm correlation data. At six months after surgery, the patient experienced multiple manually triggered transmissions from her device, which were all consistent with sinus tachycardia. She had no episode suggestive of any supraventricular tachycardia and is thus being treated for inappropriate sinus tachycardia. This case highlights the importance of gathering adequate symptom–rhythm correlation data before pursuing more invasive treatment options for an arrhythmic etiology in low-risk patients.
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Affiliation(s)
- Khalil Kanjwal
- Michigan State University, McLaren Greater Lansing Hospital, Lansing, MI, USA
| | | | - Abdul Q Haji
- Martinsburg VA Medical Center, Marinsburg, WV, USA
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Kanjwal K, Kanjwal S, Ruzieh M. Atrioventricular Nodal Reentrant Tachycardia in Very Elderly Patients: A Single-center Experience. J Innov Card Rhythm Manag 2020; 11:3990-3995. [PMID: 32368371 PMCID: PMC7192148 DOI: 10.19102/icrm.2020.110202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/15/2019] [Indexed: 11/25/2022] Open
Abstract
We present a series of elderly patients older than 80 years who had recurrent palpitations for decades and who were subsequently diagnosed with atrioventricular (AV) nodal reentrant tachycardia (AVNRT). Through a retrospective chart analysis, we identified 12 patients (nine females and three males) aged 88 years ± 3.7 years (range: 80–92 years) seen at our center from 2015 to 2016 for recurrent palpitations and supraventricular tachycardia (SVT) who were ultimately diagnosed with AVNRT. These patients had palpitations and had been treated for anxiety and panic attacks for decades. They underwent electrophysiology (EP) study and successful ablation of the slow pathway. The demographic data, symptoms, and EP characteristics during the EP studies of the patients were evaluated. All 12 patients experienced palpitations and all but three had documented SVT on a loop recorder or an event monitor. During EP study, all patients displayed slow-pathway conduction. Nine patients demonstrated discontinuous AV nodal conduction curves, while three showed continuous AV nodal conduction curves. The observed tachycardia rates were 496.7 ms ± 25.7 ms. Three patients had atrial fibrillation (AF), which was noted during monitoring with the implanted loop recorders. Tachycardia was induced with both burst atrial pacing and atrial extrastimuli in five patients and with extrastimuli only in two patients. In five patients, no tachycardia induction was noted, but these individuals showed evidence of dual AV node physiology. Successful elimination of residual slow-pathway conduction postablation and/or noninducibility of tachycardia in the postablation period were achieved in all patients. All patients remained symptom-free over a period of one year. The patients who had AF in addition to AVNRT also did not present any recurrent AF following AVNRT ablation but are being monitored for recurrence. AVNRT in elderly people is often confused with panic attacks; hence, reports of panic attacks in elderly people should be properly evaluated for an arrhythmic etiology.
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Affiliation(s)
- Khalil Kanjwal
- McLaren Greater Lansing Hospital, Central Michigan University, Lansing, MI, USA
| | - Shaffi Kanjwal
- St. Mary's of Michigan, Central Michigan University, Lansing, MI, USA
| | - Mohammed Ruzieh
- Penn State Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Vicente Steijn R, Sedmera D, Blom NA, Jongbloed M, Kvasilova A, Nanka O. Apoptosis and epicardial contributions act as complementary factors in remodeling of the atrioventricular canal myocardium and atrioventricular conduction patterns in the embryonic chick heart. Dev Dyn 2018; 247:1033-1042. [PMID: 30152577 DOI: 10.1002/dvdy.24642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/26/2018] [Accepted: 05/31/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND During heart development, it has been hypothesized that apoptosis of atrioventricular canal myocardium and replacement by fibrous tissue derived from the epicardium are imperative to develop a mature atrioventricular conduction. To test this, apoptosis was blocked using an established caspase inhibitor and epicardial growth was delayed using the experimental epicardial inhibition model, both in chick embryonic hearts. RESULTS Chicken embryonic hearts were either treated with the peptide caspase inhibitor zVAD-fmk by intrapericardial injection in ovo (ED4) or underwent epicardial inhibition (ED2.5). Spontaneously beating embryonic hearts isolated (ED7-ED8) were then stained with voltage-sensitive dye Di-4-ANEPPS and imaged at 0.5-1 kHz. Apoptotic cells were quantified (ED5-ED7) by whole-mount LysoTracker Red and anti-active caspase 3 staining. zVAD-treated hearts showed a significantly increased proportion of immature (base to apex) activation patterns at ED8, including ventricular activation originating from the right atrioventricular junction, a pattern never observed in control hearts. zVAD-treated hearts showed decreased numbers of apoptotic cells in the atrioventricular canal myocardium at ED7. Hearts with delayed epicardial outgrowth showed also increased immature activation patterns at ED7.5 and ED8.5. However, the ventricular activation always originated from the left atrioventricular junction. Histological examination showed no changes in apoptosis rates, but a diminished presence of atrioventricular sulcus tissue compared with controls. CONCLUSIONS Apoptosis in the atrioventricular canal myocardium and controlled replacement of this myocardium by epicardially derived HCN4-/Trop1- sulcus tissue are essential determinants of mature ventricular activation pattern. Disruption can lead to persistence of accessory atrioventricular connections, forming a morphological substrate for ventricular pre-excitation. Developmental Dynamics 247:1033-1042, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Rebecca Vicente Steijn
- Department of Anatomy & Embryology, Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - David Sedmera
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic.,Institute of Physiology, Czech Academy of Sciences, Prague, Czech Republic
| | - Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique Jongbloed
- Department of Anatomy & Embryology, Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alena Kvasilova
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ondrej Nanka
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Kipp RT, Abu Sham'a R, Hiroyuki I, Han FT, Refaat M, Hsu JC, Field ME, Kopp DE, Marcus GM, Scheinman MM, Hoffmayer KS. Concealed Accessory Pathways with a Single Ventricular and Two Discrete Atrial Insertion Sites. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:255-263. [PMID: 28098354 DOI: 10.1111/pace.13024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/27/2016] [Accepted: 12/11/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atrioventricular reciprocating tachycardia (AVRT) utilizing a concealed accessory pathway is common. It is well appreciated that some patients may have multiple accessory pathways with separate atrial and ventricular insertion sites. METHODS We present three cases of AVRT utilizing concealed pathways with evidence that each utilizing a single ventricular insertion and two discrete atrial insertion sites. RESULTS In case one, two discrete atrial insertion sites were mapped in two separate procedures, and only during the second ablation was the Kent potential identified. Ablation of the Kent potential at this site remote from the two atrial insertion sites resulted in the termination of the retrograde conduction in both pathways. Case two presented with supraventricular tachycardia (SVT) with alternating eccentric atrial activation patterns without alteration in the tachycardia cycle length. The two distinct atrial insertion sites during orthodromic AVRT and ventricular pacing were targeted and each of the two atrial insertion sites were successfully mapped and ablated. In case three, retrograde decremental conduction utilizing both atrial insertion sites was identified prior to ablation. After mapping and ablation of the first discrete atrial insertion site, tachycardia persisted utilizing the second atrial insertion site. Only after ablation of the second atrial insertion site was SVT noninducible, and VA conduction was no longer present. CONCLUSIONS Concealed retrograde accessory pathways with discrete atrial insertion sites may have a common ventricular insertion site. Identification and ablation of the ventricular insertion site or the separate discrete atrial insertion sites result in successful treatment.
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Affiliation(s)
- Ryan T Kipp
- Division of Cardiology, Section of Electrophysiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Raed Abu Sham'a
- Cardiac Pacing and Electrophysiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ito Hiroyuki
- Division of Cardiology, Section of Electrophysiology, University of California, San Francisco, California
| | - Frederick T Han
- Division of Cardiovascular Medicine, Section of Electrophysiology, University of Utah, Salt Lake City, Utah
| | - Marwan Refaat
- Department of Internal Medicine, Cardiovascular Medicine/Cardiac Electrophysiology, American University of Beirut Faculty of Medicine and Medical Center, Beirut, Lebanon
| | - Jonathan C Hsu
- Division of Cardiology, Section of Electrophysiology, University of California, San Diego, California
| | - Michael E Field
- Division of Cardiology, Section of Electrophysiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Douglas E Kopp
- Division of Cardiology, Section of Electrophysiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Gregory M Marcus
- Division of Cardiology, Section of Electrophysiology, University of California, San Francisco, California
| | - Melvin M Scheinman
- Division of Cardiology, Section of Electrophysiology, University of California, San Francisco, California
| | - Kurt S Hoffmayer
- Division of Cardiology, Section of Electrophysiology, University of California, San Diego, California.,Division of Cardiology, Section of Electrophysiology, VA San Diego Healthcare System, San Diego, California
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Roberts JD, Marcus GM. Ablatogenomics: can genotype guide catheter ablation for cardiac arrhythmias? Pharmacogenomics 2016; 17:1931-1940. [PMID: 27790939 DOI: 10.2217/pgs-2016-0114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Previously confined to the management of rare inherited arrhythmia syndromes, a role for genetics within cardiac electrophysiology has begun to emerge for more common arrhythmias, including atrial fibrillation (AF). Catheter ablation for AF is an invasive procedure effective for restoring normal rhythm, however, fails in up to 40% of those undergoing their first procedure and carries a risk for serious adverse events. Recent studies have suggested that a common genetic variant within chromosome 4q25 may be a powerful predictor of procedural success, highlighting the potential of an 'ablatogenomic' strategy. Although still in its infancy, an ablatogenomic approach for AF may facilitate delivery of ablation to those most likely to benefit, while sparing those prone to fail from its risks.
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Affiliation(s)
- Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON N6A 4A5, Canada
| | - Gregory M Marcus
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA 94143-1354, USA
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Ge HY, Li XM, Tang XJ, Zhang Y, Liu HJ, Li YH. Optimal noninvasive assessment of initial left ventricular dysfunction in children with ectopic atrial tachycardia. Eur J Pediatr 2015; 174:1015-22. [PMID: 25665973 DOI: 10.1007/s00431-015-2500-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 01/20/2015] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
Abstract
UNLABELLED Tissue Doppler imaging (TDI) can identify cardiac dysfunction in adults. This study is aimed to improve early identification of initial left ventricular (LV) dysfunction secondary to ectopic atrial tachycardia (EAT) in children by TDI. A total of 70 children with EAT were included in the present study. Cardiac function was evaluated by conventional echocardiography, TDI, and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP). Doppler signals obtained from the mitral inflow and TDI of the mitral annulus were the average values of three consecutive heartbeats. Left ventricular ejection fraction (LVEF), peak early diastolic transmitral velocity (E), peak systolic mitral annulus velocity (S'), early diastolic mitral annular velocity (E'), the ratio E/E', and TDI-derived myocardial performance index (TDI-MPI) were compared between two groups of children with normal or elevated plasma NT-proBNP concentrations. Of the children, 18.6% demonstrated tachycardia-induced cardiomyopathy (TIC). Compared with LVEF, the TDI-MPI and E/E' showed better correlations with elevated plasma NT-proBNP. Addition of TDI-MPI and E/E' to LVEF provided increased information to detect elevated plasma NT-proBNP (91.67% sensitivity). CONCLUSIONS TIC occurred in 18.6% of children with EAT. Initial LV dysfunction assessed by the TDI-MPI and E/E' is associated with elevated plasma NT-proBNP, even the LVEF is normal.
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Affiliation(s)
- Hai-Yan Ge
- Department of Pediatric Cardiology, Heart Center, the First Hospital of Tsinghua University, Medical Center, Tsinghua University, Beijing, 100016, China,
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Link MS, Exner DV, Anderson M, Ackerman M, Al-Ahmad A, Knight BP, Markowitz SM, Kaufman ES, Haines D, Asirvatham SJ, Callans DJ, Mounsey JP, Bogun F, Narayan SM, Krahn AD, Mittal S, Singh J, Fisher JD, Chugh SS. HRS policy statement: clinical cardiac electrophysiology fellowship curriculum: update 2011. Heart Rhythm 2011; 8:1340-56. [PMID: 21699868 DOI: 10.1016/j.hrthm.2011.06.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Indexed: 01/29/2023]
Affiliation(s)
- Mark S Link
- Tufts Medical Center, Boston, Massachusetts, USA
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Castellá M, Nadal M. Indicaciones de la cirugía en el tratamiento de las taquiarritmias. Guías clínicas. CIRUGIA CARDIOVASCULAR 2010. [DOI: 10.1016/s1134-0096(10)70109-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Hornero F, García-Cosío F, José López Gude M. Cirugía de la taquicardia auricular regular. Mecanismos macrorreentrante y focal. CIRUGIA CARDIOVASCULAR 2010. [DOI: 10.1016/s1134-0096(10)70111-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Gjesdal K. Non-investigational antiarrhythmic drugs: long-term use and limitations. Expert Opin Drug Saf 2009; 8:345-55. [DOI: 10.1517/14740330902927647] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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