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Adverse Events during Vitrectomy under Adequacy of Anesthesia-An Additional Report. J Clin Med 2021; 10:jcm10184172. [PMID: 34575281 PMCID: PMC8468095 DOI: 10.3390/jcm10184172] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 08/31/2021] [Accepted: 09/14/2021] [Indexed: 12/24/2022] Open
Abstract
The intraprocedural immobilization of selected subsets of patients undergoing pars plana vitrectomy (PPV) requires the performance of general anesthesia (GA), which entails the intraoperative use of hypnotics and titration of opioids. The Adequacy of Anesthesia (AoA) concept of GA guidance optimizes the intraoperative dosage of hypnotics and opioids. Pre-emptive analgesia (PA) is added to GA to minimize intraoperative opioid (IO) usage. The current additional analysis evaluated the advantages of PA using either COX-3 inhibitors or regional techniques when added to AoA-guided GA on the rate of presence of postoperative nausea and vomiting (PONV), oculo-emetic (OER), and oculo-cardiac reflex (OCR) in patients undergoing PPV. A total of 176 patients undergoing PPV were randomly allocated into 5 groups: (1) Group GA, including patients who received general anesthesia alone; (2) Group T, including patients who received preventive topical analgesia by triple instillation of 2% proparacaine 15 min before induction of GA; (3) Group PBB, including patients who received PBB; (4) Group M, including patients who received PA using a single dose of 1 g of metamizole; (5) Group P, including patients who received PA using a single dose of 1 g of acetaminophen. The incidence rates of PONV, OCR, and OER were studied as a secondary outcome. Despite the group allocation, intraoperative AoA-guided GA resulted in an overall incidence of PONV in 9%, OCR in 12%, and OER in none of the patients. No statistically significant differences were found between groups regarding the incidence of OCR. PA using COX-3 inhibitors, as compared to that of the T group, resulted in less overall PONV (p < 0.05). Conclusions: PA using regional techniques in patients undergoing PPV proved to have no advantage when AoA-guided GA was utilised. We recommend using intraoperative AoA-guided GA to reduce the presence of OCR, and the addition of PA using COX-3 inhibitors to reduce the rate of PONV.
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Stasiowski MJ, Pluta A, Lyssek-Boroń A, Kawka M, Krawczyk L, Niewiadomska E, Dobrowolski D, Rejdak R, Król S, Żak J, Szumera I, Missir A, Jałowiecki P, Grabarek BO. Preventive Analgesia, Hemodynamic Stability, and Pain in Vitreoretinal Surgery. ACTA ACUST UNITED AC 2021; 57:medicina57030262. [PMID: 33809346 PMCID: PMC7998194 DOI: 10.3390/medicina57030262] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 01/20/2023]
Abstract
Background and Objectives: Although vitreoretinal surgery (VRS) is most commonly performed under regional anaesthesia (RA), in patients who might be unable to cooperate during prolonged procedures, general anaesthesia (GA) with intraprocedural use of opioid analgesics (OA) might be worth considering. It seems that the surgical pleth index (SPI) can be used to optimise the intraprocedural titration of OA, which improves haemodynamic stability. Preventive analgesia (PA) is combined with GA to minimise intraprocedural OA administration. Materials and Methods: We evaluated the benefit of PA combined with GA using SPI-guided fentanyl (FNT) administration on the incidences of PIPP (postprocedural intolerable pain perception) and haemodynamic instability in patients undergoing VRS (p < 0.05). We randomly assigned 176 patients undergoing VRS to receive GA with SPI-guided FNT administration alone (GA group) or with preventive topical 2% proparacaine (topical anaesthesia (TA) group), a preprocedural peribulbar block (PBB) using 0.5% bupivacaine with 2% lidocaine (PBB group), or a preprocedural intravenous infusion of 1.0 g of metamizole (M group) or 1.0 g of paracetamol (P group). Results: Preventive PBB reduced the intraprocedural FNT requirement without influencing periprocedural outcomes (p < 0.05). Intraprocedural SPI-guided FNT administration during GA resulted in PIPP in 13.5% of patients undergoing VRS and blunted the periprocedural effects of preventive intravenous and regional analgesia with respect to PIPP and haemodynamic instability. Conclusions: SPI-guided FNT administration during GA eliminated the benefits of preventive analgesia in the PBB, TA, M, and P groups following VRS.
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Affiliation(s)
- Michał Jan Stasiowski
- Department of Emergency Medicine, Faculty of Medical Sciences, Medical University of Silesia, 41-200 Sosnowiec, Poland; (A.P.); (L.K.); (J.Ż.); (I.S.); (A.M.); (P.J.)
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, Medykow Square 1, 41-200 Sosnowiec, Poland;
- Correspondence:
| | - Aleksandra Pluta
- Department of Emergency Medicine, Faculty of Medical Sciences, Medical University of Silesia, 41-200 Sosnowiec, Poland; (A.P.); (L.K.); (J.Ż.); (I.S.); (A.M.); (P.J.)
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, Medykow Square 1, 41-200 Sosnowiec, Poland;
| | - Anita Lyssek-Boroń
- Department of Ophthalmology with Paediatric Unit, 5th Regional Hospital, Medykow Square 1, 41-200 Sosnowiec, Poland; (A.L.-B.); (M.K.)
- Department of Ophthalmology, Faculty of Medicine in Zabrze, University of Technology, 41-800 Zabrze, Poland
| | - Magdalena Kawka
- Department of Ophthalmology with Paediatric Unit, 5th Regional Hospital, Medykow Square 1, 41-200 Sosnowiec, Poland; (A.L.-B.); (M.K.)
| | - Lech Krawczyk
- Department of Emergency Medicine, Faculty of Medical Sciences, Medical University of Silesia, 41-200 Sosnowiec, Poland; (A.P.); (L.K.); (J.Ż.); (I.S.); (A.M.); (P.J.)
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, Medykow Square 1, 41-200 Sosnowiec, Poland;
| | - Ewa Niewiadomska
- Department of Epidemiology and Biostatistics, Faculty of Health Sciences, Medical University of Silesia, 41-902 Bytom, Poland;
| | - Dariusz Dobrowolski
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences, Medical University of Silesia, 41-200 Zabrze, Poland;
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University of Lublin, 20-059 Lublin, Poland;
| | - Seweryn Król
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, Medykow Square 1, 41-200 Sosnowiec, Poland;
- Department of General, Colorectal and Polytrauma Surgery, Faculty of Health Sciences, Medical University of Silesia, 40-055 Katowice, Poland
| | - Jakub Żak
- Department of Emergency Medicine, Faculty of Medical Sciences, Medical University of Silesia, 41-200 Sosnowiec, Poland; (A.P.); (L.K.); (J.Ż.); (I.S.); (A.M.); (P.J.)
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, Medykow Square 1, 41-200 Sosnowiec, Poland;
| | - Izabela Szumera
- Department of Emergency Medicine, Faculty of Medical Sciences, Medical University of Silesia, 41-200 Sosnowiec, Poland; (A.P.); (L.K.); (J.Ż.); (I.S.); (A.M.); (P.J.)
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, Medykow Square 1, 41-200 Sosnowiec, Poland;
| | - Anna Missir
- Department of Emergency Medicine, Faculty of Medical Sciences, Medical University of Silesia, 41-200 Sosnowiec, Poland; (A.P.); (L.K.); (J.Ż.); (I.S.); (A.M.); (P.J.)
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, Medykow Square 1, 41-200 Sosnowiec, Poland;
| | - Przemysław Jałowiecki
- Department of Emergency Medicine, Faculty of Medical Sciences, Medical University of Silesia, 41-200 Sosnowiec, Poland; (A.P.); (L.K.); (J.Ż.); (I.S.); (A.M.); (P.J.)
- Department of Anaesthesiology and Intensive Therapy, 5th Regional Hospital, Medykow Square 1, 41-200 Sosnowiec, Poland;
| | - Beniamin Oskar Grabarek
- Department of Histology, Cytophysiology and Embryology, Faculty of Medicine, University of Technology in Katowice, 41-800 Zabrze, Poland;
- Department of Nursing and Maternity, High School of Strategic Planning, 41-300 Dąbrowa Górnicza, Poland
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Urfalıoğlu A, Urfalıoğlu S, Öksüz G. The Knowledge of Eye Physicians on Local Anesthetic Toxicity and Intravenous Lipid Treatment: Questionnaire Study. Turk J Ophthalmol 2017; 47:320-325. [PMID: 29326848 PMCID: PMC5758766 DOI: 10.4274/tjo.79446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/19/2017] [Indexed: 12/01/2022] Open
Abstract
Objectives To evaluate the knowledge of ophthalmologists regarding local anesthesia toxicity syndrome (LATS) and intravenous lipid emulsion used in treatment, and to raise awareness of this issue. Materials and Methods A questionnaire comprising 14 questions about demographics, local anesthesia (LA) use, toxicity, and treatment methods was administered to ophthalmologists at different hospitals. Results The study included 104 ophthalmologists (25% residents, 67.3% specialists, 7.7% faculty members) with a mean age of 35.71±6.53 years. The highest number of participants was from state hospitals (65.4%), and 34.6% of the physicians had been working in ophthalmology for more than 10 years. Seventy-six percent of the participants reported using LA every day or more than twice a week, but 56.7% had received no specific training on this subject. No statistically significant difference was observed between different education levels and the rates of training (p=0.419). Bupivacaine was the most preferred LA and the majority of respondents (97.1%) did not use a test dose. Allergy (76%) and hypotension (68.3%) were the most common responses for early findings of LATS, while cardiac arrest (57.4%) and hepatotoxicity (56.4%) were given for late findings. The most common responses concerning the prevention of LATS included monitorization (72.4%) and use of appropriate doses (58.2%). Symptomatic treatment was selected by 72.4% of respondents and cardiopulmonary resuscitation and antihistamine treatment by 58.8%. Of the ophthalmologists in the study, 62.5% had never encountered LATS. The use of 20% intravenous lipid emulsion therapy for toxicity was known by 65% of the physicians, but only 1 participant stated having used it previously. Conclusion The importance of using 20% lipid emulsion in LATS treatment and having it available where LA is administered must be emphasized, and there should be compulsory training programs for ophthalmologists on this subject.
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Affiliation(s)
- Aykut Urfalıoğlu
- Sütçü İmam University Faculty of Medicine, Department of Anesthesiology and Reanimation, Kahramanmaraş, Turkey
| | - Selma Urfalıoğlu
- Necip Fazıl State Hospital, Opthalmology Clinic, Kahramanmaraş, Turkey
| | - Gözen Öksüz
- Sütçü İmam University Faculty of Medicine, Department of Anesthesiology and Reanimation, Kahramanmaraş, Turkey
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Boone CHT, Grove RA, Adamcova D, Seravalli J, Adamec J. Oxidative stress, metabolomics profiling, and mechanism of local anesthetic induced cell death in yeast. Redox Biol 2017; 12:139-149. [PMID: 28236766 PMCID: PMC5328717 DOI: 10.1016/j.redox.2017.01.025] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 11/23/2022] Open
Abstract
The World Health Organization designates lidocaine as an essential medicine in healthcare, greatly increasing the probability of human exposure. Its use has been associated with ROS generation and neurotoxicity. Physiological and metabolomic alterations, and genetics leading to the clinically observed adverse effects have not been temporally characterized. To study alterations that may lead to these undesirable effects, Saccharomyces cerevisiae grown on aerobic carbon sources to stationary phase was assessed over 6h. Exposure of an LC50 dose of lidocaine, increased mitochondrial depolarization and ROS/RNS generation assessed using JC-1, ROS/RNS specific probes, and FACS. Intracellular calcium also increased, assessed by ICP-MS. Measurement of the relative ATP and ADP concentrations indicates an initial 3-fold depletion of ATP suggesting an alteration in the ATP:ADP ratio. At the 6h time point the lidocaine exposed population contained ATP concentrations roughly 85% that of the negative control suggesting the surviving population adapted its metabolic pathways to, at least partially restore cellular bioenergetics. Metabolite analysis indicates an increase of intermediates in the pentose phosphate pathway, the preparatory phase of glycolysis, and NADPH. Oxidative stress produced by lidocaine exposure targets aconitase decreasing its activity with an observed decrease in isocitrate and an increase citrate. Similarly, increases in α-ketoglutarate, malate, and oxaloacetate imply activation of anaplerotic reactions. Antioxidant molecule glutathione and its precursor amino acids, cysteine and glutamate were greatly increased at later time points. Phosphatidylserine externalization suggestive of early phase apoptosis was also observed. Genetic studies using metacaspase null strains showed resistance to lidocaine induced cell death. These data suggest lidocaine induces perpetual mitochondrial depolarization, ROS/RNS generation along with increased glutathione to combat the oxidative cellular environment, glycolytic to PPP cycling of carbon generating NADPH, obstruction of carbon flow through the TCA cycle, decreased ATP generation, and metacaspase dependent apoptotic cell death.
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Affiliation(s)
- Cory H T Boone
- Department of Biochemistry and Redox Biology Center, University of Nebraska - Lincoln, Lincoln, NE, United States of America
| | - Ryan A Grove
- Department of Biochemistry and Redox Biology Center, University of Nebraska - Lincoln, Lincoln, NE, United States of America
| | - Dana Adamcova
- Department of Biochemistry and Redox Biology Center, University of Nebraska - Lincoln, Lincoln, NE, United States of America
| | - Javier Seravalli
- Department of Biochemistry and Redox Biology Center, University of Nebraska - Lincoln, Lincoln, NE, United States of America
| | - Jiri Adamec
- Department of Biochemistry and Redox Biology Center, University of Nebraska - Lincoln, Lincoln, NE, United States of America.
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Kazancıoğlu L, Batçık Ş, Kazdal H, Şen A, Gediz BŞ, Erdivanlı B. Complication of Peribulbar Block: Brainstem Anaesthesia. Turk J Anaesthesiol Reanim 2017; 45:231-233. [PMID: 28868171 DOI: 10.5152/tjar.2017.95881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/24/2017] [Indexed: 01/29/2023] Open
Abstract
Peribulbar block is used to obtain anaesthesia and akinesia of the eye by injecting a local anaesthetic around the musclecone. A patient scheduled for cataract surgery received peribulbar block with 6 mL of 2% lidocaine hydrochloride. Following the injection, confusion, hypotension and dilatation of the contralateral pupil rapidly progressed to loss of consciousness and respiratory arrest. The patient was intubated and mechanically ventilated for 30 min. The patient regained her consciousness, was extubated and transferred to the intensive care unit for further follow-up. Although brainstem anaesthesia because of peribulbar block is very rare, this procedure should be performed with complete monitorisation and resuscitation equipment.
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Affiliation(s)
- Leyla Kazancıoğlu
- Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Şule Batçık
- Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Hızır Kazdal
- Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Ahmet Şen
- Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Berrak Şekeryapan Gediz
- Department of Eye Diseases, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Başar Erdivanlı
- Department of Anaesthesiology and Reanimation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
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Boone CHT, Grove RA, Adamcova D, Braga CP, Adamec J. Revealing oxidative damage to enzymes of carbohydrate metabolism in yeast: An integration of 2D DIGE, quantitative proteomics, and bioinformatics. Proteomics 2016; 16:1889-903. [PMID: 27193513 DOI: 10.1002/pmic.201500546] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 04/19/2016] [Accepted: 05/16/2016] [Indexed: 12/17/2022]
Abstract
Clinical usage of lidocaine, a pro-oxidant has been linked with severe, mostly neurological complications. The mechanism(s) causing these complications is independent of the blockade of voltage-gated sodium channels. The budding yeast Saccharomyces cerevisiae lacks voltage-gated sodium channels, thus provides an ideal system to investigate lidocaine-induced protein and pathway alterations. Whole-proteome alterations leading to these complications have not been identified. To address this, S. cerevisiae was grown to stationary phase and exposed to an LC50 dose of lidocaine. The differential proteomes of lidocaine treatment and control were resolved 6 h post exposure using 2D DIGE. Amine reactive dyes and carbonyl reactive dyes were used to assess protein abundance and protein oxidation, respectively. Quantitative analysis of these dyes (⩾ 1.5-fold alteration, p ⩽ 0.05) revealed a total of 33 proteoforms identified by MS differing in abundance and/or oxidation upon lidocaine exposure. Network analysis showed enrichment of apoptotic proteins and cell wall maintenance proteins, while the abundance of proteins central to carbohydrate metabolism, such as triosephosphate isomerase and glyceraldehyde-3-phosphate dehydrogenase, and redox proteins superoxide dismutase and peroxiredoxin were significantly decreased. Enzymes of carbohydrate metabolism, such as phosphoglycerate kinase and enolase, the TCA cycle enzyme aconitase, and multiple ATP synthase subunits were found to be oxidatively modified. Also, the activity of aconitase was found to be decreased. Overall, these data suggest that toxic doses of lidocaine induce significant disruption of glycolytic pathways, energy production, and redox balance, potentially leading to cell malfunction and death.
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Affiliation(s)
- Cory H T Boone
- Redox Biology Center, Department of Biochemistry, University of Nebraska - Lincoln, Lincoln, NE, USA
| | - Ryan A Grove
- Redox Biology Center, Department of Biochemistry, University of Nebraska - Lincoln, Lincoln, NE, USA
| | - Dana Adamcova
- Redox Biology Center, Department of Biochemistry, University of Nebraska - Lincoln, Lincoln, NE, USA
| | - Camila P Braga
- Redox Biology Center, Department of Biochemistry, University of Nebraska - Lincoln, Lincoln, NE, USA.,Department of Chemistry and Biochemistry, Institute of Bioscience, São Paulo State University, Botucatu, SP, Brazil
| | - Jiri Adamec
- Redox Biology Center, Department of Biochemistry, University of Nebraska - Lincoln, Lincoln, NE, USA
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Dettoraki M, Dimitropoulou C, Nomikarios N, Moschos MM, Brοuzas D. Generalized seizures and transient contralateral hemiparesis following retrobulbar anesthesia: a case report. BMC Anesthesiol 2015. [PMID: 26215739 PMCID: PMC4517554 DOI: 10.1186/s12871-015-0084-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retrobulbar block is a local anesthetic technique widely used for intraocular surgery. Although retrobulbar anesthesia is considered to be relatively safe, a number of serious adverse events have been reported. To our knowledge, immediate onset of generalized seizures with contralateral hemiparesis after retrobulbar anesthesia has not been reported. CASE PRESENTATION A 62-year-old Caucasian healthy male with a right eye retinal detachment was admitted for pars plana vitrectomy. During retrobulbar anesthesia with ropivacaine and before needle withdrawal, the patient developed twitching of the face which rapidly progressed to generalized tonic-clonic seizures. Arterial oxygen saturation decreased to 75 %. Chin lift was performed and 100 % oxygen was administrated via face mask, which increased saturation to 99 %. Midazolam 2 mg was administrated intravenously to control seizures. After cessation of seizures, left-sided hemiparesis was evident. Brain computed tomography and electroencephalogram were normal 3 h later. The patient underwent pars plana vitrectomy under general anesthesia 4 days later. CONCLUSION Serious complications of local anesthesia for ophthalmic surgery are uncommon. We present a case in which generalized tonic-clonic seizures developed during retrobulbar anesthesia, followed by transient contralateral hemiparesis. The early onset of seizures indicated intra-arterial injection of the anesthetic. Our case suggested the need for close monitoring during the performance of retrobulbar anesthesia and the presence of well-trained personnel for early recognition and immediate management of the complications.
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Affiliation(s)
- Maria Dettoraki
- 1st Department of Ophthalmology, University of Athens, "G. Gennimatas" General Hospital of Athens, 10 G. Papandreou Str, Byron, Athens, 16231, Greece
| | | | - Nikolaos Nomikarios
- 1st Department of Ophthalmology, University of Athens, "G. Gennimatas" General Hospital of Athens, 10 G. Papandreou Str, Byron, Athens, 16231, Greece
| | - Marilita M Moschos
- 1st Department of Ophthalmology, University of Athens, "G. Gennimatas" General Hospital of Athens, 10 G. Papandreou Str, Byron, Athens, 16231, Greece
| | - Dimitrios Brοuzas
- 1st Department of Ophthalmology, University of Athens, "G. Gennimatas" General Hospital of Athens, 10 G. Papandreou Str, Byron, Athens, 16231, Greece.
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