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Palermo AE, Cahalin LP, Nash MS. A Secondary Analysis of Short- and Long-Term Variability of Inspiratory Muscle Performance in People Living With SCI. Top Spinal Cord Inj Rehabil 2023; 29:97-106. [PMID: 37235194 PMCID: PMC10208253 DOI: 10.46292/sci22-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Objectives To explore the expected variability in repeated short-term (ST) and long-term (LT) inspiratory muscle performance (IMP) in individuals with chronic spinal cord injury (SCI). Methods Maximal inspiratory pressure (MIP), sustained MIP (SMIP), and inspiratory duration (ID) were collected from 22 individuals with chronic SCI (C1-T9, American Spinal Injury Association Impairment Scale [AIS] A-C) over 18 months. ST data were collected four times within 2 weeks (n = 19). LT data were collected at two time points at least 7 months apart (n = 20). Results SMIP was the most reliable IMP assessment with an intraclass correlation coefficient (ICC) of 0.959, followed by MIP (ICC 0.874) and ID (ICC 0.689). The ID was the only ST measure to have a significant difference [MIP: F(3, 54) = 2.5, p = .07; SMIP: F(3, 54) = 1.3, p = .29; ID: F(1.4, 25.6) = 4.8, p = .03]. Post hoc analysis showed the mean day 1 ST ID measure was significantly different from both days 3 and 4. The percent change of ID from day 3 to day 6 was 11.6%. No LT measures differed significantly [mean change (SD) [95% CI] for MIP: 5.2 cm H2O (18.8) [-3.6, 13.9], p = .235; SMIP: 60.9 pressure time unit (166.1) [-16.9, 138.6], p = .118; ID: 0.1 s (2.5) [-1.1, 1.3], p = .855]. Conclusion These data provide a foundation for understanding normal variance in ST and LT IMP in the SCI population. Change in MIP function outside 10% is likely a true and meaningful change and may help clinicians recognize individuals with SCI at risk for respiratory compromise. Future studies should explore changes in MIP and SMIP that are associated with meaningful functional changes.
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Affiliation(s)
- Anne E. Palermo
- Neuroscience Research Australia (NeuRA), Sydney, Australia
- University of New South Wales, Sydney Australia
| | | | - Mark S. Nash
- The Miami Project to Cure Paralysis, University of Miami, Miami, Florida
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Solinsky R, Schleifer GD, Draghici AE, Hamner JW, Taylor JA. Methodologic implications for rehabilitation research: Differences in heart rate variability introduced by respiration. PM R 2022; 14:1483-1489. [PMID: 35077032 PMCID: PMC9309192 DOI: 10.1002/pmrj.12770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/09/2021] [Accepted: 01/07/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Heart rate variability is a measure of autonomic activity that is growing in popularity as a research outcome. However, despite its increased use, the known effects of respiration on heart rate variability measures are rarely accounted for in rehabilitation medicine research, leading to potential misinterpretation. OBJECTIVE To describe the effect that unpaced and paced breathing introduces to heart rate variability measures in a rehabilitation medicine relevant example of individuals with spinal cord injury. DESIGN Cross-sectional comparison of heart rate variability during unpaced and paced breathing (0.25 Hz, 15 breaths per minute) within the same individuals during the same lab session. SETTING Academic autonomic physiology laboratory. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Mean low frequency (LF) and high frequency (HF) heart rate variability power, percentage of total power derived from the LF spectrum, LF:HF ratio. RESULTS Fifty-nine individuals with spinal cord injury completed laboratory assessments using standardized protocols (NCT02139436). In repeated measures within individuals, mean LF power was significantly higher in unpaced breathing compared to paced breathing (1292 vs. 573 ms2 , p < .001). A Bland-Altman plot demonstrated significant positive proportional bias for LF power when comparing unpaced and paced breathing conditions (R2 = 0.39). Mean HF power was similar between unpaced and paced breathing conditions, although there were wide positive and negative differences between measures, leading to notable uncertainty when respiratory confounders were not accounted for. The percentages of total power derived from the LF spectrum and the mean LF:HF ratio were both significantly higher for unpaced breathing compared to paced breathing (64 vs. 42%, p < .001; and 3.2 vs. 1.1, p < .001, respectively). CONCLUSION Respiration has a significant effect on heart rate variability following spinal cord injury, and not accounting for this has serious consequences for accurate interpretation of unpaced data. Future studies of heart rate variability in rehabilitation medicine should accordingly consider paced breathing.
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Affiliation(s)
- Ryan Solinsky
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
| | | | - Adina E Draghici
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
| | - Jason W Hamner
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
| | - J Andrew Taylor
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
- Spaulding Research Institute, Boston, Massachusetts, USA
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Wecht JM, Weir JP, Noonavath M, Vaccaro DH, Escalon MX, Huang V, Bryce TN. Evaluation of Cardiovascular Autonomic Function during Inpatient Rehabilitation following Traumatic Spinal Cord Injury. J Neurotrauma 2022; 39:1636-1644. [PMID: 35579968 PMCID: PMC9734019 DOI: 10.1089/neu.2021.0379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Assessment of the degree of impaired autonomic nervous system (ANS) function is not part of routine clinical practice during inpatient rehabilitation following traumatic spinal cord injury (SCI). The goal of this investigation was to determine the utility of the International Standards for Neurologic Classification of SCI (ISNCSCI) and the recently revised International Standards to document remaining Autonomic Function after SCI (ISAFSCI) in documenting cardiovascular ANS impairment during inpatient rehabilitation following traumatic SCI. Beat-to-beat recording of supine heart rate (HR) and blood pressure (BP) were collected at the bedside for estimation of total cardiovascular ISAFSCI score, cardio-vagal modulation (i.e., high frequency HR variability [HFHRV]) and sympathetic vasomotor regulation (i.e., Mayer wave component of systolic BP [SBPmayer]). A total of 41 participants completed baseline testing, which was conducted 11 ± 5 days from the admission ISNCSCI examination. There were no differences in supine HR or BP based on the ISNCSCI or ISAFSCI assessments. The HFHRV was generally lower with more distal lesions (r2 = 0.15; p = 0.01), and SBPmayer was significantly lower in those with American Spinal Injury Association Impairment Scale (AIS) A compared with AIS B, C, D (Cohen's d = -1.4; p < 0.001). There were no significant differences in HFHRV or SBPmayer in patients with or without ISAFSCI evidence of cardiovascular ANS impairment. These preliminary data suggest that neither the ISNCSCI nor the ISAFSCI are sensitive to changes in ANS cardiovascular function following traumatic SCI. Bedside assessment of HR and BP variabilities may provide insight, but are not readily available in the clinical setting. Further research is required to evaluate methods that accurately assess the degree of ANS impairment following traumatic SCI.
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Affiliation(s)
- Jill M. Wecht
- James J. Peters VA Medical Center, Bronx, New York, USA
- Bronx Veterans Medical Research Foundation, Bronx, New York, USA
- Department of Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
- Department of Rehabilitation and Human Performance, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Joseph P. Weir
- Department of Health, Sport and Exercise Sciences, University of Kansas, Lawrence, Kansas, USA
| | - Meghana Noonavath
- James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Rehabilitation and Human Performance, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Daniel H. Vaccaro
- James J. Peters VA Medical Center, Bronx, New York, USA
- Department of Rehabilitation and Human Performance, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Miguel X. Escalon
- Department of Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
- Department of Rehabilitation and Human Performance, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Vincent Huang
- Department of Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
- Department of Rehabilitation and Human Performance, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Thomas N. Bryce
- Department of Medicine, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
- Department of Rehabilitation and Human Performance, The Icahn School of Medicine, Mount Sinai, New York, New York, USA
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Tsou HK, Shih KC, Lin YC, Li YM, Chen HY. Altered heart rate variability and pulse-wave velocity after spinal cord injury. World J Clin Cases 2022; 10:9680-9692. [PMID: 36186200 PMCID: PMC9516939 DOI: 10.12998/wjcc.v10.i27.9680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Heart rate variability (HRV) and pulse-wave velocity (PWV), indicators of cardiac function, are altered in patients with spinal cord injury (SCI), suggesting that autonomic cardiac function and arterial stiffness may underlie the high risk of cardiovascular complications in these patients. No study has simultaneously investigated HRV and PWV in the same patients.
AIM To evaluate cardiovascular complications in SCI patients by comparing HRV and PWV between patients with and without SCI.
METHODS In this cross-sectional pilot study, patients with (n = 60) and without SCI (n = 60) were recruited from December 7, 2019 to January 21, 2020. Each participant received a five-minute assessment of HRV and the cardiovascular system using the Medicore HRV Analyzer SA-3000P. Differences in HRV and PWV parameters between participants with and without SCI were statistically examined.
RESULTS We observed a significant difference between participants with and without SCI with respect to the standard deviation of all normal-to-normal intervals, square root of the mean sum of squared successive risk ratio interval differences, physical stress index, total power, very-low frequency, low frequency, high frequency, and arterial elasticity.
CONCLUSION Patients with SCI have weaker sympathetic and parasympathetic activity as well as lower arterial elasticity compared to those without, suggesting that SCI may increase cardiac function loading.
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Affiliation(s)
- Hsi-Kai Tsou
- Functional Neurosurgery Division, Neurological Institute, Taichung Veterans General Hospital, Taichung 404, Taiwan
- Department of Rehabilitation, Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli County 356, Taiwan
- College of Health, National Taichung University of Science and Technology, Taichung 403, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Kuan-Chung Shih
- Research Assistant, The Rong Sing Medical Foundation, Taichung 404, Taiwan
| | - Yueh-Chiang Lin
- Research Assistant, Neurological Institute, Taichung Veterans General Hospital, Taichung 404, Taiwan
| | - Yi-Ming Li
- Research Assistant, Department of Nursing, National Taichung University of Science and Technology, Taichung 403, Taiwan
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei 106, Taiwan
| | - Hsiao-Yu Chen
- Department of Nursing, National Taichung University of Science and Technology, Taichung 403, Taiwan
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Henke AM, Billington ZJ, Gater DR. Autonomic Dysfunction and Management after Spinal Cord Injury: A Narrative Review. J Pers Med 2022; 12:jpm12071110. [PMID: 35887607 PMCID: PMC9320320 DOI: 10.3390/jpm12071110] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/02/2022] [Accepted: 07/05/2022] [Indexed: 12/20/2022] Open
Abstract
The autonomic nervous system (ANS), composed of the sympathetic and parasympathetic nervous systems, acts to maintain homeostasis in the body through autonomic influences on the smooth muscle, cardiac muscles, blood vessels, glands and organs of the body. The parasympathetic nervous system interacts via the cranial and sacral segments of the central nervous system, and the sympathetic nervous system arises from the T1–L2 spinal cord segments. After a spinal cord injury (SCI), supraspinal influence on the ANS is disrupted, leading to sympathetic blunting and parasympathetic dominance resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions and uncontrolled bowel, bladder, and sexual dysfunction. Further, afferent signals to the sympathetic cord elicit unabated reflex sympathetic outflow in response to noxious stimuli below the level of SCI. This article outlines the pathophysiology of SCI on the ANS, clinical ramifications of autonomic dysfunction, and the potential long-term sequelae of these influences following SCI.
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Affiliation(s)
- Austin M. Henke
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.H.); (Z.J.B.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
| | - Zackery J. Billington
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.H.); (Z.J.B.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA; (A.M.H.); (Z.J.B.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Correspondence:
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Singh V, Mitra S. Psychophysiological impact of spinal cord injury: Depression, coping and heart rate variability. J Spinal Cord Med 2022; 46:441-449. [PMID: 35353026 PMCID: PMC10114979 DOI: 10.1080/10790268.2022.2052503] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES The aim was to examine the association of post-injury heart rate variability (HRV), coping with injury (fighting-acceptance), and depression symptoms in individuals with spinal cord injury (SCI). STUDY DESIGN Cross-sectional study. SETTING Tertiary care spinal cord injury hospital. PARTICIPANTS Ninety-one individuals with SCI. METHODS All participants were assessed for HRV using polar heart rate monitor RS 800 CX and completed the Patient Health Questionnaire and Spinal Cord Lesion Coping Strategy questionnaire. Participants were grouped based on level of injury (tetraplegic, high paraplegia, and low paraplegia) and injury duration (early vs. late). Odds ratio calculated the risk of depression using HRV and coping as factors for early and late duration groups. Spearman rho estimated the correlation between three ratios: HRV (LF vs. HF), depression (somatic vs. cognitive), and coping (fighting spirit vs. acceptance) for each level of injury group for early and late duration. RESULTS Individuals with SCI with high HRV had lower odds of depression (OR = 0.14, CI = 0.03-0.78) than individuals with SCI with low HRV in the early duration group. Individuals with SCI with high acceptance had lower odds of depression (OR = 0.19, CI = 0.44-0.79) than individuals with SCI with low acceptance in the later duration group. In the later duration, HRV ratio negatively correlated with coping ratio in individuals with low paraplegia and depression ratio in individuals with high paraplegia. CONCLUSION The aftermath of spinal cord injury might reflect a close association between the physiological response of autonomic variability and psychological response of coping and depression with implications for the level of injury and post-injury duration.
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Affiliation(s)
- Varsha Singh
- Department of Humanities and Social Sciences, IIT-Delhi, Delhi, India
| | - Shambhovi Mitra
- Department of Humanities and Social Sciences, IIT-Delhi, Delhi, India.,Indian Spinal Injuries Centre, Delhi, India
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Henrique Rufino Batista L, Jorge Ribeiro Domingues W, de Athayde Costa e Silva A, Augusta Thomé Lopes K, Leopoldina de Castro Amorim M, Rossato M. Heart rate variability responses determined by photoplethysmography in people with spinal cord injury. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bayo-Tallón V, Esquirol-Caussa J, Pàmias-Massana M, Planells-Keller K, Palao-Vidal DJ. Effects of manual cranial therapy on heart rate variability in children without associated disorders: Translation to clinical practice. Complement Ther Clin Pract 2019; 36:125-141. [PMID: 31383430 DOI: 10.1016/j.ctcp.2019.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 06/11/2019] [Accepted: 06/30/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND and purpose: Heart rate variability (HRV) represents a marker of autonomic activity, self-regulation and psychiatric illness. Few studies of manual therapy have investigated the neurophysiological effects of manual cranial therapy (MC-t). This study assessed the neurophysiological short/medium-term effects of two manual therapy interventions: massage therapy (Mss-t) and MC-t. MATERIALS AND METHODS A double-blind clinical trial was conducted with 50 healthy children, randomized into two groups who received a Mss-t intervention or MC-t. The variables analysed included vital signs (temperature, respiratory rate, heart rate, blood pressure) and HRV components, including the root mean square of successive differences (RMSSD), high frequency (HF), low frequency (LF) and LF/HF ratio. RESULTS Both interventions produced short-term parasympathetic effects, although the effects of MC-t were more persistent. CONCLUSION The persistence of the MC-t intervention suggested a prominent vagal control and better self-regulation. Autonomic imbalances in mental pathologies may benefit from the neurophysiological effects of MC-t.
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Affiliation(s)
- Vanessa Bayo-Tallón
- Universitary Research Service of Physical Therapy, Servei Universitari de Recerca en Fisioteràpia -S.U.R.F, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain.
| | - Jordi Esquirol-Caussa
- Universitary Research Service of Physical Therapy, Servei Universitari de Recerca en Fisioteràpia -S.U.R.F, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain.
| | - Montserrat Pàmias-Massana
- Executive Direction of Adult, Child and Juvenile Mental Health Area at Corporación Sanitaria y Universitaria Parc Taulí (Neurosciences) (Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Kalia Planells-Keller
- Executive Direction of Adult, Child and Juvenile Mental Health Area at Corporación Sanitaria y Universitaria Parc Taulí (Neurosciences) (Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
| | - Diego J Palao-Vidal
- Executive Direction of Adult, Child and Juvenile Mental Health Area at Corporación Sanitaria y Universitaria Parc Taulí (Neurosciences) (Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
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Hoekstra SP, Leicht CA, Kamijo YI, Kinoshita T, Stephenson BT, Goosey-Tolfrey VL, Bishop NC, Tajima F. The inflammatory response to a wheelchair half-marathon in people with a spinal cord injury - the role of autonomic function. J Sports Sci 2019; 37:1717-1724. [DOI: 10.1080/02640414.2019.1586296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sven P. Hoekstra
- The Peter Harrison Centre for Disability Sport; School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - Christof A. Leicht
- The Peter Harrison Centre for Disability Sport; School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - Yoshi-Ichiro Kamijo
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Tokio Kinoshita
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Ben T. Stephenson
- The Peter Harrison Centre for Disability Sport; School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - Victoria L. Goosey-Tolfrey
- The Peter Harrison Centre for Disability Sport; School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - Nicolette C. Bishop
- The Peter Harrison Centre for Disability Sport; School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, UK
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
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