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Calvet J, Berenguer-Llergo A, Orellana C, García-Manrique M, Rusiñol M, Garcia-Cirera S, Llop M, Arévalo M, Garcia-Pinilla A, Galisteo C, Aymerich C, Gómez R, Serrano A, Carreras A, Gratacós J. Specific-cytokine associations with outcomes in knee osteoarthritis subgroups: breaking down disease heterogeneity with phenotyping. Arthritis Res Ther 2024; 26:19. [PMID: 38212829 PMCID: PMC10782658 DOI: 10.1186/s13075-023-03244-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Despite existing extensive literature, a comprehensive and clinically relevant classification system for osteoarthritis (OA) has yet to be established. In this study, we aimed to further characterize four knee OA (KOA) inflammatory phenotypes (KOIP) recently proposed by our group, by identifying the inflammatory factors associated with KOA severity and progression in a phenotype-specific manner. METHODS We performed an analysis within each of the previously defined four KOIP groups, to assess the association between KOA severity and progression and a panel of 13 cytokines evaluated in the plasma and synovial fluid of our cohort's patients. The cohort included 168 symptomatic female KOA patients with persistent joint effusion. RESULTS Overall, our analyses showed that associations with KOA outcomes were of higher magnitude within the KOIP groups than for the overall patient series (all p-values < 1.30e-16) and that several of the cytokines showed a KOIP-specific behaviour regarding their associations with KOA outcomes. CONCLUSION Our study adds further evidence supporting KOA as a multifaceted syndrome composed of multiple phenotypes with differing pathophysiological pathways, providing an explanation for inconsistencies between previous studies focussed on the role of cytokines in OA and the lack of translational results to date. Our findings also highlight the potential clinical benefits of accurately phenotyping KOA patients, including improved patient stratification, tailored therapies, and the discovery of novel treatments.
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Affiliation(s)
- Joan Calvet
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Antoni Berenguer-Llergo
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Cristóbal Orellana
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - María García-Manrique
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Menna Rusiñol
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Silvia Garcia-Cirera
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Maria Llop
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Marta Arévalo
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Alba Garcia-Pinilla
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Carlos Galisteo
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Cristina Aymerich
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Rafael Gómez
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Alejandra Serrano
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Anna Carreras
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Jordi Gratacós
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Maricar N, Parkes MJ, Callaghan MJ, Felson DT, O'Neill TW. Do Clinical Correlates of Knee Osteoarthritis Predict Outcome of Intraarticular Steroid Injections? J Rheumatol 2020; 47:431-440. [PMID: 30936283 PMCID: PMC10563584 DOI: 10.3899/jrheum.180233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether clinical correlates of knee osteoarthritis (OA) affect the outcome of intraarticular steroid injections (IASI) in symptomatic knee OA. METHODS Men and women aged ≥ 40 years with painful knee OA who participated in an open-label trial of IASI completed questionnaires and clinical examination. The Outcome Measures in Rheumatology (OMERACT)-Osteoarthritis Research Society International (OARSI) criteria were used to assess response to therapy in the short term (within 2 weeks). Among those who initially responded, those whose pain had not returned to within 20% of the baseline Knee Injury and Osteoarthritis Outcome Score pain score at 6 months were characterized as longer-term responders. Log-binomial regression was used to examine factors associated with outcome. RESULTS One hundred ninety-nine participants were included, of whom 146 (73.4%) were short-term and 40 (20.1%) longer-term responders. Compared to short-term nonresponders, participants with these characteristics were more likely to be short-term responders: medial joint line tenderness [relative risk (RR) 1.42, 95% CI 1.10-1.82], medial and lateral joint line tenderness (RR 1.38, 95% CI 1.03-1.84), patellofemoral tenderness (RR 1.27, 95% CI 1.04-1.55), anserine tenderness (RR 1.27, 95% CI 1.06-1.52), and a belief that treatment would be effective [RR/unit increase (range 0-10) = 1.05 (1.01-1.09)]. Aspiration of joint fluid (RR 0.79, 95% CI 0.66-0.95) and previous ligament/meniscus injury (RR 0.63, 95% CI 0.44-0.91) were associated with a reduced risk of being a short-term responder. Compared to initial nonresponders and those whose pain recurred within 6 months, participants with a higher number of pain sites [RR/unit increase (range 0-10) = 0.83, 95% CI 0.72-0.97], chronic widespread pain (RR 0.32, 95% CI 0.10-0.98), perceived chronicity of disease [RR/unit increase (range 0-10) = 0.86, 95% CI 0.78-0.94], and a higher depression score [RR/unit increase (range 0-21) = 0.89, 95% CI 0.81-0.99] were less likely to be longer-term responders. CONCLUSION Among patients with symptomatic knee OA, tenderness around the knee was associated with better short-term outcome of IASI. However, clinical-related factors did not predict longer-term response, while those with chronic widespread pain and depressive symptoms were less likely to obtain longer-term benefits.
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Affiliation(s)
- Nasimah Maricar
- From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester; National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Sciences Centre; Department of Physiotherapy, Salford Royal NHS Foundation Trust; Department of Health Professions, Manchester Metropolitan University; Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
- N. Maricar, PhD, MSc, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Parkes, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre; M.J. Callaghan, Dip. in Physiotherapy, M.Phil, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Health Professions, Manchester Metropolitan University; D.T. Felson, AB, MD, MPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MD, MSc, FRCP(I), FFPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust.
| | - Matthew J Parkes
- From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester; National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Sciences Centre; Department of Physiotherapy, Salford Royal NHS Foundation Trust; Department of Health Professions, Manchester Metropolitan University; Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA
- N. Maricar, PhD, MSc, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Parkes, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre; M.J. Callaghan, Dip. in Physiotherapy, M.Phil, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Health Professions, Manchester Metropolitan University; D.T. Felson, AB, MD, MPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MD, MSc, FRCP(I), FFPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust
| | - Michael J Callaghan
- From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester; National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Sciences Centre; Department of Physiotherapy, Salford Royal NHS Foundation Trust; Department of Health Professions, Manchester Metropolitan University; Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA
- N. Maricar, PhD, MSc, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Parkes, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre; M.J. Callaghan, Dip. in Physiotherapy, M.Phil, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Health Professions, Manchester Metropolitan University; D.T. Felson, AB, MD, MPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MD, MSc, FRCP(I), FFPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust
| | - David T Felson
- From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester; National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Sciences Centre; Department of Physiotherapy, Salford Royal NHS Foundation Trust; Department of Health Professions, Manchester Metropolitan University; Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA
- N. Maricar, PhD, MSc, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Parkes, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre; M.J. Callaghan, Dip. in Physiotherapy, M.Phil, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Health Professions, Manchester Metropolitan University; D.T. Felson, AB, MD, MPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MD, MSc, FRCP(I), FFPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust
| | - Terence W O'Neill
- From the Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester; National Institute for Health Research (NIHR) Manchester Biomedical Research Centre, Manchester University National Health Service (NHS) Foundation Trust, Manchester Academic Health Sciences Centre; Department of Physiotherapy, Salford Royal NHS Foundation Trust; Department of Health Professions, Manchester Metropolitan University; Department of Rheumatology, Salford Royal NHS Foundation Trust, Manchester, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA
- N. Maricar, PhD, MSc, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Parkes, BSc(Hons), Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre; M.J. Callaghan, Dip. in Physiotherapy, M.Phil, PhD, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Health Professions, Manchester Metropolitan University; D.T. Felson, AB, MD, MPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MD, MSc, FRCP(I), FFPH, Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, and NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, and Department of Rheumatology, Salford Royal NHS Foundation Trust
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