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Pritikin J, Silvers S, Rosenbloom J, Davis B, Signore AD, Sedaghat AR, Tajudeen BA, Schmale I, Lyons J, Corey J, Chandra R. Temperature-controlled radiofrequency device treatment of septal swell bodies for nasal airway obstruction: An open-label, single arm multicenter study. Int Forum Allergy Rhinol 2023; 13:1915-1925. [PMID: 36908245 DOI: 10.1002/alr.23156] [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] [Received: 12/07/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Nasal airway obstruction (NAO) is a highly prevalent disorder. Septal swell body (SSB) hypertrophy is an often overlooked contributor to NAO. SSB treatment may relieve symptoms of NAO. The objective of this study was to assess the clinical use of a temperature-controlled radiofrequency (TCRF) device to treat SSBs to improve symptoms in adults with NAO. METHODS In this prospective, multicenter, open-label, single arm study, patients with severe or extreme NAO related to SSB hypertrophy received bilateral TCRF treatment in the SSB area. The primary endpoint was improvement in Nasal Obstruction Symptom Evaluation (NOSE) Scale scores from baseline to 3 months postprocedure. A subset of study patients underwent computed tomography (CT) imaging to evaluate posttreatment changes in SSB size. RESULTS Mean NOSE Scale scores significantly improved from 73.5 (SD 14.2) at baseline to 27.9 (SD 17.2) at 3 months postprocedure, a reduction of -45.3 (SD 21.4, 95% confidence interval [CI]: -50.4 to -40.1; p < 0.0001); the responder rate was 95.7% (95% CI: 0.88 to 0.99; p < 0.0001). CT evaluation at 3 months showed statistically significant reductions in the SSB with the greatest reduction in the middle thickness (mean change -3.4 [SD 1.8] mL, 95% CI: -4.0 to -2.8; p < 0.0001). Minimal adverse events with any relationship to the device or procedure were reported; none were serious in nature and no septal perforations occurred. CONCLUSIONS This study demonstrates that TCRF treatment of SSB hypertrophy is well tolerated and effective at reducing both SSB size and symptoms of NAO at 3 months posttreatment.
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Affiliation(s)
| | - Stacey Silvers
- Madison ENT & Facial Plastic Surgery, New York, New York, USA
| | | | - Bryan Davis
- Colorado ENT & Allergy, Colorado Springs, Colorado, USA
| | - Anthony Del Signore
- Department of Otolaryngology - Head and Neck Surgery, Mount Sinai Hospital, New York, New York, USA
| | - Ahmad R Sedaghat
- Department of Otolaryngology - Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Bobby A Tajudeen
- Department of Otorhinolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Isaac Schmale
- Otolaryngology (Ear, Nose and Throat), University of Rochester Medical Center, Rochester, New York, USA
| | - Jack Lyons
- Diagnostic Radiology - Midwest Imaging Professionals, Chicago, Illinois, USA
| | | | - Rakesh Chandra
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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张 亚, 马 瑞, 王 玉, 董 敬, 张 靖, 胡 真, 杨 飞, 巩 敏, 娄 淼, 田 琳, 张 璐, 王 波, 彭 裕, 郑 国. [Effect of nasal swell body on nasal airflow and Artemisia pollen deposition]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2023; 37:535-541. [PMID: 37549945 PMCID: PMC10570100 DOI: 10.13201/j.issn.2096-7993.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Indexed: 08/09/2023]
Abstract
Objective:The nasal swell body(NSB) consists of the nasal septal cartilage, nasal bone, and swollen soft tissue, all of which are visible during endoscopic and imaging examinations. Although the function of the NSB remains uncertain, there is evidence to suggest that it plays a vital role in regulating nasal airflow and filtering inhaled air. Based on anatomical and histological evidence, it is hypothesized that the NSB is indispensable in these processes. This study aims to investigate the impact of NSB on nasal aerodynamics and the deposition of allergen particles under physiological conditions. Methods:The three-dimensional (3D) nasal models were reconstructed from computed tomography (CT) scans of the paranasal sinus and nasal cavity in 30 healthy adult volunteers from Northwest China, providing basis for the construction of models without NSB following virtual NSB-removal surgery. To analyze the distribution of airflow in the nasal cavity, nasal resistance, heating and humidification efficiency, and pollen particle deposition rate at various anatomical sites, we employed the computed fluid dynamics(CFD) method for numerical simulation and quantitative analysis. In addition, we created fully transparent segmented nasal cavity models through 3D printing, which were used to conduct bionic experiments to measure nasal resistance and allergen particle deposition. Results:①The average width and length of the NSB in healthy adults in Northwest China were (12.85±1.74) mm and (28.30±1.92) mm, respectively. ②After NSB removal, there was no significant change in total nasal resistance, and cross-sectional airflow velocity remained essentially unaltered except for a decrease in topical airflow velocity in the NSB plane. ③There was no discernible difference in the nasal heating and humidification function following the removal of the NSB; ④After NSB removal, the deposition fraction(DF) of Artemisia pollen in the nasal septum decreased, and the DFs post-and pre-NSB removal were(22.79±6.61)% vs (30.70±12.27)%, respectively; the DF in the lower airway increased, and the DFs post-and pre-NSB removal were(24.12±6.59)% vs (17.00±5.57)%, respectively. Conclusion:This study is the first to explore the effects of NSB on nasal airflow, heating and humidification, and allergen particle deposition in a healthy population. After NSB removal from the healthy nasal cavities: ①nasal airflow distribution was mildly altered while nasal resistance showed no significantly changed; ②nasal heating and humidification were not significantly changed; ③the nasal septum's ability to filter out Artemisia pollen was diminished, which could lead to increased deposition of Artemisia pollen in the lower airway.
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Affiliation(s)
- 亚 张
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710000)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710000, China
| | - 瑞萍 马
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710000)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710000, China
| | - 玉升 王
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710000)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710000, China
| | - 敬亮 董
- 维多利亚大学可持续产业与宜居城市研究所Institute for Sustainable Industries & Liveable Cities, Victoria University, Australia
| | - 靖彬 张
- 西安交通大学第二附属医院影像科Department of Medical Imaging, the Second Affiliated Hospital of Xi'an Jiaotong University
| | - 真真 胡
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710000)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710000, China
| | - 飞轮 杨
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710000)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710000, China
| | - 敏杰 巩
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710000)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710000, China
| | - 淼 娄
- 陕西省人民医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, Shaanxi Provincial People's Hospital
| | - 琳 田
- 皇家墨尔本理工大学航空机械及制造工程学院School of Engineering, RMIT University, Australia
| | - 璐瑶 张
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710000)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710000, China
| | - 波涛 王
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710000)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710000, China
| | - 裕萍 彭
- 榆林市第一医院耳鼻咽喉头颈外科Department of Otolaryngology Head and Neck Surgery, Yulin No. 1 Hospital
| | - 国玺 郑
- 西安交通大学第二附属医院耳鼻咽喉头颈外科(西安,710000)Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710000, China
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Brake DA, Snider S, Miglani A, Hamilton GS, Bansberg SF. Nasal Swell Body Characteristics in Patients With Septal Perforation. OTO Open 2023; 7:e43. [PMID: 36998544 PMCID: PMC10046736 DOI: 10.1002/oto2.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/28/2022] [Accepted: 01/21/2023] [Indexed: 02/25/2023] Open
Abstract
Objective To determine whether septal perforations have an effect on nasal swell body (NSB) size. Study Design Retrospective cohort study. Setting Two tertiary academic medical centers. Methods Computed tomography maxillofacial scans of 126 patients with septal perforation and 140 control patients from November 2010 to December 2020 were evaluated. Perforation etiology was determined. Measurements included perforation length and height and swell body width, height, and length. Swell body volume was calculated. Results The width and volume of the NSB are significantly smaller in perforation patients when compared to controls. The swell body is significantly smaller and thinner in perforations exceeding 14 mm in height compared to small perforations. Perforation etiology groupings into prior septal surgery, septal trauma, septal inflammatory, and mucosal vasoconstriction categories all demonstrated decreased swell body volume and width compared to controls. Inflammatory etiology had the greatest decrease in swell body size. The hemi-swell body on the contralateral side of a septal deviation is significantly thicker than the ipsilateral side. Conclusion The NSB is smaller in patients with septal perforation regardless of perforation size or etiology.
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Affiliation(s)
- Daniela A. Brake
- Department of Otolaryngology–Head and Neck Surgery Mayo Clinic Phoenix Arizona USA
| | - Sam Snider
- Department of Otolaryngology–Head and Neck Surgery Mayo Clinic Phoenix Arizona USA
| | - Amar Miglani
- Department of Otolaryngology–Head and Neck Surgery Mayo Clinic Phoenix Arizona USA
| | - Grant S. Hamilton
- Department of Otolaryngology–Head and Neck Surgery Mayo Clinic Rochester Minnesota USA
| | - Stephen F. Bansberg
- Department of Otolaryngology–Head and Neck Surgery Mayo Clinic Phoenix Arizona USA
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Pshennikov DS, Angotoeva IB. [The septal tubercle: the state of the problem]. Vestn Otorinolaringol 2022; 87:51-56. [PMID: 35605272 DOI: 10.17116/otorino20228702151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The septal tubercle is considered to be a thickened area of the nasal septum, which is located above the lower nasal concha and in front of the middle nasal concha. Taking into account its histological structure and location in the distal segment of the internal nasal valve, it is located and structured for secretory function and vasoactive regulation of the respiratory air flow. These histologically rich tissues with glandular elements are well adapted to the possible dryness that occurs under the influence of intense air flow during breathing, and the existence of a certain number of venous sinusoids of the blood confirms the connection with part of the extensive vascular tissues in the nasal cavity. It is believed that the tubercle of the nasal septum is more pronounced in patients with chronic inflammation of the sinonasal region, for example, with chronic allergic rhinitis or chronic rhinosinusitis. There is currently no consensus on the issue of surgery of the nasal septum body. Due to the lack of consensus among practitioners, many surgeons do not routinely perform operations on this structure and consider the surgical intervention too aggressive, and the effect on nasal obstruction is insignificant. However, according to the presented studies, the results of surgical reduction of soft tissues of the enlarged septal tubercle in the treatment of nasal obstruction using radiofrequency ablation, coblation or microdebrider seem promising, which requires additional study of this issue during long-term follow-up.
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Affiliation(s)
- D S Pshennikov
- Ryazan State Medical University, Ryazan, Russia.,Semashko Regional Clinical Hospital, Ryazan, Russia
| | - I B Angotoeva
- Russian Medical Academy for Continuous Professional Education, Moscow, Russia
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Meng X, Zhu G. Nasal Septal Swell Body: A Distinctive Structure in the Nasal Cavity. EAR, NOSE & THROAT JOURNAL 2021:1455613211010093. [PMID: 33881954 DOI: 10.1177/01455613211010093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The nasal septal swell body (NSB), also known as the nasal septal turbinate, is located in the anterior part of the nasal septum. This study is a narrative review of the existing knowledge on recent developments in NSB. METHODS A literature search was performed using PubMed, Embase, Web of Science, Ovid, and Cochrane Library databases. Google Scholar was used to access more extensive literature. The inclusion criteria were human studies published in English. The exclusion criteria were non-English language and animal studies. RESULTS Of the 345 articles that were initially obtained from 5 databases and Google Scholar, 28 were included in this review. There have been many names for NSBs in the past, which still have no unified terminology recognized by professionals. Pathological investigations revealed that NSB contains a certain amount of sinusoidal blood components. Nasal septal swell body is closely related to the internal nasal valve. Imaging studies have found that the size of NSB is associated with nasal diseases, and NSB hypertrophy can cause anatomic obstruction. In recent years, several procedures for NSB have been reported, and preliminary effectiveness has been achieved. However, the long-term outcomes of volume reduction techniques remain unproven. CONCLUSIONS The NSB is a distinct anatomic structure that may contribute to nasal obstruction and may be reduced surgically with unclear long-term results. Although being investigated for over a century, the unique physiological roles of NSB are not yet fully understood. More evidence is needed to elucidate its physiological effects.
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Affiliation(s)
- Xiangming Meng
- Department of Otorhinolaryngology, Wuxi Huishan District People's Hospital, Wuxi, P. R. China
| | - Guochen Zhu
- Department of Otorhinolaryngology-Head and Neck Surgery, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China
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Zald PB. Septal swell body treatment by transmucosal, incisionless radiofrequency reduction. ACTA ACUST UNITED AC 2020. [DOI: 10.1016/j.otot.2019.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Ghorab S, Taylor CM, Bansberg SF. The Nasal Swell Body and Septal Perforation Repair. Laryngoscope 2020; 130:2795-2801. [PMID: 32324280 DOI: 10.1002/lary.28621] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 02/06/2020] [Accepted: 02/21/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To review our experience with secondary surgery for persistent nasal obstruction following successful septal perforation repair and describe the potential contribution of the nasal swell body (NSB) to obstruction. STUDY DESIGN Retrospective chart review. METHODS IRB-approved retrospective chart review of perforation repairs utilizing bilateral mucosal flaps performed by the senior author from October 2008 through April 2019 was performed. Patients who underwent secondary surgery for persistent nasal obstruction were identified. Data regarding patient demographics, perforation characteristics, primary closure technique, and secondary surgical procedures for persistent postoperative obstruction were analyzed. Nasal Obstruction Symptom Evaluation (NOSE) scores were assessed pre and post revision surgery. RESULTS Thirty-four patients (14.7% of 232 successful repairs) met study criteria. Of those, 30 patients underwent revision septal surgery. An inferiorly advanced NSB was surgically reduced in 9.9% (23/232) of patients following successful closure to improve persistent obstruction. There was no incidence of reperforation. All patients undergoing NSB reduction reported improved nasal airflow postoperatively and 13 completed the NOSE questionnaire. The mean preoperative NOSE score (95% CI) was 52.7 (42.2-63.2; median, 50). The mean postoperative NOSE score (95% CI) was 19.2 (12.8-25.6; median, 15). The difference between the preoperative and postoperative NOSE scores was statistically significant (P < .001). CONCLUSIONS Repair of a septal perforation using a superior bipedicle flap carries the potential for the NSB to contribute to persistent postoperative nasal obstruction. The swell body can be surgically reduced, without re-perforation, to relieve obstructive symptoms in the patient with a successful perforation repair. LEVEL OF EVIDENCE IV Laryngoscope, 2020.
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Affiliation(s)
- Saba Ghorab
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Cullen M Taylor
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
| | - Stephen F Bansberg
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, Arizona, U.S.A
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Physiological changes in the size of the septal swell body correlate with changes in inferior turbinate size. The Journal of Laryngology & Otology 2020; 134:323-327. [PMID: 32241312 DOI: 10.1017/s0022215120000675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The nasal septal swell body is a normal anatomical structure located in the superior nasal septum anterior to the middle turbinate. However, the impact of the septal swell body in nasal breathing during normal function and disease remains unclear. This study aimed to establish that the septal swell body varies in size over time and correlates this with the natural variation of the inferior turbinates. METHOD Consecutive patients who underwent at least two computed tomography scans were identified. The width and height of the septal swell body and the inferior turbinates was recorded. A correlation between the difference in septal swell body and turbinates between the two scans was performed using a Pearson's coefficient. RESULTS A total of 34 patients (53 per cent female with a mean age of 58.3 ± 20.2 years) were included. The mean and mean difference in septal swell body width between scans for the same patient was 1.57 ± 1.00 mm. The mean difference in turbinate width between scans was 2.23 ± 2.52 mm. A statistically significant correlation was identified between the difference in septal swell body and total turbinate width (r = 0.35, p = 0.04). CONCLUSION The septal swell body is a dynamic structure that varies in width over time in close correlation to the inferior turbinates. Further research is required to quantify its relevance as a surgical area of interest.
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Moss WJ, Faraji F, Jafari A, DeConde AS. A systematic review of the nasal septal turbinate: An overlooked surgical target. Am J Otolaryngol 2019; 40:102188. [PMID: 31376923 DOI: 10.1016/j.amjoto.2019.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/25/2019] [Accepted: 03/04/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The nasal septal turbinate (NST) is a conspicuous structure located in the anterior nasal cavity that impacts the internal nasal valve. Its structure and function is often thought to be poorly characterized, and it is rarely addressed surgically. The authors perform a systematic review in an attempt to synthesize what has been learned of this structure and to evaluate its potential as a treatment target. METHODS A query of the Medline, Embase, Web of Science and Cochrane databases was undertaken in search of studies evaluating the NST. This qualitative systematic review was performed in accordance with PRISMA guidelines. Study quality and risk of bias were assessed with established criteria. RESULTS Of the initial 1069 hits from the four databases, 16 articles were ultimately included in the review, which varied in quality and risk of bias. The included articles consisted predominantly of radiographic and histopathologic studies. Four studies evaluated NST treatment outcomes. The NST represents a fusiform-shaped region of erectile tissue, similar in structure and function to that of the inferior turbinates. Preliminary treatment outcomes suggest the NST represents an important surgical target in nasal airway surgery. CONCLUSION When evaluating nasal obstruction patients, surgeons should assess the NST and consider addressing it surgically.
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Yu MS, Choi CH, Jung MS, Kim HC. Correlation between septal body size and inferior turbinate hypertrophy on computerised tomography scans in fifty patients: A radiological analysis. Clin Otolaryngol 2018; 43:952-955. [PMID: 29377481 DOI: 10.1111/coa.13073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2018] [Indexed: 11/28/2022]
Affiliation(s)
- M S Yu
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - C H Choi
- Department of Otolaryngology, Konkuk University School of Medicine, Chungju, Korea
| | - M S Jung
- Department of Otolaryngology, Konkuk University School of Medicine, Chungju, Korea
| | - H C Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji Hospital, Eulji University College of Medicine, Seoul, Korea
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