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Wu Y, Chen Z, Yao C, Sun H, Li H, Du X, Cheng J, Wan X. Effect of systemic lidocaine on postoperative quality of recovery, the gastrointestinal function, inflammatory cytokines of lumbar spinal stenosis surgery: a randomized trial. Sci Rep 2023; 13:17661. [PMID: 37848527 PMCID: PMC10582089 DOI: 10.1038/s41598-023-45022-5] [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: 11/04/2022] [Accepted: 10/14/2023] [Indexed: 10/19/2023] Open
Abstract
Surgery is one of the most frequent and effective intervention strategies for lumbar spinal stenosis, however, one-third of patients are not satisfied with postoperative outcomes. It is not clear whether perioperative systemic lidocaine could accelerate the early postoperative quality of recovery in patients undergoing lumbar spinal stenosis surgery. 66 patients were enrolled in this trial. Lidocaine or placebo was administered at a loading dose of 1.5 mg/kg for 10 min and then infused at 2.0 mg/kg/hour till the end of surgery. Continued infusion by postoperative patient-controlled intravenous analgesia with a dose of 40 mg/hour. The primary outcome was the quality of recovery. Secondary outcomes included the time of the patient's first flatus, catheter removal time, underground time from the end of the surgery, pain score, levels of inflammatory factors (IL-6, IL-10, TNF-α), postoperative nausea and vomiting (PONV), sufentanil rescues, patients' satisfaction scores, and complications of lidocaine. Eventually, 56 patients were in the final analysis with similar age, Body Mass Index (BMI), duration of surgery and anesthesia, and median QoR-15 score (a development and Psychometric Evaluation of a Postoperative Quality of Recovery Score). The difference in median QoR-15 score in placebo versus lidocaine patients was statistically significant (IQR, 106 (104-108) versus 114 (108.25-119.25), P < 0.001). The Numeric Rating Scale (NRS) score at the 12th hour, median sufentanil rescue consumption, IL-6, tumor necrosis factor-alpha (TNF-α) of patients treatment with lidocaine were lower. Nevertheless, patients given lidocaine had high satisfaction scores. Suggesting that lidocaine enhanced the postoperative quality of recovery, met early postoperative gastrointestinal function recovery, provided superior pain relief, lessened inflammatory cytokines, etc., indicating it may be a useful intervention to aid recovery following lumbar spinal stenosis surgery.
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Affiliation(s)
- Yu Wu
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Zhuoming Chen
- School of Textile and Fashion, Shanghai University of Engineering Science, Shanghai, 201620, China
| | - Caimiao Yao
- Department of Clinical Laboratory, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Houxin Sun
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Hongxia Li
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Xuyang Du
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, China
| | - Jianzheng Cheng
- Department of Anesthesiology, Bethune International Peace Hospital, Shijiazhuang, 050082, China.
| | - Xiaojian Wan
- Department of Anesthesiology and Critical Care Medicine, Changhai Hospital, Naval Medical University, Shanghai, 200433, China.
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La Rocca G, Mazzucchi E, Pignotti F, Nasto LA, Galieri G, Olivi A, De Santis V, Rinaldi P, Pola E, Sabatino G. Intraoperative CT-guided navigation versus fluoroscopy for percutaneous pedicle screw placement in 192 patients: a comparative analysis. J Orthop Traumatol 2022; 23:44. [PMID: 36048284 PMCID: PMC9437178 DOI: 10.1186/s10195-022-00661-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
Background Percutaneous pedicle screw (PPS) placement is a key step in several minimally invasive spinal surgery (MISS) procedures. Traditional technique for PPS makes use of C-arm fluoroscopy assistance (FA). More recently, newer intraoperative imaging techniques have been developed for PPS, including CT-guided navigation (CTNav). The aim of this study was to compare FA and CTNav techniques for PPS with regard to accuracy, complications, and radiation dosage. Materials and methods A total of 192 patients with degenerative lumbar spondylolisthesis and canal stenosis who underwent MISS posterior fusion ± interbody fusion through transforaminal approach (TLIF) were retrospectively reviewed. Pedicle screws were placed percutaneously using either standard C-arm fluoroscopy guidance (FA group) or CT navigation (CTNav group). Intraoperative effective dose (ED, mSv) was measured. Screw placement accuracy was assessed postoperatively on a CT scan using Gertzbein and Robbins classification (grades A–E). Oswestry disability index (ODI) and visual analog scale (VAS) scores were compared in both groups before and after surgery. Results A total of 101 and 91 procedures were performed with FA (FA group) and CTNav approach (CTNav group), respectively. Median age was 61 years in both groups, and the most commonly treated level was L4–L5. Median ED received from patients was 1.504 mSv (0.494–4.406) in FA technique and 21.130 mSv (10.840–30.390) in CTNav approach (p < 0.001). Percentage of grade A and B screws was significantly higher for the CTNav group (96.4% versus 92%, p < 0.001), whereas there were 16 grade E screws in the FA group and 0 grade E screws in the CTNav group (p < 0.001). A total of seven and five complications were reported in the FA and CTNav group, respectively (p = 0.771). Conclusions CTNav technique increases accuracy of pedicle screw placement compared with FA technique without affecting operative time. Nevertheless, no significant difference was noted in terms of reoperation rate due to screw malpositioning between CTNav and FA techniques. Radiation exposure of patients was significantly higher with CTNav technique. Level of Evidence: Level 3.
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Affiliation(s)
- Giuseppe La Rocca
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy.,Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy.,Neurosurgical Training Center and Brain Research, Mater Olbia Hospital, Olbia, Italy
| | - Edoardo Mazzucchi
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy.,Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| | - Fabrizio Pignotti
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy.,Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| | - Luigi Aurelio Nasto
- Unit of Orthopedics and Spine Surgery, Primo Policlinico Di Napoli, Università Della Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 2, 80138, Naples, Italy
| | - Gianluca Galieri
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy.,Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy.,Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy
| | - Vincenzo De Santis
- Institute of Orthopedics, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University of Rome, Rome, Italy.,Unit of Orthopedics, Mater Olbia Hospital, Olbia, Italy
| | | | - Enrico Pola
- Unit of Orthopedics and Spine Surgery, Primo Policlinico Di Napoli, Università Della Campania Luigi Vanvitelli, Piazza Luigi Miraglia, 2, 80138, Naples, Italy.
| | - Giovanni Sabatino
- Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy.,Institute of Neurosurgery, IRCCS Fondazione Policlinico Universitario Agostino Gemelli, Catholic University, Rome, Italy.,Neurosurgical Training Center and Brain Research, Mater Olbia Hospital, Olbia, Italy
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Du Y, Li J, Tang X, Liu Y, Bian G, Shi J, Zhang Y, Zhao B, Zhao H, Sui K, Xi Y. The Thermosensitive Injectable Celecoxib-Loaded Chitosan Hydrogel for Repairing Postoperative Intervertebral Disc Defect. Front Bioeng Biotechnol 2022; 10:876157. [PMID: 35837544 PMCID: PMC9274121 DOI: 10.3389/fbioe.2022.876157] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Percutaneous endoscopic lumbar discectomy has been widely used in clinical practice for lumbar spine diseases. But the postoperative disc re-herniation and inflammation are the main reason for pain recurrence after surgery. The postoperative local defect of the intervertebral disc will lead to the instability of the spine, further aggravating the process of intervertebral disc degeneration. In this work, we successfully synthesized the thermosensitive injectable celecoxib-loaded chitosan hydrogel and investigated its material properties, repair effect, biocompatibility, and histocompatibility in in vitro and in vivo study. In vitro and in vivo, the hydrogel has low toxicity, biodegradability, and good biocompatibility. In an animal experiment, this composite hydrogel can effectively fill local tissue defects to maintain the stability of the spine and delay the process of intervertebral disc degeneration after surgery. These results indicated that this composite hydrogel will be a promising way to treat postoperative intervertebral disc disease in future clinical applications.
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Affiliation(s)
- Yukun Du
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianyi Li
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaojie Tang
- Department of Spinal Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Yingying Liu
- State Key Laboratory of Bio-Fibers and Eco-Textiles, College of Materials Science and Engineering, Shandong Collaborative Innovation Center of Marine Biobased Fibers and Ecological Textiles, Qingdao University, Qingdao, China
| | - Guoshuai Bian
- State Key Laboratory of Bio-Fibers and Eco-Textiles, College of Materials Science and Engineering, Shandong Collaborative Innovation Center of Marine Biobased Fibers and Ecological Textiles, Qingdao University, Qingdao, China
| | - Jianzhuang Shi
- State Key Laboratory of Bio-Fibers and Eco-Textiles, College of Materials Science and Engineering, Shandong Collaborative Innovation Center of Marine Biobased Fibers and Ecological Textiles, Qingdao University, Qingdao, China
| | - Yixin Zhang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- Health Care Ward III, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Baomeng Zhao
- Department of Surgery teaching and research, Binzhou Medical University, Yantai, China
| | - Hongri Zhao
- Department of Spinal Surgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, China
| | - Kunyan Sui
- State Key Laboratory of Bio-Fibers and Eco-Textiles, College of Materials Science and Engineering, Shandong Collaborative Innovation Center of Marine Biobased Fibers and Ecological Textiles, Qingdao University, Qingdao, China
- *Correspondence: Kunyan Sui, ; Yongming Xi,
| | - Yongming Xi
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
- *Correspondence: Kunyan Sui, ; Yongming Xi,
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Effect of Ultrasound-Guided Fascia Iliac Compartment Block on Serum NLRP3 and Inflammatory Factors in Patients with Femoral Intertrochanteric Fracture. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1944659. [PMID: 35620203 PMCID: PMC9129941 DOI: 10.1155/2022/1944659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/18/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022]
Abstract
Objective To investigate the effects of ultrasound-guided fascia iliac compartment block (FICB) on patients' postoperative pain and inflammatory factors as well as nucleotide-binding domain and leucine-rich repeat (NLR) family, pyrin domain-containing 3 (NLRP3) in femoral intertrochanteric fracture. Methods This single-blind randomized controlled study included 231 patients with femoral intertrochanteric fracture treated in our hospital from January 2017 to December 2020. All patients were randomized into two groups, the FICB group (n = 116) and the general anesthesia group (control group, n = 115). The serum NLRP3 levels and inflammatory factors were evaluated. The heart rate (HR), mean arterial pressure (MAP), and SpO2 values were recorded. Pain condition was measured by the visual analogue scale (VAS) score. Harris score was performed for positive hip function. Results The values of HR and MAP were significantly lower after anesthesia induction in FICB groups compared with the control group. However, no significant difference was found for SpO2. Compared with the control group, the VAS scores within 72 h after surgery were all markedly lower in the FICB group than in the control group and showed no significant difference at 1 week after surgery. The levels of NLRP3 and interleukin 6 (IL-6) were significantly lower in FICB patients at 1 h, 6 h, 24 h, 48 h, and 72 h after surgery compared with the control group. Tumor necrosis factor-α (TNF-α) showed a significant lower level in the FICB group at 1 h and 6 h after surgery, and significant lower levels of C-reactive protein (CRP) were found at 1 h and 24 h after surgery compared with the control group. Positive correlation was found between NLRP3 and IL-6, as well as CRP and VAS scores after 1 h of the surgery. No significant difference was found for both Harris score and postoperative complications between the two groups. Conclusion Fascia iliac compartment block could reduce the postoperative pain, which might be associated with the decrease of the serum levels of NLRP3, CRP, IL-6, and TNF-α in femoral intertrochanteric fracture patients.
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Walker PB, Sark C, Brennan G, Smith T, Sherman WF, Kaye AD. Spinal Epidural Lipomatosis: A Comprehensive Review. Orthop Rev (Pavia) 2021; 13:25571. [PMID: 34745483 DOI: 10.52965/001c.25571] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/03/2021] [Indexed: 01/23/2023] Open
Abstract
Purpose of review This is a comprehensive review regarding the epidemiology, diagnosis, and management of spinal epidural lipomatosis (SEL). Recent Findings SEL is a relatively rare condition that has gained scientific relevance over the past few decades. Recent findings include expanding treatment strategies to include minimally invasive surgical techniques. Summary SEL is caused by an excess of adipose tissue accumulation localized to the thoracic and lumbar regions of the spine. While the exact pathogenesis is not fully elucidated, the etiology of SEL can be broadly classified based on five commonly associated risk factors; exogenous steroid use, obesity, endogenous steroid hormonal disease, spine surgery, and idiopathic disease. Progression of SEL may lead to neurological deficits, myelopathy, radiculopathy, neurogenic claudication, loss of sensation, difficulty voiding, lower extremity weakness, and rarely cauda equina syndrome. Conservative management is largely patient-specific and aimed at mitigating symptoms that arise from shared risk factors. If more advanced treatment measures are necessary, minimally invasive surgery and open surgical techniques, have proven successful.
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Affiliation(s)
| | - Cain Sark
- Louisiana State University Health Science Center Shreveport
| | - Gioe Brennan
- Louisiana State University Health Science Center Shreveport
| | - Taylor Smith
- Louisiana State University Health Science Center Shreveport
| | | | - Alan D Kaye
- Louisiana State University Health Science Center Shreveport
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Liu X, Liu H, Wang Y. Application of a new percutaneous multi-function pedicle locator in minimally invasive spine surgery. Sci Rep 2021; 11:21451. [PMID: 34728727 PMCID: PMC8563717 DOI: 10.1038/s41598-021-01027-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022] Open
Abstract
In this study, a new percutaneous multi-function pedicle locator was designed for personalized three-dimensional positioning of a pedicle in minimally invasive spine surgery (MISS) without computer-assisted navigation technology. The proposed locator was used in a number of patients during MISS, and its advantages were analyzed. Based on the position of a pedicle determined by computed tomography (CT) and fluoroscopic images of a patient, 6 lines and 2 distances were used to determine the puncture point of a pedicle screw on skin, while 2 angles were used to indicate the direction of insertion of a pedicle guide needle from the patient's body surface. The results of the proposed locator were compared with those of the conventional freehand technique in MISS. The potential benefits of using the locator included enhanced surgical accuracy, reduced operation time, alleviation of the harmful intra-operative radiation exposure, lower costs, and shortened learning curve for young orthopedists.
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Affiliation(s)
- Xiaojian Liu
- Department of Pharmacology, School of Basic Medical Sciences, Jinzhou Medical University, Jinzhou, 121001, Liaoning, People's Republic of China
| | - Hairun Liu
- Department of Orthopedics, Jinzhou Central Hospital, Jinzhou, 121001, Liaoning, People's Republic of China
| | - Yushan Wang
- Department of Orthopedics, Jinzhou Central Hospital, Jinzhou, 121001, Liaoning, People's Republic of China. .,Department of Orthopedics, Antai Hospital, No. 9~9-1, Xindalu, Section 2, Heping Road, Guta District, Jinzhou, 121001, Liaoning, People's Republic of China.
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SIRT6 enhances telomerase activity to protect against DNA damage and senescence in hypertrophic ligamentum flavum cells from lumbar spinal stenosis patients. Aging (Albany NY) 2021; 13:6025-6040. [PMID: 33568575 PMCID: PMC7950242 DOI: 10.18632/aging.202536] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 09/28/2020] [Indexed: 12/18/2022]
Abstract
Lumbar spinal stenosis (LSS) is a condition wherein patients exhibit age-related fibrosis, elastin-to-collagen ratio reductions, and ligamentum flavum hypertrophy. This study was designed to assess the relationship between SIRT6 and telomerase activity in hypertrophic ligamentum flavum (LFH) cells from LSS patients. We observed significant reductions in SIRT6, TPP1, and POT1 protein levels as well as increases in telomerase reverse transcriptase (TERT) levels and telomerase activity in LFH tissues relative to non- hypertrophic ligamentum flavum (LFN) tissues. When SIRT6 was overexpressed in these LFH cells, this was associated with significant increases in telomerase activity and a significant reduction in fibrosis-related protein expression. These effects were reversed, however, when telomerase activity was inactivated by hTERT knockdown in these same cells. SIRT6 overexpression was further found to reduce the frequency of senescence-associated β-galactosidase (SA-β-Gal)-positive LFH cells and to decrease p16, MMP3, and L1 mRNA levels and telomere dysfunction-induced foci (TIFs) in LFH cells. In contrast, hTERT knockdown-induced telomerase inactivation eliminated these SIRT6-dependent effects. Overall, our results indicate that SIRT6 functions as a key protective factor that prevents cellular senescence and telomere dysfunction in ligamentum flavum cells, with this effect being at least partially attributable to SIRT6-dependent telomerase activation.
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Sprau AC, Basil G, Borowsky P, Yoon JW, Wang MY. Patient Participation With a Mobile Phone Application for Objective Activity Assessment Before and After Spinal Fusion. Cureus 2020; 12:e10326. [PMID: 33052287 PMCID: PMC7546594 DOI: 10.7759/cureus.10326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Evolution within spine surgery is driven by a surgeon’s desire for expertise and significant improvement in their patients’ quality of life. As surgeons move away from using subjective patient-reported outcome (PRO) surveys, there must be an alternative objective metric in its place. Modern iPhone (Apple Inc., Cupertino, CA) technology can be used to capture daily activity in a simple, non-user biased manner. These health data can be used to analyze objective functional status in conjunction with PRO surveys to measure surgical outcomes. Methods Patients who underwent an awake transforaminal lumbar interbody fusion (TLIF) between 2014 and 2018 at our institution were identified. Patients were consented and instructed to download the application “QS Access” (Quantified Self Labs, San Francisco, CA). Following data collection, we analyzed the demographic information of patients who were reached to gauge participation and feasibility of data exportation. Results A total of 177 patients who underwent an awake TLIF at our institution were contacted. Of those who answered, 41 (44.6%) agreed to participate and 51 (55.4%) declined to participate. When comparing those who either participated or declined, there were no significant differences in age (p=0.145), sex (p=0.589), or ethnicity (p=0.686). Conclusion Our pilot study examined the patient participation in the novel usage of Apple "Health" data, queried from "QS Access" (Quantified Self Labs), to objectively measure relative patient functional status surrounding spinal fusion. We demonstrated that a smartphone-based application was mostly well received by our patient cohort and has the potential to be used as an objective operative metric moving forward.
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Affiliation(s)
- Annelise C Sprau
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Gregory Basil
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Peter Borowsky
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
| | - Jang W Yoon
- Neurological Surgery, University of Pennsylvania, Philadelphia, USA
| | - Michael Y Wang
- Neurological Surgery, University of Miami Miller School of Medicine, Miami, USA
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