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Vetta G, Parlavecchio A, Caminiti R, Crea P, Magnocavallo M, Della Rocca DG, Lavalle C, Vetta F, Marano G, Ruggieri C, Lofrumento F, Dattilo G, Ferraù L, Dell'Aera C, Giammello F, La Spina P, Musolino RF, Luzza F, Carerj S, Micari A, Di Bella G. Non-conducted premature atrial complexes: A new independent predictor of atrial fibrillation in cryptogenic stroke. J Electrocardiol 2022; 74:46-53. [PMID: 35964522 DOI: 10.1016/j.jelectrocard.2022.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 07/06/2022] [Accepted: 07/23/2022] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Atrial fibrillation (AF) is the main cardiac cause of stroke, but it frequently remains undetected. In patients with cryptogenic stroke an Holter electrocardiogram (ECG) monitoring for AF is recommended. OBJECTIVE To evaluate the prognostic role of Non-Conducted Premature Atrial Complexes (ncPACs) recorded on Holter ECG. METHODS We prospectively enrolled consecutive patients admitted to the Stroke Unit of our hospital with a diagnosis of cryptogenic stroke between December 2018 and January 2020; all patients underwent 24-h Holter ECG monitoring during hospitalization. Two follow-up visits were scheduled, including a 24-h Holter ECG at 3 and 6 months to detect AF. RESULTS Among 112 patients, 58% were male with an average age of 72.2 ± 12.2 years. At follow-up, AF was diagnosed in 21.4% of the population. The baseline 24-h Holter ECG burden of ncPACs and Premature Atrial Complexes (PACs) was higher in patients with AF detected on follow-up (13.5 vs 2, p = 0.001; 221.5 vs 52; p = 0.01). ROC analysis showed that ncPACs had the best diagnostic accuracy in predicting AF (AUC:0.80; 95% CI 0.68-0.92). Cut-off value of ≥7 for ncPACs burden showed the highest accuracy with sensitivity of 62.5% and specificity 97.7% to predict AF onset at follow-up. Moreover, at multivariate Cox-proportional hazard analysis ncPACs burden ≥7 was a powerful independent predictor of AF onset (HR 12.4; 95% CI 4.8-32.8; p < 0.0001). CONCLUSIONS NcPACs burden ≥7 represents a new predictor of AF that could guide the screening of this arrhythmia in cryptogenic stroke patients.
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Affiliation(s)
- Giampaolo Vetta
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Antonio Parlavecchio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rodolfo Caminiti
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Pasquale Crea
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Michele Magnocavallo
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, 00161 Rome, Italy; Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX 78705, USA
| | | | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, "Sapienza" University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | | | - Giovanni Marano
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Chiara Ruggieri
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesca Lofrumento
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Dattilo
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Ludovica Ferraù
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Cristina Dell'Aera
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Fabrizio Giammello
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Paolino La Spina
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Rosa Fortunata Musolino
- Stroke Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Luzza
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Scipione Carerj
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Micari
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gianluca Di Bella
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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Vetta G, Parlavecchio A, Caminiti R, Magnocavallo M, Lavalle C, Della Rocca DG, Marano G, Ruggieri C, Crea P, Dattilo G, Ferrau L, Musolino R, Zito C, Luzza F, Micari A, Carerj S, Di Bella G. 754 Non-conducted premature atrial complexes: a new predictor for atrial fibrillation in cryptogenic stroke patients. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab127.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Atrial fibrillation (AF) is the main cardiac cause of stroke, but it frequently remains undetected. In these patient monitoring for AF is recommended using a Holter electrocardiogram (ECG). The aim of the present study is to study non-conducted atrial complexes (ncPAC) recorded on Holter ECG as a new predictor of AF.
Methods and results
Patients admitted to the Stroke Unit of our hospital for cryptogenic stroke from December 2018 to January 2020 who underwent 24-h electrocardiographic monitoring were prospectively enrolled in the study and were subsequently submitted to 3-month and 6-month follow-up to investigate the occurrence of AF. The study recruited 112 patients. At follow-up visit, AF was diagnosed in 21.4% of the population. The only statistically significant difference between the group with and without a AF diagnosis was the presence of ncPAC (83.3% vs. 16.7%; P < 0.0001). ROC analysis was performed and showed that ncPAC had the best diagnostic accuracy in the AF diagnosis [AUC: 0.798; confidence interval (CI): 0.675–0.921]. The AUC of ncPAC was significantly better than the AUC of premature atrial complexes (PACs) (P < 0.05), CHA2DS2-VASc, HATCH, HAVOC, and C2HEST scores (P < 0.01). Kaplan–Meier curve survival estimate for AF onset by the presence of ncPAC revealed that there was a significant difference in the AF onset between patients with ncPAC and those without (P < 0.0001) and multivariate Cox-proportional hazard analysis revealed that ncPAC presence was an independent predictors of AF onset [hazards ratio (HR): 9.28; CI 95%: 2,66–32,40; P = 0.0001].
Conclusions
The presence of ncPAC represents a new predictor of AF that could further guide the investigation of AF in patients with cryptogenic stroke.
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Affiliation(s)
- Giampaolo Vetta
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, Italy
| | - Antonio Parlavecchio
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
| | - Rodolfo Caminiti
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
| | - Michele Magnocavallo
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, Italy
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, Italy
| | - Domenico G Della Rocca
- Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, ‘Sapienza’ University of Rome, Policlinico Umberto I, Italy
| | - Giovanni Marano
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
| | - Chiara Ruggieri
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
| | - Pasquale Crea
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
| | - Giuseppe Dattilo
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
| | - Ludovica Ferrau
- Dipartimento di Neuroscienze, Scienze Psichiatriche e Anestesiologiche Clinica Neurologica, Università di Messina, Italy
| | - Rosa Musolino
- Dipartimento di Neuroscienze, Scienze Psichiatriche e Anestesiologiche Clinica Neurologica, Università di Messina, Italy
| | - Concetta Zito
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
| | - Francesco Luzza
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
| | - Antonio Micari
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
| | - Scipione Carerj
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
| | - Gianluca Di Bella
- Cardiology Unit, Department of Clinical and Experimental Medicine, University Hospital of Messina, Italy
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Caminiti R, Vetta G, Parlavecchio A, Marano G, Ruggieri C, Citro R, Radano I, Pucci M, Di Bella G, Micari A, Carerj S, Zito C. Prediction of early left ventricular recovery and adverse remodelling in patients with acute myocardial infarction: the role of non-invasive myocardial work evaluation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Left ventricular recovery (LVR) and adverse left ventricular remodelling (aLVR) after acute myocardial infarction (AMI) play an important prognostic role.
Purpose
Our aim was to evaluate the usefulness of non-invasive myocardial work (MW), a new index of global and regional myocardial performance, to predict LVR and aLVR.
Methods
Fifty patients with AMI (mean age, 63,8±13,4 years), treated by percutaneous coronary intervention (PCI), were prospectively enrolled and underwent a transthoracic Doppler echocardiography within 48 hours after PCI and a median of 31 days at follow-up. Myocardial work is derived from the strain-pressure relation, integrating in its calculation the non-invasive arterial pressure. Segmental LVR was defined as an absolute improvement of left ventricular ejection fraction (LVEF) ≥5% from LVEF at the baseline. The aLVR was defined as an increase of ≥20% of the LV end diastolic volume (LVEDV) at 1 month follow up.
Results
We found significant differences between the baseline and the follow-up value of LVEF (49,28 vs 52,80 p=0.001), Global Longitudinal Strain (GLS) (−13,41 vs −18,72, p=0.016), Global Work Index (GWI) (1368,68 vs 1788,08, p<0.0001), Global Work Efficiency (GWE) (86,96 vs 91,36, p=0.001), and Global Constructive Work (GCW) (1619,16 vs 2008,68, p<0.0001). The LVR at 1 month of follow-up was observed in 36% of the population enrolled, whereas aLVR was described in 18% of cases. Using ROC curve analysis, we identified a cut off value of 137 mmHg/% for baseline Global Wasted Work (Sensitivity 100%, Specificity 57,14%, AUC 0.6667, CI 95%: 0,51618- 0,81715, p<0.0001) to identify patients with aLVR at 1 month. With regards to conventional echo parameters, patients with LVR showed lower baseline Wall Motion Score Index (WMSI) than those with LVR (1,73 vs 1,38, p=0.007).
Conclusions
Baseline global wasted work can predict early adverse left ventricular remodelling at 1 months after AMI. These parameters could be used at baseline in order to predict worse outcome in AMI patients. Further larger scale studies are needed to validate these findings.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Caminiti
- University of Messina, Department of Cardiology, Messina, Italy
| | - G Vetta
- University of Messina, Department of Cardiology, Messina, Italy
| | - A Parlavecchio
- University of Messina, Department of Cardiology, Messina, Italy
| | - G Marano
- University of Messina, Department of Cardiology, Messina, Italy
| | - C Ruggieri
- University of Messina, Department of Cardiology, Messina, Italy
| | - R Citro
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Cardio-Thoracic-Vascular Department, Salerno, Italy
| | - I Radano
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Cardio-Thoracic-Vascular Department, Salerno, Italy
| | - M Pucci
- AOU S. Giovanni di Dio e Ruggi d'Aragona, Cardio-Thoracic-Vascular Department, Salerno, Italy
| | - G Di Bella
- University of Messina, Department of Cardiology, Messina, Italy
| | - A Micari
- University of Messina, Department of Cardiology, Messina, Italy
| | - S Carerj
- University of Messina, Department of Cardiology, Messina, Italy
| | - C Zito
- University of Messina, Department of Cardiology, Messina, Italy
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Ruggieri C, Ruffino M, Veglia S, Garabello D, Davini O, Righi D. Role of the Cardiac Synchronised Computed Tomography Angiography in the Dissection of Descending Thoracic Aorta. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mariscotti G, Houssami N, Durando M, Bergamasco L, Campanino PP, Ruggieri C, Regini E, Luparia A, Bussone R, Sapino A, Fonio P, Gandini G. Accuracy of mammography, digital breast tomosynthesis, ultrasound and MR imaging in preoperative assessment of breast cancer. Anticancer Res 2014; 34:1219-1225. [PMID: 24596363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To define the accuracy of digital breast tomosynthesis (DBT) and magnetic resonance imaging (MRI) added to digital mammography (DM) and ultrasound (US) in the preoperative assessment of breast cancer. PATIENTS AND METHODS We performed a prospective study of 200 consecutive women with histologically-proven breast cancer using the above imaging techniques. Accuracy measurements were estimated using a lesion-by-lesion analysis for unifocal, multifocal/multicentric, bilateral and all carcinomas. We also calculated sensitivity according to breast density. RESULTS DBT had higher sensitivity than DM (90.7% vs. 85.2%). Combined DM and DBT with US yielded a 97.7% sensitivity; despite high sensitivity of MRI (98.8%), the addition of MRI to combined DM with DBT and US did not significantly improve sensitivity. Overall accuracy did not significantly differ between MRI and DM with DBT and US (92.3% vs. 93.7%). Breast density affected sensitivity of DM and DBT (statistically significant difference for DM), not MRI. CONCLUSION There is little gain in sensitivity and no gain in overall accuracy, by performing MRI for patients who have been evaluated with DM with DBT and US.
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/diagnosis
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/diagnosis
- Carcinoma, Lobular/surgery
- Female
- Follow-Up Studies
- Humans
- Image Processing, Computer-Assisted
- Magnetic Resonance Imaging
- Mammography
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Staging
- Prognosis
- Prospective Studies
- Tomography, X-Ray Computed
- Ultrasonography, Mammary
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Affiliation(s)
- Giovanna Mariscotti
- Breast Imaging Service, Institute of Diagnostic and Interventional Radiology, University of Turin, Department of Diagnostic Imaging, Città della Salute e della Scienza Hospital, Via Genova 3, 10126 Turin, Italy.
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Carpagnano GE, Koutelou A, Natalicchio MI, Martinelli D, Ruggieri C, Di Taranto A, Antonetti R, Carpagnano F, Foschino-Barbaro MP. HPV in exhaled breath condensate of lung cancer patients. Br J Cancer 2011; 105:1183-90. [PMID: 21952627 PMCID: PMC3208494 DOI: 10.1038/bjc.2011.354] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: A recent intriguing carcinogenetic hypothesis for lung cancer foresees its viral aetiology. The human papilloma virus (HPV) is the main virus actually recognised in the pathogenesis of lung cancer. The aim of this study was to investigate, for the first time to our knowledge, the presence of HPV in the exhaled breath condensate (EBC) of lung cancer patients. Materials and method: We enrolled 89 patients affected by lung cancer and 68 controls. HPV infections were investigated in their EBC, paired bronchial brushing and neoplastic lung tissue through genotyping. Results: We were able to detect HPV in the EBC, bronchial brushing and neoplastic lung tissue. We described the presence of an HPV infection in 16.4% of the subjects affected by non-small cell lung cancer, but in none of the controls. HPV 16 and 31 turned out to be the most widespread genotypes. The HPV positivity in airways as well as in the smoking habit was seen to independently increase the individual's susceptibility to developing lung cancer. Conclusion: When summing up, we demonstrated the possibility to identify an HPV infection in the EBC of lung cancer patients; further, we supported the notion that the EBC is a suitable tool to study airway colonisation. That being said, although further studies are needed to confirm our results, we retain the study of HPV in EBC to be very interesting in terms of future programmes involving lung-cancer screening.
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Affiliation(s)
- G E Carpagnano
- Institute of Respiratory Disease, Department of Medical and Occupational Sciences, Faculty of Medicine, University of Foggia, Foggia, Italy.
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Bouchaud O, Houzé S, Longuet C, di Piazza JP, Ruggieri C, Sécardin Y, Coulaud JP, Le Bras J. Use of the Parasight-F diagnostic test for imported malaria in a travel clinic. Am J Trop Med Hyg 2000; 63:76-9. [PMID: 11358000 DOI: 10.4269/ajtmh.2000.63.76] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The Parasight-F test based on the detection of a soluble antigen specific for Plasmodium falciparum is designed for the immediate diagnosis of malaria infection. We evaluated its use by clinicians during consultations. This prospective study of its diagnostic utility in febrile patients consulting a travel clinic on their return from areas endemic for malaria was conducted between May 1996 and May 1997. The Parasight-F test was performed by the clinician with confirmation by means of standard microscopic examination of venous blood. One-hundred and forty patients were enrolled. Forty-three (31%) cases of malaria were identified by microscopic examination. Thirty-eight were due to P. falciparum. The Parasight-F tests yielded 6 false-positive and 3 false-negative results compared to the microscopic findings. The specificity and sensitivity for the diagnosis of P. falciparum malaria were 94% and 92%. These results show that the Parasight-F test alone cannot replace microscopic diagnosis of malaria in travel clinics.
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Affiliation(s)
- O Bouchaud
- Department of Infectious and Tropical Diseases, H pital Bichat-Claude Bernard, Paris, France.
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Abstract
Osteochondroma is the most common bone tumor of the foot. This should be easily recognized by foot and ankle specialists. Malignant transformation does occur, although it is quite rare, and should be a consideration when deciding on treatment. An unusual case of recurrent osteochondroma is reviewed.
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Affiliation(s)
- F N Day
- Doctors Hospital, New Boston, TX, USA
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Abstract
The spontaneous development of malignant non-Hodgkin lymphoma in a patient with idiopathic myelofibrosis is described. The tumor appeared 3 years after clinical diagnosis of the latter. Implications of the association between myeloproliferative and lymphoproliferative disorders at a pathogenetic level are briefly discussed.
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Affiliation(s)
- G V Bogliolo
- Cattedra di Patologia Medica B, University of Genoa, Italy
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Abstract
The present study supports earlier reports showing poorer free recall for the item preceding a unique item in an otherwise homogeneous list. Subjects were shown lists of common nouns and instructed either prior to or immediately following list presentation to be aware of a word in the list from a particular taxonomic category. Recall of the unique item was improved both by priority and “posteriority” instructions, whereas recall was depressed for the immediately preceding item in both conditions. It was concluded that encoding failures are sufficient but not necessary to produce induced retrograde amnesia.
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