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Tarantini G, Cardaioli F, De Iaco G, Tuccillo B, De Angelis MC, Mauro C, Boccalatte M, Trivisonno A, Ribichini F, Vadalà G, Caramanno G, Caruso M, Lombardi M, Fischetti D, Danesi A, Abbracciavento L, Lorenzoni G, Gregori D, Panza A, Nai Fovino L, Esposito G. A more-Comers populAtion trEated with an ultrathin struts polimer-free Sirolimus stent: an Italian post-maRketing study (the CAESAR registry). Front Cardiovasc Med 2024; 10:1326091. [PMID: 38299080 PMCID: PMC10828965 DOI: 10.3389/fcvm.2023.1326091] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 12/11/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction The use of contemporary drug-eluting stents (DES) has significantly improved outcomes of patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). However, concerns exist regarding the long-term proinflammatory effects of durable polymer coatings used in most DES, potentially leading to long-term adverse events. First-generation polymer-free stent technologies, such as sirolimus- and probucol-eluting stents (PF-SES), have shown an excellent safety and efficacy profile. The aim of this study was to evaluate the safety and efficacy of the new ultrathin Coroflex ISAR NEO PF-SES, in a more-comers PCI population. Methods The CAESAR (a more-Comers populAtion trEated with an ultrathin struts polimer-free Sirolimus stent: An Italian post-maRketing study) registry is a multicenter, prospective study conducted in Italy, enrolling more-comers CAD patients undergoing PCI with the Coroflex ISAR NEO stent. Patients with left main (LM) disease, cardiogenic shock (CS), or severely reduced left-ventricular ejection fraction (LVEF) were excluded. The primary endpoint was target-lesion revascularization (TLR) at 1 year. Results A total of 425 patients were enrolled at 13 centers (mean age 66.9 ± 11.6 years, Diabetes mellitus 29%, acute coronary syndrome 67%, chronic total occlusion 9%). Of these, 40.9% had multivessel disease (MVD) and in 3.3% cases, the target lesion was in-stent restenosis (ISR). Clinical device success was reached in 422 (99.6%) cases. At 1 year, only two (0.5%) subjects presented ischemia-driven TLR. The 1-year rates of target vessel revascularization and MACE were 0.5% and 5.1%, respectively. Major bleeding was observed in four (1.0%) patients. Conclusion In this multicenter, prospective registry, the use of a new ultrathin Coroflex ISAR NEO PF-SES in a more-comers PCI population showed good safety and efficacy at 1 year.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Francesco Cardaioli
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Giuseppe De Iaco
- Department of Cardiology, Hospital “Cardinal G. Panico”, Tricase, Italy
| | | | | | - Ciro Mauro
- Department of Cardiology, Hospital Cardarelli, Naples, Italy
| | - Marco Boccalatte
- Interventional Cardiology Unit, Ospedale Santa Maria Delle Grazie Pozzuoli, Napoli, Italy
| | - Antonio Trivisonno
- Department of Cardiovascular Disease, “Antonio Cardarelli” Hospital, Campobasso, Italy
| | | | - Giuseppe Vadalà
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | - Giuseppe Caramanno
- Interventional Cardiology, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Marco Caruso
- Interventional Cardiology Unit, ARNAS Civico, G. Di Cristina Benfratelli, Palermo, Italy
| | - Mario Lombardi
- Interventional Cardiology Unit, A.O. Riuniti Villa Sofia-Cervello, Palermo, Italy
| | | | | | | | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Andrea Panza
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Giovanni Esposito
- Division of Cardiology, Università Degli Studi di Napoli Federico II, Napoli, Italy
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Giuliani L, Archilletti F, Andò G, Rossi S, Sacchetta G, De Iaco G, Saporito F, Contarini M, Parisi R, Gallina S, Zimarino M, Gutiérrez-Chico JL, Maddestra N. A Prospective, observational, Italian multi-center registry of self-aPposing® cOronary Stents in patients presenting with ST-segment Elevation Myocardial InfarcTION: The iPOSITION registry. Cardiol J 2021; 28:842-848. [PMID: 33942280 PMCID: PMC8747812 DOI: 10.5603/cj.a2021.0045] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/08/2020] [Accepted: 12/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background Primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) can be challenging for high thrombus burden and catecholamine-induced vasoconstriction. The Xposition-S stent was designed to prevent stent undersizing and minimize strut malapposition. We evaluated 1-year clinical outcomes of a nitinol, self-apposing®, sirolimus-eluting stent, pre-mounted on a novel balloon delivery system, in de novo lesions of patients presenting with STEMI undergoing pPCI. Methods The iPOSITION is a prospective, multicenter, post-market, observational study. The primary endpoint, target lesion failure (TLF), was defined as the composite of cardiac death, recurrent target vessel myocardial infarction (TV-MI), and clinically driven target lesion revascularization (TLR). Results The study enrolled 247 STEMI patients from 7 Italian centers. Both device and procedural success occurred in 99.2% of patients, without any death, TV-MI, TLR, or stent thrombosis during the hospital stay and at 30-day follow-up. At 1 year, TLF occurred in 2.6%, cardiac death occurred in 1.7%, TV-MI occurred in 0.4%, and TLR in 0.4% of patients. The 1-year stent thrombosis rate was 0.4%. Conclusions The use of an X-position S self-apposing® stent is feasible in STEMI pPCI, with excellent post-procedural results and 1-year outcomes.
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Affiliation(s)
- Livio Giuliani
- Interventional Cardiology Unit, "SS. Annunziata" Hospital, Chieti, Italy.
| | - Federico Archilletti
- Institute of Cardiology, G. D'Annunzio University, Chieti-Pescara, Italy, Via dei Vestini, 66100 Chieti, Italy
| | - Giuseppe Andò
- Policlinico "Gaetano Martino" Hospital - University of Messina, Italy
| | - Serena Rossi
- Interventional Cardiology Unit, "SS. Annunziata" Hospital, Chieti, Italy
| | | | - Giuseppe De Iaco
- Interventional Cardiology Unit, "Cardinal G. Panico" Hospital, Tricase (Lecce), Italy
| | | | | | - Rosario Parisi
- Interventional Cardiology Unit, "S. Salvatore" Hospital, "Ospedali riuniti Marche Nord", Pesaro, Italy
| | - Sabina Gallina
- Institute of Cardiology, G. D'Annunzio University, Chieti-Pescara, Italy, Via dei Vestini, 66100 Chieti, Italy
| | - Marco Zimarino
- Institute of Cardiology, G. D'Annunzio University, Chieti-Pescara, Italy, Via dei Vestini, 66100 Chieti, Italy.,Interventional Cardiology Unit, "SS. Annunziata" Hospital, Chieti, Italy
| | | | - Nicola Maddestra
- Interventional Cardiology Unit, "SS. Annunziata" Hospital, Chieti, Italy
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Tumscitz C, Di Cesare A, Balducelli M, Piva T, Santarelli A, Saia F, Tarantino F, Preti G, Picchi A, Rolfo C, Attisano T, Colonna G, De Iaco G, Parodi G, Di Marco M, Cerrato E, Pierini S, Fileti L, Cavazza C, Dall'Ara G, Govoni B, Mantovani G, Serenelli M, Penzo C, Tebaldi M, Campo G, Biscaglia S. Safety, efficacy and impact on frailty of mini-invasive radial balloon aortic valvuloplasty. Heart 2021; 107:874-880. [PMID: 33627400 DOI: 10.1136/heartjnl-2020-318548] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 01/22/2021] [Accepted: 01/25/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The study was designed to: (1) confirm safety and feasibility of mini-invasive radial balloon aortic valvuloplasty (BAV); (2) assess its impact in terms of quality of life and frailty; and (3) evaluate whether changes in frailty after BAV are associated with death in patients undergoing transcatheter aortic valve implantation (TAVI). METHODS 330 patients undergoing BAV in 16 Italian centres were prospectively included. The primary endpoint was the occurrence of major and minor Valve Academic Research Consortium (VARC)-2 bleeding. Secondary endpoints were scales of quality of life, frailty, evaluated at baseline and 30 days, and their relationship with the occurrence of all-cause death. RESULTS BAV was performed by radial access in 314 (95%) patients. No VARC-2 major and six (1.8%) VARC-2 minor bleedings occurred in the study population. Quality of life, as well as frailty status, significantly improved 30 days after BAV. At 1 year, patients undergoing TAVI with baseline essential frailty toolset (EFT) <3 or achieving an EFT <3 after BAV had a comparable occurrence of all-cause death (15% vs 19%, p=0.58). On the contrary, patients with EFT ≥3 at 30 days despite BAV showed the worst prognosis (all-cause death: 40% vs 15% and 19%, p=0.006 and p=0.05, respectively). CONCLUSIONS Mini-invasive radial BAV is safe, feasible and associated with a low rate of vascular complications. Patients improving EFT 30 days after BAV showed a favourable outcome after TAVI. TRIAL REGISTRATION NUMBER NCT03087552.
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Affiliation(s)
- Carlo Tumscitz
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Cona, Emilia-Romagna, Italy
| | - Annamaria Di Cesare
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Cona, Emilia-Romagna, Italy
| | - Marco Balducelli
- Cardiovascular Department, Azienda Unità Sanitaria Locale della Romagna, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | - Tommaso Piva
- Cardiology Unit, Ospedali Riuniti Umberto I - GM Lancisi, Ancona, Italy
| | | | - Francesco Saia
- Cardiology Unit, Cardio-Thoracic-Vascular Department, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | | | - Gerlando Preti
- Cardiac Unit, Aulss 2 Marca Trevigiana, Ospedale civile, Conegliano Veneto (TV), Italy
| | - Andrea Picchi
- Cardiovascular Department, Azienda USL Toscana SudEst, Misericordia Hospital, Grosseto, Italy
| | - Cristina Rolfo
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli (TO), Italy
| | - Tiziana Attisano
- Interventional Cardiology Unit, Heart Department, AOU S.Giovanni di Dio e Ruggi D'Aragona (SA), Salerno, Italy
| | | | - Giuseppe De Iaco
- Interventional Cardiology, AO Cardinal G Panico, Tricase (LE), Italy
| | - Guido Parodi
- Clinica Cardiologica, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
| | | | - Enrico Cerrato
- Interventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli (TO), Italy
| | - Simona Pierini
- Cardiovascular Department, ASST Nord Milano - Bassini Hospital, Cinisello Balsamo (MI), Italy, Cinisello Balsamo, Italy
| | - Luca Fileti
- Cardiovascular Department, Azienda Unità Sanitaria Locale della Romagna, Ospedale Santa Maria delle Croci, Ravenna, Italy
| | | | | | - Benedetta Govoni
- Department of Medical Sciences, Ferrara University, Ferrara, Italy
| | | | - Matteo Serenelli
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Cona, Emilia-Romagna, Italy
| | - Carlo Penzo
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Cona, Emilia-Romagna, Italy
| | - Matteo Tebaldi
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Cona, Emilia-Romagna, Italy
| | - Gianluca Campo
- Department of Medical Sciences, Cardiology Unit, Azienda Ospedaliera Universitaria di Ferrara, Cona (FE), Italy
| | - Simone Biscaglia
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Cona, Emilia-Romagna, Italy
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Biggi A, Musiari L, Iori M, De Iaco G, Magnani G, Pelloni I, Pinelli S, Pelà GM, Novarini A, Cabassi A, Montanari A. Contribution of bradykinin B2 receptors to the inhibition by valsartan of systemic and renal effects of exogenous angiotensin II in salt-repleted humans. J Pharmacol Exp Ther 2010; 334:911-6. [PMID: 20504911 DOI: 10.1124/jpet.110.166942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
To investigate whether bradykinin (BK) participates in the inhibition of renal effects of exogenous angiotensin II (AngII) by AngII type 1 receptor (AT1R) blockade, eight salt-repleted volunteers underwent four p-aminohippurate- and inulin-based renal studies of AngII infusion at increasing rates of 0.625, 1.25, and 2.5 ng.kg.min(-1) for 30 min. Studies 1 and 2 were preceded by 3 days of placebo, whereas studies 3 and 4 used 240 to 320 mg.day(-1) valsartan. Bradykinin B2-type receptor (BKB2R) antagonist icatibant (50 mug.kg(-1)) was coinfused in studies 2 and 4. Mean blood pressure (MBP), glomerular filtration rate (GFR), renal blood flow (RBF), and renal sodium excretion (UNaV) were measured. In study 1, MBP rose by 12.8%, UNaV decreased by 68%, and GFR and RBF also fell (p < 0.001 for all). In study 2, GFR and RBF fell as in study 1, but the rise in MBP and the fall in UNaV were accentuated [+20.0%, analysis of variance (ANOVA), p < 0.02 versus study 1 and -80.0%, p < 0.05, respectively]. In study 3, AngII had no effects, and in study 4, renal hemodynamics remained unaffected, but MBP still rose and UNaV fell (ANOVA, p < 0.02 and 0.005 versus study 3, respectively). Icatibant accentuated AngII-induced changes in MBP and UNaV. Previous AT1R blockade prevented any systemic and renal effects of AngII, but significant changes in MBP and UNaV still followed AngII plus icatibant even after AT1R blockade. BK, through BKB2Rs, participates in the inhibitory action of AT1R blockers toward actions of exogenous AngII on MBP and UNaV in healthy humans.
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Affiliation(s)
- Almerina Biggi
- Department of Clinical Sciences, University of Parma Medical School, Parma, Italy
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Abstract
This is a case report of a 35 young man with Klinefelter Syndrome presented breathlessness, palpitations and chest pain. It shows a rare case of a thrombus located through the PFO, in patient with pulmonary and paradoxical embolism, which takes back to exciting hypothesis on thrombus growth. A thrombus, which has grown 'in situ' or trapped through the patent foramen ovale, may be a cause of relapsing pulmonary or systemic embolism during anticoagulation therapy. To prevent recurrent paradoxical embolism, percutaneous closure of PFO is recommended, but in this case, thrombus was trapped through the PFO and the patient was referred to the surgeon. We believe that under these circumstances the clinician should be informed of the presence of PFO in critical pulmonary embolism; this case points out the key role of TEE to face a diagnostic and therapeutic scenarios.
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Affiliation(s)
- Walter Serra
- Heart department, Cardiology division, Azienda Ospedaliera/Universitaria Parma, Italy
| | - Giuseppe De Iaco
- Heart department, Cardiology division, Azienda Ospedaliera/Universitaria Parma, Italy
| | - Claudio Reverberi
- Heart department, Cardiology division, Azienda Ospedaliera/Universitaria Parma, Italy
| | - Tiziano Gherli
- Heart department, Cardiac heart surgery institute, Azienda Ospedaliera/Universitaria Parma, Italy
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Biggi A, Carra N, Cabassi A, Barilli AL, Musiari L, Iori M, De Iaco G, Azzarone M, Novarini A, Montanari A. Impaired renal haemodynamic response to L-arginine in essential hypertension: role of buffering anion and tubuloglomerular feedback. J Hypertens 2007; 25:679-88. [PMID: 17278985 DOI: 10.1097/hjh.0b013e3280117550] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 01/11/2023]
Abstract
OBJECTIVE To investigate whether changes in tubuloglomerular feedback (TGF) dependent upon the tubular effects of buffering anions affect the renal haemodynamic response to L-arginine in healthy (control) individuals and patients with essential hypertension. METHODS Mean arterial pressure (MAP), glomerular filtration rate (GFR), renal blood flow (RBF) and fractional excretion of sodium (FENa), chloride (FECl) and lithium (FELi) were measured in 10 control individuals and 10 hypertensive patients during two 3-h infusions of 0.012 mmol/kg per min L-arginine buffered with either HCl or citric acid. RESULTS FELi, FECl and FENa increased (P < 0.001) comparably in controls and hypertensive individuals with arginine-HCl and decreased with arginine-citrate (P < 0.001). MAP was unchanged in controls with arginine-HCl and decreased by 3% with arginine-citrate (P < 0.001), and decreased in hypertensive individuals with both arginine-HCl and arginine-citrate (by 3 and 7%, respectively; P < 0.001). GFR increased with arginine-citrate in controls and hypertensive individuals (by 6.1 and 5.4%, respectively; P < 0.001), but did not change with arginine-HCl in controls and declined by 4.6% in hypertensive individuals (P < 0.05). RBF increased equally after arginine-citrate in controls and hypertensive individuals (by 34 and 33%, respectively; P < 0.001); it also increased after arginine-HCl (22 and 13%, respectively; P < 0.001), but less than after arginine-citrate (P < 0.001), and 41% less in hypertensive individuals than in controls (P < 0.001). DISCUSSION Because arginine-HCl, unlike arginine-citrate, inhibits tubular reabsorption and elicits much less renal vasodilatation than does arginine-citrate, renal haemodynamics in response to L-arginine are modulated by changes in reabsorption and TGF according to the tubular effects of the attendant anion. As renal vasodilatation in hypertensive individuals was reduced only with arginine-HCl, which activates TGF, the blunted vasodilatation of the hypertensive kidney in response to arginine-HCl reflects an exaggerated response to an activated TGF.
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Affiliation(s)
- Almerina Biggi
- Department of Clinical Sciences, University of Parma, Parma, Italy
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Fattori B, Berrettini S, Casani A, Nacci A, De Vito A, De Iaco G. Sudden Hypoacusis Treated with Hyperbaric Oxygen Therapy: A Controlled Study. Ear Nose Throat J 2001. [DOI: 10.1177/014556130108000911] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The term sudden hypoacusis describes a hearing loss of rapid onset and unknown origin that can progress to severe deafness. Of the many therapeutic protocols that have been proposed for treating sudden hypoacusis, hyperbaric oxygen therapy (HOT) plays a leading role. We studied 50 patients who had been referred to our ENT unit within 48 hours of the onset of sudden hypoacusis. We randomly assigned 30 of these patients to undergo once-daily administration of HOT for 10 days; the other 20 patients were treated for 10 days with an intravenous vasodilator. Response to therapy in all patients was evaluated by calculating the mean hearing threshold at frequencies between 500 and 4, 000 Hz and by assessing liminal tonal audiometry results recorded at baseline and 10 days after the cessation of treatment. These results, plus the findings of other audiologic and otoneurologic examinations, revealed that the patients in the HOT group experienced a significantly greater response to treatment than did those in the vasodilator group, regardless of age and sex variables. Significantly more patients in the HOT group experienced a good or significant response. In both groups, patients with pantonal hypoacusis responded significantly better than did those with a milder condition. Based on our findings, coupled with the fact that oxygen therapy is well tolerated and produces no side effects, we conclude that HOT should be considered the preferred treatment for patients with sudden hypoacusis.
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Affiliation(s)
- Bruno Fattori
- From the ENT Clinic. Department of Neurosciences, University of Pisa, Italy
| | - Stefano Berrettini
- From the ENT Clinic. Department of Neurosciences, University of Pisa, Italy
| | - Augusto Casani
- From the ENT Clinic. Department of Neurosciences, University of Pisa, Italy
| | - Andrea Nacci
- From the ENT Clinic. Department of Neurosciences, University of Pisa, Italy
| | - Andrea De Vito
- From the ENT Clinic. Department of Neurosciences, University of Pisa, Italy
| | - Giuseppe De Iaco
- Department of Hyperbaric Oxygen Therapy, University of Pisa, Italy
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