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  • 1
    Language: English
    In: The New England journal of medicine, 2014-09-18, Vol.371 (12), p.1111-1120
    Description: In a randomized trial, over 7000 patients with ST-segment elevation MI were assigned to undergo thrombus aspiration followed by percutaneous coronary intervention or PCI alone. At 1 year, there was no significant between-group difference in the rate of death from any cause. Acute ST-segment elevation myocardial infarction (STEMI) is often caused by intracoronary thrombus formation with blockage of antegrade coronary flow leading to myocardial ischemia and cell death. 1 Thrombus burden, reduced coronary flow, and reduced myocardial perfusion are important predictors of a poor clinical outcome, including recurrence of myocardial infarction, stent thrombosis, and death. 2 Prompt initiation of antithrombotic therapy in combination with percutaneous coronary intervention (PCI) is the preferred approach to optimize myocardial perfusion and clinical outcomes. 3 Coronary-artery thrombus aspiration before PCI reduces the thrombus burden and improves ST-segment resolution and coronary flow. 4 , 5 To our knowledge, however, no adequately powered randomized . . .
    Subject(s): Cardiology. Vascular system ; Heart ; General aspects ; Biological and medical sciences ; Myocarditis. Cardiomyopathies ; Medical sciences ; Coronary heart disease ; Suction ; Myocardial Infarction - mortality ; Patient Readmission ; Humans ; Middle Aged ; Coronary Restenosis ; Kaplan-Meier Estimate ; Male ; Combined Modality Therapy ; Cause of Death ; Coronary Thrombosis - therapy ; Myocardial Infarction - therapy ; Electrocardiography ; Female ; Aged ; Percutaneous Coronary Intervention ; Complications and side effects ; Patient outcomes ; Development and progression ; Research ; Thrombosis ; Heart attack ; Risk factors ; Blood clot ; Studies ; Myocardial infarction ; Heart attacks ; Medical imaging ; Mortality ; Implants ; Clinical trials ; Death ; Clinical outcomes ; Blood clots ; Veins & arteries ; Abridged Index Medicus ; Kardiologi ; Clinical Medicine ; Cardiac and Cardiovascular Systems ; Medical and Health Sciences ; Klinisk medicin ; Medicin och hälsovetenskap ; Hälsovetenskap ; Health and Caring Sciences ; Allmänmedicin ; General Practice ; Radiologi och bildbehandling ; Myocardial Infarction: therapy ; Radiology, Nuclear Medicine and Medical Imaging ; Coronary Thrombosis: therapy ; Myocardial Infarction: mortality
    ISSN: 0028-4793
    ISSN: 1533-4406
    E-ISSN: 1533-4406
    Source: Single Journals
    Source: SWEPUB Freely available online
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  • 2
    Language: English
    In: Acta anaesthesiologica Scandinavica, 2019-10, Vol.63 (9), p.1210-1215
    Description: Background Intensive care treat critically ill patients. When intensive care is not considered beneficial for the patient, decisions to withdraw or withhold treatments are made. We aimed to identify independent patient variables that increase the odds for receiving a decision to withdraw or withhold intensive care. Methods Registry study using data from the Swedish Intensive Care Registry (SIR) 2014‐2016. Age, condition at admission, including co‐morbidities (Simplified Acute Physiology Score version 3, SAPS 3), diagnosis, sex, and decisions on treatment limitations were extracted. Patient data were divided into a full care (FC) group, and a withhold or withdraw (WW) treatment group. Results Of all 97 095 cases, 47.1% were 61‐80 years old, 41.9% were women and 58.1% men. 14 996 (15.4%) were allocated to the WW group and 82 149 (84.6%) to the FC group. The WW group, compared with the FC group, was older (P 〈 0.001), had higher SAPS 3 (P 〈 0.001) and were predominantly female (P 〈 0.001). Compared to patients 16‐20 years old, patients 〉81 years old had 11 times higher odds of being allocated to the WW group. Higher SAPS 3 (continuous) increased the odds of being allocated to the WW group by odds ratio [OR] 1.085, (CI 1.084‐1.087). Female sex increased the odds of being allocated to the WW group by 18% (1.18; CI 1.13‐ 1.23). Conclusion Older age, higher SAPS 3 at admission and female sex were found to be independent variables that increased the odds to receive a decision to withdraw or withhold intensive care.
    Subject(s): ethics ; life‐sustaining care ; age ; sex ; SAPS 3 ; Life Sciences & Biomedicine ; Anesthesiology ; Science & Technology ; Anestesi och intensivvård ; Anesthesiology and Intensive Care ; life-sustaining care
    ISSN: 0001-5172
    E-ISSN: 1399-6576
    Source: Academic Search Ultimate
    Source: Web of Science - Science Citation Index Expanded - 2019〈img src="http://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /〉
    Source: Alma/SFX Local Collection
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  • 3
    Language: English
    In: Acta anaesthesiologica Scandinavica, 2020-10, Vol.64 (9), p.1335-1342
    Description: Background The onset of cerebral ischemia is difficult to predict in patients with altered consciousness using the methods available. We hypothesize that changes in Heart Rate Variability (HRV), Near‐Infrared Spectroscopy (NIRS), and Electroencephalography (EEG) correlated with clinical data and processed by artificial intelligence (AI) can indicate the development of imminent cerebral ischemia and reperfusion, respectively. This study aimed to develop a method that enables detection of imminent cerebral ischemia in unconscious patients, noninvasively and with the support of AI. Methods This prospective observational study will include patients undergoing elective surgery for carotid endarterectomy and patients undergoing acute endovascular embolectomy for cerebral arterial embolism. HRV, NIRS, and EEG measurements and clinical information on patient status will be collected and processed using machine learning. The study will take place at Sahlgrenska University Hospital, Gothenburg, Sweden. Inclusion will start in September 2020, and patients will be included until a robust model can be constructed. By analyzing changes in HRV, EEG, and NIRS measurements in conjunction with cerebral ischemia or cerebral reperfusion, it should be possible to train artificial neural networks to detect patterns of impending cerebral ischemia. The analysis will be performed using machine learning with long short‐term memory artificial neural networks combined with convolutional layers to identify patterns consistent with cerebral ischemia and reperfusion. Discussion Early signs of cerebral ischemia could be detected more rapidly by identifying patterns in integrated, continuously collected physiological data processed by AI. Clinicians could then be alerted, and appropriate actions could be taken to improve patient outcomes.
    Subject(s): cerebral reperfusion ; machine learning ; monitoring ; cerebral ischemia ; artificial intelligence ; near-infrared spectroscopy ; individual patient data ; transcranial ; eeg ; stroke ; Anestesi och intensivvård ; Anesthesiology and Intensive Care ; doppler ; Anesthesiology
    ISSN: 0001-5172
    E-ISSN: 1399-6576
    Source: Academic Search Ultimate
    Source: Alma/SFX Local Collection
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  • 4
    Language: English
    In: Acta neurologica Scandinavica, 2021-02, Vol.143 (2), p.195-205
    Description: Objectives Recent reports suggest an association between the inflammatory response after aneurysmal subarachnoid haemorrhage (aSAH) and patients' outcome. The primary aim of this study was to identify a potential association between the inflammatory response after aSAH and 1‐year outcome. The secondary aim was to investigate whether the inflammatory response after aSAH could predict the development of delayed cerebral ischaemia (DCI). Materials and methods This prospective observational pilot study included patients with an aSAH admitted to Sahlgrenska University Hospital, Gothenburg, Sweden, between May 2015 and October 2016. The patients were stratified according to the extended Glasgow Outcome Scale (GOSE) as having an unfavourable (score: 1–4) or favourable outcome (score: 5–8). Furthermore, patients were stratified depending on development of DCI or not. Patient data and blood samples were collected and analysed at admission and after 10 days. Results Elevated serum concentrations of inflammatory markers such as tumour necrosis factor‐α and interleukin (IL)‐6, IL‐1Ra, C‐reactive protein and intercellular adhesion molecule‐1 were detected in patients with unfavourable outcome. When adjustments for Glasgow coma scale were made, only IL‐1Ra remained significantly associated with poor outcome (p = 0.012). The inflammatory response after aSAH was not predictive of the development of DCI. Conclusion Elevated serum concentrations of inflammatory markers were associated with poor neurological outcome 1‐year after aSAH. However, inflammatory markers are affected by many clinical events, and when adjustments were made, only IL‐1Ra remained significantly associated with poor outcome. The robustness of these results needs to be tested in a larger trial.
    Subject(s): subarachnoid haemorrhage ; inflammation ; delayed cerebral ischaemia ; outcome ; Interleukins - blood ; Humans ; Middle Aged ; Glasgow Outcome Scale ; Male ; Subarachnoid Hemorrhage - complications ; Biomarkers - blood ; Brain Ischemia - etiology ; Subarachnoid Hemorrhage - pathology ; Brain Ischemia - blood ; Glasgow Coma Scale ; Brain Ischemia - pathology ; Adult ; Female ; Intercellular Adhesion Molecule-1 - blood ; Aged ; C-Reactive Protein - analysis ; Subarachnoid Hemorrhage - blood ; Medicine, Experimental ; Medical research ; Inflammation ; Interleukins ; Klinisk medicin ; Clinical Medicine ; Anestesi och intensivvård ; Anesthesiology and Intensive Care ; Neurologi ; Neurology
    ISSN: 0001-6314
    ISSN: 1600-0404
    E-ISSN: 1600-0404
    Source: Academic Search Ultimate
    Source: Alma/SFX Local Collection
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  • 5
    Language: English
    In: Acta anaesthesiologica Scandinavica, 2006-08, Vol.50 (7), p.833-839
    Description: Background:  Morbidly obese patients have an increased risk for peri-operative lung complications and develop a decrease in functional residual capacity (FRC). Electric impedance tomography (EIT) can be used for continuous, fast-response measurement of lung volume changes. This method was used to optimize positive end-expiratory pressure (PEEP) to maintain FRC. Methods:  Fifteen patients with a body mass index of 49 ± 8 kg/m2 were studied during anaesthesia for laparoscopic gastric bypass surgery. Before induction, 16 electrodes were placed around the thorax to monitor ventilation-induced impedance changes. Calibration of the electric impedance tomograph against lung volume changes was made by increasing the tidal volume in steps of 200 ml. PEEP was titrated stepwise to maintain a horizontal baseline of the EIT curve, corresponding to a stable FRC. Absolute FRC was measured with a nitrogen wash-out/wash-in technique. Cardiac output was measured with an oesophageal Doppler method. Volume expanders, 1 ± 0.5 l, were given to prevent PEEP-induced haemodynamic impairment. Results:  Impedance changes closely followed tidal volume changes (R2 〉 0.95). The optimal PEEP level was 15 ± 1 cmH2O, and FRC at this PEEP level was 1706 ± 447 ml before and 2210 ± 540 ml after surgery (P 〈 0.01). The cardiac index increased significantly from 2.6 ± 0.5 before to 3.1 ± 0.8 l/min/m2 after surgery, and the alveolar dead space decreased. PaO2/FiO2, shunt and compliance remained unchanged. Conclusion:  EIT enables rapid assessment of lung volume changes in morbidly obese patients, and optimization of PEEP. High PEEP levels need to be used to maintain a normal FRC and to minimize shunt. Volume loading prevents circulatory depression in spite of a high PEEP level.
    Subject(s): electric impedance tomography ; positive end-expiratory pressure ; monitoring ; body mass index ; functional residual capacity ; positive end‐expiratory pressure ; Anesthesia, General ; Gastric Bypass ; Obesity, Morbid - surgery ; Lung Compliance ; Humans ; Middle Aged ; Cardiac Output ; Male ; Laparoscopy ; Electric Impedance ; Functional Residual Capacity ; Positive-Pressure Respiration - methods ; Lung Volume Measurements ; Obesity, Morbid - physiopathology ; Tomography ; Adult ; Female ; Pulmonary Gas Exchange ; Obesity ; Usage ; Surgery ; Gastric bypass ; methods ; Positive-Pressure Respiration ; physiopathology ; Anestesi och intensivvård ; Anesthesiology and Intensive Care ; Anesthesia ; General ; Morbid ; surgery
    ISSN: 0001-5172
    E-ISSN: 1399-6576
    Source: Academic Search Ultimate
    Source: Alma/SFX Local Collection
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  • 6
    Language: English
    In: Acta anaesthesiologica Scandinavica, 2020-08, Vol.64 (7), p.945-952
    Description: Background Delayed cerebral ischemia (DCI) is a major cause of impaired outcome after aneurysmal subarachnoidal hemorrhage (aSAH). In this observational cohort study we investigated whether changes in heart rate variability (HRV) that precede DCI could be detected. Methods Sixty‐four patients with aSAH were included. HRV data were collected for up to 10 days and analyzed offline. Correlation with clinical status and/or radiologic findings was investigated. A linear mixed model was used for the evaluation of HRV parameters over time in patients with and without DCI. Extended Glasgow outcome scale score was assessed after 1 year. Results In 55 patients HRV data could be analyzed. Fifteen patients developed DCI. No changes in HRV parameters were observed 24 hours before onset of DCI. Mean of the HRV parameters in the first 48 hours did not correlate with the development of DCI. Low/high frequency (LF/HF) ratio increased more in patients developing DCI (β −0.07 (95% confidence interval, 0.12‐0.01); P = .012). Lower STDRR (standard deviation of RR intervals), RMSSD (root mean square of the successive differences between adjacent RR intervals), and total power (P = .003, P = .007 and P = .004 respectively) in the first 48 hours were seen in patients who died within 1 year. Conclusion Impaired HRV correlated with 1‐year mortality and LF/HF ratio increased more in patients developing DCI. Even though DCI could not be detected by the intermittent analysis of HRV used in this study, continuous HRV monitoring may have potential in the detection of DCI after aSAH using different methods of analysis.
    Subject(s): Anestesi och intensivvård ; Anesthesiology and Intensive Care
    ISSN: 0001-5172
    ISSN: 1399-6576
    E-ISSN: 1399-6576
    Source: Academic Search Ultimate
    Source: Alma/SFX Local Collection
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  • 7
    Language: English
    In: Neurocritical care, 2018-12, Vol.29 (3), p.404-412
    Description: Cardiac complications frequently occur after subarachnoid hemorrhage (SAH) and are associated with an increased risk of neurological complications and poor outcomes. The aim of this study was to evaluate the impact of acute cardiac complications after SAH on long-term mortality and cardiovascular events. All patients admitted to our Neuro intensive care unit with verified SAH from January 2010 to April 2015, and electrocardiogram, echocardiogram, and troponin T or NTproBNP data obtained within 72 h of admission were included in the study. Mortality data were obtained from the Swedish population register. Data regarding cause of death and hospitalization for cardiovascular events were obtained from the Swedish Board of Health and Welfare. A total of 455 patients were included in the study analysis. There were 102 deaths during the study period. Cardiac troponin release (HR 1.08, CI 1.02-1.15 per 100 ng/l, p = 0.019), NTproBNP (HR 1.05, CI 1.01-1.09 per 1000 ng/l, p = 0.018), and ST-T abnormalities (HR 1.53, CI 1.02-2.29, p = 0.040) were independently associated with an increased risk of death. However, these associations were significant only during the first 3 months after the hemorrhage. Cardiac events were observed in 25 patients, and cerebrovascular events were observed in 62 patients during the study period. ST-T abnormalities were independently associated with an increased risk of cardiac events (HR 5.52, CI 2.07-14.7, p 〈 0.001), and stress cardiomyopathy was independently associated with an increased risk of cerebrovascular events (HR 3.65, CI 1.55-8.58, p = 0.003). Cardiac complications after SAH are associated with an increased risk of short-term death. Patients with electrocardiogram abnormalities and stress cardiomyopathy need appropriate follow-up for the identification of cardiac disease or risk factors for cardiovascular disease.
    Subject(s): Stroke (Disease) ; Complications and side effects ; Medical research ; Neurosciences ; Subarachnoid hemorrhage ; Analysis ; Mortality ; Cardiac patients ; Electrocardiogram ; Medicine, Experimental ; Electrocardiography ; Risk factors ; Myocardial ischemia ; Stroke ; Stress cardiomyopathy ; Original ; Kardiologi ; Neurologi ; Neurology ; Cardiac and Cardiovascular Systems ; Anestesi och intensivvård ; Anesthesiology and Intensive Care
    ISSN: 1541-6933
    ISSN: 1556-0961
    E-ISSN: 1556-0961
    Source: Alma/SFX Local Collection
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  • 8
    Language: English
    In: Brain and behavior, 2019-07, Vol.9 (7), p.e01303-n/a
    Description: Background Mental fatigue, as part of cognitive dysfunction, has been reported to be common after subarachnoid hemorrhage and it significantly affects quality of life. Aims of the Study The aim of this study was to assess mental fatigue one year after an aneurysmal subarachnoid hemorrhage and to correlate the degree of mental fatigue to functional outcome assessed with the Extended Glasgow Outcome Scale (GOSE). Methods One year after an aneurysmal subarachnoid hemorrhage, the GOSE was assessed and a questionnaire for self‐assessment of mental fatigue, the Mental Fatigue Scale, was distributed to all included patients. The maximum score is 42 and a score of ≥10.5 indicates mental fatigue. Results All patients with GOSE 8, indicating full recovery, had a mental fatigue score of 〈10.5. A linear correlation between the GOSE and the mental fatigue score was observed (p 〈 0.0001). Conclusions Patients with a favorable outcome and GOSE 5–7 could benefit from the assessments of mental fatigue in order to receive satisfactory rehabilitation. Mental fatigue, as part of cognitive dysfunction, has been reported to be common after aneurysmal subarachnoid hemorrhage and it significantly affects quality of life. The Mental Fatigue Scale score was significantly correlated to the Extended Glasgow Outcome Scale (GOSE) score. Patients with GOSE 5‐7 could benefit from assessments of mental fatigue in order to receive satisfactory rehabilitation.
    Subject(s): mental fatigue ; aneurysmal subarachnoid hemorrhage ; outcome assessment ; Neurosciences ; Neurosciences & Neurology ; Life Sciences & Biomedicine ; Behavioral Sciences ; Science & Technology ; Mental Fatigue - diagnosis ; Reproducibility of Results ; Humans ; Middle Aged ; Weights and Measures ; Glasgow Outcome Scale ; Male ; Subarachnoid Hemorrhage - complications ; Mental Fatigue - psychology ; Cognitive Dysfunction - etiology ; Mental Fatigue - rehabilitation ; Outcome Assessment, Health Care - methods ; Quality of Life ; Adult ; Diagnostic Self Evaluation ; Female ; Surveys and Questionnaires ; Aged ; Cognitive Dysfunction - diagnosis ; Subarachnoid Hemorrhage - diagnosis ; Mental Fatigue - etiology ; Stroke (Disease) ; Subarachnoid hemorrhage ; Fatigue ; Ischemia ; Patients ; Questionnaires ; Original Research ; Neurovetenskaper
    ISSN: 2162-3279
    E-ISSN: 2162-3279
    Source: Web of Science - Science Citation Index Expanded - 2019〈img src="http://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /〉
    Source: PubMed Central
    Source: Web of Science - Social Sciences Citation Index – 2019〈img src="http://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /〉
    Source: DOAJ Directory of Open Access Journals - Not for CDI Discovery
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  • 9
    Language: English
    In: Acta anaesthesiologica Scandinavica, 2021-05-08
    Description: There is increasing evidence that the individual physician is the main factor influencing variability in end-of-life decision-making in intensive care units. End-of-life decisions are complex and should be adapted to each patient. Physician-related variability is problematic as it may result in unequal assessments that affect patient outcomes. The primary aim of this study was to investigate factors contributing to physician-related variability in end-of-life decision-making. This is a qualitative substudy of a previously conducted study. In-depth thematic analysis of semistructured interviews with 19 critical care specialists from five different Swedish intensive care units was performed. Interviews took place between 1 February 2017 and 31 May 2017. Factors influencing physician-related variability consisted of different assessment of patient preferences, as well as intensivists' personality and values. Personality was expressed mainly through pace and determination in the decision-making process. Personal prejudices appeared in decisions, but few respondents had personally witnessed this. Avoidance of criticism and conflicts as well as individual strategies for emotional coping were other factors that influenced physician-related variability. Many respondents feared criticism for making their assessments, and the challenging nature of end-of-life decision-making lead to avoidance as well as emotional stress. Variability in end-of-life decision-making is an important topic that needs further investigation. It is imperative that such variability be acknowledged and addressed in a more formal and transparent manner. The ethical issues faced by intensivists have recently been compounded by the devastating impact of the COVID-19 pandemic, demonstrating in profound terms the importance of the topic.
    Subject(s): sustaining ; health-care ; withdrawal of life‐ ; treatment ; making ; thematic analysis ; critical care ; of‐ ; units ; withdrawal ; variability ; life decision‐ ; intensive care units ; Anestesi och intensivvård ; end‐ ; difficulties ; Anesthesiology and Intensive Care ; qualitative research ; Anesthesiology
    ISSN: 0001-5172
    E-ISSN: 1399-6576
    Source: Alma/SFX Local Collection
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  • 10
    Language: English
    In: Acta anaesthesiologica Scandinavica, 2011-02, Vol.55 (2), p.157-164
    Description: Background: Continuous positive airway pressure (CPAP) has been shown to improve oxygenation and a number of different CPAP systems are available. The aim of this study was to assess lung volume and ventilation distribution using three different CPAP techniques. Methods: A high‐flow CPAP system (HF‐CPAP), an ejector‐driven system (E‐CPAP) and CPAP using a Servo 300 ventilator (V‐CPAP) were randomly applied at 0, 5 and 10 cmH2O in 14 volunteers. End‐expiratory lung volume (EELV) was measured by N2 dilution at baseline; changes in EELV and tidal volume distribution were assessed by electric impedance tomography. Results: Higher end‐expiratory and mean airway pressures were found using the E‐CPAP vs. the HF‐CPAP and the V‐CPAP system (P〈0.01). EELV increased markedly from baseline, 0 cmH2O, with increased CPAP levels: 1110±380, 1620±520 and 1130±350 ml for HF‐, E‐ and V‐CPAP, respectively, at 10 cmH2O. A larger fraction of the increase in EELV occurred for all systems in ventral compared with dorsal regions (P〈0.01). In contrast, tidal ventilation was increasingly directed toward dorsal regions with increasing CPAP levels (P〈0.01). The increase in EELV as well as the tidal volume redistribution were more pronounced with the E‐CPAP system as compared with both the HF‐CPAP and the V‐CPAP systems (P〈0.05) at 10 cmH2O. Conclusion: EELV increased more in ventral regions with increasing CPAP levels, independent of systems, leading to a redistribution of tidal ventilation toward dorsal regions. Different CPAP systems resulted in different airway pressure profiles, which may result in different lung volume expansion and tidal volume distribution.
    Subject(s): Biological and medical sciences ; Anesthesia ; Medical sciences ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Expiratory Reserve Volume - physiology ; Humans ; Middle Aged ; Air Pressure ; Male ; Electric Impedance ; Tidal Volume ; Nitrogen ; Continuous Positive Airway Pressure - instrumentation ; Adult ; Female ; Supine Position - physiology ; Respiratory Mechanics - physiology ; Continuous positive airway pressure ; Continuous Positive Airway Pressure ; Expiratory Reserve Volume ; physiology ; Anestesi och intensivvård ; Anesthesiology and Intensive Care ; diagnostic use ; instrumentation ; Respiratory Mechanics ; Supine Position
    ISSN: 0001-5172
    ISSN: 1399-6576
    E-ISSN: 1399-6576
    Source: Academic Search Ultimate
    Source: Alma/SFX Local Collection
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