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3.
In Vivo ; 34(3): 1427-1432, 2020.
Article in English | MEDLINE | ID: mdl-32354941

ABSTRACT

BACKGROUND/AIM: Down syndrome (DS) patients often show characteristic changes in the skull, e.g. short cranial base. The synchondroses of the skull base have a significant influence on the shape of the skull. The sphenooccipital synchondrosis (SOS) is the last of the basal synchondroses to ossify. This report is about residual ossification of SOS in an elderly patient with DS. CASE REPORT: The 65-year-old DS patient was polytraumatized by a fall. In the course of treatment, a purulent otitis externa on the right side was diagnosed, which had developed as a result of the fracture of the fossa glenoidalis. Computed tomograms of the skull base showed the fracture of the mandibular condyle, glenoid fossa and vestiges of SOS. CONCLUSION: The coincidental finding of vestiges of SOS in an elderly patient with DS raises the question of whether cross-sectional skull base images can show differences in the ossification of SOS between DS patients and a normal population.


Subject(s)
Down Syndrome/complications , Osteogenesis , Skull Fracture, Basilar/complications , Skull Fracture, Basilar/diagnosis , Aged , Humans , Male , Tomography, X-Ray Computed
4.
J Trauma Nurs ; 25(5): 301-306, 2018.
Article in English | MEDLINE | ID: mdl-30216260

ABSTRACT

Although clinical signs for the diagnosis of basilar skull fracture (BSF) are ambiguous, they are widely used to make decisions on initial interventions involving trauma patients. We aimed to assess the performance of early and late (within 48 hr posttrauma) signs for BSF diagnosis and to verify the correlation between the presence of these signs and head injury severity. We conducted a prospectively designed follow-up study at a referral hospital for trauma care in Sao Paulo, Brazil, and performed structured observations for 48 hr post-blunt head injury in patients aged 12 years or older. The following signs of BSF were considered: raccoon eyes, Battle's sign, otorrhea, and rhinorrhea. Among the 136 enrolled patients (85.3% male; mean age 40 ± 21.4 years), 28 patients (20.6%) had BSF. The clinical signs for the early or late detection of BSF had low accuracy (55.9% vs. 43.4%), specificity (52.8% vs. 30.5%), and positive predictive value (25.7% vs. 27.1%). However, the presence of these signs was correlated to head injury severity, indicated by the Glasgow Coma Scale (p = .041) and Maximum Abbreviated Injury Scale-Head region (p = .002). In view of the low accuracy of these signs, resulting low clinical value of their presence, and their high sensitivity in the late stage, the study results contraindicate the value of BSF signs for making decisions about using the nasal route for the introduction of catheters and tubes in initial trauma care.


Subject(s)
Head Injuries, Closed/diagnostic imaging , Head Injuries, Closed/physiopathology , Hospital Mortality/trends , Skull Fracture, Basilar/diagnostic imaging , Skull Fracture, Basilar/physiopathology , Adolescent , Adult , Age Factors , Brazil , Child , Clinical Decision-Making , Cohort Studies , Emergency Service, Hospital , Emergency Treatment/methods , Female , Glasgow Coma Scale , Head Injuries, Closed/diagnosis , Head Injuries, Closed/mortality , Hospitals, University , Humans , Injury Severity Score , Male , Middle Aged , Prospective Studies , Risk Assessment , Sex Factors , Skull Fracture, Basilar/diagnosis , Skull Fracture, Basilar/mortality , Survival Rate , Tomography, X-Ray Computed/methods , Young Adult
5.
Ann Emerg Med ; 68(4): 431-440.e1, 2016 10.
Article in English | MEDLINE | ID: mdl-27471139

ABSTRACT

STUDY OBJECTIVE: We describe presentations and outcomes of children with basilar skull fractures in the emergency department (ED) after blunt head trauma. METHODS: This was a secondary analysis of an observational cohort of children with blunt head trauma. Basilar skull fracture was defined as physical examination signs of basilar skull fracture without basilar skull fracture on computed tomography (CT), or basilar skull fracture on CT regardless of physical examination signs of basilar skull fracture. Other definitions included isolated basilar skull fracture (physical examination signs of basilar skull fracture or basilar skull fracture on CT with no other intracranial injuries on CT) and acute adverse outcomes (death, neurosurgery, intubation for >24 hours, and hospitalization for ≥2 nights with intracranial injury on CT). RESULTS: Of 42,958 patients, 558 (1.3%) had physical examination signs of basilar skull fracture, basilar skull fractures on CT, or both. Of the 525 (94.1%) CT-imaged patients, 162 (30.9%) had basilar skull fracture on CT alone, and 104 (19.8%) had both physical examination signs of basilar skull fracture and basilar skull fracture on CT; 269 patients (51.2%) had intracranial injuries other than basilar skull fracture on CT. Of the 363 (91.7%) CT-imaged patients with physical examination signs of basilar skull fracture, 104 (28.7%) had basilar skull fracture on CT. Of 266 patients with basilar skull fracture on CT, 104 (39.1%) also had physical examination signs of basilar skull fracture. Of the 256 CT-imaged patients who had isolated basilar skull fracture, none had acute adverse outcomes (0%; 95% confidence interval 0% to 1.4%), including none (0%; 95% confidence interval 0% to 6.1%) of 59 with isolated basilar skull fractures on CT. CONCLUSION: Approximately 1% of children with blunt head trauma have physical examination signs of basilar skull fracture or basilar skull fracture on CT. The latter increases the risk of acute adverse outcomes more than physical examination signs of basilar skull fracture. A CT scan is needed to adequately stratify the risk of acute adverse outcomes for these children. Children with isolated basilar skull fractures are at low risk for acute adverse outcomes and, if neurologically normal after CT and observation, are candidates for ED discharge.


Subject(s)
Head Injuries, Closed/diagnosis , Skull Fracture, Basilar/diagnosis , Adolescent , Child , Child, Preschool , Emergency Service, Hospital/statistics & numerical data , Female , Glasgow Coma Scale , Head Injuries, Closed/diagnostic imaging , Head Injuries, Closed/therapy , Humans , Male , Skull Fracture, Basilar/diagnostic imaging , Skull Fracture, Basilar/therapy , Time Factors , Tomography, X-Ray Computed , Treatment Outcome
6.
Facial Plast Surg ; 31(4): 332-44, 2015 Aug.
Article in English | MEDLINE | ID: mdl-26372707

ABSTRACT

Frontobasal fractures occur in up to 24% of head injuries and often require a multidisciplinary approach. Besides the common bone fractures, the complex anatomy can cause damage to the sense of vision and smell. Further possibly lethal complications such as cerebrospinal fluid leak followed by meningitis or internal carotid bleeding can follow. Diagnostic and treatment options are reviewed with a focus on the endoscopic endonasal approach.


Subject(s)
Carotid Artery Injuries/etiology , Cranial Nerve Injuries/etiology , Facial Bones/injuries , Optic Nerve Diseases/therapy , Skull Fracture, Basilar/diagnosis , Skull Fracture, Basilar/surgery , Carotid Artery, Internal , Cerebrospinal Fluid Leak/diagnosis , Cerebrospinal Fluid Leak/surgery , Frontal Sinus/injuries , Humans , Natural Orifice Endoscopic Surgery , Nose , Olfaction Disorders/etiology , Optic Nerve Diseases/etiology , Skull Fracture, Basilar/complications
7.
Otolaryngol Head Neck Surg ; 149(6): 931-9, 2013 Dec.
Article in English | MEDLINE | ID: mdl-24135209

ABSTRACT

OBJECTIVE: To determine rates of cerebrospinal fluid (CSF) leak, meningitis, and readmission in pediatric and adult patients with isolated basilar skull fracture. STUDY DESIGN: Cross-sectional analysis of a statewide database. SUBJECTS: Patients with isolated basilar skull fracture (1995-2010). METHODS: Patients were identified within the California Office of Statewide Health Planning and Development database using ICD-9 diagnosis codes. RESULTS: A total of 3563 pediatric and 10,761 adult patients met inclusion criteria. In-hospital rates of meningitis (0.48% and 0.64%, P = .3360) and CSF leak (2.33% and 1.75%, P = .0270) were similar among children and adults, respectively. Rates of 90-day meningitis (0.17% and 0.37%, P = .0714) and CSF leak (0.40% and 0.40%, P = .9823) were also similar. Thirty-day readmission was 4.6% for children compared with 12.4% for adults (P < .001). For both pediatric and adult patients, extra-axial hematoma (odds ratio [OR] [confidence interval {CI}] 1.65 [1.05-2.59] and 1.61 [1.34-1.95]) and comorbidities (OR [CI] 2.19 [1.11-4.34] and 1.28 [1.04-1.59]) were associated with significant increases in 30-day readmission. Loss of consciousness greater than 1 hour (OR, 3.05; 95% CI, 1.53-6.08) and CSF leak (OR, 3.28; 95% CI, 1.41-7.64) increased the likelihood of pediatric readmissions. Lack of insurance (OR, 0.67; 95% CI, 0.50-0.90) and female gender (OR 0.83; 95% CI, 0.70-0.99) reduced the likelihood of adult readmission. CONCLUSION: Meningitis and CSF leak following isolated basilar skull fractures are uncommon. Readmission within 30 days was more common in adults than in children. CSF leak, hematoma, and prolonged loss of consciousness increased the likelihood of readmission in children. Intracranial injury, male gender, having insurance, and comorbidities increased the likelihood of readmission in adults.


Subject(s)
Cerebrospinal Fluid Rhinorrhea/epidemiology , Hematoma, Subdural/epidemiology , Meningitis, Bacterial/epidemiology , Patient Readmission/statistics & numerical data , Skull Fracture, Basilar/epidemiology , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , California/epidemiology , Cerebrospinal Fluid Leak , Cerebrospinal Fluid Rhinorrhea/diagnosis , Cerebrospinal Fluid Rhinorrhea/etiology , Cerebrospinal Fluid Rhinorrhea/therapy , Child , Child, Preschool , Cross-Sectional Studies , Female , Hematoma, Subdural/diagnosis , Hematoma, Subdural/etiology , Hematoma, Subdural/therapy , Humans , Infant , Male , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/etiology , Meningitis, Bacterial/therapy , Middle Aged , Risk Assessment , Risk Factors , Sex Distribution , Skull Fracture, Basilar/complications , Skull Fracture, Basilar/diagnosis , Skull Fracture, Basilar/therapy , Treatment Outcome , Unconsciousness/epidemiology , Unconsciousness/etiology
12.
Laryngorhinootologie ; 91(9): 585-97, 2012 Sep.
Article in German | MEDLINE | ID: mdl-22907624

ABSTRACT

Independent of its origin a frontobasal cerebrospinal fluid (CSF) fistula is characterized by an open connection between the intracranial space with the outside world (usually the nose and paranasal sinuses). It leads to loss of CSF and is associated with a significant risk of developing meningitis for the patient during further life. Precise knowledge of possible aetiologies, clinical symptoms, current diagnostic options and surgical strategies are essential for the detection and successful management of frontobasal CSF fi fistulas. This article summarizes aetiology and clinical signs of frontobasal CSF fistulas. Further, laboratory tests to analyse fluid samples for cerebrospinal fluid as well as radiological and endoscopic investigation methods aiming to localize a CSF-fistula are presented. Finally, surgical techniques to close a frontobasal CSF fistula are explained.


Subject(s)
Cerebrospinal Fluid Otorrhea/diagnosis , Cerebrospinal Fluid Rhinorrhea/diagnosis , Cerebrospinal Fluid Otorrhea/surgery , Cerebrospinal Fluid Rhinorrhea/surgery , Endoscopy , Fluorescein , Humans , Magnetic Resonance Imaging , Predictive Value of Tests , Prognosis , Skull Fracture, Basilar/complications , Skull Fracture, Basilar/diagnosis , Tomography, X-Ray Computed , Transferrin/analysis
13.
Neurosurg Focus ; 32(6): E3, 2012 Jun.
Article in English | MEDLINE | ID: mdl-22655692

ABSTRACT

Cerebrospinal fluid rhinorrhea is a serious and potentially fatal condition because of an increased risk of meningitis and brain abscess. Approximately 80% of all cases occur in patients with head injuries and craniofacial fractures. Despite technical advances in the diagnosis and management of CSF rhinorrhea caused by craniofacial injury through the introduction of MRI and endoscopic extracranial surgical approaches, difficulties remain. The authors review here the pathophysiology, diagnosis, and management of CSF rhinorrhea relevant exclusively to traumatic anterior skull base injuries and attempt to identify areas in which further work is needed.


Subject(s)
Cerebrospinal Fluid Rhinorrhea/diagnosis , Cerebrospinal Fluid Rhinorrhea/therapy , Skull Fracture, Basilar/diagnosis , Skull Fracture, Basilar/therapy , Accidents , Cerebrospinal Fluid Rhinorrhea/etiology , Craniocerebral Trauma/complications , Craniocerebral Trauma/diagnosis , Craniocerebral Trauma/therapy , Humans , Skull Fracture, Basilar/complications , Treatment Outcome
14.
Spine (Phila Pa 1976) ; 37(16): E964-8, 2012 Jul 15.
Article in English | MEDLINE | ID: mdl-22414996

ABSTRACT

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: To evaluate the outcomes of patients with occipital condyle fractures (OCFs) treated nonoperatively and establish factors associated with neck disability. SUMMARY OF BACKGROUND DATA: The majority of OCFs are treated nonoperatively; however, few studies have reported long-term functional outcomes of these patients. METHODS: From 1999 to 2007, 103 patients with OCFs were identified. Of this cohort, 28 patients with 32 fractures met the inclusion criteria. Fracture and patient characteristics, including patient age and sex, Anderson and Montesano fracture type, bilaterality, associated head injury, and fracture displacement, were noted. The Neck Disability Index (NDI) was calculated at final follow-up. RESULTS: Anderson and Montesano type III fractures were the most commonly observed (54%), followed by type II (43%). The mean NDI was 14.0, which correlates with mild disability, and the NDI headache question showed the highest mean disability score of all questions. There was no statistically significant association between NDI scores and fracture type, displacement of fracture, sex, bilaterality, or presence of head injury. Age was associated with NDI scores, with age range of 40 to 60 years having a mean NDI score of 24.3. CONCLUSION: Anderson and Montessano types I, II, and III OCFs may be treated nonoperatively in the absence of ligamentous instability and concomitant cervical injuries with the expectation of mild neck disability regardless of the displacement, bilaterality, sex, or presence of head injury. Greater disability may be expected in patients aged between 40 and 60 years than in other ages.


Subject(s)
Multiple Trauma/therapy , Occipital Bone/injuries , Skull Fracture, Basilar/therapy , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Alabama , Disability Evaluation , Female , Fracture Healing , Humans , Male , Middle Aged , Multiple Trauma/diagnosis , Multiple Trauma/physiopathology , Neck/physiopathology , Neck Pain/diagnosis , Neck Pain/physiopathology , Neck Pain/therapy , Occipital Bone/diagnostic imaging , Pain Measurement , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Skull Fracture, Basilar/diagnosis , Skull Fracture, Basilar/physiopathology , Time Factors , Tomography, X-Ray Computed , Treatment Outcome , Young Adult
17.
HNO ; 59(8): 791-9, 2011 Aug.
Article in German | MEDLINE | ID: mdl-21833834

ABSTRACT

The role of ENT surgery in the management of anterior skull base defects has become increasingly important in recent years. Transnasal endoscopic surgical techniques and intraoperative navigation enable a minimally invasive approach in a large proportion of patients, thus helping to avoid morbidity typically associated with neurosurgical subfrontal approaches. Whereas traffic accidents and sport injuries are the main causes of anterior skull base trauma in the civilian setting, penetrating injuries caused by gunshots and improvised explosive devices (IEDs) play an increasing role in the military arena and terroristic attacks. Minor injuries to the anterior skull base are usually managed by ENT surgeons. Major injuries, involving the midface or neurocranium, require an interdisciplinary approach including maxillofacial surgeons and neurosurgeons. A centre for head and neck medicine and surgery is an ideal setting for such interdisciplinary teams to provide appropriate care for patients with complex skull base trauma in cooperation with ophthalmologists and interventional neuoradiologists. The present article describes concepts for the treatment of anterior skull base trauma established at the head, neck and skull base center at the Ulm military hospital in Germany.


Subject(s)
Blast Injuries/diagnosis , Blast Injuries/surgery , Cranial Fossa, Anterior/injuries , Cranial Fossa, Anterior/surgery , Facial Injuries/diagnosis , Facial Injuries/surgery , Wounds, Gunshot/surgery , Brain Edema/diagnosis , Brain Edema/surgery , Cerebral Hemorrhage, Traumatic/diagnosis , Cerebral Hemorrhage, Traumatic/surgery , Cerebrospinal Fluid Rhinorrhea/diagnosis , Cerebrospinal Fluid Rhinorrhea/surgery , Cooperative Behavior , Craniotomy/methods , Endoscopy/methods , Foreign Bodies/diagnosis , Foreign Bodies/surgery , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Interdisciplinary Communication , Magnetic Resonance Imaging/methods , Minimally Invasive Surgical Procedures/methods , Skull Fracture, Basilar/diagnosis , Skull Fracture, Basilar/surgery , Surgery, Computer-Assisted/methods , Tomography, X-Ray Computed , Trauma Centers , Wounds, Gunshot/diagnosis
18.
Lik Sprava ; (1-2): 111-4, 2010.
Article in Russian | MEDLINE | ID: mdl-20608036

ABSTRACT

140 patients with fractures of the upper jaw have been observed regarding terms of their admission to special department in the hospital, age, sex, and reasons of damages. The ration of fractures of the upper jaw to damages of other bones of facing part of the skull and soft tissues, as well complications from it have been studied.


Subject(s)
Accidents, Home , Accidents, Traffic , Facial Bones/injuries , Maxillary Fractures/diagnosis , Multiple Trauma/diagnosis , Skull Fracture, Basilar/diagnosis , Accidents, Home/statistics & numerical data , Accidents, Traffic/statistics & numerical data , Adolescent , Adult , Child , Female , Humans , Male , Maxillary Fractures/epidemiology , Maxillary Fractures/etiology , Middle Aged , Multiple Trauma/epidemiology , Multiple Trauma/etiology , Skull Fracture, Basilar/epidemiology , Skull Fracture, Basilar/etiology , Young Adult
19.
Spine (Phila Pa 1976) ; 35(8): E316-21, 2010 Apr 15.
Article in English | MEDLINE | ID: mdl-20308946

ABSTRACT

STUDY DESIGN: Case report and literature review. OBJECTIVE: To discuss the diagnosis, limitations, and treatment of combined occipital-cervical and atlantoaxial disassociation with normal neurologic function. SUMMARY OF BACKGROUND DATA: Injuries to the craniocervical junction can lead to devastating neurologic deficits. Occipital-cervical disassociation is a well-documented injury pattern that can lead to pain, spinal cord injury, and death. Early diagnosis and treatment can preserve neurologic function. Combined injuries to both the occipital-cervical and atlantoaxial segments are less common and, to date, have only been described with severe neurologic injury. METHODS: Retrospective review of a case. Literature review was performed through Medline and Pubmed searches. RESULTS: This is the first case to present a combined occipital-cervical and atlantoaxial disassociation with a neurologically intact patient. Initial physical examination was limited, but early imaging revealed evidence of instability. Early diagnosis and early (< 24) surgical stabilization was performed with no complications and neurologic preservation. One-year follow-up visit revealed normal neurologic examination with neck pain VAS = 2/10 and neck disability index = 6. CONCLUSION: Combined injuries to the occipital-cervical and atlantoaxial can result in upper cervical instability. Despite previous reports, neurologic preservation remains a possibility in this injury pattern. Limitations in physical examination and radiographic imaging persist, but early diagnosis and surgical stabilization may improve neurologic outcomes.


Subject(s)
Atlanto-Axial Joint/injuries , Joint Dislocations/diagnosis , Joint Dislocations/surgery , Spinal Fractures/diagnosis , Spinal Fractures/surgery , Accidents, Traffic , Adolescent , Atlanto-Axial Joint/diagnostic imaging , Atlanto-Axial Joint/pathology , Atlanto-Occipital Joint/diagnostic imaging , Atlanto-Occipital Joint/injuries , Atlanto-Occipital Joint/pathology , Axis, Cervical Vertebra/diagnostic imaging , Axis, Cervical Vertebra/injuries , Axis, Cervical Vertebra/pathology , Cervical Atlas/diagnostic imaging , Cervical Atlas/injuries , Cervical Atlas/pathology , Early Diagnosis , Emergency Treatment/methods , Emergency Treatment/standards , Female , Humans , Internal Fixators , Joint Dislocations/nursing , Ligaments/diagnostic imaging , Ligaments/injuries , Ligaments/pathology , Occipital Bone/diagnostic imaging , Occipital Bone/injuries , Occipital Bone/pathology , Pelvis/injuries , Prosthesis Implantation/instrumentation , Prosthesis Implantation/methods , Radiology/methods , Radiology/standards , Retrospective Studies , Skull Fracture, Basilar/diagnosis , Skull Fracture, Basilar/nursing , Skull Fracture, Basilar/surgery , Spinal Cord Compression/etiology , Spinal Cord Compression/physiopathology , Spinal Cord Compression/prevention & control , Spinal Fractures/nursing , Spinal Fusion/instrumentation , Spinal Fusion/methods , Spleen/injuries , Tomography, X-Ray Computed/methods , Tomography, X-Ray Computed/standards , Treatment Outcome , Zygapophyseal Joint/injuries , Zygapophyseal Joint/pathology
20.
Rev. chil. pediatr ; 81(1): 58-63, feb. 2010. ilus
Article in Spanish | LILACS | ID: lil-561877

ABSTRACT

Introduction: Reported incidence of cranial lesions in childbirth is about 1.7 to 59 per 10,000 births. Among these, fracture of the base of the skull is rare but serious due to sequelae and mortality. Objective: Describe a case of a newborn with a fracture of the temporal bone, review diagnosis and management of skull fractures. Clinical Case: The patient was born with assistance, use of forceps, showed deviation of the buccal commisure and otorrhagia on the left side during puerperium. CT Sean detected fracture of the base of the cranium at the level of the temporal bone. Hemogram, cultures and spinal fluid studies were done. Prophylactic therapy was initiated. All blood studies were negative and follow up studies were normal. Discussion: Literature reviews support the diagnosis to be confirmed through a CT sean, and an active search for meningitis be started through hemocultures, hemogram, and Cerebrospinal Fluid. Management should be conservative, evaluating the need for an LR Evidence shows that antibiotic prophylaxis for meningitis has little indication in these cases.


Introducción: La incidencia de lesiones de cráneo en recién nacidos reportadas son del orden de 1,7 a 59 por 10 000 nacimientos. Dentro de estas, las fracturas de base de cráneo son eventos poco frecuentes, pero de consideración dado su potencial gravedad en cuanto a mortalidad y secuelas. Objetivo: Relatar el caso de un recién nacido con una fractura de peñasco y revisar el diagnóstico y manejo de las lesiones de cráneo. Caso Clínico: El paciente, tras parto instrumentalizado por fórceps, presentó desviación de comisura bucal y otorragia durante su estadía en puerperio. La TAC de cerebro con reconstrucción ósea fue compatible con una fractura de base de cráneo (peñasco izquierdo). Se tomaron hemocultivo, hemograma y PCR y se inició antibioticoterapia profiláctica para meningitis. Evolucionó favorablemente con hemocultivos negativos, hemograma y PCR normales, TAC de control sin cambios y examen neurológico normal. Discusión: La literatura recomienda que el diagnóstico de fractura de base de cráneo debe ser confirmado por medio de TAC de cerebro y que debe realizarse una búsqueda activa de meningitis por medio de hemocultivos, hemograma y PCR, evaluar la necesidad de punción lumbar y manejar en forma conservadora. La evidencia señala que la profilaxis antibiótica para meningitis en estos pacientes no tiene indicación.


Subject(s)
Humans , Male , Infant, Newborn , Skull Fracture, Basilar/drug therapy , Skull Fracture, Basilar , Antibiotic Prophylaxis , Anti-Bacterial Agents/therapeutic use , Skull Fracture, Basilar/classification , Skull Fracture, Basilar/complications , Skull Fracture, Basilar/diagnosis , Meningitis, Bacterial/prevention & control , Tomography, X-Ray Computed
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