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1.
Int J Med Sci ; 19(8): 1227-1234, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35928725

RESUMO

Background: Although vascular risk factors have been found to be closely related to the development of benign paroxysmal positional vertigo (BPPV), the relationship between BPPV and cerebral small vessels diseases (CSVDs) has rarely been discussed in literature. This study set out to investigate the efficacy of repositioning therapy and prognosis among BPPV patients with CSVDs. Methods: We enrolled 553 BPPV patients who had undergone brain MRI, and categorized them into two groups based on the presence or absence of CSVDs. After controlling for other confounders using a propensity score matching (PSM) approach, we compared the incidence of recurrence and residual dizziness (RD). Then, we analyzed the recurrence rate and RD incidence in 176 BPPV patients with CSVDs, and assessed potential risk factors. Results: White matter hyperintensity (WMH, 72.2%) and lacunar infarction (LI, 65.9%) were the two CSVDs that were present in the highest proportion among the BPPV patients. The incidence of RD in patients with CSVDs was significantly higher compared to subjects without CSVDs. Patients with RD (n=100, 56.8%) were older, had more severe WMH, and had a higher incidence of brain atrophy; age and higher Fazekas score were independent risk factors. Among the recurrent patients (n=61, 34.7%), the ages were older, the Fazekas score of WMH was higher, and number of LIs was increased; age was the sole independent risk factor. Conclusion: BPPV patients with a combination of CSVD comorbidities, especially elderly patients with WMHs, are more likely to develop RD, which needs to be paid more attention.


Assuntos
Vertigem Posicional Paroxística Benigna , Doenças de Pequenos Vasos Cerebrais , Idoso , Vertigem Posicional Paroxística Benigna/diagnóstico , Vertigem Posicional Paroxística Benigna/epidemiologia , Vertigem Posicional Paroxística Benigna/terapia , Doenças de Pequenos Vasos Cerebrais/complicações , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Doenças de Pequenos Vasos Cerebrais/epidemiologia , Tontura/complicações , Tontura/terapia , Humanos , Posicionamento do Paciente , Prognóstico , Estudos Retrospectivos
3.
Eur J Med Res ; 27(1): 149, 2022 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-35962440

RESUMO

BACKGROUND: To investigate whether prone position can reduce the risk of patients with mild or moderate COVID-19 who progress to severe or critical illness. METHODS: The prone position group was treated in prone position on the day of admission in addition to conventional treatment. Indicators such as saturation of pulse oximetry (SpO2), heart rate, blood pressure, respiratory rate, and prone position-related adverse events were recorded before prone ventilation, 5 min after prone position and 30 min after prone position. Meanwhile, the cases of severe and critical patients, the percentage of transformation and the final clinical outcome of this group were analyzed. Conversion rates and mortality were calculated for patients with mild or moderate COVID-19 retrieved from the database who received only conventional care without combined prone positioning as control group. RESULTS: (1) A total of 34 patients were included in prone position group. There were significant differences in SpO2 between the first 4 days after admission and the day of discharge (F = 3.17, P < 0.001). (2) The main complications were back and neck muscle soreness (55.9%), followed by abdominal distension (8.9%). (3) In control group, a total of 4873 cases of mild and moderate patients were included from 19 literatures, with an average deterioration rate of 22.7% and mortality rate of 1.7%. (4) In prone position group, there were no severe or critical transformation cases and also no death cases. The prone position group had a significantly lower deterioration rate when compared with the control group (χ2 = 9.962, P < 0.01). CONCLUSION: Prone position improves SpO2 in patients with mild or moderate COVID-19. It can also reduce the percentage of mild or moderate patients progressing to severe or critical patients. The application of prone position is a simple, feasible, safe and effective treatment method in such patients.


Assuntos
COVID-19 , Humanos , Posicionamento do Paciente/métodos , Decúbito Ventral , Respiração Artificial/métodos , Estudos Retrospectivos
4.
Emerg Med Clin North Am ; 40(3): 459-472, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35953211

RESUMO

Acute respiratory distress syndrome (ARDS) occurs in up to 10% of patients with respiratory failure admitted through the emergency department. Use of noninvasive respiratory support has proliferated in recent years; clinicians must understand the relative merits and risks of these technologies and know how to recognize signs of failure. The cornerstone of ARDS care of the mechanically ventilated patient is low-tidal volume ventilation based on ideal body weight. Adjunctive therapies, such as prone positioning and neuromuscular blockade, may have a role in the emergency department management of ARDS depending on patient and department characteristics.


Assuntos
Síndrome do Desconforto Respiratório , Insuficiência Respiratória , Humanos , Posicionamento do Paciente , Respiração com Pressão Positiva , Respiração Artificial , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/terapia , Volume de Ventilação Pulmonar
5.
Curr Opin Anaesthesiol ; 35(4): 465-471, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35861473

RESUMO

PURPOSE OF REVIEW: Postprocedural positioning injuries are an under-appreciated source of morbidity for patients. These injuries may not present until days after anesthesia and may be missed for multiple reasons including the distracting injury of the procedural site, illness of the patient, lack of follow-up, and insufficient awareness of this type of injury. Risks for these adverse events are exacerbated in the nonoperating room anesthesia (NORA) population for several reasons. These patients tend to be older and sicker than patients presenting to the operating room, increasing the risk of an injury. Proceduralists and anesthesia providers are usually consultants, not the primary care team, so may have limited patient follow-up. This review will discuss the risk factors for position-related injuries and how to prevent them with proper positioning and padding. RECENT FINDINGS: The mainstay of preventing periprocedural positioning injuries is careful positioning of the patient and proper padding of pressure points. This may be particularly challenging because of physical constraints and positioning requirements for NORA procedures, as well as preference for radiolucent positioning materials. Recent studies have shown the potential benefit of monitoring somatosensory evoked potentials (SSEP) in high-risk patients. SUMMARY: Careful consideration of patient positioning and thorough understanding of peripheral nerve and pressure injuries is essential for anesthesia providers to avoid positioning injuries during NORA procedures. VIDEO ABSTRACT: http://links.lww.com/COAN/A87.


Assuntos
Anestesia , Anestesiologia , Anestesia/efeitos adversos , Anestesia/métodos , Humanos , Monitorização Fisiológica , Salas Cirúrgicas , Posicionamento do Paciente/efeitos adversos
9.
Ann Intern Med ; 175(7): JC81, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35785529

RESUMO

SOURCE CITATION: Li J, Luo J, Pavlov I, et al. Awake prone positioning for non-intubated patients with COVID-19-related acute hypoxaemic respiratory failure: a systematic review and meta-analysis. Lancet Respir Med. 2022;10:573-83. 35305308.


Assuntos
COVID-19 , Insuficiência Respiratória , Humanos , Intubação Intratraqueal , Posicionamento do Paciente , Decúbito Ventral , Insuficiência Respiratória/terapia , Decúbito Dorsal , Vigília
10.
Respir Care ; 67(8): 1011-1021, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35882445

RESUMO

Prone positioning (PP) has been used extensively for patients requiring invasive mechanical ventilation for hypoxemic respiratory failure during the COVID-19 pandemic. Evidence suggests that PP was beneficial during the pandemic, as it improves oxygenation and might improve chances of survival, especially in those with a continuum of positive oxygenation responses to the procedure. Additionally, the pandemic drove innovation regarding PP, as it brought attention to awake PP (APP) and the value of an interdisciplinary team approach to PP during a pandemic. APP appears to be safe and effective at improving oxygenation; APP may also reduce the need for intubation in patients requiring advanced respiratory support like high-flow nasal cannula or noninvasive ventilation. Teams specifically assembled for PP during a pandemic also appear useful and can provide needed assistance to bedside clinicians in the time of crisis. Complications associated with PP can be mitigated, and a multidisciplinary approach to reduce the incidence of complications is recommended.


Assuntos
COVID-19 , Ventilação não Invasiva , Insuficiência Respiratória , Humanos , Ventilação não Invasiva/efeitos adversos , Pandemias , Posicionamento do Paciente/métodos , Decúbito Ventral/fisiologia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia
11.
Lung ; 200(4): 441-445, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35708780

RESUMO

PURPOSE: Prone position is known to improve acute lung injury, and chest radiographs are often necessary to monitor disease and confirm support device placement. However, there is a paucity of literature regarding radiographs obtained in this position. We evaluated prone radiographs for distinguishing features and ability to identify support devices. METHODS: Pairs of prone and supine radiographs obtained during the COVID-19 pandemic were assessed retrospectively. IRB approval and waiver of informed consent were obtained. Radiographs were assessed for imaging adequacy, distinguishing features, and support device identification (endotracheal tube, enteric tube, or central line). Radiographs were reviewed by ≥ 2 cardiothoracic radiologists. RESULTS: Radiographs from 81 patients (63yo ± 13, 30% women) were reviewed. Prone and supine radiographs were comparable for imaging the lung bases (81% vs. 90%, p = 0.35) and apices (93% vs. 94%, p = 1); prone radiographs more frequently had significant rotation (36% vs. 19%, p = 0.021). To identify prone technique, scapula tip located beyond the rib border was 89% sensitive (95%CI 80-95%) and 85% specific (76-92%), and a fundal stomach bubble was 44% sensitive (33-56%) and 90% specific (81-96%). For women, displaced breast shadow was 46% sensitive (26-67%) and 92% specific (73-99%). Prone and supine radiographs each identified > 99% of support devices. Prone exams trended toward increased rate of malpositioned device (12% vs. 6%, p = 0.07). CONCLUSION: Scapula position reliably distinguishes prone from supine position; fundal stomach bubble or displaced breast shadow is specific for prone position. Prone radiographs reliably identify line and tube position, which is particularly important as prone patients appear at increased risk for malpositioned devices.


Assuntos
COVID-19 , Pandemias , COVID-19/diagnóstico por imagem , Feminino , Humanos , Masculino , Posicionamento do Paciente/métodos , Decúbito Ventral , Estudos Retrospectivos , Decúbito Dorsal
13.
Am J Nurs ; 122(7): 62, 2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35736607

RESUMO

Preemptive interventions are needed to prevent pressure injuries in patients with COVID-19 who are placed in the prone position.Risk factors for pressure injuries in these patients include severe obesity, a long duration of prone positioning, male sex, a high D-dimer level, and the use of commercial endotracheal tube holders.


Assuntos
COVID-19 , Humanos , Intubação Intratraqueal , Masculino , Posicionamento do Paciente/efeitos adversos , Decúbito Ventral , Fatores de Risco
14.
Comput Intell Neurosci ; 2022: 2369925, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35707185

RESUMO

With the development of information management of sports events, basketball teams have higher requirements for the management of training data. The development of data visualization technology has provided convenience for information management which evolves from a digital management model to an efficient graphical management model. In this article, we will mainly design a human body positioning system based on wireless sensor networks. The weak signal from the sensor is tuned by the circuit, and the cylindrical Fresnel lens array is selected to modulate the field of view to ensure an effective response to the infrared signal of the moving human body. The wireless sensor network is used to integrate the human body detected by each pyroelectric sensor node, and the infrared signal is sent to the upper computer for analysis and processing. Through the host computer interface, observe and analyze the relationship between the detection signal of a single pyroelectric sensor and the position, speed, and movement of the moving human body, and deeply explore the operating process of the wireless pyroelectric infrared sensor network system. With the development of the new era, Chinese basketball training and teaching methods generally have some drawbacks, which have seriously affected the quality and effect of college basketball training and restricted the development of college basketball. Therefore, the focus of research is to solve these problems in order to achieve more effective college basketball training and education effects. This article mainly through the research of 5G technology wireless sensing human body positioning shows that wireless sensing technology has made great progress in its aspects, systematically analyzes basketball training, and proposes better training methods.


Assuntos
Basquetebol , Redes de Comunicação de Computadores , Corpo Humano , Humanos , Posicionamento do Paciente , Tecnologia sem Fio
15.
BMC Pulm Med ; 22(1): 234, 2022 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-35710365

RESUMO

BACKGROUND: The application of prone position (PP) in acute respiratory distress syndrome (ARDS) supported by venovenous extracorporeal membrane oxygenation (VV-ECMO) is controversial. OBJECTIVES: To evaluate the safety and efficacy of application of PP during VV-ECMO in patients with ARDS. METHODS: This was a single-center, retrospective study of patients who met the Berlin definition of ARDS, and were supported with VV-ECMO. We divided the patients into two groups. The prone group included patients who were supported by VV-ECMO, and experienced at least one period of PP, while those without PP during VV-ECMO were defined as the supine group. Propensity score matching (PSM) at a ratio of 1:1 was introduced to minimize potential confounders. The primary outcomes were the complications of PP and the change of arterial oxygen pressure/fraction of the inspiration (PaO2/FiO2) ratio after PP. The secondary outcomes were hospital survival, ICU survival, and ECMO weaning rate. RESULTS: From April 2013 to October 2020, a total of 91 patients met the diagnostic criteria of ARDS who were supported with ECMO. 38 patients (41.8%) received at least one period of PP during ECMO, while 53 patients (58.2%) were maintained in supine position during ECMO. 22 minor complications were reported in the prone group and major complications were not found. The other ECMO-related complications were similar between two groups. The PaO2/FiO2 ratio significantly improved after PP compared with before (174.50 (132.40-228.25) mmHg vs. 158.00 (122.93-210.33) mmHg, p < 0.001). PSM selected 25 pairs of patients with similar characteristics. Hospital survival or ICU survival did not differ between the two groups (40% vs. 28%, p = 0.370; 40% vs. 32%, p = 0.556). Significant difference of ECMO weaning rate between two groups was not found (56% vs. 32%, p = 0.087). CONCLUSIONS: PP during VV-ECMO was safe and could improve oxygenation. A large-scale and well-designed RCT is needed in the future.


Assuntos
Oxigenação por Membrana Extracorpórea , Síndrome do Desconforto Respiratório , Oxigenação por Membrana Extracorpórea/efeitos adversos , Humanos , Posicionamento do Paciente , Decúbito Ventral , Síndrome do Desconforto Respiratório/terapia , Estudos Retrospectivos
18.
Radiat Oncol ; 17(1): 104, 2022 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-35659685

RESUMO

PURPOSE: To propose a specific surface guided stereotactic radiotherapy (SRT) treatment procedure with open-face mask immobilization and evaluate the initial clinical experience in improving setup accuracy. METHODS AND MATERIALS: The treatment records of 48 SRT patients with head lesions were retrospectively analyzed. For each patient, head immobilization was achieved with a double-shell open-face mask. The anterior shell was left open to expose the forehead, nose, eyes and cheekbones. The exposed facial area was used as region-of-interest for surface tracking by AlignRT (VisionRT Inc, UK). The posterior shell provided a sturdy and personalized headrest. Patient initial setup was guided by 6DoF real-time deltas (RTD) using the reference surface obtained from the skin contour delineated on the planning CT images. The endpoint of initial setup was 1 mm in translational RTD and 1 degree in rotational RTD. CBCT guidance was performed to derive the initial setup errors, and couch shifts for setup correction were applied prior to treatment delivery. CBCT couch shifts, AlignRT RTD values, repositioning rate and setup time were analyzed. RESULTS: The absolute values of median (maximal) CBCT couch shifts were 0.4 (1.3) mm in VRT, 0.1 (2.5) mm in LNG, 0.2 (1.6) mm in LAT, 0.1(1.2) degree in YAW, 0.2 (1.4) degree in PITCH and 0.1(1.3) degree in ROLL. The couch shifts and AlignRT RTD values exhibited highly agreement except in VRT and PITCH (p value < 0.01), of which the differences were as small as negligible. We did not find any case of patient repositioning that was due to out-of-tolerance setup errors, i.e., 3 mm and 2 degree. The surface guided setup time ranged from 52 to 174 s, and the mean and median time was 97.72 s and 94 s respectively. CONCLUSIONS: The proposed surface guided SRT procedure with open-face mask immobilization is a step forward in improving patient comfort and positioning accuracy in the same process. Minimized initial setup errors and repositioning rate had been achieved with reasonably efficiency for routine clinical practice.


Assuntos
Radiocirurgia , Radioterapia Guiada por Imagem , Tomografia Computadorizada de Feixe Cônico/métodos , Humanos , Imobilização/métodos , Máscaras , Posicionamento do Paciente , Planejamento da Radioterapia Assistida por Computador/métodos , Erros de Configuração em Radioterapia/prevenção & controle , Radioterapia Guiada por Imagem/métodos , Estudos Retrospectivos
19.
Cochrane Database Syst Rev ; 6: CD003645, 2022 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-35661343

RESUMO

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a significant cause of hospitalisation and death in young children. Positioning and mechanical ventilation have been regularly used to reduce respiratory distress and improve oxygenation in hospitalised patients. Due to the association of prone positioning (lying on the abdomen) with sudden infant death syndrome (SIDS) within the first six months, it is recommended that young infants be placed on their back (supine). However, prone positioning may be a non-invasive way of increasing oxygenation in individuals with acute respiratory distress, and offers a more significant survival advantage in those who are mechanically ventilated. There are substantial differences in respiratory mechanics between adults and infants. While the respiratory tract undergoes significant development within the first two years of life, differences in airway physiology between adults and children become less prominent by six to eight years old. However, there is a reduced risk of SIDS during artificial ventilation in hospitalised infants. Thus, an updated review focusing on positioning for infants and young children with ARDS is warranted. This is an update of a review published in 2005, 2009, and 2012. OBJECTIVES: To compare the effects of different body positions in hospitalised infants and children with acute respiratory distress syndrome aged between four weeks and 16 years. SEARCH METHODS: We searched CENTRAL, which contains the Acute Respiratory Infections Group's Specialised Register, MEDLINE, Embase, and CINAHL from January 2004 to July 2021. SELECTION CRITERIA: Randomised controlled trials (RCTs) or quasi-RCTs comparing two or more positions for the management of infants and children hospitalised with ARDS. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from each study. We resolved differences by consensus, or referred to a third contributor to arbitrate. We analysed bivariate outcomes using an odds ratio (OR) and 95% confidence interval (CI). We analysed continuous outcomes using a mean difference (MD) and 95% CI. We used a fixed-effect model, unless heterogeneity was significant (I2 statistic > 50%), when we used a random-effects model. MAIN RESULTS: We included six trials: four cross-over trials, and two parallel randomised trials, with 198 participants aged between 4 weeks and 16 years, all but 15 of whom were mechanically ventilated. Four trials compared prone to supine positions. One trial compared the prone position to good-lung dependent (where the person lies on the side of the healthy lung, e.g. if the right lung was healthy, they were made to lie on the right side), and independent (or non-good-lung independent, where the person lies on the opposite side to the healthy lung, e.g. if the right lung was healthy, they were made to lie on the left side) position. One trial compared good-lung independent to good-lung dependent positions. When the prone (with ventilators) and supine positions were compared, there was no information on episodes of apnoea or mortality due to respiratory events. There was no conclusive result in oxygen saturation (SaO2; MD 0.40 mmHg, 95% CI -1.22 to 2.66; 1 trial, 30 participants; very low certainty evidence); blood gases, PCO2 (MD 3.0 mmHg, 95% CI -1.93 to 7.93; 1 trial, 99 participants; low certainty evidence), or PO2 (MD 2 mmHg, 95% CI -5.29 to 9.29; 1 trial, 99 participants; low certainty evidence); or lung function (PaO2/FiO2 ratio; MD 28.16 mmHg, 95% CI -9.92 to 66.24; 2 trials, 121 participants; very low certainty evidence). However, there was an improvement in oxygenation index (FiO2% X MPAW/ PaO2) with prone positioning in both the parallel trials (MD -2.42, 95% CI -3.60 to -1.25; 2 trials, 121 participants; very low certainty evidence), and the cross-over study (MD -8.13, 95% CI -15.01 to -1.25; 1 study, 20 participants). Derived indices of respiratory mechanics, such as tidal volume, respiratory rate, and positive end-expiratory pressure (PEEP) were reported. There was an apparent decrease in tidal volume between prone and supine groups in a parallel study (MD -0.60, 95% CI -1.05 to -0.15; 1 study, 84 participants; very low certainty evidence). When prone and supine positions were compared in a cross-over study, there were no conclusive results in respiratory compliance (MD 0.07, 95% CI -0.10 to 0.24; 1 study, 10 participants); changes in PEEP (MD -0.70 cm H2O, 95% CI -2.72 to 1.32; 1 study, 10 participants); or resistance (MD -0.00, 95% CI -0.05 to 0.04; 1 study, 10 participants). One study reported adverse events. There were no conclusive results for potential harm between groups in extubation (OR 0.57, 95% CI 0.13 to 2.54; 1 trial, 102 participants; very low certainty evidence); obstructions of the endotracheal tube (OR 5.20, 95% CI 0.24 to 111.09; 1 trial, 102 participants; very low certainty evidence); pressure ulcers (OR 1.00, 95% CI 0.41 to 2.44; 1 trial, 102 participants; very low certainty evidence); and hypercapnia (high levels of arterial carbon dioxide; OR 3.06, 95% CI 0.12 to 76.88; 1 trial, 102 participants; very low certainty evidence). One study (50 participants) compared supine positions to good-lung dependent and independent positions. There was no conclusive evidence that PaO2 was different between supine and good-lung dependent positioning (MD 3.44 mm Hg, 95% CI -23.12 to 30.00; 1 trial, 25 participants; very low certainty evidence). There was also no conclusive evidence for supine position and good-lung independent positioning (MD -2.78 mmHg, 95% CI -28.84, 23.28; 25 participants; very low certainty evidence); or between good-lung dependent and independent positioning (MD 6.22, 95% CI -21.25 to 33.69; 1 trial, 25 participants; very low certainty evidence). As most trials did not describe how possible biases were addressed, the potential for bias in these findings is unclear. AUTHORS' CONCLUSIONS: Although included studies suggest that prone positioning may offer some advantage, there was little evidence to make definitive recommendations. There appears to be low certainty evidence that positioning improves oxygenation in mechanically ventilated children with ARDS. Due to the increased risk of SIDS with prone positioning and lung injury with artificial ventilation, it is recommended that hospitalised infants and children should only be placed in this position while under continuous cardiorespiratory monitoring.


Assuntos
Síndrome do Desconforto Respiratório , Morte Súbita do Lactente , Adulto , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , Posicionamento do Paciente/métodos , Respiração com Pressão Positiva/métodos , Respiração Artificial , Síndrome do Desconforto Respiratório/terapia
20.
Radiother Oncol ; 173: 188-196, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35661677

RESUMO

Surface guidance systems enable patient positioning and motion monitoring without using ionising radiation. Surface Guided Radiation Therapy (SGRT) has therefore been widely adopted in radiation therapy in recent years, but guidelines on workflows and specific quality assurance (QA) are lacking. This ESTRO-ACROP guideline aims to give recommendations concerning SGRT roles and responsibilities and highlights common challenges and potential errors. Comprehensive guidelines for procurement, acceptance, commissioning, and QA of SGRT systems installed on computed tomography (CT) simulators, C-arm linacs, closed-bore linacs, and particle therapy treatment systems are presented that will help move to a consensus among SGRT users and facilitate a safe and efficient implementation and clinical application of SGRT.


Assuntos
Radioterapia Guiada por Imagem , Humanos , Aceleradores de Partículas , Posicionamento do Paciente , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem/métodos , Tomografia Computadorizada por Raios X/métodos
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