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Casazzo M, Pisani L, Md Erfan Uddin RA, Sattar A, Mirzada R, Zahed ASM, Sarkar S, Barua A, Paul S, Faiz MA, Sayeed AA, Leopold SJ, Lee SJ, Mukaka M, Hassan Chowdhury MA, Srinamon K, Schilstra M, Dutta AK, Grasso S, Schultz MJ, Ghose A, Dondorp A, Plewes K. The Accuracy of the Passive Leg Raising Test Using the Perfusion Index to Identify Preload Responsiveness-A Single Center Study in a Resource-Limited Setting. Diagnostics (Basel) 2025; 15:103. [PMID: 39795631 PMCID: PMC11719506 DOI: 10.3390/diagnostics15010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2024] [Revised: 11/05/2024] [Accepted: 11/20/2024] [Indexed: 01/13/2025] Open
Abstract
Background: We investigated the accuracy of predicting preload responsiveness by means of a passive leg raising test (PLR) using the perfusion index (PI) in critically ill patients showing signs of hypoperfusion in a resource-limited setting. Methods: We carried out a prospective observational single center study in patients admitted for sepsis or severe malaria with signs of hypoperfusion in Chattogram, Bangladesh. A PLR was performed at baseline, and at 6, 24, 48, and 72 h. Preload responsiveness assessed through PI was compared to preload responsiveness assessed through cardiac index (CI change ≥5%), as reference test. The primary endpoint was the accuracy of preload responsiveness prediction of PLR using PI at baseline; secondary endpoints were the accuracies at 6, 24, 48, and 72 h. Receiver operating characteristic (ROC) curves were constructed. Results: The study included 34 patients admitted for sepsis with signs of hypoperfusion and 10 patients admitted for severe malaria. Of 168 PLR tests performed, 143 had reliable PI measurements (85%). The best identified PI change cutoff to discriminate responders from non-responders was 9.7%. The accuracy of PLR using PI in discriminating a preload responsive patient at baseline was good (area under the ROC 0.87 95% CI 0.75-0.99). The test showed high sensitivity and negative predictive value, with comparably lower specificity and positive predictive value. Compared to baseline, the AUROC of PLR using PI was lower at 6, 24, 48, and 72 h. Restricting the analysis to sepsis patients did not change the findings. Conclusions: In patients with sepsis or severe malaria and signs of hypoperfusion, changes in PI after a PLR test detected preload responsiveness. The diagnostic accuracy was better when PI changes were measured at baseline.
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Affiliation(s)
- Marialessia Casazzo
- Department of Anesthesia and Intensive Care, University of Bari, 70124 Bari, Italy; (M.C.); (S.G.)
| | - Luigi Pisani
- Department of Anesthesia and Intensive Care, University of Bari, 70124 Bari, Italy; (M.C.); (S.G.)
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand; (S.J.L.); (M.M.); (K.S.); (M.S.); (M.J.S.); (A.D.); (K.P.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | - Rabiul Alam Md Erfan Uddin
- Department of Medicine, Chittagong Medical College Hospital, Chattogram 4203, Bangladesh; (R.A.M.E.U.); (A.S.); (R.M.); (A.S.M.Z.); (S.S.); (A.B.); (S.P.); (A.A.S.); (A.K.D.); (A.G.)
| | - Abdus Sattar
- Department of Medicine, Chittagong Medical College Hospital, Chattogram 4203, Bangladesh; (R.A.M.E.U.); (A.S.); (R.M.); (A.S.M.Z.); (S.S.); (A.B.); (S.P.); (A.A.S.); (A.K.D.); (A.G.)
| | - Rashed Mirzada
- Department of Medicine, Chittagong Medical College Hospital, Chattogram 4203, Bangladesh; (R.A.M.E.U.); (A.S.); (R.M.); (A.S.M.Z.); (S.S.); (A.B.); (S.P.); (A.A.S.); (A.K.D.); (A.G.)
| | - Abu Shahed Mohammad Zahed
- Department of Medicine, Chittagong Medical College Hospital, Chattogram 4203, Bangladesh; (R.A.M.E.U.); (A.S.); (R.M.); (A.S.M.Z.); (S.S.); (A.B.); (S.P.); (A.A.S.); (A.K.D.); (A.G.)
| | - Shoman Sarkar
- Department of Medicine, Chittagong Medical College Hospital, Chattogram 4203, Bangladesh; (R.A.M.E.U.); (A.S.); (R.M.); (A.S.M.Z.); (S.S.); (A.B.); (S.P.); (A.A.S.); (A.K.D.); (A.G.)
| | - Anupam Barua
- Department of Medicine, Chittagong Medical College Hospital, Chattogram 4203, Bangladesh; (R.A.M.E.U.); (A.S.); (R.M.); (A.S.M.Z.); (S.S.); (A.B.); (S.P.); (A.A.S.); (A.K.D.); (A.G.)
| | - Sujat Paul
- Department of Medicine, Chittagong Medical College Hospital, Chattogram 4203, Bangladesh; (R.A.M.E.U.); (A.S.); (R.M.); (A.S.M.Z.); (S.S.); (A.B.); (S.P.); (A.A.S.); (A.K.D.); (A.G.)
| | | | - Abdullah Abu Sayeed
- Department of Medicine, Chittagong Medical College Hospital, Chattogram 4203, Bangladesh; (R.A.M.E.U.); (A.S.); (R.M.); (A.S.M.Z.); (S.S.); (A.B.); (S.P.); (A.A.S.); (A.K.D.); (A.G.)
| | - Stije J. Leopold
- Department of Internal Medicine, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands;
| | - Sue J. Lee
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand; (S.J.L.); (M.M.); (K.S.); (M.S.); (M.J.S.); (A.D.); (K.P.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Mavuto Mukaka
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand; (S.J.L.); (M.M.); (K.S.); (M.S.); (M.J.S.); (A.D.); (K.P.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
| | | | - Ketsanee Srinamon
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand; (S.J.L.); (M.M.); (K.S.); (M.S.); (M.J.S.); (A.D.); (K.P.)
| | - Marja Schilstra
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand; (S.J.L.); (M.M.); (K.S.); (M.S.); (M.J.S.); (A.D.); (K.P.)
| | - Asok Kumar Dutta
- Department of Medicine, Chittagong Medical College Hospital, Chattogram 4203, Bangladesh; (R.A.M.E.U.); (A.S.); (R.M.); (A.S.M.Z.); (S.S.); (A.B.); (S.P.); (A.A.S.); (A.K.D.); (A.G.)
| | - Salvatore Grasso
- Department of Anesthesia and Intensive Care, University of Bari, 70124 Bari, Italy; (M.C.); (S.G.)
| | - Marcus J. Schultz
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand; (S.J.L.); (M.M.); (K.S.); (M.S.); (M.J.S.); (A.D.); (K.P.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Department of Intensive Care, Amsterdam University Medical Centers, Location AMC, 1105 AZ Amsterdam, The Netherlands
- Department of Anesthesia, General Intensive Care and Pain Management, Division of Cardiothoracic and Vascular Anesthesia & Critical Care Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Aniruddha Ghose
- Department of Medicine, Chittagong Medical College Hospital, Chattogram 4203, Bangladesh; (R.A.M.E.U.); (A.S.); (R.M.); (A.S.M.Z.); (S.S.); (A.B.); (S.P.); (A.A.S.); (A.K.D.); (A.G.)
| | - Arjen Dondorp
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand; (S.J.L.); (M.M.); (K.S.); (M.S.); (M.J.S.); (A.D.); (K.P.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Department of Global Health, Amsterdam University Medical Centers, Location AMC, 1005 AZ Amsterdam, The Netherlands
| | - Katherine Plewes
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok 10400, Thailand; (S.J.L.); (M.M.); (K.S.); (M.S.); (M.J.S.); (A.D.); (K.P.)
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1L5, Canada
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Sirkiä J, Panula T, Kaisti M. Non-Invasive Hemodynamic Monitoring System Integrating Spectrometry, Photoplethysmography, and Arterial Pressure Measurement Capabilities. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2310022. [PMID: 38647403 PMCID: PMC11199981 DOI: 10.1002/advs.202310022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/12/2024] [Indexed: 04/25/2024]
Abstract
Minimally invasive and non-invasive hemodynamic monitoring technologies have recently gained more attention, driven by technological advances and the inherent risk of complications in invasive techniques. In this article, an experimental non-invasive system is presented that effectively combines the capabilities of spectrometry, photoplethysmography (PPG), and arterial pressure measurement. Both time- and wavelength-resolved optical signals from the fingertip are measured under external pressure, which gradually increased above the level of systolic blood pressure. The optical channels measured at 434-731 nm divided into three groups separated by a group of channels with wavelengths approximately between 590 and 630 nm. This group of channels, labeled transition band, is characterized by abrupt changes resulting from a decrease in the absorption coefficient of whole blood. External pressure levels of maximum pulsation showed that shorter wavelengths (<590 nm) probe superficial low-pressure blood vessels, whereas longer wavelengths (>630 nm) probe high-pressure arteries. The results on perfusion indices and DC component level changes showed clear differences between the optical channels, further highlighting the importance of wavelength selection in optical hemodynamic monitoring systems. Altogether, the results demonstrated that the integrated system presented has the potential to extract new hemodynamic information simultaneously from macrocirculation to microcirculation.
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Affiliation(s)
- Jukka‐Pekka Sirkiä
- Department of ComputingUniversity of TurkuVesilinnantie 5Turku20500Finland
| | - Tuukka Panula
- Department of ComputingUniversity of TurkuVesilinnantie 5Turku20500Finland
| | - Matti Kaisti
- Department of ComputingUniversity of TurkuVesilinnantie 5Turku20500Finland
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Delmotte L, Desebbe O, Alexander B, Kouz K, Coeckelenbergh S, Schoettker P, Turgay T, Joosten A. Smartphone-Based versus Non-Invasive Automatic Oscillometric Brachial Cuff Blood Pressure Measurements: A Prospective Method Comparison Volunteer Study. J Pers Med 2023; 14:15. [PMID: 38276230 PMCID: PMC10817276 DOI: 10.3390/jpm14010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction: Mobile health diagnostics have demonstrated effectiveness in detecting and managing chronic diseases. This method comparison study aims to assess the accuracy and precision of the previously evaluated OptiBP™ technology over a four-week study period. This device uses optical signals recorded by placing a patient's fingertip on a smartphone's camera to estimate blood pressure (BP). Methods: In adult participants without cardiac arrhythmias and minimal interarm blood pressure difference (systolic arterial pressure (SAP) < 15 mmHg or diastolic arterial pressure (DAP) < 10 mmHg), three pairs of 30 s BP measurements with the OptiBP™ (test method) were simultaneously compared using three pairs of measurements with the non-invasive oscillometric brachial cuff (reference method) on the opposite arm over a period of four consecutive weeks at a rate of two measurements per week (one in the morning and one in the afternoon). The agreement of BP values between the two technologies was analyzed using Bland-Altman and error grid analyses. The performance of the smartphone application was investigated using the International Organization for Standardization (ISO) definitions, which require the bias ± standard deviation (SD) between two technologies to be lower than 5 ± 8 mmHg. Results: Among the 65 eligible volunteers, 53 participants had adequate OptiBP™ BP values. In 12 patients, no OptiBP™ BP could be measured due to inadequate signals. Only nine participants had known chronic arterial hypertension and 76% of those patients were treated. The mean bias ± SD between both technologies was -1.4 mmHg ± 10.1 mmHg for systolic arterial pressure (SAP), 0.2 mmHg ± 6.5 mmHg for diastolic arterial pressure (DAP) and -0.5 mmHg ± 6.9 mmHg for mean arterial pressure (MAP). Error grid analyses indicated that 100% of the pairs of BP measurements were located in zones A (no risk) and B (low risk). Conclusions: In a cohort of volunteers, we observed an acceptable agreement between BP values obtained with the OptiBPTM and those obtained with the reference method over a four-week period. The OptiBPTM fulfills the ISO standards for MAP and DAP (but not SAP). The error grid analyses showed that 100% measurements were located in risk zones A and B. Despite the need for some technological improvements, this application may become an important tool to measure BP in the future.
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Affiliation(s)
- Lila Delmotte
- Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium; (L.D.); (T.T.)
| | - Olivier Desebbe
- Department of Anesthesiology & Perioperative Medicine, Sauvegarde Clinic, Ramsay Santé, 69009 Lyon, France;
| | - Brenton Alexander
- Department of Anesthesiology, University of California San Diego, La Jolla, CA 92103, USA;
| | - Karim Kouz
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Sean Coeckelenbergh
- Department of Anesthesiology, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), 94800 Villejuif, France
- Outcomes Research Consortium, Cleveland, OH 44195, USA
| | - Patrick Schoettker
- Biospectal SA, 1003 Lausanne, Switzerland;
- Department of Anesthesiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Tuna Turgay
- Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium; (L.D.); (T.T.)
| | - Alexandre Joosten
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
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Muhammad R, Htun KT, Nettey-Oppong EE, Ali A, Jeon DK, Jeong HW, Byun KM, Choi SH. Pulse Oximetry Imaging System Using Spatially Uniform Dual Wavelength Illumination. SENSORS (BASEL, SWITZERLAND) 2023; 23:3723. [PMID: 37050784 PMCID: PMC10099045 DOI: 10.3390/s23073723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/25/2023] [Accepted: 03/16/2023] [Indexed: 06/19/2023]
Abstract
Pulse oximetry is a non-invasive method for measuring blood oxygen saturation. However, its detection scheme heavily relies on single-point measurements. If the oxygen saturation is measured at a single location, the measurements are influenced by the profile of illumination, spatial variations in blood flow, and skin pigment. To overcome these issues, imaging systems that measure the distribution of oxygen saturation have been demonstrated. However, previous imaging systems have relied on red and near-infrared illuminations with different profiles, resulting in inconsistent ratios between transmitted red and near-infrared light over space. Such inconsistent ratios can introduce fundamental errors when calculating the spatial distribution of oxygen saturation. In this study, we developed a novel illumination system specifically designed for a pulse oximetry imaging system. For the illumination system, we customized the integrating sphere by coating a mixture of barium sulfate and white paint inside it and by coupling eight red and eight near-infrared LEDs. The illumination system created identical patterns of red and near-infrared illuminations that were spatially uniform. This allowed the ratio between transmitted red and near-infrared light to be consistent over space, enabling the calculation of the spatial distribution of oxygen saturation. We believe our developed pulse oximetry imaging system can be used to obtain spatial information on blood oxygen saturation that provides insight into the oxygenation of the blood contained within the peripheral region of the tissue.
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Affiliation(s)
- Riaz Muhammad
- Department of Biomedical Engineering, Yonsei University, Wonju 26493, Republic of Korea; (R.M.); (K.T.H.); (E.E.N.-O.); (A.A.)
| | - Kay Thwe Htun
- Department of Biomedical Engineering, Yonsei University, Wonju 26493, Republic of Korea; (R.M.); (K.T.H.); (E.E.N.-O.); (A.A.)
| | - Ezekiel Edward Nettey-Oppong
- Department of Biomedical Engineering, Yonsei University, Wonju 26493, Republic of Korea; (R.M.); (K.T.H.); (E.E.N.-O.); (A.A.)
| | - Ahmed Ali
- Department of Biomedical Engineering, Yonsei University, Wonju 26493, Republic of Korea; (R.M.); (K.T.H.); (E.E.N.-O.); (A.A.)
- Department of Electrical Engineering, Sukkur IBA University, Sukkur 65200, Pakistan
| | - Dae Keun Jeon
- Mediana, R&D Center, Wonju 26365, Republic of Korea;
| | - Hyun-Woo Jeong
- Department of Biomedical Engineering, Eulji University, Seongnam 13135, Republic of Korea;
| | - Kyung Min Byun
- Department of Biomedical Engineering, Kyung Hee University, Yongin 17104, Republic of Korea
- Department of Electronics and Information Convergence Engineering, Kyung Hee University, Yongin 17104, Republic of Korea
| | - Seung Ho Choi
- Department of Biomedical Engineering, Yonsei University, Wonju 26493, Republic of Korea; (R.M.); (K.T.H.); (E.E.N.-O.); (A.A.)
- Department of Integrative Medicine, Major in Digital Healthcare, Yonsei University College of Medicine, Seoul 06229, Republic of Korea
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Hassan EA, Mohamed SN, Hamouda EH, Ahmed NT. Clinical evaluation for the pharyngeal oxygen saturation measurements in shocked patients. BMC Nurs 2022; 21:290. [PMID: 36316710 PMCID: PMC9624017 DOI: 10.1186/s12912-022-01073-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Background Monitoring oxygen saturation in shocked patients is a challenging nursing procedure. Shock syndrome alters peripheral tissue perfusion and hinders peripheral capillary oxygen saturation (SpO2) measurements. Our study aimed to find a solution to this problem. The pharynx is expected to be an accurate SpO2 measurement site in shocked patients. We clinically evaluated the pharyngeal SpO2 measurements against the arterial oxygen saturation (SaO2) measurements. Methods A prospective cohort research design was used. This study included 168 adult shocked patients. They were admitted to five intensive care units from March to December 2020 in an Egyptian hospital. A wrap oximeter sensor was attached to the posterior surface of an oropharyngeal airway (OPA) by adhesive tape. The optical component of the sensor adhered to the pharyngeal surface after the OPA insertion. Simultaneous pharyngeal peripheral capillary oxygen saturation (SpO2) and arterial oxygen saturation (SaO2) measurements were recorded. The pharyngeal SpO2 was clinically evaluated. Also, variables associated with the SpO2 bias were evaluated for their association with the pharyngeal SpO2 bias. Results The pharyngeal SpO2 bias was − 0.44% with − 1.65 to 0.78% limits of agreement. The precision was 0.62, and the accuracy was 0.05. The sensitivity to detect mild and severe hypoxemia was 100%, while specificity to minimize false alarm of hypoxemia was 100% for mild hypoxemia and 99.4% for severe hypoxemia. None of the studied variables were significantly associated with the pharyngeal SpO2 bias. Conclusion The pharyngeal SpO2 has a clinically acceptable bias, which is less than 0.5% with high precision, which is less than 2%.
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Affiliation(s)
- Eman Arafa Hassan
- grid.7155.60000 0001 2260 6941Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Sherouk Nasser Mohamed
- grid.7155.60000 0001 2260 6941Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Emad Hamdy Hamouda
- grid.7155.60000 0001 2260 6941Critical Medicine Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nadia Taha Ahmed
- grid.7155.60000 0001 2260 6941Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
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Abstract
Smartphones are increasingly powerful computers that fit in our pocket. Thanks to dedicated applications or "Apps," they can connect with external sensors to record, analyze, display, store, and share multiple physiologic signals and data. In addition, because modern smartphones are equipped with accelerometers, gyroscopes, cameras, and pressure sensors, they can also be used to directly gather physiologic information. Smartphones and connected sensors are creating opportunities to empower patients, individualize perioperative care, follow patients during their surgical journey, and simplify clinicians' life.
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