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Beyond the Wada: An updated approach to pre-surgical language and memory testing: An updated review of available evaluation techniques and recommended workflow to limit Wada test use to essential clinical cases. Epilepsy Res 2021; 174:106673. [PMID: 34082393 DOI: 10.1016/j.eplepsyres.2021.106673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/27/2021] [Accepted: 05/13/2021] [Indexed: 11/21/2022]
Abstract
The Intracarotid amobarbital test (IAT), also called Wada test, is considered the "gold standard" for lateralizing language dominance in the pre-surgical evaluation of patients with epilepsy. In addition, it has been further modified to assess the postoperative risk of amnesia in patients undergoing temporal lobectomy. Since then it has been utilized to lateralize language and assess pre-surgical memory function. Over the years, its popularity has declined due to several limitations and availability of alternative procedures like fMRI and MEG. A survey of its use in the pre-surgical evaluation for epilepsy surgery has not been performed since the 2008 international survey by Baxendale et al. and it was heavily skewed due to data from European and North American countries. Only approximately 12% of the epilepsy centers indicated that they used the Wada test in every patient to assess preoperative memory function and language lateralization before temporal lobectomy. Nowadays, we have many functional mapping tools at our disposal. It has become somewhat unsuitable to have epilepsy patients undergo an invasive test such as the Wada test for the risks associated with it outweigh the benefits. Our objective is to review the Wada Test and alternative methods of assessing language and memory dominance, as it is past its prime and should only be used in specific circumstances.
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Tailby C, Collins AJ, Vaughan DN, Abbott DF, O'Shea M, Helmstaedter C, Jackson GD. Teleneuropsychology in the time of COVID-19: The experience of The Australian Epilepsy Project. Seizure 2020; 83:89-97. [PMID: 33120327 PMCID: PMC7561524 DOI: 10.1016/j.seizure.2020.10.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/30/2020] [Accepted: 10/10/2020] [Indexed: 01/17/2023] Open
Abstract
PURPOSE Traditional neuropsychological testing carries elevated COVID-19 risk for both examinee and examiner. Here we describe how the pilot study of the Australian Epilepsy Project (AEP) has transitioned to tele-neuropsychology (teleNP), enabling continued safe operations during the pandemic. METHODS The AEP includes adults (age 18-60) with a first unprovoked seizure, new diagnosis of epilepsy or drug resistant focal epilepsy. Shortly after launching the study, COVID-related restrictions necessitated adaptation to teleNP, including delivery of verbal tasks via videoconference; visual stimulus delivery via document camera; use of web-hosted, computerised assessment; substitution of oral versions for written tests; online delivery of questionnaires; and discontinuation of telehealth incompatible tasks. RESULTS To date, we have completed 24 teleNP assessments: 18 remotely (participant in own home) and six on-site (participant using equipment at research facility). Five face-to-face assessments were conducted prior to the transition to teleNP. Eight of 408 tests administered via teleNP (1.9 %) have been invalidated, for a variety of reasons (technical, procedural, environmental). Data confirm typical patterns of epilepsy-related deficits (p < .05) affecting processing speed, executive function, language and memory. Questionnaire responses indicate elevated rates of patients at high risk of mood (34 %) and anxiety disorder (38 %). CONCLUSION Research teleNP assessments reveal a typical pattern of impairments in epilepsy. A range of issues must be considered when introducing teleNP, such as technical and administrative set up, test selection and delivery, and cohort suitability. TeleNP enables large-scale neuropsychological research during periods of social distancing (and beyond), and offers an opportunity to expand the reach and breadth of neuropsychological services.
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Affiliation(s)
- Chris Tailby
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; Department of Clinical Neuropsychology, Austin Health, Heidelberg, Australia.
| | - Alana J Collins
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia
| | - David N Vaughan
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; Department of Neurology, Austin Health, Heidelberg, Australia
| | - David F Abbott
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; The Florey Department of Neuroscience and Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Marie O'Shea
- Department of Clinical Neuropsychology, Austin Health, Heidelberg, Australia; School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | | | - Graeme D Jackson
- The Florey Institute of Neuroscience and Mental Health, Heidelberg, Australia; Department of Neurology, Austin Health, Heidelberg, Australia; The Florey Department of Neuroscience and Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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Kraus D, Vannest J, Arya R, Hutton JS, Leach JL, Mangano FT, Tenney JR, Byars AW, DeWitt TG, Horowitz-Kraus T. Reading in children with drug-resistant epilepsy was related to functional connectivity in cognitive control regions. Acta Paediatr 2020; 109:2105-2111. [PMID: 31999871 DOI: 10.1111/apa.15201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/12/2019] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to define whether individuals with drug-resistant focal epilepsy also used regions related to cognitive control to facilitate reading. METHODS We focused on patients with drug-resistant focal epilepsy in 2011-2014, who were aged 8-20 years and were being treated at the Cincinnati Children's Hospital, USA. They performed a verb generation functional magnetic resonance imaging task known to involve language and cognitive control, as well as a formal reading assessment. The reading scores were correlated with functional connectivity of the anterior cingulate cortex (ACC) using seed-to-voxel analysis. RESULTS There were 81 potential patients and 13 (seven females) met the inclusion criteria. Their age at seizure onset was 0-13 years, and they had a mean age of 12.66 ± 3.17 years at the time of the study. Individuals with epilepsy demonstrated average intelligence and word reading ability. Their reading scores were positively correlated with functional connectivity between the ACC and regions related to emotional processing (right amygdala), learning and language processing (left cerebellum) and visual processing. CONCLUSION Our results support the role that the ACC plays in proficient reading among children with drug-resistant epilepsy, even in those with epileptogenic foci in areas related to language.
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Affiliation(s)
- Dror Kraus
- Institute of Child Neurology, Schneider Children's Medical Center of Israel, Petah-Tikva, Israel
| | - Jennifer Vannest
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ravindra Arya
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - John S Hutton
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James L Leach
- Division of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Francesco T Mangano
- Division of Pediatric Neurosurgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jeffrey R Tenney
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Anna W Byars
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Thomas G DeWitt
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tzipi Horowitz-Kraus
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Educational Neuroimaging Center, Faculty of Biomedical Engineering, Technion, Haifa, Israel.,Faculty of Education in Science and Technology, Technion, Haifa, Israel
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Bradshaw AR, Woodhead ZVJ, Thompson PA, Bishop DVM. Investigation into inconsistent lateralisation of language functions as a potential risk factor for language impairment. Eur J Neurosci 2019; 51:1106-1121. [PMID: 31738452 PMCID: PMC7078955 DOI: 10.1111/ejn.14623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/18/2019] [Accepted: 11/12/2019] [Indexed: 01/07/2023]
Abstract
Disruption to language lateralisation has been proposed as a cause of developmental language impairments. In this study, we tested the idea that consistency of lateralisation across different language functions is associated with language ability. A large sample of adults with variable language abilities (N = 67 with a developmental disorder affecting language and N = 37 controls) were recruited. Lateralisation was measured using functional transcranial Doppler sonography (fTCD) for three language tasks that engage different language subprocesses (phonological decision, semantic decision and sentence generation). The whole sample was divided into those with consistent versus inconsistent lateralisation across the three tasks. Language ability (using a battery of standardised tests) was compared between the consistent and inconsistent groups. The results did not show a significant effect of lateralisation consistency on language skills. However, of the 31 individuals showing inconsistent lateralisation, the vast majority (84%) were in the disorder group with only five controls showing such a pattern, a difference that was higher than would be expected by chance. The developmental disorder group also demonstrated weaker correlations between laterality indices across pairs of tasks. In summary, although the data did not support the hypothesis that inconsistent language lateralisation is a major cause of poor language skills, the results suggested that some subtypes of language disorder are associated with inefficient distribution of language functions between hemispheres. Inconsistent lateralisation could be a causal factor in the aetiology of language disorder or may arise in some cases as the consequence of developmental disorder, possibly reflective of compensatory reorganisation.
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Affiliation(s)
- Abigail R Bradshaw
- Department of Experimental Psychology, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Zoe V J Woodhead
- Department of Experimental Psychology, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Paul A Thompson
- Department of Experimental Psychology, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Dorothy V M Bishop
- Department of Experimental Psychology, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
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Tailby C, Kowalczyk MA, Jackson GD. Cognitive impairment in epilepsy: the role of reduced network flexibility. Ann Clin Transl Neurol 2017; 5:29-40. [PMID: 29376090 PMCID: PMC5771327 DOI: 10.1002/acn3.503] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 10/18/2017] [Indexed: 01/10/2023] Open
Abstract
Objective The dominant model of cognitive impairment in focal epilepsy has emphasised structural bases for cognitive deficits. Current theories of cognition in the healthy brain emphasise the importance of the reweighting of brain network interactions in support of task performance. Here, we explore the hypothesis that cognitive deficits in epilepsy arise through abnormalities of dynamic functional network interactions. Method We studied 19 healthy controls and 37 temporal lobe epilepsy (TLE) patients, using a behavioural measure of verbal fluency (the Controlled Oral Word Association Test) and an fMRI verbal fluency paradigm (Orthographic Lexical Retrieval). Results Behaviourally, verbal fluency was significantly impaired in TLE. Psychophysiological interaction analyses of the fMRI data, which capture state-dependent changes in network connectivity, revealed reduced task-dependent modulations of connectivity from left superior medial frontal cortex to left middle frontal gyrus in TLE patients. Individual differences in verbal fluency among TLE cases was correlated with task-dependent changes in connectivity from left posterior cingulate to left superior medial frontal cortex, and from left superior medial frontal cortex to a range of right predominant brain areas. Interpretation These data reveal that the typical pattern of task-driven shifts in network connectivity is not observed in TLE. Our observations go beyond simple structure-function associations and suggest that failure of network flexibility can be an important contributor to cognitive impairment in epilepsy.
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Affiliation(s)
- Chris Tailby
- Florey Institute of Neuroscience and Mental Health Heidelberg Victoria Australia.,Institute for Social Neuroscience Heidelberg Victoria Australia.,Austin Health Heidelberg Victoria Australia
| | | | - Graeme D Jackson
- Florey Institute of Neuroscience and Mental Health Heidelberg Victoria Australia.,Austin Health Heidelberg Victoria Australia.,The University of Melbourne Parkville Victoria Australia
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Bradshaw AR, Thompson PA, Wilson AC, Bishop DV, Woodhead ZV. Measuring language lateralisation with different language tasks: a systematic review. PeerJ 2017; 5:e3929. [PMID: 29085748 PMCID: PMC5659218 DOI: 10.7717/peerj.3929] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/26/2017] [Indexed: 11/25/2022] Open
Abstract
Language lateralisation refers to the phenomenon in which one hemisphere (typically the left) shows greater involvement in language functions than the other. Measurement of laterality is of interest both to researchers investigating the neural organisation of the language system and to clinicians needing to establish an individual's hemispheric dominance for language prior to surgery, as in patients with intractable epilepsy. Recently, there has been increasing awareness of the possibility that different language processes may develop hemispheric lateralisation independently, and to varying degrees. However, it is not always clear whether differences in laterality across language tasks with fMRI are reflective of meaningful variation in hemispheric lateralisation, or simply of trivial methodological differences between paradigms. This systematic review aims to assess different language tasks in terms of the strength, reliability and robustness of the laterality measurements they yield with fMRI, to look at variability that is both dependent and independent of aspects of study design, such as the baseline task, region of interest, and modality of the stimuli. Recommendations are made that can be used to guide task design; however, this review predominantly highlights that the current high level of methodological variability in language paradigms prevents conclusions as to how different language functions may lateralise independently. We conclude with suggestions for future research using tasks that engage distinct aspects of language functioning, whilst being closely matched on non-linguistic aspects of task design (e.g., stimuli, task timings etc); such research could produce more reliable and conclusive insights into language lateralisation. This systematic review was registered as a protocol on Open Science Framework: https://osf.io/5vmpt/.
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Affiliation(s)
- Abigail R. Bradshaw
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Paul A. Thompson
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Alexander C. Wilson
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Dorothy V.M. Bishop
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Zoe V.J. Woodhead
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
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Tailby C, Abbott DF, Jackson GD. The diminishing dominance of the dominant hemisphere: Language fMRI in focal epilepsy. NEUROIMAGE-CLINICAL 2017; 14:141-150. [PMID: 28180072 PMCID: PMC5279902 DOI: 10.1016/j.nicl.2017.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 01/12/2017] [Accepted: 01/15/2017] [Indexed: 02/05/2023]
Abstract
“Which is the dominant hemisphere?” is a question that arises frequently in patients considered for neurosurgery. The concept of the dominant hemisphere implies uniformity of language lateralisation throughout the brain. It is increasingly recognised that this is not the case in the healthy control brain, and it is especially not so in neurological diseases such as epilepsy. In the present work we adapt our published objective lateralisation method (based on the construction of laterality curves) for use with sub-lobar cortical, subcortical and cerebellar regions of interest (ROIs). We apply this method to investigate regional lateralisation of language activation in 12 healthy controls and 18 focal epilepsy patients, using three different block design language fMRI paradigms, each tapping different aspects of language processing. We compared lateralisation within each ROI across tasks, and investigated how the quantity of data collected affected the ability to robustly estimate laterality across ROIs. In controls, lateralisation was stronger, and the variance across individuals smaller, in cortical ROIs, particularly in the Inferior Frontal (Broca) region. Lateralisation within temporal ROIs was dependent on the nature of the language task employed. One of the healthy controls was left lateralised anteriorly and right lateralised posteriorly. Consistent with previous work, departures from normality occurred in ~ 15–50% of focal epilepsy patients across the different ROIs, with atypicality most common in the Lateral Temporal (Wernicke) region. Across tasks and ROIs the absolute magnitude of the laterality estimate increased and its across participant variance decreased as more cycles of task and rest were included, stabilising at ~ 4 cycles (~ 4 min of data collection). Our data highlight the importance of considering language as a complex task where lateralisation varies at the subhemispheric scale. This is especially important for presurgical planning for focal resections where the concept of ‘hemispheric dominance’ may be misleading. This is a precision medicine approach that enables objective evaluation of language dominance within specific brain regions and can reveal surprising and unexpected anomalies that may be clinically important for individual cases. Different brain regions support different aspects of language function. The degree of language lateralisation varies in different brain regions. Atypical lateralisation is common in focal epilepsy patients, particularly in the temporal lobe. Even in normal controls, frontal and temporal language systems can be in opposite hemispheres. Language dominance is more complex than often thought.
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Affiliation(s)
- Chris Tailby
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, VIC, Australia; School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - David F Abbott
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, VIC, Australia; Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Graeme D Jackson
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Melbourne, VIC, Australia; Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia; Department of Neurology, Austin Health, Melbourne, VIC, Australia
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Lu C, Qi Z, Harris A, Weil LW, Han M, Halverson K, Perrachione TK, Kjelgaard M, Wexler K, Tager-Flusberg H, Gabrieli JDE. Shared neuroanatomical substrates of impaired phonological working memory across reading disability and autism. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 1:169-177. [PMID: 26949750 PMCID: PMC4776338 DOI: 10.1016/j.bpsc.2015.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Individuals with reading disability or individuals with autism spectrum disorder (ASD) are characterized, respectively, by their difficulties in reading or social communication, but both groups often have impaired phonological working memory (PWM). It is not known whether the impaired PWM reflects distinct or shared neuroanatomical abnormalities in these two diagnostic groups. METHODS White-matter structural connectivity via diffusion weighted imaging was examined in sixty-four children, ages 5-17 years, with reading disability, ASD, or typical development (TD), who were matched in age, gender, intelligence, and diffusion data quality. RESULTS Children with reading disability and children with ASD exhibited reduced PWM compared to children with TD. The two diagnostic groups showed altered white-matter microstructure in the temporo-parietal portion of the left arcuate fasciculus (AF) and in the temporo-occipital portion of the right inferior longitudinal fasciculus (ILF), as indexed by reduced fractional anisotropy and increased radial diffusivity. Moreover, the structural integrity of the right ILF was positively correlated with PWM ability in the two diagnostic groups, but not in the TD group. CONCLUSIONS These findings suggest that impaired PWM is transdiagnostically associated with shared neuroanatomical abnormalities in ASD and reading disability. Microstructural characteristics in left AF and right ILF may play important roles in the development of PWM. The right ILF may support a compensatory mechanism for children with impaired PWM.
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Affiliation(s)
- Chunming Lu
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing 100875, China
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal University, Beijing 100875, China
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Zhenghan Qi
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Adrianne Harris
- Department of Psychological & Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Lisa Wisman Weil
- Department of Psychological & Brain Sciences, Boston University, Boston, MA 02215, USA
| | - Michelle Han
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Kelly Halverson
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Tyler K. Perrachione
- Department of Speech, Language & Hearing Sciences, Boston University, Boston, MA 02215, USA
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Margaret Kjelgaard
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- MGH Institute of Health Professions, Boston, MA 02129, USA
| | - Kenneth Wexler
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Helen Tager-Flusberg
- Department of Psychological & Brain Sciences, Boston University, Boston, MA 02215, USA
| | - John D. E. Gabrieli
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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