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Yu J, Tang J, Chen M, Ren Q, He J, Tang M, Zhang X, Liu Z, Ding H. Traumatic subdural hygroma and chronic subdural hematoma: A systematic review and meta-analysis. J Clin Neurosci 2023; 107:23-33. [PMID: 36462413 DOI: 10.1016/j.jocn.2022.11.010] [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: 09/10/2022] [Revised: 11/12/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022]
Abstract
Recently, a relationship between traumatic subdural hygroma (SDG) and chronic subdural hematoma (CSDH) has been proposed. However, the role of traumatic SDG in development of CSDH has not been well characterized. This systematic review aimed to estimate the rate of evolution of traumatic SDG to CSDH, and to identify risk factors associated with traumatic SDG evolution to CSDH. We searched MEDLINE, EMBASE, and Cochrane Library databases from inception to May 26, 2021, using the combination of the terms "subdural hygroma" and "chronic subdural hematoma." Using a random-effects model, we calculated a pooled estimate of rate of evolution of traumatic SDG to CSDH. In addition, we conducted a systematic review of studies of risk factors for traumatic SDG evolution to CSDH. Nineteen studies with 1,335 patients met the inclusion criteria for meta-analysis. The pooled estimate of evolution rate was 25.0 % (95 % CI, 19.3 %-30.7 %; I2 = 85.6 %), with significant heterogeneity among studies (P < 0.01). Age ≥ 60 years was associated independently with traumatic SDG evolution to CSDH, after adjustment for study design using multivariate meta-regression. Risk factors associated with evolution of traumatic SDG to CSDH were radiological characteristics such as thicker SDG and higher SDG CT value. The rate of traumatic SDGs evolution to CSDH is approximately 25 %. Patients aged 60 or older with traumatic SDGs are at increased risk of CSDH development. Thicker SDG and higher SDG CT value, are commonly reported risk factors for traumatic SDG evolution to CSDH. However, higher quality studies are needed.
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Affiliation(s)
- Jinhui Yu
- Department of Neurosurgery, People's Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Jiuning Tang
- Department of Neurosurgery, People's Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Minruo Chen
- Department of Neurosurgery, People's Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Qifu Ren
- Department of Neurosurgery, People's Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Jun He
- Department of Neurosurgery, People's Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Maoyuan Tang
- Department of Neurosurgery, People's Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Xinhai Zhang
- Department of Neurosurgery, People's Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Zhi Liu
- Department of Neurosurgery, People's Hospital of Yubei District of Chongqing City, Chongqing, China
| | - Huaqiang Ding
- Department of Neurosurgery, People's Hospital of Yubei District of Chongqing City, Chongqing, China.
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The risk factors associated with traumatic subdural effusion for patients with traumatic brain injury who did not undergo decompressive craniectomy. Acta Neurol Belg 2022:10.1007/s13760-022-02099-5. [DOI: 10.1007/s13760-022-02099-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/12/2022] [Indexed: 11/01/2022]
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Khizar A, Kumar Yadav P. Immediate improvement in GCS following needle aspiration of bilateral traumatic subdural effusion in a child in emergency room. Clin Case Rep 2022; 10:e6205. [PMID: 35957768 PMCID: PMC9360344 DOI: 10.1002/ccr3.6205] [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: 06/13/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/06/2022] Open
Abstract
A minor head injury can cause traumatic subdural effusion in a child. They often present to pediatric emergencies initially, and there is a delayed referral to neurosurgery. In the emergency room, they should undergo subdural effusion needle aspiration, which can result in an immediate improvement in GCS.
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Affiliation(s)
- Ahtesham Khizar
- Department of NeurosurgeryPakistan Institute of Medical SciencesIslamabadPakistan
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Prieto R, Soriano MC, Ortega C, Kalantari T, Rabanal AP. Subdural fluid accumulation caused by ventriculoperitoneal shunt underdrainage: A rare and paradoxical complication. Surg Neurol Int 2020; 11:451. [PMID: 33408936 PMCID: PMC7771393 DOI: 10.25259/sni_620_2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background: Subdural fluid collection in patients with internal cerebrospinal fluid (CSF) shunts has generally been linked to overdrainage and more rarely to pus accumulation. The authors present a previously unrecognized condition leading to extra-axial CSF accumulation: shunt underdrainage. Treatment of coexisting subdural fluid collection and hydrocephalus, disorders that have previously only been reported concurrently following head trauma or subarachnoid hemorrhage, is controversial. In addition, we intend to provide insight into the physiopathology of abnormal CSF accumulation within both the subdural space and ventricles simultaneously. Case Description: A 42-year-old female with a history of hypothalamic glioma and obstructive hydrocephalus during childhood presented with headache, vomiting, and gait disturbance. Following the insertion of her first ventriculoperitoneal shunt (VPS) by the age of 8, she underwent several surgeries due to shunt failure, all of them associating ventriculomegaly. Ventricles remained notably enlarged following insertion of her most recent VPS, and the computed tomography scan performed 2 months later at her admission showed a large subdural collection. Afterward, a malpositioned distal catheter causing shunt blockage was confirmed. Both, the subdural accumulation and hydrocephalus, were resolved following adequate placement of the peritoneal catheter. Conclusion: This case demonstrates that subdural fluid accumulations may occur following VPS underdrainage with hydrocephalus. Development of such extra-axial collection was probably caused by pressure related to CSF spillage from the ventricles into the subdural space. Our case also supports that a mass-effect subdural accumulation with hydrocephalus can be satisfactorily treated with adequate VPS alone, without directly treating the subdural collection.
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Affiliation(s)
- Ruth Prieto
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - Matias Cea Soriano
- Department of Surgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - Celia Ortega
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
| | - Teresa Kalantari
- Department of Neurosurgery, Puerta de Hierro University Hospital, Madrid, Spain
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Fan G, Ding J, Wang H, Wang Y, Liu Y, Wang C, Li Z. Risk factors for the development of chronic subdural hematoma in patients with subdural hygroma. Br J Neurosurg 2020; 35:1-6. [PMID: 31992088 DOI: 10.1080/02688697.2020.1717444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Patients with subdural hygroma (SDG) are at increased risk of developing chronic subdural hematoma (CSDH). However, the factors that increase the risk of conversion are not fully understood. This study was to assess the risk factors of SDG conversion to CSDH. METHODS We reviewed the literature and retrospectively studied a series of cases in which CSDH was preceded by SDG to understand the natural history. We reviewed 45 cases of SDG from our hospital between 2015 and 2018. The cases were divided into two groups according to whether SDG converted into CSDH. Data were collected clinical presentation, imaging findings et al. Univariate and multivariate logistic regression analyses were performed to identify factors associated with SDG conversion. RESULTS Univariate analysis showed that the SDG thickness (p = .009), SDG location (p = .026), and bilateral SDG (p = .042) were significantly associated with CSDH development. Multivariate analysis revealed that SDG thickness (odds ratio, 1.6; 95% confidence interval, 1.111-2.324; p = .012) and bilateral SDG (odds ratio, 27.6; 95% confidence interval 2.889-263.548; p = .004) were independent risk factors for SDG development. Receiver operating characteristic curve analysis revealed that SDG thickness was a significant variable for predicting SDG development. A thickness >11.37 mm was an appropriate cutoff value, and the possibility of SDG conversion had a sensitivity 50.0% and specificity of 87.0%. CONCLUSIONS Bilateral SDG and SDG thickness were independent risk factors for SDG progression into CSDH. An SDG thickness >11.37 mm had a high risk of SDG conversion.
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Affiliation(s)
- Gangxian Fan
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Jinke Ding
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Henglu Wang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Yuguo Wang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Yongliang Liu
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Chao Wang
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
| | - Zefu Li
- Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China
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Wu R, Ye Y, Ma T, Jia G, Qin H. Management of subdural effusion and hydrocephalus following decompressive craniectomy for posttraumatic cerebral infarction in a patient with traumatic brain injury: a case report. BMC Surg 2019; 19:26. [PMID: 30813919 PMCID: PMC6391787 DOI: 10.1186/s12893-019-0489-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Subdural effusion with hydrocephalus (SDEH) is a rare complication of traumatic brain injury, especially following decompressive craniectomy (DC) for posttraumatic cerebral infarction. The diagnosis and treatment are still difficult and controversial for neurosurgeons. Case presentation A 45-year-old man developed traumatic cerebral infarction after traumatic brain injury and underwent DC because of the mass effect of cerebral infarction. Unfortunately, the complications of traumatic subdural effusion (SDE) and hydrocephalus occurred in succession following DC. Burr-hole drainage and subdural peritoneal shunt were performed in sequence because of the mass effect of SDE, which only temporarily improved the symptoms of the patient. Cranioplasty and ventriculoperitoneal shunt were performed ultimately, after which SDE disappeared completely. However, the patient remains severely disabled, with a Glasgow Outcome Scale of 3. Conclusions It is important for neurosurgeons to consider the presence of accompanying hydrocephalus when treating patients with SDE. Once the diagnosis of SDEH is established and the SDE has no mass effect, timely ventriculoperitoneal shunt may be needed to avoid multiple surgical procedures, which is a safe and effective surgical method to treat SDEH.
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Affiliation(s)
- Ruhong Wu
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, No.185, Juqian Road, Changzhou City, 213003, China
| | - Yun Ye
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, No.185, Juqian Road, Changzhou City, 213003, China
| | - Tao Ma
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, No.185, Juqian Road, Changzhou City, 213003, China
| | - Geng Jia
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, No.185, Juqian Road, Changzhou City, 213003, China
| | - Huaping Qin
- Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, No.185, Juqian Road, Changzhou City, 213003, China.
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Almenzalawy MA, Essa AEA, Ragab MH. Subdural Hygroma: Different Treatment Modalities and Clinical Outcome. OPEN JOURNAL OF MODERN NEUROSURGERY 2019; 09:208-220. [DOI: 10.4236/ojmn.2019.93020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Yoon JE, Lee CY, Sin EG, Song J, Kim HW. Clinical Feature and Outcomes of Secondary Hydrocephalus Caused by Head Trauma. Korean J Neurotrauma 2018; 14:86-92. [PMID: 30402424 PMCID: PMC6218345 DOI: 10.13004/kjnt.2018.14.2.86] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/26/2018] [Accepted: 08/31/2018] [Indexed: 12/01/2022] Open
Abstract
Objective Post-traumatic hydrocephalus (PTH) is a frequent and serious complication following brain injury. The incidence of PTH varies greatly among studies. The purpose of this study was to investigate the incidence and treatment of PTH in patients with head trauma. Methods We examined 956 patients with head trauma who visited our center from January 2012 to December 2015. The hydrocephalus diagnosis was based on radiologic findings and clinical features, and patients were classified into the mild (Group 1, Glasgow Coma Scale score [GCS] 13–15), moderate (Group 2, GCS 9–12), or severe (Group 3, GCS 3–8) brain injury group according to their GCS at admission. To compare these groups, we used age, gender, radiologic findings, PTH developmental period, and postoperative results (Glasgow Outcome Scale). Results Of the 956 patients, 24 (2.5%) developed PTH. PTH occurred in 11 (1.4%), 3 (5.6%), and 10 (7.0%) patients in Groups 1, 2, and 3, respectively. Of the 24 patients with PTH, 22 (91.7%) developed PTH within 12 weeks post-trauma; the higher the GCS, the later the onset, and the lower the GCS, the earlier the onset (p=0.019). Twenty-one patients underwent ventriculoperitoneal shunting, and 13 had improved symptoms. Conclusion The incidence of PTH cannot be ignored. The possibility of PTH needs to be considered in patients with head trauma and appropriate follow-up should be undertaken. PTH is a treatable complication and patients' quality of life and neurological status can be improved if the appropriate treatment is selected and applied.
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Affiliation(s)
- Jae Eon Yoon
- Department of Neurosurgery, Konyang University Hospital, Konyang University Collge of Medicine, Daejeon, Korea
| | - Cheol Young Lee
- Department of Neurosurgery, Konyang University Hospital, Konyang University Collge of Medicine, Daejeon, Korea
| | - Eui Gyu Sin
- Department of Neurosurgery, Konyang University Hospital, Konyang University Collge of Medicine, Daejeon, Korea
| | - Jihye Song
- Department of Neurosurgery, Konyang University Hospital, Konyang University Collge of Medicine, Daejeon, Korea
| | - Hyun Woo Kim
- Department of Neurosurgery, Konyang University Hospital, Konyang University Collge of Medicine, Daejeon, Korea
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Subdural effusion protects the aging brain from harmful ventriculomegaly. Med Hypotheses 2017; 108:108-114. [PMID: 29055382 DOI: 10.1016/j.mehy.2017.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 06/17/2017] [Accepted: 08/06/2017] [Indexed: 11/21/2022]
Abstract
The human brain loses its volume and its function during aging. The solid part of the brain within the intracranial space, the brain parenchyma, decreases in volume with age; while the cerebrospinal fluid (CSF) volume increases. With progressive loss of brain parenchymal volume (BPV), CSF may shift from cerebral ventricles to the subdural space, forming subdural effusion (SDE), whose role in the brain aging process remains unclear. We hypothesize that damages associated with ventriculomegaly can be lessened after formation of SDE. As the BPV decreases, the enlarged ventricular surface area causes dysfunction of its lining ependymal cells, followed by damages to the periventricular tissue. The periventricular nerve fibers are stretched by the enlarged ventricles. We hypothesize that after the formation of SDE, ventriculomegaly can be stopped or even reversed. By allowing the atrophic brain to reside in a smaller fraction of the intracranial volume, damages associated with ventriculomegaly can be alleviated. If our hypothesis is correct, physicians should continue to maintain a conservative approach for uncomplicated SDE. For focal or global brain parenchymal loss caused by various pathologies, intracranial spacers can be employed to simulate the effect of SDE to protect the brain. For treatment of idiopathic normal pressure hydrocephalus, aggressive ventricular size reduction should be pursued. Finally, the protective effects of SDE have its limits. Extremely enlarged subdural volume can cause acute or chronic subdural hematoma, further damaging the brain.
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Nasi D, Dobran M, Iacoangeli M, Di Somma L, Gladi M, Scerrati M. Paradoxical Brain Herniation After Decompressive Craniectomy Provoked by Drainage of Subdural Hygroma. World Neurosurg 2016; 91:673.e1-4. [PMID: 27108031 DOI: 10.1016/j.wneu.2016.04.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/10/2016] [Accepted: 04/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Paradoxical brain herniation (PBH) is a rare and potentially life-threatening complication of decompressive craniectomy (DC) and results from the combined effects of brain gravity, atmospheric pressure and intracranial hypotension causing herniation in the direction opposite to the site of the DC with subsequent brainstem compression. To date, the cases of PBH reported in literature are spontaneous or provoked by a lumbar puncture, a cerebrospinal fluid (CSF) shunt, or ventriculostomy. CASE DESCRIPTION We present an uncommon case of PBH provoked by percutaneous drainage of a huge subdural hygroma (SH) ipsilateral to the decompressive craniectomy causing mass effect and neurologic deterioration. After percutaneous evacuation of SH, the patient became unresponsive with dilated and fixed left pupil. A brain computed tomography scan showed marked midline shift in the direction opposite to the craniectomy site with subfalcine herniation and effacement of the peripontine cisterns. Paradoxical brain herniation (PBH) was diagnosed. Conservative treatment failed, and the patient required an emergency cranioplasty for reverse PBH. CONCLUSIONS The present case highlights the possibility that all forms of CSF depletion, including percutaneous drainage of subdural CSF collection and not only CSF shunting and/or lumbar puncture, can be dangerous for patients with large craniotomies and result in PBH. Moreover, an emergency cranioplasty could represent a safe and effective procedure in patients not responding to conservative treatment.
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Affiliation(s)
- Davide Nasi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy.
| | - Mauro Dobran
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Maurizio Iacoangeli
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Lucia Di Somma
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Maurizio Gladi
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
| | - Massimo Scerrati
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy
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Avecillas-Chasin JM. Subdural effusion in decompressive craniectomy. Acta Neurochir (Wien) 2015; 157:2121-3. [PMID: 26264071 DOI: 10.1007/s00701-015-2537-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 07/30/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Josué M Avecillas-Chasin
- Department of Neurosurgery, Institute of Neurosciences, Instituto de Investigación Sanitaria San Calos, Hospital Clínico San Carlos, Prof. Martín Lagos s/n, 28040, Madrid, Spain.
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Ventricular-Peritoneal Shunt for an Infant With Post-Meningitic External Hydrocephalus. J Craniofac Surg 2015; 26:2236-7. [DOI: 10.1097/scs.0000000000001753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Fang X, Shen H, Zhou F. Letter to the editor: another treatment choice for subdural effusion with ventricle dilation. Acta Neurochir (Wien) 2015; 157:665-6. [PMID: 25690884 DOI: 10.1007/s00701-015-2371-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 02/05/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Xiaodong Fang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88, Hangzhou City, Zhejiang Province, 310009, China
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