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Jafar NKA, Fan M, Moran LJ, Mansfield DR, Bennett CJ. Sex Hormones, Sex Hormone-Binding Globulin and Sleep Problems in Females With Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis. Clin Endocrinol (Oxf) 2025; 102:708-720. [PMID: 39996383 PMCID: PMC12046544 DOI: 10.1111/cen.15219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2024] [Revised: 02/05/2025] [Accepted: 02/09/2025] [Indexed: 02/26/2025]
Abstract
OBJECTIVE Sleep problems like obstructive sleep apnea (OSA) are common in polycystic ovary syndrome (PCOS), although the underlying mechanisms are not well understood. We aimed to determine the prevalence of sleep problems, synthesise and appraise studies analysing the associations between serum sex hormones, sex hormone-binding globulin (SHBG) and sleep problems in females with PCOS. DESIGN Systematic review and meta-analysis. METHODS A systematic search using MEDLINE, Embase, PsycInfo, CINAHL, Scopus, and Google Scholar was performed till 3 August 2024. Studies that examined serum sex hormones, SHBG or hyperandrogenism with sleep disorders and/or sleep disturbances in PCOS were eligible. Random effects meta-analyses of sex hormones and SHBG among females with PCOS with compared to without OSA were conducted. RESULTS From 4487 screened studies, 24 were included, with nine suitable for meta-analyses. Among females with PCOS, 46.0% had OSA and 56.0% had other sleep disturbances. SHBG levels were significantly lower in women with PCOS and OSA compared to those without OSA (standardised mean difference = -0.62; 95% CI = -0.82 to -0.42; I2 = 0%; 179 participants; p < 0.00001), but no differences were seen in total and free testosterone, dehydroepiandrosterone sulfate, androstenedione, and oestradiol. No significant associations between serum sex hormones, SHBG or hyperandrogenism with sleep disturbances in PCOS were observed. CONCLUSION SHBG, rather than hyperandrogenism, may play a more important mechanistic role for OSA in PCOS, while other sleep disturbances exhibit a less severe SHBG profile. These findings enhance comprehension of underlying pathophysiology of sleep problems in PCOS. Further validation across PCOS populations is warranted.
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Affiliation(s)
- Nur K. Abdul Jafar
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonAustralia
| | - Meng Fan
- Monash Lung and Sleep, Monash Health, ClaytonVictoriaAustralia
| | - Lisa J. Moran
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health SciencesMonash UniversityClaytonAustralia
| | - Darren R. Mansfield
- Monash Lung and Sleep, Monash Health, ClaytonVictoriaAustralia
- Faculty of Medicine, Nursing and Health Sciences, School of Psychological SciencesMonash University, ClaytonVictoriaAustralia
| | - Christie J. Bennett
- Be Active Sleep and Eat (BASE) Facility, Department of Nutrition and DieteticsSchool of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Notting HillVictoriaAustralia
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Zhou B, Yao Y, Wang Y, Yue W, Zhang J, He Y, Zhang Q, Wang Y, Hu K. Association Between Metabolic Score for Insulin Resistance (METS-IR) and Risk of Obstructive Sleep Apnea: Analysis of NHANES Database and a Chinese Cohort. Nat Sci Sleep 2025; 17:607-620. [PMID: 40260090 PMCID: PMC12011028 DOI: 10.2147/nss.s400125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Accepted: 04/07/2025] [Indexed: 04/23/2025] Open
Abstract
Purpose Insulin resistance (IR) plays a significant role in the development of obstructive sleep apnea (OSA). The metabolic score for insulin resistance (METS-IR) is a novel method for assessing IR. This study aims to explore the relationship between METS-IR and the risk of OSA. Patients and Methods This cross-sectional study included a total of 8297 subjects from NHANES (National Health and Nutrition Examination Survey) database, as well as 581 patients who underwent sleep monitoring in Renmin Hospital of Wuhan University. Logistic regression, subgroup analysis, and receiver operating characteristic (ROC) curve analysis were employed for evaluation. Results In the American population, a significant positive association was found between METS-IR and increased risk of OSA. For each unit increase in METS-IR, the risk of OSA increased by 4.4% (OR= 1.044; 95% CI: 1.037-1.059; P <0.001). A similar relationship was observed in the Chinese population. Multivariate Logistic regression model showed that for each unit increase in METS-IR, the prevalence of OSA increased by 6.7% (OR= 1.067; 95% CI: 1.035-1.103; P <0.001), and apnea-hypopnea index (AHI) increased by 0.732 (β= 0.732; 95% CI: 0.573-0.732; P <0.001). Gender subgroup analysis further showed that the association between METS-IR and OSA was particularly significant in male participants (OR= 1.111; 95% CI: 1.065-1.163; P <0.001). In the ROC analysis, the area under the curve (AUC) value of METS-IR for predicting OSA was 0.777, but it is not statistically significantly different from triglyceride glucose (TyG) (AUC = 0.749; P = 0.054), body mass index (BMI) (AUC = 0.769; P = 0.269), and triglyceride glucose-body mass index (TyG-BMI) (AUC = 0.777; P = 0.996). Conclusion METS-IR is significantly associated with the risk of OSA and may serve as an effective predictive marker for identifying OSA.
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Affiliation(s)
- Beini Zhou
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
| | - Yan Yao
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
| | - Yuhan Wang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
| | - Wuriliga Yue
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
| | - Jingyi Zhang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
| | - Yang He
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
| | - Qingfeng Zhang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
| | - Yixuan Wang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
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Wang H, Liang Y, Dong X, Fu M, Wang Y, Wang Y, Han H, Wang M, Zuo Y, Zhang S, Shen H, Han F, Gao F. Association between snoring and in vitro fertilization outcomes among infertile women. Sleep Med 2025; 128:74-81. [PMID: 39892082 DOI: 10.1016/j.sleep.2025.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 12/29/2024] [Accepted: 01/13/2025] [Indexed: 02/03/2025]
Abstract
OBJECTIVE To explore the association between snoring and in vitro fertilization (IVF) outcomes in infertile women, focusing on embryological parameters and pregnancy outcomes. METHODS This study represents a secondary analysis of the PKU-ERC study (NCT05373290). We included a cohort of 632 infertile women, aged 24-45 years, undergoing their first IVF treatment from the Reproductive Center of Peking University People's Hospital between January 2018 and November 2021. All patients with the assistance of their husbands completed a questionnaire including snoring status and frequency before ovulation induction (OI). Embryology parameters were evaluated during the first IVF cycle, and pregnancy outcomes were assessed through follow-up. RESULTS Among 579 subjects, 33.5 % reported occasional snoring, and 8.8 % reported frequent snoring. After adjusting for confounding factors, multiple linear regression model showed that frequent snorers had higher β-coefficients for the number of blastocysts and available embryos compared to non-snorers (both P < 0.05). Among 551 subjects who completed the first embryo transfer, 6.2 % suffered biochemical pregnancy loss. Frequent snorers were more likely to experience biochemical pregnancy loss compared to non-snorers and occasional snorers (5.7 % vs. 14.6 %, P = 0.033; 4.8 % vs. 14.6 %, P = 0.026). Multivariable analysis revealed that frequent snoring was a risk factor for biochemical pregnancy loss (adjusted odds ratio, aOR: 2.95, 95 % confidence interval, CI: 1.06-8.24, P = 0.039), while high-density lipoprotein cholesterol (HDL-C) level was a protective factor after IVF (aOR: 0.21, 95 % CI: 0.05-0.92, P = 0.038). CONCLUSION Frequent snoring is associated with a decreased number of available oocytes and an increased risk of biochemical pregnancy loss following IVF. However, the potential influence of undiagnosed obstructive sleep apnea (OSA) should be considered when interpreting these results.
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Affiliation(s)
- Huanhuan Wang
- Peking University School of Nursing, Beijing, 100191, China; Division of Sleep Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Yun Liang
- School of Basic Medical Sciences, Tsinghua University, Beijing, 100084, China
| | - Xiaosong Dong
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Min Fu
- Reproductive Center of Peking University Peoples' Hospital, Beijing, 100044, China
| | - Yiping Wang
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Yanbin Wang
- Reproductive Center of Peking University Peoples' Hospital, Beijing, 100044, China
| | - Hongjing Han
- Reproductive Center of Peking University Peoples' Hospital, Beijing, 100044, China
| | - Mengmeng Wang
- Peking University School of Nursing, Beijing, 100191, China; Division of Sleep Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Yuhua Zuo
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, 100044, China
| | - Shuyi Zhang
- Reproductive Center of Peking University Peoples' Hospital, Beijing, 100044, China
| | - Huan Shen
- Reproductive Center of Peking University Peoples' Hospital, Beijing, 100044, China
| | - Fang Han
- Division of Sleep Medicine, Peking University People's Hospital, Beijing, 100044, China.
| | - Fumei Gao
- Reproductive Center of Peking University Peoples' Hospital, Beijing, 100044, China.
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Li J, Huang Y, Xu S, Wang Y. Sleep disturbances and female infertility: a systematic review. BMC Womens Health 2024; 24:643. [PMID: 39707272 DOI: 10.1186/s12905-024-03508-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 12/10/2024] [Indexed: 12/23/2024] Open
Abstract
BACKGROUND Sleep disturbances are more prevalent among women with infertility. Current research increasingly highlights the significant relationship between sleep disturbances and female infertility, suggesting that sleep may be a key factor in reproductive health. In this review, we aim to delve into the complex interplay between sleep disturbances and female infertility, as well as to assess the underlying mechanisms involved, and seek to illuminate the causes of sleep-related fertility issues. The understanding of these contents may help clinicians enhance clinical strategies for managing sleep disturbances in women facing infertility challenges and provide timely support to those seeking fertility treatments. METHODS A comprehensive literature search was conducted in the PubMed and EMBASE databases. Studies that described sleep patterns or any type of sleep disturbance, sleep breathing disorders and their associations with female infertility or female fecundity, published between January 1, 2010, and November 1, 2023, were identified and extracted. The screening, data extraction, and quality assessment processes were independently performed by paired reviewers. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal tools for observational and cohort studies. RESULTS A total of 1,179 articles were initially identified from the search strategy (PubMed, n = 377; EMBASE, n = 802). After removing duplicates (n = 83) and screening for eligibility (n = 75), 19 studies were reviewed and determined to be eligible for inclusion. Infertile women generally report poorer sleep quality and exhibit more evening sleep chronotypes. Sleep disorders are significantly associated with infertility. Poor sleep quality, extreme sleep durations, and certain sleep chronotypes are associated with poorer fertility treatment outcomes, such as a reduced number of retrieved oocytes, decreased embryo quality, and lower fertilization rates. Obstructive sleep apnea (OSA) is also more prevalent in women with fertility issues, especially those with polycystic ovary syndrome (PCOS), and may negatively impact reproductive outcomes. The circadian rhythms of the Clock gene system, melatonin and hormone dysregulation, oxidative stress and immune response are considered to be potential mechanisms explaining how sleep disturbance impairs reproductive function, remain to be fully elucidated, and therefore, require further investigation. CONCLUSIONS Sleep disturbances are negatively associated with female infertility and poor fertility treatment outcomes. Longitudinal studies are expected to substantiate these findings and inform more nuanced approaches to prior sleep management and lifestyle advisement for infertile women, especially those undergoing fertility treatments. TRIAL REGISTRATION This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO, #CRD42024498443).
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Affiliation(s)
- Jing Li
- Reproductive Medical Center, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Yali Huang
- Reproductive Medical Center, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Shirong Xu
- Reproductive Medical Center, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Ying Wang
- Reproductive Medical Center, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
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Zhang J, Liu X, Zha S, Chen H, Zhang Q, Hu K. Physiological Effects and Tolerance of Wearing Surgical and N95 Masks during Sleep in Normal Individuals and Patients with Mild-Moderate Obstructive Sleep Apnea: A Randomized Crossover Trial. Am J Med 2024; 137:1128-1135.e4. [PMID: 38925495 DOI: 10.1016/j.amjmed.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 04/22/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND In certain situations, masks are worn during sleep to prevent respiratory infections. However, the effects of mask wearing on cardiopulmonary function during sleep are unknown. This study aimed to determine whether wearing masks during sleep has an impact on cardiopulmonary function, including in patients with obstructive sleep apnea. METHODS This was a prospective, randomized crossover-controlled trial. The effects of wearing surgical masks or N95 respirators on cardiopulmonary function were measured in healthy subjects and patients with mild-moderate obstructive sleep apnea. Sleep breathing parameters were monitored during nocturnal sleep using a sleep monitor, and subjective feelings about mask wearing were assessed using a questionnaire. RESULTS Wearing masks during sleep at night did not significantly impact sleep breathing parameters. Furthermore, there were no significant differences in heart rate, blood oxygenation, and blood pressure before and after wearing masks. However, wearing masks, especially the N95 mask, had an adverse impact on sleep quality, and masks were found to be subjectively uncomfortable. CONCLUSION Wearing masks during sleep at night does not adversely affect cardiopulmonary function but they can be uncomfortable, especially the N95 mask. Thus, in circumstances where wearing N95 masks during nocturnal sleep proves intolerable, we recommend the use of surgical masks as a more comfortable alternative.
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Affiliation(s)
- Jingyi Zhang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xu Liu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shiqian Zha
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hao Chen
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qingfeng Zhang
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Ke Hu
- Department of Respiratory and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan, China.
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He J, Ruan X, Li J. Polycystic ovary syndrome in obstructive sleep apnea-hypopnea syndrome: an updated meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1418933. [PMID: 39247914 PMCID: PMC11377251 DOI: 10.3389/fendo.2024.1418933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 08/06/2024] [Indexed: 09/10/2024] Open
Abstract
Background Obstructive sleep apnea-hypopnea syndrome (OSAHS) is correlated with metabolic deterioration in patients experiencing polycystic ovary syndrome (PCOS). Women diagnosed with PCOS exhibit a heightened prevalence of OSAHS. This meta-analysis aims to assess the morbidity of OSAHS in women affected by PCOS and to examine the differences in metabolism-related indicators between OSAHS-positive and OSAHS-negative in women with PCOS. Methods A comprehensive literature analysis of OSAHS morbidity in women with PCOS was conducted, utilizing databases such as CNKI, EMBASE, PubMed, Web of Science, and Wanfang. A comparison was carried out between patients with OSAHS-positive and those with OSAHS-negative in terms of their clinical characteristics and metabolic differences. The search language included English and Chinese. The acquired data were analyzed by employing RevMan 5.2 and Stata 11.0. Continuous variables with the same units were combined and analyzed through weighted mean differences (WMDs) as effect sizes, while continuous variables with different units were combined and analyzed through standardized mean differences (SMDs) as effect sizes. A conjoint analysis was performed on the basis of I2 value, using either a fixed effect model (I2 ≤ 50%) or a random effect model (I2 > 50%). Results A total of 21 articles met the inclusion criteria for this study. The findings indicated that 20.8% of women with PCOS were found to have comorbid OSAHS. The subjects were categorized into various subgroups for meta-analysis on the basis of race, age, disease severity, body mass index (BMI), and diagnostic criteria of PCOS. The results revealed high morbidity of OSAHS in all subgroups. In addition, most metabolic indicators and parameters of metabolic syndrome were notably worse in women suffering from both PCOS and OSAHS in comparison to their counterparts solely diagnosed with PCOS. Conclusion The current literature indicates higher morbidity of OSAHS among women with PCOS, linking OSAHS with worse metabolic status and obesity in this population. Consequently, clinicians are advised to prioritize the detection and management of OSAHS in women with PCOS. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/#myprospero PROSPERO, identifier (CRD42024528264).
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Affiliation(s)
- Jie He
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
- Key Laboratory of Geriatric Respiratory Diseases of Sichuan Higher Education Institutes, Chengdu, Sichuan, China
| | - Xia Ruan
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Rehabilitation, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Jia Li
- Clinical Medical College of Chengdu Medical College, Chengdu, Sichuan, China
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
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Bulka CM, Mathyk BA, Imudia AN. Good and uninterrupted sleep may be better for eggs. J Clin Sleep Med 2024; 20:1-2. [PMID: 37937536 PMCID: PMC10758548 DOI: 10.5664/jcsm.10920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/09/2023]
Affiliation(s)
| | - Begum Aydogan Mathyk
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Anthony N. Imudia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, Florida
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Cromack SC, Walter J, Feinberg EC. To sleep perchance to dream…of pregnancy. Fertil Steril 2023:S0015-0282(23)02077-0. [PMID: 38101561 DOI: 10.1016/j.fertnstert.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Sarah C Cromack
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jessica Walter
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eve C Feinberg
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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