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Titova, O. E., Lindberg, E., Tan, X., Elmståhl, S., Lind, L., Schiöth, H. B. & Benedict, C. (2020). Association between sleep duration and executive function differs between diabetic and non-diabetic middle-aged and older adults.. Psychoneuroendocrinology, 111, Article ID 104472.
Open this publication in new window or tab >>Association between sleep duration and executive function differs between diabetic and non-diabetic middle-aged and older adults.
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2020 (English)In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 111, article id 104472Article in journal (Refereed) Published
Abstract [en]

Executive function is defined as a set of cognitive skills that are necessary to plan, monitor, and execute a sequence of goal-directed complex actions. Executive function is influenced by a variety of factors, including habitual sleep duration and diabetes. In the present study, we investigated in 18,769 Swedish adults (mean age: 61 y) the association between executive function, diabetes, and self-reported sleep duration. We observed a significant interaction between diabetes and sleep duration for the Trail Making Test (TMT) ratio (P < 0.01). This ratio is a measure of executive function where higher values indicate worse performance. Among diabetic participants (n = 1,523), long (defined as ≥9 h per day) vs. normal sleep duration (defined as 7-8 hours per day) was associated with a higher TMT ratio (P < 0.05). Similar significant results were observed in diabetic individuals without pharmacological treatment for diabetes (n = 1,062). Among non-diabetic participants (n = 17,246), no association between long sleep duration and the TMT ratio was observed (P > 0.05). Instead, short (defined as <7 h per day) vs. normal sleep duration was linked to a higher TMT ratio (P < 0.05). These findings suggest that the association between sleep duration and executive function differs between diabetic and non-diabetic middle-aged and older adults. Based on the cross-sectional design of the study, no firm conclusions can be drawn on the causality of the relations.

Keywords
Cohort study, Diabetes, Executive function, Sleep duration
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:uu:diva-401482 (URN)10.1016/j.psyneuen.2019.104472 (DOI)000503085600005 ()31610410 (PubMedID)
Funder
Novo Nordisk, NNF190C0056777The Swedish Brain Foundation, F02019-0028Swedish Research Council, 2015-03100Åke Wiberg Foundation, M18-0169Fredrik och Ingrid Thurings Stiftelse, 2018-00365Swedish Society for Medical Research (SSMF), P18-0084
Available from: 2020-01-08 Created: 2020-01-08 Last updated: 2020-01-22Bibliographically approved
Lindberg, E., Bonsignore, M. R. & Polo-Kantola, P. (2020). Role of menopause and hormone replacement therapy in sleep-disordered breathing. Sleep Medicine Reviews, 49, Article ID 101225.
Open this publication in new window or tab >>Role of menopause and hormone replacement therapy in sleep-disordered breathing
2020 (English)In: Sleep Medicine Reviews, ISSN 1087-0792, E-ISSN 1532-2955, Vol. 49, article id 101225Article, review/survey (Refereed) Published
Abstract [en]

There are suggestions that the loss of female sex hormones following menopause is critical for the development or progression of sleep-disordered breathing (SDB). We conducted a review of the literature on the role of menopause and hormone replacement therapy (HRT) in SDB risk. There is an increase in SDB during the menopausal transition period, but data on an effect beyond that of increasing age and changes in body habitus are weak or absent. Early community-based, observational studies reported a protective effect by HRT on SDB prevalence, but this could possibly be explained as a healthy user effect. Interventional studies of the effect of HRT on SDB are sparse, with only a few randomized placebo-controlled studies, often performed on small samples of women without clinically significant SDB. HRT regimens have varied and all the studies are fairly old. They do not definitely assure the alleviation of SDB and HRT cannot thus be recommended as treatment for SDB. It is concluded that there is no evidence that female sex hormone changes during menopause per se are able to explain the increase in SDB in midlife women and conclusions on the effect of HRT on SDB cannot be drawn from the current literature.

Keywords
Menopause, Sleep-disordered breathing, Obstructive sleep apnea, Hormone replacement therapy, Estrogen, Woman, Obesity, Metabolism
National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-408061 (URN)10.1016/j.smrv.2019.101225 (DOI)000517792300008 ()31739179 (PubMedID)
Available from: 2020-04-03 Created: 2020-04-03 Last updated: 2020-04-03Bibliographically approved
Lehmann, S., Ringbaek, T., Lökke, A., Grote, L., Hedner, J. & Lindberg, E. (2019). A randomized trial to determine the impact of indacaterol/glycopyrronium on nighttime oxygenation and symptoms in patients with moderate-to-severe COPD: the DuoSleep study. The International Journal of Chronic Obstructive Pulmonary Disease, 14, 199-210
Open this publication in new window or tab >>A randomized trial to determine the impact of indacaterol/glycopyrronium on nighttime oxygenation and symptoms in patients with moderate-to-severe COPD: the DuoSleep study
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2019 (English)In: The International Journal of Chronic Obstructive Pulmonary Disease, ISSN 1176-9106, E-ISSN 1178-2005, Vol. 14, p. 199-210Article in journal (Refereed) Published
Abstract [en]

Purpose: This study investigated the effect of dual bronchodilation with the long-acting beta-receptor agonist/long-acting muscarinic antagonist combination, indacaterol/glycopyrronium (IND/GLY), on nighttime oxygenation, lung function, sleep quality, and symptoms in patients with moderate-to-severe COPD.

Patients and methods: This was a 4-week, double-blind, multicenter, placebo-controlled, two-period crossover study. Patients were randomized in a 1:1 ratio to receive IND/GLY 110/50 mu g once daily or matching placebo. The primary objective was to evaluate the effect of treatment with IND/GLY on mean nighttime oxygenation, compared with placebo. The secondary objective was to determine the time spent <90% in blood oxygen saturation (SpO(2)) compared with placebo. Exploratory objectives were to assess the effect of IND/GLY, compared with placebo, on sleep quality measured by the Medical Outcomes Study (MOS) Sleep Scale and the COPD and Asthma Sleep Impact Scale (CASIS) questionnaires and on symptoms assessed by COPD Assessment Test (CAT) questionnaire.

Results: In total, 38 patients were randomized (n= 22, IND/GLY; n= 16, placebo). The change in nighttime oxygenation (SpO(2)) was similar, and there was a comparable difference in time spent,90% SpO(2) between IND/GLY and placebo. Increases from baseline for the difference between IND/GLY and placebo for trough FEV1, FVC, and inspiratory capacity (P<0.05) were seen, with a corresponding reduction in residual volume and functional residual capacity (P<0.05). IND/GLY treatment showed an improvement in scores for CAT (P=0.0208), CASIS, and the MOS Sleep Scale measures, Sleep Problems Index I, Sleep Problems Index II (P=0.0315), Sleep Adequacy, Sleep Disturbance Scale, Somnolence Scale, and Short of Breath Scale (P=0.0031).

Conclusion: In this study, IND/GLY 110/50 mu g once daily improved symptoms, sleep quality, and lung function, but showed no effect on nighttime oxygenation in patients with moderate-to-severe COPD.

Place, publisher, year, edition, pages
DOVE MEDICAL PRESS LTD, 2019
Keywords
bronchodilator, sleep, hypoxia, quality of life, lung function
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-375229 (URN)10.2147/COPD.S184127 (DOI)000455508400001 ()30666100 (PubMedID)
Available from: 2019-01-29 Created: 2019-01-29 Last updated: 2019-01-29Bibliographically approved
Tan, X., Titova, O. E., Lindberg, E., Elmståhl, S., Lind, L., Schiöth, H. B. & Benedict, C. (2019). Association Between Self-Reported Sleep Duration and Body Composition in Middle-Aged and Older Adults. Journal of Clinical Sleep Medicine (JCSM), 15(3), 431-435
Open this publication in new window or tab >>Association Between Self-Reported Sleep Duration and Body Composition in Middle-Aged and Older Adults
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2019 (English)In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 15, no 3, p. 431-435Article in journal (Refereed) Published
Abstract [en]

STUDY OBJECTIVES: The current study sought to examine whether self-reported sleep duration is linked to an adverse body composition in 19,709 adults aged 45 to 75 years.

METHODS: All variables used in the current study were derived from the Swedish EpiHealth cohort study. Habitual sleep duration was measured by questionnaires. Body composition was assessed by bioimpedance. The main outcome variables were fat mass and fat-free mass (in kg). Analysis of covariance adjusting for age, sex, fat mass in the case of fat-free mass (and vice versa), leisure time physical activity, smoking, and alcohol consumption was used to investigate the association between sleep duration and body composition.

RESULTS: Short sleep (defined as ≤ 5 hours sleep per day) and long sleep (defined as 8 or more hours of sleep per day) were associated with lower fat-free mass and higher fat mass, compared with 6 to 7 hours of sleep duration (P< .05).

CONCLUSIONS: These observations could suggest that both habitual short and long sleep may contribute to two common clinical phenotypes in middle-aged and older humans, ie, body adiposity and sarcopenia. However, the observational nature of our study does not allow for causal interpretation.

Keywords
body fat, elderly, fat-free mass, middle-aged, sleep
National Category
Neurosciences
Identifiers
urn:nbn:se:uu:diva-379286 (URN)10.5664/jcsm.7668 (DOI)000461417900009 ()30853046 (PubMedID)
Funder
Swedish Research CouncilNovo Nordisk, NNF14OC0009349Swedish Research Council, 2015-03100Ernfors FoundationÅke Wiberg Foundation, M17-0088Åke Wiberg Foundation, M18-0169Fredrik och Ingrid Thurings Stiftelse, 2017-00313Fredrik och Ingrid Thurings Stiftelse, 2018-00365
Available from: 2019-03-14 Created: 2019-03-14 Last updated: 2020-01-09Bibliographically approved
Triebner, K., Accordini, S., Calciano, L., Johannessen, A., Benediktsdottir, B., Bifulco, E., . . . Real, F. G. (2019). Exogenous female sex steroids may reduce lung ageing after menopause: A 20-year follow-up study of a general population sample (ECRHS). Maturitas, 120, 29-34
Open this publication in new window or tab >>Exogenous female sex steroids may reduce lung ageing after menopause: A 20-year follow-up study of a general population sample (ECRHS)
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2019 (English)In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 120, p. 29-34Article in journal (Refereed) Published
Abstract [en]

Objectives: Menopause involves hypoestrogenism, which is associated with numerous detrimental effects, including on respiratory health. Hormone replacement therapy (HRT) is often used to improve symptoms of menopause. The effects of HRT on lung function decline, hence lung ageing, have not yet been investigated despite the recognized effects of HRT on other health outcomes. Study design: The population-based multi-centre European Community Respiratory Health Survey provided complete data for 275 oral HRT users at two time points, who were matched with 383 nonusers and analysed with a two-level linear mixed effects regression model. Main outcome measures: We studied whether HRT use was associated with the annual decline in forced vital capacity (FVC) and forced expiratory volume in one second (FEV1). Results: Lung function of women using oral HRT for more than five years declined less rapidly than that of nonusers. The adjusted difference in FVC decline was 5.6 mL/y (95%CI: 1.8 to 9.3, p = 0.01) for women who had taken HRT for six to ten years and 8.9 mL/y (3.5 to 14.2, p = 0.003) for those who had taken it for more than ten years. The adjusted difference in FEV1 decline was 4.4 mL/y (0.9 to 8.0, p = 0.02) with treatment from six to ten years and 5.3 mL/y (0.4 to 10.2, p = 0.048) with treatment for over ten years. Conclusions: In this longitudinal population-based study, the decline in lung function was less rapid in women who used HRT, following a dose-response pattern, and consistent when adjusting for potential confounding factors. This may signify that female sex hormones are of importance for lung ageing.

Place, publisher, year, edition, pages
ELSEVIER IRELAND LTD, 2019
Keywords
Hormone replacement therapy (HRT), Lung function, Menopause, Reproductive aging, Sex hormones
National Category
Respiratory Medicine and Allergy Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-376811 (URN)10.1016/j.maturitas.2018.11.007 (DOI)000456223000005 ()30583761 (PubMedID)
Funder
EU, Horizon 2020
Available from: 2019-02-22 Created: 2019-02-22 Last updated: 2019-12-19Bibliographically approved
Bengtsson, C., Jonsson, L., Holmstrom, M., Hellgren, J., Franklin, K., Gislason, T., . . . Lindberg, E. (2019). Incident Chronic Rhinosinusitis Is Associated With Impaired Sleep Quality: Results of the RHINE Study. Journal of Clinical Sleep Medicine (JCSM), 15(6), 899-905, Article ID PII jc-18-00575.
Open this publication in new window or tab >>Incident Chronic Rhinosinusitis Is Associated With Impaired Sleep Quality: Results of the RHINE Study
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2019 (English)In: Journal of Clinical Sleep Medicine (JCSM), ISSN 1550-9389, E-ISSN 1550-9397, Vol. 15, no 6, p. 899-905, article id PII jc-18-00575Article in journal (Refereed) Published
Abstract [en]

Study Objectives: Chronic rhinosinusitis (CRS) is a common inflammatory disease of the nasal cavity and paranasal sinuses. Associations between CRS and poor sleep quality have been reported. This 10-year follow-up study investigates possible associations between incident CRS and sleep quality. Methods: A questionnaire was sent to 16,500 individuals in Sweden, Norway, Denmark, Iceland and Estonia in 2000. It included questions on airway diseases, age, sex, body mass index, smoking habits, comorbidities, education and sleep quality. In 2010, a second questionnaire was sent to the same individuals, with a response rate of 53%. A subgroup of 5,145 individuals without nasal symptoms in 2000 was studied. Multiple logistic regression was performed to examine associations between CRS (defined according to the European position paper on rhinosinusitis and nasal polyps epidemiological criteria) at follow-up and sleep quality, with adjustment for potential confounders. Individuals with the respective sleep problem at baseline were excluded. Results: Over 10 years, 141 (2.7%) of the individuals without nasal symptoms in 2000 had developed CRS. CRS was associated with difficulties inducing sleep (adjusted odds ratio 2.81 [95% CI 1.67-4.70]), difficulties maintaining sleep (2.07 [1.35-3.18]), early morning awakening (3.03 [1.91-4.81]), insomnia (2.21 [1.46-3.35]), excessive daytime sleepiness (2.85 [1.79-4.55]), and snoring (3.31 [2.07-5.31]). Three insomnia symptoms at baseline increased the risk of CRS at follow-up by 5.00 (1.93-12.99). Conclusions: Incident CRS is associated with impaired sleep quality and excessive daytime sleepiness. Insomnia symptoms may be a risk factor for the development of CRS.

Place, publisher, year, edition, pages
AMER ACAD SLEEP MEDICINE, 2019
Keywords
chronic rhinosinusitis, CRS, epidemiology, insomnia, sleep quality
National Category
Otorhinolaryngology
Identifiers
urn:nbn:se:uu:diva-389988 (URN)10.5664/jcsm.7846 (DOI)000471747600013 ()31138385 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Heart Lung FoundationSwedish Asthma and Allergy Association
Available from: 2019-08-02 Created: 2019-08-02 Last updated: 2019-12-19Bibliographically approved
Amid Hägg, S., Emilsson, Ö. I., Franklin, K., Janson, C. & Lindberg, E. (2019). Nocturnal gastroesophageal reflux increases the risk of daytime sleepiness in women. Sleep Medicine, 53, 94-100
Open this publication in new window or tab >>Nocturnal gastroesophageal reflux increases the risk of daytime sleepiness in women
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2019 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 53, p. 94-100Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Daytime sleepiness is common in women and has negative health effects. Nocturnal gastroesophageal reflux (nGER) and snoring are risk factors for daytime sleepiness, but the effect of their interaction remains unknown. The aim of this study was to examine how nGER and snoring combined affected daytime sleepiness and involuntary falling asleep in women.

METHODS: A questionnaire was sent to randomly selected women in 2000 and 2010. Participants who answered questions regarding both nGER and snoring in both questionnaires were included (N = 4882). Daytime sleepiness was defined as severe or very severe problems with daytime sleepiness. Involuntary falling asleep was defined as sometimes, often or very often falling asleep involuntarily during the day. Respondents snoring loudly and disturbingly sometimes, often or very often were defined as snorers. Having nocturnal heartburn or acid reflux sometimes, often or very often was defined as having nGER.

RESULTS: Daytime sleepiness was reported by 14% of the participants, involuntary falling asleep by 11%. After adjustment for age, smoking, physical activity, caffeine intake and alcohol dependency, increased odd ratios (ORs) for both daytime sleepiness (adjusted OR 4.2, 95% confidence interval (CI): 1.9-9.2) and involuntary falling asleep (adjusted OR 3.1, 95% CI: 1.5-6.4) were seen in women with the combination of nGER and snoring at both baseline and follow-up. The association with daytime sleepiness was also strong for those with only persistent nGER but not for those with only persistent snoring.

CONCLUSION: Women with nGER were at increased risk of developing daytime sleepiness and snoring augmented this association. In addition, women with both nGER and snoring were also at increased risk of developing involuntary falling asleep.

Keywords
Daytime sleepiness, Involuntary falling asleep, Nocturnal gastroesophageal reflux, Snoring
National Category
Gastroenterology and Hepatology Respiratory Medicine and Allergy
Research subject
Lung Medicine
Identifiers
urn:nbn:se:uu:diva-375498 (URN)10.1016/j.sleep.2018.08.036 (DOI)000457169500016 ()30504084 (PubMedID)
Funder
Swedish Heart Lung Foundation
Available from: 2019-01-30 Created: 2019-01-30 Last updated: 2019-12-06Bibliographically approved
Triebner, K., Markevych, I., Hustad, S., Benediktsdottir, B., Forsberg, B., Franklin, K. A., . . . Dadvand, P. (2019). Residential surrounding greenspace and age at menopause: A 20-year European study (ECRHS). Environment International, 132, Article ID UNSP 105088.
Open this publication in new window or tab >>Residential surrounding greenspace and age at menopause: A 20-year European study (ECRHS)
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2019 (English)In: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 132, article id UNSP 105088Article in journal (Refereed) Published
Abstract [en]

Background: Menopause is associated with a number of adverse health effects and its timing has been reported to be influenced by several lifestyle factors. Whether greenspace exposure is associated with age at menopause has not yet been investigated.

Objective: To investigate whether residential surrounding greenspace is associated with age at menopause and thus reproductive aging.

Methods: This longitudinal study was based on the 20-year follow-up of 1955 aging women from a large, population-based European cohort (ECRHS). Residential surrounding greenspace was abstracted as the average of satellite-based Normalized Difference Vegetation Index (NDVI) across a circular buffer of 300 m around the residential addresses of each participant during the course of the study. We applied mixed effects Cox models with centre as random effect, menopause as the survival object, age as time indicator and residential surrounding greenspace as time-varying predictor. All models were adjusted for smoking habit, body mass index, parity, age at menarche, ever-use of contraception and age at completed full-time education as socio-economic proxy.

Results: An increase of one interquartile range of residential surrounding greenspace was associated with a 13% lower risk of being menopausal (Hazard Ratio: 0.87, 95% Confidence Interval: 0.79–0.95). Correspondingly the predicted median age at menopause was 1.4 years older in the highest compared to the lowest NDVI quartile. Results remained stable after additional adjustment for air pollution and traffic related noise amongst others.

Conclusions: Living in greener neighbourhoods is associated with older age at menopause and might slow reproductive aging. These are novel findings with broad implications. Further studies are needed to see whether our findings can be replicated in different populations and to explore the potential mechanisms underlying this association.

 

Keywords
Greenspace, MenopauseN, DVI, Reproductive aging, Sex hormones
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:uu:diva-397650 (URN)10.1016/j.envint.2019.105088 (DOI)000493552400048 ()31437647 (PubMedID)
Funder
The Research Council of Norway, 228174EU, Horizon 2020, 633212
Available from: 2019-12-03 Created: 2019-12-03 Last updated: 2019-12-19Bibliographically approved
Palm, A. & Lindberg, E. (2019). Response to "The dark side of adherence" by Crawford and Vallieres [Letter to the editor]. Sleep Medicine, 59, 97-97
Open this publication in new window or tab >>Response to "The dark side of adherence" by Crawford and Vallieres
2019 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 59, p. 97-97Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
ELSEVIER SCIENCE BV, 2019
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-390003 (URN)10.1016/j.sleep.2018.10.019 (DOI)000471665700020 ()30551924 (PubMedID)
Available from: 2019-08-05 Created: 2019-08-05 Last updated: 2019-08-05Bibliographically approved
Åkerstedt, T., Schwarz, J., Gruber, G., Theorell-Haglöw, J. & Lindberg, E. (2019). Short sleep-poor sleep?: A polysomnographic study in a large population-based sample of women. Journal of Sleep Research, 28(4), Article ID e12812.
Open this publication in new window or tab >>Short sleep-poor sleep?: A polysomnographic study in a large population-based sample of women
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2019 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, Vol. 28, no 4, article id e12812Article in journal (Refereed) Published
Abstract [en]

There is a lack of studies on the association between total sleep time (TST) and other polysomnographical parameters. A key question is whether a short sleep is an expression of habitual short sleep, or whether it reflects temporary impairment. The purpose of the present study was to investigate the association between TST and amount of sleep stages and sleep continuity measures, in a large population-based sample of women (n = 385), sleeping at home in a normal daily life setting. The results show that sleep efficiency, N1 (min), N2 (min), REM (min), REM% and proportion of long sleep segments, increased with increasing TST, whereas the number of awakenings/hr, the number of arousals/hr, N1% and REM intensity decreased. In addition, longer sleep was more associated with TST being perceived as of "usual" duration and with better subjective sleep quality. TST was not associated with habitual reported sleep duration. It was concluded that short TST of a recorded sleep in a real-life context may be an indicator of poor objective sleep quality for that particular sleep episode. Because individuals clearly perceived this reduction, it appears that self-reports of poor sleep quality often may be seen as indicators of poor sleep quality. It is also concluded that PSG-recorded sleep duration does not reflect habitual reported sleep duration in the present real-life context.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
delta dominance, REM density, REM intensity, sleep spindles
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:uu:diva-391294 (URN)10.1111/jsr.12812 (DOI)000476602100008 ()30609172 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Heart Lung Foundation
Available from: 2019-08-22 Created: 2019-08-22 Last updated: 2019-08-22Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-8552-4510

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