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  • 1. Bächli, Heidi
    et al.
    Leiggener, Christoph
    Gawelin, Petter
    Audigé, Laurent
    Enblad, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Zeilhofer, Hans-Florian
    Hirsch, Jan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Buitrago-Téllez, Carlos
    Skull base and maxillofacial fractures: two centre study with correlation of clinical findings with a comprehensive craniofacial classification system2009In: Journal of Cranio-Maxillofacial Surgery, ISSN 1010-5182, E-ISSN 1878-4119, Vol. 37, no 6, p. 305-11Article in journal (Refereed)
    Abstract [en]

    PURPOSE: A comprehensive classification based on high resolution computed tomography (CT) of the whole craniofacial region was correlated with clinical findings of combined skull base and maxillofacial fractures. MATERIAL AND METHODS: In a study of two clinical centres, 70 patients with such injuries were admitted at the Universities of Basel (n=29) and Uppsala (n=41). Clinical signs (rhinorrhoea, periorbital haematoma and pneumencephalus) and surgical versus conservative treatment were correlated with a cranio-maxillofacial injury severity score (CMF-ISS) calculated from the classification system. Fracture classifications were decided in consensus on the basis of CT and semiautomatic classification software. The classification system defined 3 fracture types (A, B, C), 3 groups (A1, A2, A3), and 3 subgroups (A1.1, A1.2, A1.3) with increasing severity from A1.1 (lowest) to C3.3 (highest). RESULTS: Of 70 patients, 43 were operated upon and 27 conservatively treated. The operated patients had significantly higher severity scores than non-operated. Patients with or without periorbital haematoma do not differ significantly in the severity score. The severity of the CMF-ISS score was significantly associated (two sample T-test P<0.01) with the occurrence of pneumencephalus, rhinorrhoea and treatment approach. CONCLUSION: Based on our present results, this system seems to be clinical useful for operative decisions and interventions.

  • 2.
    Chrcanovic, Bruno Ramos
    et al.
    Malmo Univ, Fac Odontol, Dept Prosthodont, Carl Gustafs Vag 34, SE-20506 Malmo, Sweden.
    Nilsson, Johanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. Zealand Univ Hosp, Dept Oral & Maxillofacial Surg, Koge, Denmark.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Survival and complications of implants to support craniofacial prosthesis: A systematic review2016In: Journal of Cranio-Maxillofacial Surgery, ISSN 1010-5182, E-ISSN 1878-4119, Vol. 44, no 10, p. 1536-1552Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the survival rate of craniofacial implants (CIs) to support facial prosthesis/epithesis and the prevalence of surgical/biological complications based on previously published studies.

    METHODS: An electronic search was undertaken in March/2016. Only studies with a minimum of 5 patients were included. Untransformed proportions of implant failures for different regions were calculated. A meta-analysis evaluated the influence of radiotherapy on the failure rates. A meta-regression was performed considering the follow-up period as covariate.

    RESULTS: Seventy publications included 2355 patients and 8184 CIs (545 failures). The probability of a failure was 5.5% for all CIs (95%CI 4.5-6.5, P < 0.001), 1.2% for CIs in the auricular region (95%CI 0.8-1.5, P < 0.001), 12.2% for the nasal region (95%CI 9.0-15.5, P = 0.017), and 12.1% for the orbital region (95%CI 9.3-15.0, P < 0.001). Radiotherapy statistically affected the CIs rates (OR 5.80, 95%CI 3.77-8.92, P < 0.00001). There was no statistically significant influence of the follow-up time on the proportion of implant failures (P = 0.814). Soft tissue adverse reactions were the most common complications.

    CONCLUSIONS: Implants placed in the auricular region have a lower probability of failure than those in the nasal and orbital regions. Soft tissue adverse reactions were the most common complications. Radiotherapy significantly affected the CIs failure rates.

  • 3. Dasmah, Amir
    et al.
    Kashani, Hossein
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Rasmusson, Lars
    Integration of fluoridated implants in onlay autogenous bone grafts: An experimental study in the rabbit tibia2014In: Journal of Cranio-Maxillofacial Surgery, ISSN 1010-5182, E-ISSN 1878-4119, Vol. 42, no 6, p. 796-800Article in journal (Refereed)
    Abstract [en]

    Introduction: Bone augmentation before treatment with endosseous implants is a common procedure for rehabilitation of the edentulous jaw. Both machined and surface modified implants have been used in one-stage and two-stage surgery protocols with varying results and survival rates. The influence of surface modification on the integration of implants has been documented in both non-grafted and grafted bone. The aim of this study was to compare the integration and stability of surface modified fluoridated vs. machined implants when placed simultaneously with an onlay bone graft. Material and methods: Eight rabbits were used in this study. A disc shaped bone graft was harvested from each side of the sagittal suture of the calvarial bone and fixed bi-cortically to the proximal tibial metaphysis by means of a dental implant, 9 mm long and 3.5 mm in diameter with a smooth machined surface as control and a blasted, fluoridated surface as test. Test and control sides were randomised. After a healing time of 8 weeks, the rabbits were sacrificed and the implants were removed en block for light microscopic analysis. Bone to implant contact (BIC) was registered as well as the amount of bone filling a rectangle indicating a region of interest (ROI) in the grafted area. Resonance frequency analysis (RFA) was conducted both at the time of surgery and at the end of the study. Results: Our results showed statistically significant differences in BIC within the grafted area and the total bone to implant contact between the test and control sides in favour of the surface modified implants. The bone area filling the threads within a region of interest showed no statistically significant difference between the test and control sides. RFA showed higher implant stability with significant differences at the time of sacrifice in favour of the fluoridated implants. Conclusion: Surface modified fluoridated implants showed a higher degree of osseointegration and stability in onlay bone grafts compared with control implants with machined surface texture.  

  • 4. Dasmah, Amir
    et al.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Ekestubbe, Annika
    Sennerby, Lars
    Rasmusson, Lars
    Particulate vs. block bone grafts: Three-dimensional changes in graft volume after reconstruction of the atrophic maxilla, a 2-year radiographic follow-up2012In: Journal of Cranio-Maxillofacial Surgery, ISSN 1010-5182, E-ISSN 1878-4119, Vol. 40, no 8, p. 654-659Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Extensive alveolar bone resorption in the maxilla limits the possibility of successful placement and osseointegration of endosseous implants for future prosthetic rehabilitation. Autogenous bone from the iliac crest may be used as lateral onlays in the atrophic maxilla, both as block and particulate bone. To our knowledge, there is no three-dimensional 2-year follow-up study measuring the volumetric reduction of the augmented areas comparing particulate and block bone grafts.

    PURPOSE:

    The aim of this study was to conduct a radiographic 2-year follow-up study, using computed tomographic (CT) images in order to evaluate and compare the extent of bone graft resorption in the frontal maxillae augmented by particulate (test) and block bone (control).

    MATERIAL AND METHODS:

    Eleven patients treated with iliac bone grafts and oral implants in the maxilla were followed with CT examinations directly post grafting and after 2years.

    RESULT:

    The volumetric changes after 6months were extensive. Additionally, the changes in particulate bone tended to be larger after 2years compared to block bone, using this protocol. However, the difference was not statistically significant.

    CONCLUSION:

    The present follow-up study showed that there is radiographically complete integration and embedding of implants installed in grafted bone despite extensive initial graft resorption. There was no significant difference in the amount of volumetric reduction between particulate bone and block bone grafts.

  • 5.
    Khonsari, Roman H.
    et al.
    Assistance Publique – Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Service de Chirurgie Maxillo-faciale et Plastique, Université Paris-Descartes, Paris, France.
    Way, Benjamin
    The Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
    Nysjö, Johan
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction.
    Odri, Guillaume A.
    Assistance Publique – Hôpitaux de Paris, Hôpital Lariboisière, Service de Chirurgie Orthopédique, Université Paris-Diderot, Paris, France.
    Olszewski, Raphaël
    Department of Oral and Maxillofacial Surgery, Saint-Luc University Hospital, Catholic University of Leuven, Brussels, Belgium.
    Evans, Robert D.
    The Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
    Dunaway, David J.
    The Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
    Nyström, Ingela
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction.
    Britto, Jonathan A.
    The Craniofacial Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
    Fronto-facial advancement and bipartition in Crouzon-Pfeiffer and Apert syndromes: Impact of fronto-facial surgery upon orbital and airway parameters in FGFR2 syndromes2016In: Journal of Cranio-Maxillofacial Surgery, ISSN 1010-5182, E-ISSN 1878-4119, Vol. 44, no 10, p. 1567-1575Article in journal (Refereed)
    Abstract [en]

    A major concern in FGFR2 craniofaciosynostosis is oculo-orbital disproportion, such that orbital malformation provides poor accommodation and support for the orbital contents and peri-orbita, leading to insufficient eyelid closure, corneal exposure and eventually to functional visual impairment. Fronto-facial monobloc osteotomy followed by distraction osteogenesis aims to correct midfacial growth deficiencies in Crouzon–Pfeiffer syndrome patients. Fronto-facial bipartition osteotomy followed by distraction is a procedure of choice in Apert syndrome patients. These procedures modify the shape and volume of the orbit and tend to correct oculo-orbital disproportion. Little is known about the detailed 3D shape of the orbital phenotype in CPS and AS, and about how this is modified by fronto-facial surgery.

    Twenty-eight patients with CMS, 13 patients with AS and 40 control patients were included. CT scans were performed before and after fronto-facial surgery. Late post-operative scans were available for the Crouzon–Pfeiffer syndrome group. Orbital morphology was investigated using conventional three-dimensional cephalometry and shape analysis after mesh-based segmentation of the orbital contents.

    We characterized the 3D morphology of CPS and AS orbits and showed how orbital shape is modified by surgery. We showed that monobloc-distraction in CPS and bipartition-distraction in AS specifically address the morphological characteristics of the two syndromes.

  • 6.
    Levasseur, Julie
    et al.
    Univ Bourgogne, Hop Francois Mitterand, Ctr Hosp Univ Dijon Bourgogne, Serv Chirurg Maxillofaciale Stomatol Chirurg Plas, Dijon, France..
    Nysjö, Johan
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
    Sandy, Ronak
    Aalborg Univ Hosp, Dept Oral & Maxillofacial Surg, Aalborg, Denmark..
    Britto, Jonathan A.
    Great Ormond St Hosp NHS Trust, Dept Plast Surg, London, England..
    Garcelon, Nicolas
    Univ Paris 05, Sorbonne Paris Cite, Inst Imagine, Paris, France.;Univ Paris 05, Sorbonne Paris Cite, Ctr Rech Cordeliers, INSERM, Paris, France..
    Haber, Samer
    Univ Paris 05, Hop Univ Necker, Hop Paris, Serv Chirurg Maxillofaciale & Plast, Paris, France..
    Picard, Arnaud
    Univ Nantes, CHU Hotel Dieu, Serv Chirurg Maxillofaciale & Stomatol, Nantes, France..
    Corre, Pierre
    Univ Nantes, CHU Hotel Dieu, Serv Chirurg Maxillofaciale & Stomatol, Nantes, France..
    Odri, Guillaume A.
    Univ Paris Diderot, Hop Univ Lariboisi, Hop Paris, Serv Chirurg Orthopol, Paris, France..
    Khonsari, Roman H.
    Univ Paris 05, Hop Univ Necker, Hop Paris, Serv Chirurg Maxillofaciale & Plast, Paris, France..
    Orbital volume and shape in Treacher Collins syndrome2018In: Journal of Cranio-Maxillofacial Surgery, ISSN 1010-5182, E-ISSN 1878-4119, Vol. 46, no 2, p. 305-311Article in journal (Refereed)
    Abstract [en]

    Orbito-palpebral reconstruction is a challenge in Treacher Collins syndrome (TCS). This study investigates orbital phenotypes in TCS using cephalometry and orbital shape analysis. Eighteen TCS and 52 control patients were included in this study, using the Dr Warehouse database. Orbital cephalometry was based on 20 landmarks, 10 planes, 16 angles, and 22 distances. Orbits were segmented. Registration-based, age-specific mean models were generated using semi-automatic segmentation, and aligned and compared using color-coded distance maps - mean absolute distance (MAD), Hausdorff distance (HD), and Dice similarity coefficient (DSC). Symmetry was assessed by mirroring and DSC computing. Central orbital depth ( COD) and medial orbital depth ( MOD) allowed 100% of orbits to be classified. COD and lateral orbital depth (LOD) were different from the controls. Average MAD between TCS and controls was <= 1.5 mm, while for HD it was > 1.5 mm, and for DSC <1. TCS orbits were more asymmetrical than controls, and orbital volumes were smaller when age was considered as a confounding factor, and had a trend for normalization with age. This report emphasizes the importance of combining different morphometric approaches in the phenotype characterization of non-trivial structures such as the orbit, and supports composite skeletal and soft-tissue strategies for the management of the peri-orbital region.

  • 7.
    Nilsson, Johanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. Department of Oral & Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.
    Nysjö, Johan
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
    Carlsson, Anders-Petter
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. Department of Oral & Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Comparison analysis of orbital shape and volume in unilateral fractured orbits2018In: Journal of Cranio-Maxillofacial Surgery, ISSN 1010-5182, E-ISSN 1878-4119, Vol. 46, no 3, p. 381-387Article in journal (Refereed)
    Abstract [en]

    Facial fractures often result in changes of the orbital volume. These changes can be measured in three-dimensional (3D) computed tomography (CT) scans for preoperative planning and postoperative evaluation. The aim of this study was to analyze the orbital volume and shape before and after surgical treatment of unilateral orbital fractures using semi-automatic image segmentation and registration techniques. The orbital volume in 21 patients was assessed by a semi-automatic model-based segmentation method. The fractured orbit was compared relative to the contralateral orbit. The same procedure was performed for the postoperative evaluation. Two observers performed the segmentation procedure, and the inter- and intraobserver variability was evaluated. The interobserver variability (mean volume difference ± 1.96 SD) was −0.6 ± 1.0 ml in the first trial and 0.7 ± 0.8 ml in the second trial. The intra-observer variability was −0.2 ± 0.7 ml for the first observer and 1.1 ± 0.9 ml for the second observer. The average volume overlap (Dice similarity coefficient) between the fractured and contralateral side increased after surgery, while the mean and maximum surface distance decreased, indicating that the surgery contributed to a re-establishment of size and shape. In conclusion, our study shows that the semi-automatic segmentation method has precision for detecting volume differences down to 1.0 ml. The combination of semi-automatic segmentation and 3D shape analysis provides a powerful tool for planning and evaluating treatment of orbital fractures.

  • 8.
    Nilsson, Johanna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery. AO Research Institute Davos, Davos, Switzerland.; Zealand University Hospital, Køge, Denmark.
    Richards, Robert Geoff
    AO Research Institute Davos, Davos, Switzerland.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Kamer, Lukas
    AO Research Institute Davos, Davos, Switzerland.
    Virtual bite registration using intraoral digital scanning, CT and CBCT: In vitro evaluation of a new method and its implication for orthognathic surgery2016In: Journal of Cranio-Maxillofacial Surgery, ISSN 1010-5182, E-ISSN 1878-4119, Vol. 44, no 9, p. 1194-1200Article in journal (Refereed)
    Abstract [en]

    Three-dimensional (3D) computer-assisted planning requires detailed visualisation of the craniomaxillofacial region and interocclusal relationship. The aim of this study was to establish and evaluate a method to create a 3D model of the craniomaxillofacial region and to adopt intraoral digital scanning to place the lower jaw into a centric relation (CR) without the need of additional plaster casts and model surgery. A standard plastic skull modified by metallic dental wires and brackets was subjected to computed tomography (CT), cone beam computed tomography (CBCT), and intraoral digital scanning. We evaluated two different virtual bite registrations, a digital scan of the buccal dental surfaces and scanning of the wax bites to position the lower jaw into a CR, and assessed the accuracy of the integration of intraoral scanning to the CT/CBCT scans. The mean registration error of corresponding mesh points for the CT and intraoral scanned images was 0.15 ± 0.12 mm, while this error was 0.18 ± 0.13 mm for the CBCT and intraoral scanned images. The mean accuracy of the two virtual bite registrations ranged from 0.41 to 0.49 mm (buccal scan technique) and from 0.65 to 1.3 mm (virtualised wax bite technique). A method for virtual bite registration was developed. It has the potential to eliminate plaster casts and model surgery and may facilitate 3D computer-assisted planning of orthognathic surgery cases.

  • 9.
    Persson, Johan
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Materials Sciences.
    Helgason, Benedikt
    Institute for Biomechanics, ETH-Zurich, Switzerland.
    Engqvist, Håkan
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Materials Sciences.
    Ferguson, Stephen
    Institute for Biomechanics, ETH Zurich, Switzerland.
    Persson, Cecilia
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Applied Materials Sciences.
    Stiffness and strength of cranioplastic implant systems in comparison to cranial bone2018In: Journal of Cranio-Maxillofacial Surgery, ISSN 1010-5182, E-ISSN 1878-4119, Vol. 46, no 3, p. 418-423Article in journal (Refereed)
    Abstract [en]

    Purpose: The aim of this study was to evaluate skull replacement options after decompressive craniectomy by systematically investigating which combination of geometrical properties and material selection would result in a mechanical response comparable in stiffness to that of native skull bone and a strength as high or higher than the same. Materials and methods: The study was conducted using a Finite Element Model of the top part of a human skull. Native skull bone, autografts and commercial implants made of PEEK, solid titanium, two titanium meshes and a titanium-ceramic composite were modeled under a set load to evaluate deformation and maximum stress. Results: The computational result showed a large variation of the strength and effective stiffness of the autografts and implants. The stiffness of native bone varied by a factor of 20 and the strength by a factor of eight. The implants span the entire span of the native skull, both in stiffness and strength. Conclusion: All the investigated implant materials had a potential for having the same effective stiffness as the native skull bone. All the materials also had the potential to be as strong as the native bone. To match inherent properties, the best choice of material and thickness is thus patient specific, depending on the quality of the patient's native bone.

  • 10.
    Ritvanen, A.
    et al.
    Aalto Univ, Sch Elect Engn, Dept Elect Engn & Automat, POB 13000, Aalto 00076, Finland..
    Savolainen, M.
    Univ Helsinki, Cent Hosp, Dept Plast Surg, POB 266, Helsinki 00290, Finland..
    Nowinski, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Saiepour, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Paulasto-Krockel, M.
    Aalto Univ, Sch Elect Engn, Dept Elect Engn & Automat, POB 13000, Aalto 00076, Finland..
    Hukki, J.
    Univ Helsinki, Cent Hosp, Dept Plast Surg, POB 266, Helsinki 00290, Finland..
    Tukiainen, E.
    Univ Helsinki, Cent Hosp, Dept Plast Surg, POB 266, Helsinki 00290, Finland..
    Leikola, J.
    Univ Helsinki, Cent Hosp, Dept Plast Surg, POB 266, Helsinki 00290, Finland..
    Force measurements during posterior calvarial vault osteodistraction: A novel measurement method2017In: Journal of Cranio-Maxillofacial Surgery, ISSN 1010-5182, E-ISSN 1878-4119, Vol. 45, no 6, p. 981-989Article in journal (Refereed)
    Abstract [en]

    Posterior calvarial vault osteodistraction (PCVO) has become increasingly popular in the correction of craniosynostosis. When compared to cranioplasty, PCVO offers a shorter, less invasive operation, greater intracranial volume advancement and a lower rate of relapse. In general, distraction protocols are based primarily on clinical observations rather than systematic research. Faster distraction protocols may reduce complications. However, distraction protocols producing higher forces can increase complications. Thus, we need to understand these forces in order to improve distraction protocols and devices. We developed a force measurement method that can be used on PCVO devices. Here, we present preliminary data about the forces developed during PCVO. We measured the forces in four bicoronal craniosynostosis patients during PCVO. We observed a linear-like trend between the force increase and the distraction distance within distraction sessions. We also observed a step-wise force increase between distraction sessions and found that the distraction force relaxed rapidly shortly after the distraction session. The mean maximum pre distraction force for one distracter was 20.4 N, while the mean maximum end-distraction force for one distracter was 57.6 N. Our data suggests that current treatment protocols might be re-evaluated favouring shorter distraction distances and more frequent distraction sessions.

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