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Diabetes Amputation Survival Rate

Report 2a: Complications And Mortality (complications Of Diabetes)

Report 2a: Complications And Mortality (complications Of Diabetes)

England and Wales • V0.22 • 7 March 2017 The Healthcare Quality Improvement Partnership (HQIP). The National Diabetes Audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP) as part of the National Clinical Audit Programme (NCA). HQIP is led by a consortium of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices. Its aim is to promote quality improvement, and in particular to increase the impact that clinical audit has on healthcare quality in England and Wales. HQIP holds the contract to manage and develop the NCA Programme, comprising more than 30 clinical audits that cover care provided to people with a wide range of medical, surgical and mental health conditions. The programme is funded by NHS England, the Welsh Government and, with some individual audits, also funded by the Health Department of the Scottish Government, DHSSPS Northern Ireland and the Channel Islands. NHS Digital is the new name for the Health and Social Care Information Centre. NHS Digital managed the publication of the 2015-2016 annual report. Diabetes UK is the largest organisation in the UK working for people with diabetes, funding research, campaigning and helping people live with the condition. 2 Prepared in collaboration with: The national cardiovascular intelligence network (NCVIN) is a partnership of leading national cardiovascular organisations which analyses information and data and turns it into meaningful timely health intelligence for commissioners, policy makers, clinicians and health professionals to improve services and outcomes. Supported by: Introduction 3 • This report from the National Diabetes Audit (NDA) covers complications of diabetes. It does not include diabetic eye disease or hypoglycaemia because Continue reading >>

Diabetes And Amputation: Everything You Need To Know To Avoid Amputation

Diabetes And Amputation: Everything You Need To Know To Avoid Amputation

In this article, we will cover everything that you need to know about how to avoid an extremity amputation due to diabetes. We will cover skin and foot care, what to look for, and when to contact your doctor. We will discuss whether or not you need to see a podiatrist, and what to do if you do have a diabetic foot ulcer. We will look at how to get it treated, so that it heals and doesn’t progress to amputation. We will also look at what to do if you are going to have, or have already had an amputation due to your diabetes. We will look at ways you can become mobile again safely. We will also discuss ways to protect your remaining limbs so that you don’t have another amputation later. We will discuss what to look for related to residual limb care, and how to locate needed resources, such as a physical therapist. In my own experience as a nurse for 22 years, and as a certified diabetes educator, I have seen many people with diabetes lose functional mobility, and even their life, after an amputation. I have seen a person go from having a blister and not even knowing they have diabetes to having a below the knee amputation in under two weeks. In addition, I have worked with people who have been through femoral popliteal bypass surgery, amputation of the toes, then a below the knee amputation. I have watched them come in and out of the hospital until they have an above the knee amputation. With cardiovascular disease, the risk of another amputation is very high. I have watched their pain and suffering, and seen the struggles that their families go through after amputation due to complications of diabetes. I have sat up late with them, while they try to deal with phantom residual limb pain, as their mind plays tricks on them and they feel pain in the already amputated leg Continue reading >>

Explainer: How Diabetic Foot Disease Can Lead To Amputations And Even Death

Explainer: How Diabetic Foot Disease Can Lead To Amputations And Even Death

People with diabetes are prone to foot disease, which can lead to amputations and even death. Australia has the second-highest rate of lower-limb amputations in the developed world – with the rate having risen by 30% over the past decade. This is because as rates of type 1 and 2 diabetes increase, so do the very common related problems of foot health – known as Diabetes-Related Foot Disease (DRFD). Five-year survival rates for those with diabetic foot problems are lower than for prostate, breast and colon cancer, yet the severity of the problem isn’t widely recognised. If you are one of the estimated one million Australians with diabetes, paying close attention to your foot health could save you from serious, sometimes devastating complications. How does diabetes cause foot disease? The most common type of foot disease related to diabetes, affecting up to a quarter of diabetes sufferers, is foot ulcers. These are actually a big financial burden as well. Of the US$116 billion allocated for diabetes care in the United States in 2007, one-third was directed to treat foot ulceration. Here’s why it happens. Diabetic skin contains less of the structural protein collagen than normal skin. This means it becomes fragile, stiff and more prone to breaking. So a diabetic is more likely to experience injury and poor wound healing. Diabetes also increases a person’s risk of developing poor blood circulation by up to four times. Stiffer blood vessels restrict blood supply to tissues in the body. When circulation is poor, injuries such as cuts and blisters are less able to heal and more likely to become infected or turn into ulcers. Wounds related to diabetes most commonly happen on the extremities (feet and lower legs) because these areas are the first to lose feeling and bl Continue reading >>

Chronic Kidney Disease And Dialysis Linked To Poor Survival After Major Leg Amputation

Chronic Kidney Disease And Dialysis Linked To Poor Survival After Major Leg Amputation

Yet another excellent epidemiology article published by Lavery et al. We knew this anecdotally, but they analyzed their 10 year medical records, to show that CKD (Chronic Kidney Disease) and Dialysis patients are at extremely high risk for major leg amputation and high mortality rate, compared to the patients with no kidney disease. Paired with the previous studies on post-amputation survival rates of DM patients (Singh et al. JAMA. 2005;293:217-228), we now know that, DM and CKD/dialysis patients are the most vulnerable groups of patients for major leg amputation and poor survival post-amputations. Kudos to Dr. Lavery! =============================================== The impact of chronic kidney disease on survival after amputation in persons with diabetes Lawrence A. Lavery et al. Diabetes Care. 2010. Abstract Objective: To identify factors that influence survival after diabetes related amputations. Research design and methods: We abstracted medical records of 1043 hospitalized subjects with diabetes and a lower extremity amputation from January 1 to December 31, 1993 in six metropolitan statistical areas in South Texas. We identified mortality in the 10 year period after amputation from death certificate data. Diabetes was verified using World Health Organization criteria. Amputations were identified by ICD-9-CM codes 84.11-84.18 and categorized as foot, below-knee (BKA), and above-knee amputations(AKA) and verified by reviewing medical records. We evaluated three levels of renal function: chronic kidney disease (CKD), hemodialysis, and no renal disease. We defined CKD based on a glomerular filtration rate < 60 mL/min and hemodialysis from CPT codes (90921, 90925, 90935, 90937). We used chi square for trend and cox regression analysis to evaluate risk factors for surv Continue reading >>

Foot Infection: The Diabetes Complication That Kills More People Than Most Cancers

Foot Infection: The Diabetes Complication That Kills More People Than Most Cancers

A foot or leg amputation is one of the most dreaded complications of diabetes. In the US, more than 65,000 such amputations occur each year. But the tragedy does not stop there. According to recent research, about half of all people who have a foot amputation die within five years of the surgery—a worse mortality rate than most cancers. That’s partly because diabetic patients who have amputations often have poorer glycemic control and more complications such as kidney disease. Amputation also can lead to increased pressure on the remaining limb and the possibility of new ulcers and infections. Latest development: To combat the increasingly widespread problem of foot infections and amputations, new guidelines for the diagnosis and treatment of diabetic foot infections have been created by the Infectious Diseases Society of America (IDSA). What you need to know… Diabetes can lead to foot infections in two main ways—peripheral neuropathy (nerve damage that can cause loss of sensation in the feet)…and ischemia (inadequate blood flow). To understand why these conditions can be so dangerous, think back to the last time you had a pebble inside your shoe. How long did it take before the irritation became unbearable? Individuals with peripheral neuropathy and ischemia usually don’t feel any pain in their feet. Without pain, the pebble will stay in the shoe and eventually cause a sore on the sole of the foot. Similarly, people with diabetes will not feel the rub of an ill-fitting shoe or the pressure of standing on one foot too long, so they are at risk of developing pressure sores or blisters. These small wounds can lead to big trouble. About 25% of people with diabetes will develop a foot ulcer—ranging from mild to severe—at some point in their lives. Any ulcer, Continue reading >>

Is There A Place For Elective Therapeutic Amputation In Diabetic Foot Care?

Is There A Place For Elective Therapeutic Amputation In Diabetic Foot Care?

Editorial 32 Diabetic Foot Canada Volume 3 No 1 2015 D iabetic foot disease is associated with significant morbidity and mortality (Boulton et al, 2005) and accounts for approximately 50% of all non-traumatic major lower-extremity amputations (LEA) in the UK (Vamos et al, 2010). There is evidence that well-organised multidisciplinary teams can reduce amputation rates (Krishnan et al, 2008; Schofield et al, 2009). However, in some instances advanced or progressive disease means amputation is inevitable. Major LEA is often considered the most feared sequelae of diabetes. The personal and socio– economic burden of amputation makes it a “last resortâ€. However, the fact that nonhealing or recurrent ulceration can also be associated with a similar level of impairment in terms of quality of life (QOL) and cost should not be underestimated (Goodridge et al, 2005). As such, a well-planned, elective amputation, in which the person with persistent ulceration has been actively involved in the decision making, can in some cases be the preferred therapeutic option, when compared to the ongoing conservative management of chronic foot ulceration with its associated morbidity. This article will consider the outcomes of diabetes related foot disease, which factors influence both the risk of amputation and the chances of successful rehabilitation post-amputation. It will also consider the potential benefits of elective versus emergency amputation in those individuals with nonhealing recalcitrant foot ulceration and the factors that can be addressed pre-amputation to improve post- operative outcomes. What are the outcomes of diabetes related foot ulceration? In considering whether elective amputation is a reasonable therapeutic option, it is worth reviewing the outcomes of Continue reading >>

Amputation-free Limb Survival In Diabetic Foot Lesions: A Review

Amputation-free Limb Survival In Diabetic Foot Lesions: A Review

Abstract In this review, we examine the current status of amputation-free survival among patients with diabetic foot lesions in terms of the prevalence of diabetic foot lesions and amputations among diabetics. Next, we examine the etiological factors that are responsible for the development of diabetic foot lesions and subsequent amputation. We have previously conducted a retrospective investigation from 2004 to 2007. From our analysis of the data collected over this period from patients with diabetic foot lesions, we were able to identify some of the main etiological categories related to the risk for amputation. Based on these etiological categories, we were able to develop a color-coded etiological key that can be easily applied in clinical practice for the assessment of the risk of amputation and thereby direct the referral and further management. Between 2007 and 2012, we conducted a prospective study to test the applicability of the etiological key. The amputation-free survival rates achieved with thiskey were found to be comparable to those reported with the use of the currently applied approach of using a multidisciplinary team. We found that changes in blood quality, mainly, anemia and hypoalbuminemia, and peripheral artery disease were the etiological factors that were associated with the least chances of requiring amputation. On the other hand, tissue loss and pervious surgical procedures were found to be indicators of the highest risk for amputation. We also examine the etiological factors conventionally considered to increase the risk of amputation and examine the current practices followed in the management of cases of diabetic foot. We also examine the traditional and advanced treatment options available for the various etiological factors with a view to Continue reading >>

Diabetic Foot: Facts And Figures

Diabetic Foot: Facts And Figures

Diabetes affects 30 million people in the US and more than 415 million people worldwide. Diabetesatlas.org/American Diabetes Association The top 10 diabetes nations International Diabetes Federation / Diabetesatlas.org Diabetes kills more people annually than breast cancer and AIDS combined. American Diabetes Association, 2009 Two thirds of all new cases of type 2 diabetes are diagnosed in low- and middle-income countries, such as Mexico, India, China and Egypt. Pharmacoeconomics, 2015 Pharmacoeconomics, 2015 If diabetes were a country, it would be the 3rd largest in the world 80% of people with diabetes are from low and middle income nations The number of people with diabetes is increasing in every single nation Half of people with diabetes don’t know they have it. American Diabetes Association / International Diabetes Federation, 2012 Quiet. Slow. Deadly. Expensive: Chronic Diseases Account for 75% of our Healthcare Costs. 25% of all medical care is consumed by 1% of the population and nearly 50% is consumed by 5%. AHRQ, 2013 1 Day with #Diabetes in USA: 5000 diagnosed, $670M, 280 lives, 200 limbs. We can do better. Today. American Diabetes Association, 2014 Seconds Count: Every 7 seconds someone dies from diabetes. Every 20 seconds someone is amputated. International Diabetes Federation / Diabetesatlas.org Armstrong, et al, Diabetes Care 2013 The cost of diabetic foot ulcers is greater than that of the five most costly forms of cancer The cost to heal a complex diabetic foot ulcer is between 3 months and 6 years’ salary depending on nationality Cavanagh, et al, Diabetes Metab Res Rev, 2012 Diabetic Foot Ulcer patients are twice as costly to US Medicare as those with diabetes alone Rice, et al, Diabetes Care, 2014 Inpatient care constitutes nearly two thirds of in Continue reading >>

Do Amputees Live Shorter Lives? Why Or Why Not?

Do Amputees Live Shorter Lives? Why Or Why Not?

Most amputees became amputees due to vascular complications (such as blood clots or diabetes) and so their amputation is actually a co-morbidity of other diseases and disorders affecting the body. Those primary conditions often cause a person to have a shorter lifespan. Amputations also often have a long course of healing and treatment including multiple wounds and delayed healing, also due to the above mentioned primary health concerns. All of that can lead to increased risk of infections and increased mortality. For those who are amputees due to congential factors, other co-morbidities could be present which could increase mortality rates. For traumatic amputees, complications from the trauma could increase mortality. For amputees due to other conditions such as bone cancer, they could have increased mortality. So yes, amputees do have increased mortality rates compared to non-amputees. There are multiple studies that attest to this fact, such as: Short and Long Term Mortality Rates after a Lower Limb Amputation Very low survival rates after non-traumatic lower limb amputation in a consecutive series: what to do? † | Interactive CardioVascular and Thoracic Surgery | Oxford Academic Long-term mortality after lower-limb amputation. Continue reading >>

Early And Five-year Amputation And Survival Rate Of Diabetic Patients With Critical Limb Ischemia: Data Of A Cohort Study Of 564 Patients

Early And Five-year Amputation And Survival Rate Of Diabetic Patients With Critical Limb Ischemia: Data Of A Cohort Study Of 564 Patients

Objective To evaluate the early and late major amputation and survival rates and related risk factors in diabetic patients with critical limb ischemia (CLI). Design Retrospective study. Methods Revascularization feasibility, major amputation, survival rate and related risk factors were recorded in 564 diabetic patients consecutively hospitalized for CLI from 1999 to 2003 and followed until June 2005. Results Peripheral angioplasty (PTA) was carried out in 420 (74.5%), bypass graft (BPG) in 117 (20.7%) patients. In 27 (4.8%) patients both PTA and BPG were not possible. Twenty-three above-the-ankle amputations (4.1%) were performed at 30 days: 6 in PTA patients, 3 in BPG patients, 14 in non revascularized patients. In the follow-up of 558 patients (98.9%), 62 repeated PTAs and 9 new BPGs, 32 new major amputations (16 in PTA patients, 14 in BPG patients and 2 in non-revascularized patients) were performed. Major amputation was associated with absence of revascularization (OR 35.9, p<0.001, CI 12.9–99.7), occlusion of each of the three crural arteries (OR 8.20, p=0.022, CI 1.35–49.6), wound infection (OR 2.1, p=0.004 CI 1.3–3.6), dialysis (OR 4.7, p=0.001 CI 1.9–11.7) increase in TcPO2 after revascularization (OR 0.80, p<0.001 CI 0.74–0.87). One hundred seventy three patients died during follow-up and this was associated with age (HR 1.05, p<0.001 CI 1.03–1.07), history of cardiac disease (HR 2.16, p<0.001 CI 1.53–3.06), dialysis (HR 3.52, p<0.001 CI 2.08–5.97), absence of revascularization (HR 1.68, p<0.001, CI 1.29–2.19) and impaired ejection fraction (HR 1.08, p<0.001, CI 1.05–1.09). Conclusions In diabetic patients with CLI the revascularization is feasible in most cases and allows a low rate of early major amputation. This rate is higher in the foll Continue reading >>

Preoperative Plr And Nlr Values As Predictors Of Mortality In Diabetic Foot Amputations

Preoperative Plr And Nlr Values As Predictors Of Mortality In Diabetic Foot Amputations

Hasan Gocer*, Ismail Buyukceren, Sina Coskun, Davut Keskin, Nevzat Dabak Department of Orthopaedics, Medicine Faculty, Ondokuz Mayıs University, Samsun, Turkey Abstract Background: The incidence of lower extremity complications associated with diabetes mellitus has been increasing as the number of patients with diabetes rises. Amputation is the most critical complication. The aim of this study was to elucidate the correlations of the preoperative platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR) with wound complications, re-amputations, and mortality. Materials and Methods: This study included 258 patients who underwent lower extremity amputations due to diabetes (152 with below-knee amputations and 106 with above-knee amputations). The preoperative PLR, NLR, and hemoglobin concentration were calculated. Postoperative deaths were classified as those that occurred within the first 6 months (Group I), from 6 months to 1 year (Group II), from 1 to 3 years (Group III), and beyond 3 years (Group IV). Age, sex, re-amputation, and wound complications were investigated. Results: The amputation level and mortality rate were significantly correlated (p=0.017). No significant difference was found among Groups I to IV in either the haemoglobin concentration (9.4, 10.1, 10.1, and 10.7 g/dl, respectively; p=0.709) or PLR (247.7, 222.3, 229.4, and 195.0, respectively; p=0.678). The NLR was significantly higher in Group I (9.2) than in Groups II to IV (5.5, 6.3, and 5.6, respectively; p=0.012). Conclusion: Patients with a high preoperative NLR and above-knee amputation due to diabetes had a higher mortality rate. The PLR is not a suitable prognostic marker for patients undergoing amputation due to diabetes. Keywords Diabetes mellitus, Amputation, Mortality, Platele Continue reading >>

Diabetes-related Amputation A Marker For Death

Diabetes-related Amputation A Marker For Death

IF a person loses some part of his body as a result of diabetes, he is marked for death. This is according to consultant endocrinologist at the Tropical Medicine Research Institute at the University of the West Indies, Dr Michael Boyne, who presented on the burden of Type 2 diabetes in Jamaica at the inaugural Jamaica Advanced Laparoscopic Seminar, put on recently by the Medical Associates Hospital at the Knutsford Court Hotel. That person's rate of survival is however dependent on the type of amputation that is done. In looking at the rate of amputation in the Caribbean and using statistics from Barbados, which according to Dr Boyne was at one point dubbed the amputation capital of the world, the consultant endocrinologist said that the rate of amputations was raised from 14 to 936 cases of amputation per 100,000 patient population. He also said that Trinidad & Tobago is rivalling Barbados in terms of the number of amputations. "If you amputated a toe you can see that by five years, 25 per cent of the people have died. By the time you end up with a below knee amputation, more than half the population has died within five years. If you have an above knee amputation, more than 80 per cent of the population have died within five years," Dr Boyne stated while looking at the survival rate for persons with amputations. "So once you have had an amputation, I am telling you, you are marked for death." Dr Boyne stressed that if the data were to be compared with data for cancer and people are told that anywhere from a quarter to 80 per cent of them would be dead within five years, this would generate some amount of urgency. However, among diabetes-related amputees, the amputation is often viewed as just the loss of a digit. "This is using some of Barbados data, but it is also tr Continue reading >>

Early And Five-year Amputation And Survival Rate Of Diabetic Patients With Critical Limb Ischemia: Data Of A Cohort Study Of 564 Patients

Early And Five-year Amputation And Survival Rate Of Diabetic Patients With Critical Limb Ischemia: Data Of A Cohort Study Of 564 Patients

To evaluate the early and late major amputation and survival rates and related risk factors in diabetic patients with critical limb ischemia (CLI). Revascularization feasibility, major amputation, survival rate and related risk factors were recorded in 564 diabetic patients consecutively hospitalized for CLI from 1999 to 2003 and followed until June 2005. Results Peripheral angioplasty (PTA) was carried out in 420 (74.5%), bypass graft (BPG) in 117 (20.7%) patients. In 27 (4.8%) patients both PTA and BPG were not possible. Twenty-three above-the-ankle amputations (4.1%) were performed at 30 days: 6 in PTA patients, 3 in BPG patients, 14 in non revascularized patients. In the follow-up of 558 patients (98.9%), 62 repeated PTAs and 9 new BPGs, 32 new major amputations (16 in PTA patients, 14 in BPG patients and 2 in non-revascularized patients) were performed. Major amputation was associated with absence of revascularization (OR 35.9, p < 0.001, CI 12.9–99.7), occlusion of each of the three crural arteries (OR 8.20, p = 0.022, CI 1.35–49.6), wound infection (OR 2.1, p = 0.004 CI 1.3–3.6), dialysis (OR 4.7, p = 0.001 CI 1.9–11.7) increase in TcPO2 after revascularization (OR 0.80, p < 0.001 CI 0.74–0.87). One hundred seventy three patients died during follow-up and this was associated with age (HR 1.05, p < 0.001 CI 1.03–1.07), history of cardiac disease (HR 2.16, p < 0.001 CI 1.53–3.06), dialysis (HR 3.52, p < 0.001 CI 2.08–5.97), absence of revascularization (HR 1.68, p < 0.001, CI 1.29–2.19) and impaired ejection fraction (HR 1.08, p < 0.001, CI 1.05–1.09). In diabetic patients with CLI the revascularization is feasible in most cases and allows a low rate of early major amputation. This rate is higher in the follow-up period. Major amputation is very Continue reading >>

Why Is High Blood Sugar A Problem In Diabetes?

Why Is High Blood Sugar A Problem In Diabetes?

Hi there! I’m a junior doctor so I have a little experience in managing diabetes, though I’m sure some on Quora will be much wiser than I am. Hopefully I can offer an easy to understand answer. Keep in mind that the literature around diabetes is ever changing, and what I describe below is merely my understanding of the current science. As you might know, diabetes leads to a chronically raised blood sugar (glucose), usually because of an inability to produce or to utilise insulin, the hormone which moves glucose from our bloodstream into our cells. A slight difference to this is our blood vessel walls which absorb glucose independent of insulin. This means when we have high blood glucose levels our blood vessels absorb a much higher amount of glucose than normal. When this occurs, the blood vessels produces more proteins (building blocks of tissues) which make the vessels thicker and results in their becoming fragile. In particular, our small blood vessels are susceptible to this damage. These include the vessels which supply our eyes, kidneys, nerves and even our heart. This is why it is important for people with diabetes to have these organs reviewed regularly; we can’t easily investigate the vascular damage but we can often see the results of their damage early. High blood sugars can also be associated with higher risk of developing infections. The way I think about this is that the bugs have a lot more sugar available to eat and multiply. Fortunately, even if you have diabetes, the risk of these complications can be minimised by closely regulating your blood sugars - by eating well, exercising (this uses up more sugar), and closely adhering to your medications/insulin regime as per your doctor. Other steps such as losing weight (which can help your insulin horm Continue reading >>

Very Low Survival Rates After Non-traumatic Lower Limb Amputation In A Consecutive Series: What To Do?

Very Low Survival Rates After Non-traumatic Lower Limb Amputation In A Consecutive Series: What To Do?

The aim of this retrospective study was to evaluate factors potentially influencing short- and long-term mortality in patients who had a non-traumatic lower limb amputation in a university hospital. A consecutive series of 93 amputations (16% toe/foot, 33% trans-tibial, 9% through knee and 42% trans-femoral) were studied. Their mean age was 75.8 years; 21 (23%) were admitted from a nursing home and 87 (92%) were amputated due to a vascular disease and/or diabetes. Thirty days and 1-year mortality were 30 and 54%, respectively. Cox regression analysis demonstrated that the 30-day mortality was associated with older age (P=0.01), and the number of co-morbidities (P=0.04), when adjusted for gender, previous amputations, cause of and amputation level, and residential status. Thus, a patient with 4 or 5 co-morbidities (n=20) was seven times more likely to die within 30 days, compared with a patient with 1 co-morbidity (n=16). Further, the risk of not surviving increased with 7% per each additional year the patient got older. Of concern, almost one-third of patients died within 1 month. This may be unavoidable, but a multidisciplinary, optimized, multimodal pre- and postoperative programme should be instituted, trying to improve the outcome. Amputation , Lower limb , Survival , Fatal outcome Having a lower limb amputation is associated with a somehow high risk of not surviving within the first year from surgery, with perioperative mortality ranging from 9 to 16% [ 15 ], and 1-year survival rates ranging from 86 to 53% [ 110 ]. The majority of non-traumatic amputations are most often caused by a vascular disease, followed by diabetes or a combination of both [ 1 , 4 , 5 , 79 ], whereas worse survival rates have been associated with factors such as older age, diabetes, more th Continue reading >>

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