Coma deep tendon definition

Continue The FriendlyCheck printer deep tendon reflexes using pulses from a hammer to stretch muscles and tendons. The limbs should be in a relaxed and symmetrical position, as these factors can affect the reflex amplitude. As in muscle strength testing, it is important to compare each reflex at once with its contralateral counterpart, so that any asymmetry can be detected. If you can't trigger a reflex, you can sometimes deduce it with certain reinforcement procedures. For example, having a patient gently contract muscles are tested by raising the limb very slightly, or their focus on forcibly contracting another muscle group just at the moment when the reflex is being tested. When the reflexes are very lively, the clone is sometimes seen. It is a repetitive vibrational muscle contraction that occurs in response to the muscles and tendon stretch. Deep tendon reflexes are often evaluated according to the following scale: 0: missing reflex 1 : trace, or seen only with reinforcement 2 : normal 3: lively 4 : invulnerable clone (i.e. repetitive vibrational movements) 5 : a steady clone of deep tendon reflexes are normal if they are 1, 2 or 3, if they are not asymistic or there is a sharp difference between the hands and feet. Reflexes rated as 0, 4 or 5 are generally considered abnormal. In addition to the clonus, other signs of hyperreflexion include the spread of reflexes to other muscles not directly tested and crossed the adduction of the opposite leg when the medial aspect of the knee is tapped. 58. Deep Tendon Reflexes Your browser does not support h.264 videos. The sequence of Deep Tendon Reflexes (see Neuroanatomy through Clinical Cases, Figure 2.21) can be reduced by abnormalities in muscles, sensory neurons, lower motor neurons, and neuromuscular communication; acute lesions of the upper motor neurons; and mechanical factors such as joint diseases. Abnormally elevated reflexes are associated with lesions of upper motor neurons. Note that deep tendon reflexes may depend on age, metabolic factors such as thyroid dysfunction or electrolyte abnormalities, and the patient's anxiety level. The main roots of the spinal nerve involved in the testing of deep tendon reflexes are summed up in the following table: Reflex Major spinal nerve roots involved Biceps C5, C6 Brachioradialis C6 Triceps C7 Patellar L4 Achilles TendonD S1 Reflexes in The ailments of The (or T-reflex) can relate to: when a stretch is created by a muscle. This is the usual definition of the term. A common example is a standard or knee-jerk reaction. Reflex tests are used to determine the integrity of the and peripheral nervous system, which can be used to determine the presence of neuromuscular disease. Note that the term deep tendon reflex (DTR) as it refers to the muscular stretch stretch (MSR), is wrong. Tendons have little to do with the answer, other than to be responsible for mechanically transmitting a sudden stretch from a reflex hammer to a muscular spindle. In addition, some muscles with stretch marks reflexes do not have tendons (such as jaw jerk muscle masseur). Golga tendon reflex, which is a reflex to extensive tension on the tendon; It functions to protect the musculoskeletal brain integrity. The sensory receptors of this reflex are anatomically located deep in the tendon. This while the sensory receptors for MSR are actually inside the proper muscle. So it's actually Golga's tendon reflex that can be called DTR rather than MSR. Testing To test the reflex, click on the tendon. In a healthy person, the intensity on both sides is equal. This means that the connections between the spinal cord and muscles are intact. Major spinal nerve roots involved: Biceps (C5, C6) Brachioradialis (C6) Triceps (C7) Patellar (L4) Achilles Tendon (S1) Features Reflex Golga Tendon is a response to extensive tension on the tendon. This helps to avoid strong muscle contractions that can tear the tendon away from the muscles or bones. In sports, rapid movements can damage the tendon before a reflex can occur. The tendon reflex also helps to distribute the workload more evenly throughout the muscle, preventing muscle fibers associated with overly formulated tendon organs, so that their contraction is more comparable to contracting the rest of the muscle. References to theFreeDictionary's Tendon Referring: Dorland Medical Dictionary for Consumers Health. 2007 dictionary.com's Tendon Reflex Linking: Merriam-Webster Medical Dictionary, 2007 and American Heritage Stedman Medical Dictionary 2002 - wustl.edu's tendon reflex Linking: wustl.edu. REFLEXORS: Tendon and others. 2008. - eNotes zgt; tendons With reference: Encyclopedia of Nursing and Allied Health. 2002 - Physical diagnostics based on evidence; McGee; Chapter 63. 2018 - Batavia, Mitchell; McDonough, Andrew L. (2000). Demonstration of the stretching reflex: mechanical model. American biology teacher. 62 (7): 503–7. doi:10.1662/0002- 7685(2000)062-0503:DTSRAM-2.0.CO;2. JSTOR 4450958. b c d Saladin, Kenneth S. Anatomy and Physiology: Unity of Form and Function. Dubuque: McGraw Hill, 2012. Print. (page needed) External references to Tondo Reflex on Dorland Medical Reflex Dictionary, Tendon at the U.S. National Library of Medicine Medical Items headlines (MeSH) by Kenneth Walker, H (1990). Tendon's deep reflexes. In Kenneth Walker, H; Dallas Hall, W; Willis Hurst, J (eds.). Clinical Methods: History, Physical and Laboratory Studies (3rd Boston: Butterworths. ISBN 0-409-90077-X. PMID 21250237. Extracted from Also found in: Thesaurus, Acronyms, Encyclopedia.Related to deep tendon reflex: the Babinski sign, a superficial tension tonic muscle contraction in response to a strength sprain, due to the stimulation of muscle proprioceptors. Farlex Partner Medical Dictionary © Farlex 2012n. Tonic muscle contraction in response to strength stretching, through stimulation of muscle proprioceptors. American Heritage® Copyright Dictionary © 2007, 2004 Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights are reserved. (m'o-tact'tick ryoflex) Medical Dictionary for Medical Professions and Care © Farlex 2012 Want to thank TFD for its existence? Tell a friend about us, add a link to this page, or visit the Webmasters page for free fun content. Link to this page: deep tendon reflex He was treated with intravenous dextrose and sodium bicarbonate and was continued on carnitine and vitamin B12 injections. Subsequently, Cook et al (6) reviewed the reliability and sensitivity of 7 clinical trials: Babinski's mark, clone, Hoffman sign, inverted supinator sign, hand output reflex, quadriceps nadpatellar reflex, and upper limb reflexes of the deep tendon. Two experienced clinicians demonstrated a significant inter-painter agreement on 4 of 7 tests. The latest information on COVID-19 Reflexes is useful for a general therapist to perform, but you can't evaluate them if... You don't have a hammer. You are not using the correct technique, in which case the reflex seems to be missing when it is present. If you don't know what deviations to expect and what they mean. Root level of bicep and Brachioradialis C5/C6 Triceps C7 (Note: Some links include C6 OR C8, however C7 is mostly involved.) Patellar L2-L4 Ankle S1 Surface Reflexes Cornel (blinking reflex) Involuntary blinking in response to corneal stimulation Afferent: nasosilar branch of the ophthalmic branch (V1) trigeminal nerve (5th nerve) Efferent: facial nerve (7th nerve) The slightly significant Cremaster reflex compression cremaster muscle (which will pull up the scrotum/testicle) after stroking the same side of the superior/inner thigh Missing with: testicular xersion upper/lower motor neuron lesions L1/L2 spinal cord injury ilioinguinal nerve injury (during hernia repair) Reflexes Reflex (anal wink) Reflexive reduction of the external sphincter when stroking the skin around the anus (afferent: pudental nerve; Efferent: S2- S4) Bulbocavernosus reflex sphincter contraction in response to contraction of the head of the penis or tugging on the indwelling Foley catheter Reflex mediated by S2-4 and used in patients with spinal cord injury DTR scale We are not a big believer in classifying reflexes (assessment of muscle strength is much more useful). However, if you need something beyond missing, present, fast, or hyperactive, then use below. If you have a hyperactive reflex, be sure to look for a clone. 0: Missing Reflex 1 : Trail, or seen only with reinforcement 2: normal 3 : lively 4: non-sustainable clone 5 : steady clonus Two articles on the history of the reflex hammer: The story of the reflex Hammers Douglas J. Lanska, 1989 Short Story reflex Francisco Pinto, 2003 On this page Reflexes are the most objective part of hammer neurological examination, and they are very useful in helping to establish the level of damage to the nervous system. First, we will discuss the various reflexes used in clinical practice and conclude the chapter by discussing the significance of the results. In some situations, reflexes may be a major part of the examination (e.g. comatose patient). They have a value that requires minimal cooperation on the part of the patient and preparation of a response that can be objectively evaluated by an expert. The list of all possible reflexes will be almost endless and a tangle of eponymic jargon for those with historical bent. You need to know the most common reflexes, and this knowledge is not very difficult to acquire. However, the interpretation of the reflex response requires some discussion. Table 8-1 is a list of many reflexes, some of them in general clinical use (and some less common). As a group, these reflexes can help in assessing most segmental levels of the nervous system from the hemisphere of the brain through the spinal cord. In this chapter, we will discuss the assessment of the usually tested reflexes of the spinal cord. Previously, we examined reflexes involving such as pupil light reflex, jaw reflex, baroreceptor reflex and gag. We also discussed reflex eye movements and many vegetative reflexes (such as oculocardia and pupil light reflex). Here we look at the reflexes of muscle stretching and superficial reflexes that are used to evaluate the sensory function of the body. All reflexes, when reduced to their simplest level, are sensory arcs. At a minimum, reflexes require a certain type of sensory (afferent) signal, as well as some motor reaction. While the simplest reflexes include a direct synaps between the sensory fiber and motor neuron (monosynaptic), many reflexes have several neurons intervened (polysynaptic reflexes). It is important to note that, even with the simplest reflexes, there are several inhibitions and facilitation effects that can affect motor neuron excitability and thus amplify or suppress the response. These effects can occur from different levels of the nervous system. The spinal cord has intra-segmental and intersegmental connections, as well as downward effects of the brain stem, cerebellum, basal ganglia and cerebral cortexes. All this can affect the excitability of motor neurons, thereby changing the reflex reaction. Defeats that damage the sensory or motor limb of the will reduce this reflex. This can occur at any level of sensory or motor pathway (in the case of muscle stretching reflex, for example, it may include: peripheral nerve and receptors; dorsal root or dorsal root ganglia; gray spinal cord matter; abdominal root; peripheral nerve; neuromuscular node; or muscle). Most of the pathways that descend the spinal cord have a tonic inhibitory effect on spinal reflexes. For this reason, the net result of lesions that damage the downward tract is the simplification of reflexes that are mediated only at the level of the spinal cord (the classic example is the reflex of the muscular stretch). With a few exceptions, this means that these spinal reflexes become hyperactive. After acute lesions, spinal reflexes often pass through the initial stage of hypoactivity. This stage has been called cerebrosal shock or diaccisis and is more severe and prolonged in proportion to the extent of the damage. For example, spinal cord transection removes the greatest amount of higher influence and may be associated with weeks of hypoactivity. Small lesions can have little effect on reflexes. When the reflexes return after rechecking the spine, they become extremely hyperactive. Some reflexes, such as the reflex of muscle stretching, are semi-knee-graded. This is also true for responses such as the pupil light reflex, where the reaction rate may indicate a sluggish response. On the other hand, many reflexes are simply marked as present or absent. This refers to superficial reflexes (see table 8-1) and that are associated with diffuse bilateral dysfunction of the hemisphere. In this latter case, reflexes are often labeled as dysinhibited because these are infantile responses that are suppressed in the normal nervous system of adults. The study of myottic (deep tendon) reflexes muscle stretching (myottic) reflex is a simple reflex, with the neuron receptor having direct connections with the apparatus in the muscles and with alpha motor neurons in the central system that send the back to that muscle (figure 8-1). 8-1). muscle stretching reflexes result in contraction only of the muscles whose tendon is stretched, and agonizing muscles (i.e. muscles that have the same effect). There is also muscle antagonist inhibition. Reflexes are evaluated at the bedside in a semi-personal manner. The reaction levels of deep tendon reflexes class 0-4 , with 2 is normal. The designation 0 does not mean any answer at all, even after reinforcement. Strengthening requires maximum isometric muscle contraction of a distant part of the body, such as squeezing the jaw, pushing the arms or legs together (depending on whether the upper or lower limb reflex is tested), or blocking the fingers of two hands and pulling (the term maneuver Jendrassik). This type of maneuver probably enhances reflexes by two mechanisms: by distracting the patient from the voluntary suppression of the reflex and reducing the amount of downward braking. Designation 1 means a sluggish, depressed or depressed reflex, while the term trail means that a barely detectable response is triggered. Reflexes that are noticeably more animated than usual are marked 3, while 4 means that the reflex is hyperactive and that there is a clone present. Clonus is a repetitive, usually rhythmic, and variably steady reflex response obtained by manually stretching the tendon. This clone can be resistant as long as the tendon is manually stretched or can stop after up to a few , despite the ongoing section of the tendon. In this case, it is useful to note how many strokes are present. One sign of reflex hyperactivity is muscle contraction, which have different actions when getting a muscle stretch reflex (e.g., reducing the hip adductors when testing patellar reflex or contracting the muscles of the finger flexor while testing the reflex brachioradiolis). This was declared a pathological spread of reflexes. The practice of observing normal reflexes in patients and initially among students is a great way to determine the range of normal life. Almost any type of reflex (outside of a sustainable clone) can be normal. The asymmetry of reflexes is the key to determining normality when the extremes of reaction do not make the designation obvious. Symptoms of the patient can facilitate the determination of which side is normal, i.e. more active or less active side. If this is a problem, the rest of the neurological examination and findings tend to clarify the matter. Reducing reflexes should lead to suspicion that the reflex arc has been affected. It can be a fiber, but it can also be a spinal cord gray matter or motor fiber. This motor fiber (the anterior horn cell and its motor ausone, abdominal root and peripheral nerve) is called the lower motor neuron (LMN). LMN leads to a decrease in reflexes. Descending motor tracts from the brain and the brain stem is called upper motor neurons (UMN). UmNs lesions increase reflexes on the spinal cord by reducing spinal inhibition. The lesions of the cerebellum and basal ganglia in humans are not associated with consistent changes in muscle stretching reflex. Classically, the destruction of the main part of the cerebellar hemispheres in humans is associated with suspended deep-ton reflexes. Reflexes are poorly checked so that when testing patellar reflex, for example, the leg can swing back and forth (like a pendulum). In normal people, muscle antagonist (in this example, hamstrings) could be expected to loosen the reflex reaction almost immediately. However, this is not a common sign of cerebellar disease, and many other signs of cerebellar involvement are more reliable and diagnostic (see Chapter 10). Basal ganglion disease (e.g. Parkinson's) is not usually associated with any predictable reflex changes; Most often reflexes are normal. Surface reflexes Surface reflexes are motor reactions to skin scraping. They are rated simply as real or absent, although markedly asymmetrical responses should also be considered abnormal. These reflexes are very different from the reflexes of muscle stretching in that the sensory signal must not only reach the spinal cord, but also have to climb the cord to reach the brain. The limb engine then has to go down the spinal cord to reach the motor neurons. As you can see from the description, it's a polysynaptic reflex. This can be reversed by serious damage to the lower motor neurons or the destruction of the sensory pathways from the skin that is stimulated. However, the usefulness of superficial reflexes is that they are reduced or reversed by conditions that interrupt the pathways between the brain and spinal cord (e.g. spinal cord damage). Classic examples of superficial reflexes include abdominal reflex, cream reflex and normal plantar response. The abdominal reflex involves contracting the abdominal muscles in the quadrant of the abdomen, which is stimulated by scraping the skin tangent or to umbilicus. This contraction can often be seen as a brisk movement umbilicus to the quadrant, which is stimulated. The cream reflex is made by scratching the skin of the medial thigh, which should produce a brisk and short egg height on this side. Both the creamy-master reflex and the abdominal reflex can be affected by surgical procedures (in the groin and abdomen, respectively). The normal reaction of the planter occurs when the sole scratches the foot from the heel along the lateral aspect of the sole and then through the ball of the foot to the base of the large foot. This usually results in the bending of the big legs (down going legs) and, in fact, all the legs. Teh the sole response can be complicated by voluntary responses to the sole withdrawal. wink is a reduction in the outer sphincter when the skin near the hole is scratched. This is often cancelled when the spinal cord is damaged (along with other superficial reflexes). Pathological reflexes The most famous (and most important) so-called pathological reflexes is Babinsky's response (up wearing a leg; the extensor response). The full expression of this reflex involves extending the big legs and inflating the other legs. It is actually a superficial reflex that is triggered in the same way as the plantar response (i.e., scratches along the lateral aspect of the sole of the foot and then through the ball legs to the big nose). This is a primitive response type of output that is normal during the first few months of life and is suppressed by supraspinal activity for about 6 months. Damage to the descending areas of the brain (either above the foramen magnum or in the spinal cord) contributes to the return of this primitive protective reflex, while at the same time cancelling the normal soler response. The appearance of this reflex indicates the presence of upper motor neurone damage. Evaluation of reflex changes will now list reflex changes associated with dysfunction at different levels of the nervous system. Muscles: Stretching reflexes depression in parallel with loss of strength. Neuromuscular compound: Stretch reflexes depression in parallel with loss of strength. Peripheral nerve: Stretching reflexes of depression are usually out of proportion to weakness (which can be minimal). This is because the afferent arc is involved in the inges of neuropathy. Nervous root: Stretching reflexes subserved the root of depression in proportion to the contribution that the root makes a reflex. Surface reflexes are rarely depressed because there is a wide overlap in the distribution of individual nerve roots of the skin and muscles tested in superficial reflexes. However, extensive damage to nerve roots can depress surface reflexes in proportion to the amount of sensory loss in the dermatoma test or engine loss in the participating muscles. Spinal cord and brain stem: Stretching reflexes are hypoactive at the level of lesion and are hyperactive below the level of lesion. As already noted, during the initial state of spinal shock after acute lesions, spinal reflexes below the lesion are also hypoactive or absent. Surface reflexes are hypoactive at both levels and normal higher. Abdominal superficial reflexes are not reliably present in normal people who are over-obese, who have abdominal scars, or who have had multiple pregnancies, and they are often poorly caused by otherwise normal seniors. Therefore, while classically depressed individuals with systemic involvement should not pay much attention to depression abdominal reflexes if they are the only abnormality found during the survey. The solel response is an extremely important superficial reflex. Not only is this normal disppear response, when the upper motor neurons are damaged, the normal reaction is replaced by an extensor (Babinski) response. Cerebellum: Classically the reflexes of stretching are hypoactive and suspended, as mentioned above. When this is the case, the test is reliable; more often than not, however, reflexes are not clearly abnormal. Basal ganglia: No successive deep tendons or superficial reflex changes. There may be the appearance of some of the primitive reflexes (e.g. glabellar, oculocephalic, gripping and feeding reflexes, see chapter 2) associated with some diffuse brain dysfunction (). Cerebral cortex: A unilateral disease affecting the motor cortex will lead to weakness of the upper motor neurons (i.e. hyperactive reflexes of muscle stretching and depressive or absent abdominal and cream reflexes) on the contralateral side. In addition, there may be Babinsky's answer. Bilateral illness is associated with the same anomalies on a bilateral basis, and there may also be primitive reflexes due to the release of these responses from cortical inhibition (see chapter 2). In the case of bilateral damage to the motor cortex (especially in case of severe damage to the cortidobulbar system), the inhibitory control of complex reflexes of emotional expression becomes defective. These people cry or laugh with minimal emotional provocation, and the patient usually says they don't understand why they cry or laugh. These complex emotional reflexes are subordinated to the limbic system and are usually subject to inhibitory neocortex modulation. Bilateral damage can lead to the release of these responses in a pattern called pseudobulbar (see Chpt. 5). Links deJong, R.N.: Neurological Examination, ed. 4. New York, Paul B. Hober, Inc., 1958. Monrad Kron, G.H., Refsum S. Clinical Examination of the Nervous System, 12, London, H.K. Lewis and Co., 1964. Wartenberg, R.: Learning reflexes: simplification. Chicago, Year of the Book Medical Publishers, 1945. The questions define the following terms: hyperreflexion, pathological spread of reflex, clonus, Babinsky sign, Hoffmann sign, myottic reflex, upper motor neurons, lower motor neurons, fittings. Hyperreflexion over-animated reflexes Pathological reflex spread occurs when reflex contraction occurs in a muscle whose tendon has not been stretched (i.e. flexion of fingers while testing the reflex brachioradialis or hip adduction when the patellar reflex is checked). This is a suggestion of hyperactive reflexes. Clonus repeated muscle contraction (usually calf muscles or flexor of the wrist) when the muscles of the muscle manually (e.g. ankle dosiflexia or wrist extension). A steady clone when this occurs repeatedly as long as the stretch is maintained. Babin's sign reflex dorsiflexion large feet and inflating other feet, stroking the side of the sole of the foot. This impact often continues through the ball of the foot to the base of the big legs. This occurs in patients with damage to the upper motor neurons. A normal plantar response for a large leg to bend. Hoffman's sign is the flexion of the thumb after maneuver, which consists primarily of passive flexion of the patient's middle finger under pressure over the nail bed, and then the sudden release of this pressure. It is a sign of lively reflexes, but is not pathological unless it is accompanied by other signs of damage to the upper motor neurons or is asymmetrical. Myottic reflex is a muscle stretch reflex (often referred to as a deep tendon reflex). Upper motor neurons are the main downward motor pathways for voluntary movement, including corticospinal and corticobulbar tracts (and some other related areas). The lower motor neurons are the front neurons of the motor horn and their axons that extend through the root of the abdominal nerve and peripheral nerves to reach the neuromuscular compound. Strengthening involves strong muscle contraction outside the area in which muscles stretch reflexes are tested. This will increase reflexes. Specific examples include squeezing the jaw, pressing the legs together or squeezing hands and trying to pull them apart (jendrasik maneuver). 8-1. What is the main impact of downward propulsion systems on reflexes? Answer 8-1. Motor bark and downward motor pathways are usually involved in suppressing (inhibition) reflexes. 8-2. What are the 7 Deep Tendon Reflex Exams (DTRs)? What sensory/motor nerves are they testing? The answer is 8-2. Biceps - muscle nerve and mainly C6; Triceps is a radial nerve and mainly C7; Brachioradialis (radial periosity) - radial nerve and mainly C6; The flexor of the fingers is a muscular nerve and mainly C7-8; Patellar - femoral nerve and mainly L3-L4; Achilles reflex (ankle spur) - thibial nerve and mainly S1; Jaw jerk - trigeminal 8-3. What are the superficial reflexes? The answer is 8-3. Surface reflexes include: abdominal cavity, cremaster, plantar, wink. 8-4. What is the effect of damage to corticospine fibers on myottic (deep tendon) reflexes? What is the effect on superficial reflexes? Answer 8-4. DTR increases with damage to downward motor tracks; superficial reflexes are reduced with damage to the downward motor paths. 8-5. What primitive reflexes occur in the diffuse bilateral dysfunction of the hemisphere? Answer 8-5. Diffuse Hemisphere dysfunction can dysidibite gripping, glabellar, suck, root, oculocephalic and nuhocephalic reflexes. 8-6. What happens to DDT in the cerebellums and basal ganglia? Answer 8-6. Usually no changes though can be sluggish with cerebellar damage. 8-7. How are DDT assessed? Answer 8-7. 0-4 . To rate the reflex as 0, you need to try reinforcement. 4 means that there is a stable clone. 1 sluggish, 2 normal and 3 fast. 8-8. What is the most important factor in the testing of reflexes? Answer 8-8. Symmetry. 8-9. What reflex changes will occur in muscle lesions? Answer 8-9. No changes unless there is a final stage. 8-10. What reflex changes will occur when neuromusculars are contracted? Answer 8-10. Normally reduced depending on the severity of the weakness. 8-11. What reflex changes will occur when peripheral nerves are affected? Answer 8-11. Decline in clinically affected areas. 8-12. What reflex changes will occur when the nerve root is defeated? Answer 8-12. Decline in clinically affected areas. 8-13. What reflex changes will occur in the spinal cord and brain stem? Answer 8-13. Usually reflexes will be increased if the gray matter (front cells of the horn, lower motor neurons) is damaged right at the reflex level. Acute spinal cord injury can lead to spinal cord shock (sluggish, reflex reduction). 8-14. How can damage sensory nerve fibers affect reflexes? Answer 8-14. Damage to sensory nerve fibers can also reduce reflexes, damaging the afferent limb of the reflex arc. 8-15. What is the effect of neuropathy on muscle stretching reflexes? Answer 8-15. Neuropathy often reduces reflexes from proportion to weakness. 8-16. What visceral reflexes can be tested? Answer 8-16. Visceral reflexes include: pupil light reflex, oculocardiac, sleepy sinuses, bulbocavernosus, rectal (inner sphincter) and orthostatic regulation of blood pressure. Regulation.

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