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Surgery pp 433-445 | Cite as

Risk Prediction, Disease Stratification, and Outcome Description in Critical Surgical Illness

  • John C. Marshall

Abstract

The first half of the 20th century saw a number of important advances in the ability of the surgeon to care for the critically ill or multiply injured patient. An understanding of fluid resuscitation, the development of blood transfusion, and the development of positive-pressure mechanical ventilation and hemodialysis all served to reduce the mortality for wartime trauma from close to 100% at the turn of the century to less than 5% by the time of the Vietnam War.1 Rapid death from acute physiological insufficiency gave way to uncomplicated recovery for some; for others, it opened the door to an unprecedented series of clinical challenges—the sequelae of life-threatening physiological instability and of the deleterious consequences of the interventions employed to sustain life during a period of otherwise lethal organ system insufficiency. Known as the multiple organ dysfunction syndrome (MODS),2 this complex disorder has emerged as the leading unsolved problem in the management of the critically ill patient.

Keywords

Intensive Care Unit Organ Dysfunction Sequential Organ Failure Assessment Sequential Organ Failure Assessment Score Simplified Acute Physiology Score 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Root HD. The way we were: 1989 presidential address, American Association for the surgery of trauma. J Trauma 1990;30:1309–1315.PubMedCrossRefGoogle Scholar
  2. 2.
    Bone RC, Balk RA, Cerra FB, et al. ACCP/SCCM Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992;101:1644–1655.PubMedCrossRefGoogle Scholar
  3. 3.
    Knaus WA, Wagner DP, Lynn J. Short-term mortality predictions for critically ill hospitalized adults: science and ethics. Science 1991;254:389–394.PubMedCrossRefGoogle Scholar
  4. 4.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.PubMedCrossRefGoogle Scholar
  5. 5.
    Le Gall J-R, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270:2957–2963.PubMedCrossRefGoogle Scholar
  6. 6.
    Lemeshow S, Klar J, Teres D, et al. Mortality probability models for patients in the intensive care unit for 48 or 72 hours: a prospective, multicenter study. Crit Care Med 1994;22:1351–1358.PubMedCrossRefGoogle Scholar
  7. 7.
    Marshall JC, Cook DJ, Christou NV, Bernard GR, Sprung CL, Sibbald WJ. Multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med 1995;23:1638–1652.PubMedCrossRefGoogle Scholar
  8. 8.
    Vincent JL, Moreno R, Takala J, et al. The sepsis-related organ failure assessment (SOFA) score to describe organ dysfunction/failure. Intensive Care Med 1996;22:707–710.PubMedCrossRefGoogle Scholar
  9. 9.
    Bernard G. The Brussels score. Sepsis 1997;1:43–44.CrossRefGoogle Scholar
  10. 10.
    Le Gall JR, Klar J, Lemeshow S, et al. The logistic organ dysfunction system: a new way to assess organ dysfunction in the intensive care unit. JAMA 1996;276:802–810.PubMedCrossRefGoogle Scholar
  11. 11.
    Curling TB. On acute ulceration of the duodenum in cases of burns. Med-Chir Tr Lond 1842;25:260–281.Google Scholar
  12. 12.
    Bywaters EGL. Anatomical changes in the liver after trauma. Clin Sci 1946;6:19.PubMedGoogle Scholar
  13. 13.
    Bywaters EGL, Beall O. Crush injuries with impairment of renal function. Br Med J 1941;1:427–432.CrossRefGoogle Scholar
  14. 14.
    Safar P, DeKornfeld T, Pearson J, et al. Intensive care unit. Anesthesia 1961;16:275.CrossRefGoogle Scholar
  15. 15.
    Burke JF, Pontoppidan H, Welch CE. High output respiratory failure: an important cause of death ascribed to peritonitis or ileus. Ann Surg 1963;158:581–595.PubMedCrossRefGoogle Scholar
  16. 16.
    Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet 1967;2:319–323.PubMedCrossRefGoogle Scholar
  17. 17.
    McCabe WR, Jackson GG. Gram negative bacteremia. Etiology and ecology. Arch Intern Med 1962;110:83–91.Google Scholar
  18. 18.
    Maclean LD, Mulligan WG, Mclean APH, Duff JH. Patterns of septic shock in man: a detailed study of 56 patients. Ann Surg 1967;166:543–562.PubMedCrossRefGoogle Scholar
  19. 19.
    Skillman JJ, Bushnell LS, Goldman H, Silen W. Respiratory failure, hypotension, sepsis, and jaundice. A clinical syndrome associated with lethal hemorrhage and acute stress ulceration in the stomach. Am J Surg 1969;117:523–530.PubMedCrossRefGoogle Scholar
  20. 20.
    Tilney NL, Bailey GL, Morgan AP. Sequential system failure after rupture of abdominal aortic aneurysms: an unsolved problem in postoperative care. Ann Surg 1973;178:117–122.PubMedCrossRefGoogle Scholar
  21. 21.
    Baue AE. Multiple, progressive, or sequential systems failure. A syndrome of the 1970s. Arch Surg 1975;110:779–781.PubMedGoogle Scholar
  22. 22.
    Eiseman B, Beart R, Norton L. Multiple organ failure. Surg Gynecol Obstet 1977;144:323–326.PubMedGoogle Scholar
  23. 23.
    Fry DE, Pearlstein L, Fulton RL, Polk HC. Multiple system organ failure. The role of uncontrolled infection. Arch Surg 1980;115:136–140.PubMedGoogle Scholar
  24. 24.
    Polk HC, Shields CL. Remote organ failure: a valid sign of occult intraabdominal infection. Surgery 1977;81:310–313.PubMedGoogle Scholar
  25. 25.
    Bell RC, Coalson JJ, Smith JD, Johanson WG. Multiple organ system failure and infection in adult respiratory distress syndrome. Ann Intern Med 1983;99:293–298.PubMedGoogle Scholar
  26. 26.
    Deitch EA. Multiple organ failure. Pathophysiology and potential future therapy. Ann Surg 1992;216:117–134.PubMedCrossRefGoogle Scholar
  27. 27.
    Beal AL, Cerra FB. Multiple organ failure syndrome in the 1990s. Systemic inflammatory response and organ dysfunction. JAMA 1994;271:226–233.PubMedCrossRefGoogle Scholar
  28. 28.
    Cook D, Rocker G, Marshall J, et al. Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit. N Engl J Med 2003;349:1123–1132.PubMedCrossRefGoogle Scholar
  29. 29.
    Knaus WA, Zimmerman JE, Wagner DP, Draper EA, Lawrence DE. APACHE, acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med 1981;9:591–597.PubMedGoogle Scholar
  30. 30.
    Le Gall JR, Loirat P, Alperovitch A, et al. A simplified acute physiology score for ICU patients. Crit Care Med 1984;12:975–977.PubMedCrossRefGoogle Scholar
  31. 31.
    Lemeshow S, Teres D, Klar J, Avrunin JS, Gehlbach SH, Rapoport J. Mortality probability models (MPM 11) based on an international cohort of intensive care unit patients. JAMA 1993;270:2478–2486.PubMedCrossRefGoogle Scholar
  32. 32.
    Hanley J, McNeil B. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982;143:29–36.PubMedGoogle Scholar
  33. 33.
    Lemeshow S, Hosmer DW. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol 1982;115:92–106.PubMedGoogle Scholar
  34. 34.
    Goris RJA, te Boekhorst TPA, Nuytinck JKS, Gimbrere JSF. Multiple organ failure. Generalized autodestructive inflammation? Arch Surg 1985;120:1109–1115.PubMedGoogle Scholar
  35. 35.
    Leteurtre S, Martinot A, Duhamel A, et al. Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet 2003;362:192–197.PubMedCrossRefGoogle Scholar
  36. 36.
    Graciano AL, Balko JA, Rahn DS, Ahmad N, Giroir BP. The Pediatric Multiple Organ Dysfunction Score (P-MODS): development and validation of an objective scale to measure the severity of multiple organ dysfunction in critically ill children. Crit Care Med 2005;33:1484–1491.PubMedCrossRefGoogle Scholar
  37. 37.
    Guyatt GH, Veldhuyzen van Zanten SJO, Feeney DH, Patrick DL. Measuring quality of life in clinical trials: a taxonomy and review. Can Med Assoc J 1989;140:1441–1448.Google Scholar
  38. 38.
    Knaus WA, Wagner DP, Draper EA, et al. The APACHE III prognostic system. Risk prediction of hospital mortality and critically ill hospitalized adults. Chest 1991;100:1619–1636.PubMedCrossRefGoogle Scholar
  39. 39.
    Le Gall J-R, Lemeshow S, Leleu G, et al. Customized probability models for early severe sepsis in adult intensive care patients. JAMA 1995;273:644–650.PubMedCrossRefGoogle Scholar
  40. 40.
    Bastos PG, Sun X, Wagner DP, Wu AW, Knaus WA. Glasgow Coma Scale score in the evaluation of outcome in the intensive care unit: findings from the acute physiology and chronic health evaluation III study. Crit Care Med 1993;21:1459–1465.PubMedCrossRefGoogle Scholar
  41. 41.
    Bosman RJ, Oudemane van Straaten HM, Zandstra DF. The use of intensive care information systems alters outcome prediction. Intensive Care Med 1998;24:953–958.PubMedCrossRefGoogle Scholar
  42. 42.
    Goldhill DR, Withington PS. Mortality predicted by APACHE II. The effect of changes in physiological values and post-ICU hospital mortality. Anaesthesia 1996;51:719–723.PubMedGoogle Scholar
  43. 43.
    Rowan K. The reliability of case mix measurement in intensive care. Curr Opin Crit Care 1996;2:209–213.CrossRefGoogle Scholar
  44. 44.
    Dragsted L, Jorgensen J, Jensen NH, et al. Interhospital comparisons of patient outcome from intensive care: importance of lead-time bias. Crit Care Med 1989;17:418–422.PubMedCrossRefGoogle Scholar
  45. 45.
    Escarce JJ, Kelley MA. Admission source to the medical intensive care unit predicts hospital death independent of APACHE II score. JAMA 1990;264:2389–2394.PubMedCrossRefGoogle Scholar
  46. 46.
    Goldhill DR, Withington PS. The effect of case mix adjustment on mortality as predicted by APACHE II. Intensive Care Med 1996;22:415–419.PubMedCrossRefGoogle Scholar
  47. 47.
    Osier TM, Rogers FB, Glance LG, Cohen M, Rutledge R, Shackford SR. Predicting survival, length of stay, and cost in the surgical intensive care unit: APACHE II versus ICISS. J Trauma 1999;45:234–238.Google Scholar
  48. 48.
    Cerra FB, Negro F, Abrams J. APACHE II score does not predict multiple organ failure or mortality in postoperative surgical patients. Arch Surg 1990;125:519–522.PubMedGoogle Scholar
  49. 49.
    Murphy-Filkins RL, Teres D, Lemeshow S, Hosmer DW. Effect of changing patient mix on the performance of an intensive care unit severity-of-illness model: how to distinguish a general from a specialty intensive care unit. Crit Care Med 1996;24:1968–1973.PubMedCrossRefGoogle Scholar
  50. 50.
    Lemeshow S, Le Gall JR. Modeling the severity of illness of ICU patients. A systems update. JAMA 1994;272:1049–1055.PubMedCrossRefGoogle Scholar
  51. 51.
    Castella X, Artigas A, Bion J, Kari A. A comparison of severity of illness scoring systems for intensive care unit patients: results of a multicenter, multinational study. The European/North American Severity Study Group. Crit Care Med 1995;23:1327–1335.PubMedCrossRefGoogle Scholar
  52. 52.
    Beck DH, Taylor BL, Millar B, Smith GB. Prediction of outcome from intensive care: a prospective cohort study comparing Acute Physiology and Chronic Health Evaluation II and III prognostic systems in a United Kingdom intensive care unit. Crit Care Med 1997;25:9–15.PubMedCrossRefGoogle Scholar
  53. 53.
    Zimmerman JE, Wagner DP, Draper EA, Wright L, Alzola C, Knaus WA. Evaluation of acute physiology and chronic health evaluation III predictions of hospital mortality in an independent database. Crit Care Med 1998;26:1317–1326.PubMedCrossRefGoogle Scholar
  54. 54.
    Bertolini G, D’Amico R, Apolone G, et al. Predicting outcome in the intensive care unit using scoring systems: is new better? A comparison of SAPS and SAPS II in a cohort of 1393 patients. Med Care 1998;36:1371–1382.PubMedCrossRefGoogle Scholar
  55. 55.
    Marks RJ, Simons RS, Blizzard RA, Browne DR. Predicting outcome in intensive therapy units: a comparison of APACHE II with subjective assessments. Intensive Care Med 1991;17:159–163.PubMedCrossRefGoogle Scholar
  56. 56.
    Teres D, Lemeshow S. Why severity models should be used with caution. Crit Care Clin 1994;19:93–110.Google Scholar
  57. 57.
    Lemeshow S, Klar J, Teres D. Outcome prediction for individual intensive care patients: useful, misused, or abused? Intensive Care Med 1995;21:770–776.PubMedCrossRefGoogle Scholar
  58. 58.
    Knaus WA, Draper EA, Wagner DP, Zimmerman JE. An evaluation of outcome from intensive care in major medical centers. Ann Intern Med 1986;104:410–418.PubMedGoogle Scholar
  59. 59.
    Multz AS, Chalfin DB, Samson IM, et al. A “closed” medical intensive care unit (MICU) improves resource utilization when compared with an “open” MICU. Am J Respir Crit Care Med 1998, 157(5 pt 1):1468–1473.PubMedGoogle Scholar
  60. 60.
    Sprung CL, Geber D, Eidelman LA, et al. Evaluation of triage decisions for intensive care admission. Crit Care Med 1999;27:1073–1079.PubMedCrossRefGoogle Scholar
  61. 61.
    Mackenzie TA, Greenaway-Coates A, Djurfeldt MS, Hopman WM. Use of severity of illness to evaluate quality of care. Int J Qual Health Care 1996;8:125–130.PubMedGoogle Scholar
  62. 62.
    Teres D, Lemeshow S. Using severity measures to describe high performance intensive care units. Crit Care Clin 1993;9:543–554.PubMedGoogle Scholar
  63. 63.
    Teres D, Higgins T, Steingrub J. Defining a high-performance ICU system for the 21st century: a position paper. J Intensive Care Med 1998;13:195–205.Google Scholar
  64. 64.
    Randolph AG, Guyatt GH, Carlet J, for the Evidence Based Medicine in Critical Care Group. Understanding articles comparing outcomes among intensive care units to rate quality of care. Crit Care Med 1998;26:773–781.PubMedCrossRefGoogle Scholar
  65. 65.
    Boyd O, Grounds RM. Physiological scoring systems and audit. Lancet 1993;341:1573–1574.PubMedCrossRefGoogle Scholar
  66. 66.
    Rowan KM, Kerr JH, Major E, McPherson K, Short A, Vessey MP. Intensive Care Society’s APACHE II study in Britain and Ireland. I: Variations in case mix of adult admissions to general intensive care units and impact on outcome. BMJ 1993;307:972–977.PubMedCrossRefGoogle Scholar
  67. 67.
    Teres D, Pekow P. A night in Tunisia. Crit Care Med 1998;26:812–813.PubMedCrossRefGoogle Scholar
  68. 68.
    Wong DT, Crofts SL, Gomez M, McGuire GP, Byrick RJ. Evaluation of predictive ability of APACHE II system and hospital outcome in Canadian intensive care unit patients. Crit Care Med 1995;23:1177–1183.PubMedCrossRefGoogle Scholar
  69. 69.
    Rowan KM, Kerr JH, Major E, McPherson K, Short A, Vessey MP. Intensive Care Society’s APACHE II study in Britain and Ireland. II: Outcome comparisons of intensive care units after adjustment for case mix by the American APACHE II method. BMJ 1993;307:977–981.PubMedCrossRefGoogle Scholar
  70. 70.
    Sirio CA, Tajimi DT, Tase C. An initial comparison of intensive care in Japan and the United States. Crit Care Med 1992;20:1207–1215.PubMedCrossRefGoogle Scholar
  71. 71.
    Bastos PG, Sun X, Wagner DP, Knaus WA, Zimmerman JE. Application of the APACHE III prognostic system in Brazilian intensive care units: a prospective multicenter study. Intensive Care Med 1996;22:564–570.PubMedCrossRefGoogle Scholar
  72. 72.
    Nouira S, Belghith M, Elatrous S, et al. Predictive value of severity scoring systems: comparison of four models in Tunisian adult intensive care units. Crit Care Med 1998;26:852–859.PubMedCrossRefGoogle Scholar
  73. 73.
    Rapoport J, Teres D, Barnett R, et al. A comparison of intensive care unit utilization in Alberta and western Massachusetts. Crit Care Med 1995;23:1336–1346.PubMedCrossRefGoogle Scholar
  74. 74.
    Hebert PC, Wells G, Blajchman MA, et al. A multicenter randomized controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999;340:409–417.PubMedCrossRefGoogle Scholar
  75. 75.
    Halevy A. Severity of illness scales and medical futility. Curr Opin Crit Care 1999;5:173–175.CrossRefGoogle Scholar
  76. 76.
    Nathens AB, Curtis JR, Beale RJ, et al. Management of the critically ill patient with severe acute pancreatitis. Crit Care Med 2004;32:2524–2536.PubMedCrossRefGoogle Scholar
  77. 77.
    Girou E, Pinsard M, Auriant I, Canone M. Influence of severity of illness measured by the amplified Acute Physiology Score (SAPS) on occurrence of nosocomial infections in ICU patients. J Hosp Infect 1996;34:131–137.PubMedCrossRefGoogle Scholar
  78. 78.
    Hebert PC, Drummond AJ, Singer J, Bernard GR, Russell JA. A simple multiple system organ failure scoring system predicts mortality of patients who have sepsis syndrome. Chest 1993;104:230–235.PubMedCrossRefGoogle Scholar
  79. 79.
    Moore FA, Moore EE, Poggetti R, et al. Gut bacterial translocation via the portal vein: a clinical perspective with major torso trauma. J Trauma 1991;31:629–638.PubMedGoogle Scholar
  80. 80.
    Keene AR, Cullen DJ. Therapeutic intervention scoring system: update 1983. Crit Care Med 1983;11:1–3.PubMedCrossRefGoogle Scholar
  81. 81.
    Cullen DJ, Ferrara LC, Briggs BA, Walker PF, Gilbert J. Survival, hospitalization charges and follow-up results in critically ill patients. N Engl J Med 1976;294:982–987.PubMedGoogle Scholar
  82. 82.
    Dickie H, Vedio A, Dundas R, Treacher DF, Leach RM. Relationship between TISS and ICU costs. Intensive Care Med 1998;24:1009–1017.PubMedCrossRefGoogle Scholar
  83. 83.
    Marshall JC, Vincent JL, Guyatt G, et al. Outcome measures for clinical research in sepsis: a report of the 2nd Cambridge Colloquium of the International Sepsis Forum. Crit Care Med 2005;33:1708–1716.PubMedCrossRefGoogle Scholar
  84. 84.
    Pettila V, Ppetilla M, Sarna S, Voutilainen P, Takkunen O. Comparison of multiple organ dysfunction scores in the prediction of hospital mortality in the critically ill. Crit Care Med 2002;30:1705–1711.PubMedCrossRefGoogle Scholar
  85. 85.
    Peres Bota D, Melot C, Lopes Ferreira F, Nguyen Ba V, Vincent J-L. The Multiple Organ Dysfunction Score (MODS) versus the Sequential Organ Failure Assessment (SOFA) score in outcome prediction. Intensive Care Med 2002;28:1619–1624.PubMedCrossRefGoogle Scholar
  86. 86.
    Ferreira FL, Bota DP, Bross A, Vincent J-L. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001;286:1754–1758.PubMedCrossRefGoogle Scholar
  87. 87.
    Barie PS, Hydo LJ. Influence of multiple organ dysfunction syndrome on duration of critical illness and hospitalization. Arch Surg 1996;131:1318–1323.PubMedGoogle Scholar
  88. 88.
    Paugam-Burtz C, Dupont H, Marmuse JP, et al. Daily organ-system failure for diagnosis of persistent intra-abdominal sepsis after postoperative peritonitis. Intensive Care Med 2002;28:594–598.PubMedCrossRefGoogle Scholar
  89. 89.
    Staubach KH, Schröder J, Stüber F, Gehrke K, Traumann E, Zabel P. Effect of pentoxifylline in severe sepsis. Results of a randomized, double-blind, placebo-controlled study. Arch Surg 1998;133:94–100.PubMedCrossRefGoogle Scholar
  90. 90.
    Jacobs S, Zuleika M, Mphansa T. The multiple organ dysfunction score as a descriptor of patient outcome in septic shock compared with two other scoring systems. Crit Care Med 1999;27:741–744.PubMedCrossRefGoogle Scholar
  91. 91.
    Cook RJ, Cook DJ, Tilley J, Lee KA, Marshall JC. Multiple organ dysfunction: baseline and serial component scores. Crit Care Med 2001;29:2046–2050.PubMedCrossRefGoogle Scholar
  92. 92.
    Bernard GR, Vincent J-L, Laterre PF, et al. Efficacy and safety of recombinant human activated protein C for severe sepsis. N Engl J Med 2001;344:699–709.PubMedCrossRefGoogle Scholar
  93. 93.
    Marshall JC, Vincent J-L, Fink MP, et al. Measures, markers, and mediators: towards a staging system for clinical sepsis. Crit Care Med 2003;31:1560–1567.PubMedCrossRefGoogle Scholar
  94. 94.
    Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Intensive Care Med 2003;29:530–538.PubMedGoogle Scholar
  95. 95.
    Sorenson TI, Nielsen GG, Andersen PK, Teasdale PW. Genetic and environmental influences on premature death in adult adoptees. N Engl J Med 1988;318:727–732.CrossRefGoogle Scholar
  96. 96.
    Mira J-P, Cariou A, Grail F, et al. Association of TNF2, a TNF-α promoter polymorphism, with septic shock susceptibility and mortality. JAMA 1999;282:561–568.PubMedCrossRefGoogle Scholar
  97. 97.
    Gibot S, Cariou A, Drouet L, Rossignol M, Ripoll L. Association between a genomic polymorphism within the CD 14 locus and septic shock susceptibility and mortality rate. Crit Care Med 2002;30:969–973.PubMedCrossRefGoogle Scholar
  98. 98.
    Annane D, Sebille V, Charpentier C, et al. Effect of treatment with low doses of hydrocortisone and fludrocortisone on mortality in patients with septic shock. JAMA 2002;288:862–871.PubMedCrossRefGoogle Scholar
  99. 99.
    Marshall J, Foster D, McKenna C, et al. Quantification of the multiple organ dysfunction syndrome (MODS) as a risk factor, outcome descriptor, and surrogate measure of morbidity in the ICU. Crit Care Med 1996;24:A53.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • John C. Marshall
    • 1
  1. 1.Department of Surgery, Critical Care MedicineUniversity of Toronto/St. Michael’s HospitalTorontoCanada

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