Report consist of the literature survey of Spinal Cord Injuries. Design and implantation of the electrode with MEMS technology to implantable pulse generator with a rechargeable battery to cure the pain.
Reduced Short- and Long-Latency Afferent Inhibition Following Acute Muscle Pa...Antonio Martinez
Corticomotor output is reduced in re-
sponse to acute muscle pain, yet the mechanisms
that underpin this effect remain unclear. Here the au-
thors investigate the effect of acute muscle pain on
short-latency afferent inhibition, long-latency afferent
inhibition, and long-interval intra-cortical inhibition to
determine whether these mechanisms could plausibly
contribute to reduced motor output in pain.
Evidence based radial shock wave therapyCORR MEDICAL
PEDRro: Physiotherapy Evidence Database. Radial Shockwave Therapy.
+info: http://ondaschoque.net
CORR MEDICAL. Expertos en ondas de choque ESWL, ESWT y rESW. Distribuidores exclusivos de los constructores líderes: Electro Medical Sytems y JenaMedTech.
Data Collection & Analysis in Human Autonomic Research: How to Guide to Succe...InsideScientific
In this American Physiological Society (APS) webinar produced in partnership with ADInstruments, Jackie Limberg, PhD discusses the basics of human autonomic research as well as some tips and tricks for successful human testing. Implementing key experimental controls and understanding nuances in data collection and analysis during human autonomic testing have important implications for the accuracy and reliability of your findings.
Dr. Limberg introduces the gold standards for measuring both basal and reflex autonomic responses in humans, what equipment is required, and how to minimize variability in your data. The focus of the webinar is on data collection, including recommendations for study design as well as data analysis and interpretation.
Key Topics Include:
- Identify tests appropriate for measuring basal versus reflex autonomic control
- Describe the pros and cons of tests used in human autonomic research
- Create a research setting that is conducive to reliable and accurate human autonomic data
- Select equipment appropriate for the research questions being addressed
- Anticipate and avoid areas that may increase data variability and reduce your ability to interpret results
Report consist of the literature survey of Spinal Cord Injuries. Design and implantation of the electrode with MEMS technology to implantable pulse generator with a rechargeable battery to cure the pain.
Reduced Short- and Long-Latency Afferent Inhibition Following Acute Muscle Pa...Antonio Martinez
Corticomotor output is reduced in re-
sponse to acute muscle pain, yet the mechanisms
that underpin this effect remain unclear. Here the au-
thors investigate the effect of acute muscle pain on
short-latency afferent inhibition, long-latency afferent
inhibition, and long-interval intra-cortical inhibition to
determine whether these mechanisms could plausibly
contribute to reduced motor output in pain.
Evidence based radial shock wave therapyCORR MEDICAL
PEDRro: Physiotherapy Evidence Database. Radial Shockwave Therapy.
+info: http://ondaschoque.net
CORR MEDICAL. Expertos en ondas de choque ESWL, ESWT y rESW. Distribuidores exclusivos de los constructores líderes: Electro Medical Sytems y JenaMedTech.
Data Collection & Analysis in Human Autonomic Research: How to Guide to Succe...InsideScientific
In this American Physiological Society (APS) webinar produced in partnership with ADInstruments, Jackie Limberg, PhD discusses the basics of human autonomic research as well as some tips and tricks for successful human testing. Implementing key experimental controls and understanding nuances in data collection and analysis during human autonomic testing have important implications for the accuracy and reliability of your findings.
Dr. Limberg introduces the gold standards for measuring both basal and reflex autonomic responses in humans, what equipment is required, and how to minimize variability in your data. The focus of the webinar is on data collection, including recommendations for study design as well as data analysis and interpretation.
Key Topics Include:
- Identify tests appropriate for measuring basal versus reflex autonomic control
- Describe the pros and cons of tests used in human autonomic research
- Create a research setting that is conducive to reliable and accurate human autonomic data
- Select equipment appropriate for the research questions being addressed
- Anticipate and avoid areas that may increase data variability and reduce your ability to interpret results
Review of Software to Analyse the Physical Conditions of the Athletes using sEMGijtsrd
Electromyography measures muscle responses of a nerve's simulation of the muscle. EMG is generally measured or recorded through surface, needle or wired electrodes. The surface electromyography is a commonly used technique for measuring the muscle exhilaration. The purpose of this project is to evaluate the use of sEMG in the practical context and to translate the given context to the appropriate analysis. The sEMG are used on the athletes while they are running and respective results are being noted. By using this technique our project wishes to implement an android iOS application to calculate the corresponding values which are being noted by the particular device which we have been made. The signals which are being given by the device is converted into the appropriate percentage values or graphs which can be determined into giving a complete overview about the person whom he is checking and can suggest the diets and exercises to make that person fit to the expectations. This software is mainly look forward for the development of the future athletes which can win the prizes. This platform provides immense forms of diets which are based on the values or results which have been depicted. Performance analysis in sports is considered to be an integral component of understanding the requirements of the optimal performance. Several measurement techniques have been used to inspect the performance of the best athletes today. it is mostly commonly done in laboratory where physiology and bio mechanics can be analyzed. in this system first, the coaches conduct a study about the agility, strength and nutrition of the excellent players of the country. Then the coaches of the respective clubs or the schools check each and every student's physical condition and compare with the stored data in order to train them. The project has got direct advantage to the aspiring future athletes of the country and also to the health conscious society by providing them a device to calculate on their body metrics and work around to improve on it. Tenwin James K | Varun Vincent | Lino Louis | Vishnuraj T | Aneesh Chandran "Review of Software to Analyse the Physical Conditions of the Athletes using sEMG" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-4 | Issue-4 , June 2020, URL: https://www.ijtsrd.com/papers/ijtsrd31546.pdf Paper Url :https://www.ijtsrd.com/computer-science/embedded-system/31546/review-of-software-to-analyse-the-physical-conditions-of-the-athletes-using-semg/tenwin-james-k
Comparison between Effectiveness of Hand Arm Bimanual Intensive Training and ...ijtsrd
Background and Objective: According to world Health Organization (WHO) stroke is defined as œrapidly developing clinical sign of focal (or global) disturbance of cerebral function lasting more than 24 hours or leading to death, with no apparent cause other than vascular origin.1 Focal neurological deficits must persists for at least 24 hours, motor deficits are characterized by paralysis (hemiplegia) or weakness (hemiparesis), typically on the side of the body opposite site of lesion.Materials and Methods: The study was performed among 30 patients of both genders, aged 45-60 years. Subjects were selected on the basis of inclusion criteria and randomly divided into two groups by convenience sampling and allocating alternate patient group A and group B, 15 in each group. Group A was treated with Repetitive Facilitation Exercises (RFE), Group B was treated with Hand Arm Bimanual Intensive Training (HABIT). Baseline assessments were taken using WMFT and FMA and data was analyzed.Results: The groups showed significant differences in WMFT and FMA variables. But on comparing the mean of both the groups: there was no significant difference between both the groups. Conclusion: This study concluded that RFE and HABIT both are effective in treatment of patients with hemiparesis. Dr. Shilpy Jetly | Sukhwinder Kaur | Dr. Jaspinder Kaur"Comparison between Effectiveness of Hand Arm Bimanual Intensive Training and Repetitive Facilitation Exercises on Upper Limb Functions In Post Stroke Hemiparetic Patients" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-1 | Issue-5 , August 2017, URL: http://www.ijtsrd.com/papers/ijtsrd2375.pdf http://www.ijtsrd.com/medicine/other/2375/comparison-between-effectiveness-of-hand-arm-bimanual-intensive-training-and-repetitive-facilitation-exercises-on-upper-limb-functions-in-post-stroke-hemiparetic-patients/dr-shilpy-jetly
The NEUROMOVE is a neurological re-learning tool, a therapy device, which has been proven to help stroke and other patients recover lost movement. Once a stroke has occurred, the brain loses neurons which cause limb weakness or paralysis. The NeuroMove can train healthy neurons to assume functions lost by damaged brain cells; a concept known as Neuroplasticity. This rehabilitation tool can be used even when there is no muscle movement available. It is sophisticated enough to use in the clinic, yet simple enough for patients to use at home. Thirty minutes a day in four to five months can provide dramatic results.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Surgical Site Infections, pathophysiology, and prevention.pptx
ZMPCZM017000.11.11
1. Clinical Rehabilitation 2005; 19: 737 Á/745
Home-based electromyography-triggered
stimulation in chronic stroke
Usama Gabr Physical Medicine and Rehabilitation Residency Program, The University of Cincinnati College of Medicine
(UCCOM), Peter Levine UCCOM and Neuromotor Recovery and Rehabilitation Laboratory (NMRRL) at Drake Rehabilitation
Center and Stephen J Page Department of Physical Medicine and Rehabilitation, The Institute for the Study of Health and
Neurosciences Graduate Program, UCCOM, Cincinnati, Ohio, USA
Received 25th November 2004; returned for revisions 1st February 2005; revised manuscript accepted 23rd May 2005.
Objectives: (1) To determine the feasibility of a home-based electromyographytriggered neuromuscular stimulation (ETMS) programme; and (2) to determine ETMS
efficacy in increasing affected wrist extension and reducing affected arm impairment.
Design: Randomized, controlled, pre Á/post, cross-over design.
Setting: Outpatient rehabilitation hospital.
Patients: Twelve chronic stroke patients with palpable muscle contraction in their
affected wrist extensors but no movement (7 males; mean age0/59.75 years, age
range 44 Á/75 years; mean time since stroke 0/52.75 months, range 13 Á/131 months).
Intervention: Subjects were randomly assigned to receive either: (a) ETMS use
twice every weekday in 35-min increments during an eight-week period followed by
an eight-week home exercise programme (ETMS/home exercise programme) (n 0/8);
or (b) an eight-week home exercise programme followed by use of ETMS twice
every weekday in 35-min increments during an eight-week period (home exercise
programme) (n 0/4).
Main outcome measures: The Fugl-Meyer, Action Research Arm Test and
goniometry.
Results: After home exercise programme participation, subjects showed nominal or
no changes on any of the outcome measures. After ETMS, patients showed modest
impairment reductions, as shown by the Fugl-Meyer, and no Action Research Arm
Test changes. However, both groups showed a 218 increase in active affected wrist
extension after ETMS use.
Conclusion: ETMS use is feasible in the home environment. Neither participation in
a traditional home exercise programme nor ETMS use conveyed changes on the
Fugl-Meyer or Action Research Arm Test. However, ETMS use increased active
affected limb extension. This new movement may provide a potential pathway for
subjects to participate in other interventions, such as modified constraint induced
therapy.
Address for correspondence: Stephen J Page, Department of
Physical Medicine and Rehabilitation, University of Cincinnati
College of Medicine, 3202 Eden Ave, Suite 275, Cincinnati, OH
45267, USA. e-mail: Stephen.Page@uc.edu
# 2005 Edward Arnold (Publishers) Ltd
10.1191/0269215505cr909oa
2. 738 U Gabr et al.
Introduction
Individuals with stroke often exhibit compromised
movement in the distal regions of their affected
arms even years after their strokes,1 which undermines performance of most activities of daily living
(ADLs). Although several stroke motor therapy
regimens have shown promise in chronic ( !/1 year
post stroke) patients,2 Á 4 most necessitate some
initial active affected limb movement out of
synergy. As a result, patients exhibiting negligible
distal movement in their affected arms are usually
discharged with significant residual motor deficits
and a negative prognosis.
It is now believed that repeated affected limb use
causes use-dependent neural changes in which
adjacent cortical areas assume functions of damaged areas.5 Á 7 Limb use can be difficult and
frustrating, though, for chronic stroke patients
who have not progressed past the initial Brunnstrum stages.8 Cyclic neuromuscular electrical
stimulation involves stimulation applied to the
affected muscle(s) to elicit muscle contraction(s).
Several studies have shown increased affected arm
function following cyclic surface neuromuscular
electrical stimulation use in acute9,10 and chronic
stroke.11 However, cyclic surface neuromuscular
electrical stimulation may be suboptimal because
patients are not encouraged to volitionally activate
their muscles during neuromuscular electrical stimulation (i.e., their participation is passive).
As an alternative, surface electromyographytriggered neuromuscular stimulation (ETMS)
incorporates concepts of repeated limb use, biofeedback, and electrical stimulation. When using
ETMS, the patient attempts to activate the affected
musculature (for the purposes of this paper, the
affected extensors). If the intended muscles are
activated such that a preset threshold is reached (as
detected by electromyography in the device), the
musculature is electrically stimulated by the device
and full extension is realized. If the threshold is not
reached, the threshold is automatically lowered,
and the patient tries again. Thus, the patient is
induced to attempt to activate the affected musculature, and, when successful, is provided with
biofeedback that reteaches active muscle contraction via the reward of electrical stimulation.
ETMS appears to increase affected wrist movement in both subacute and chronic stroke patients
who, before intervention, exhibited trace active
extension.12 Á 15 These changes appear to increase
functional activity performance. For example,
Kraft and colleagues14 showed a 42% improvement
on the Fugl-Meyer among patients who received
ETMS, and Francisco and colleagues16 showed a
17-point improvement on the Fugl-Meyer and a
3-point improvement on the Functional Independence Measure. Caraugh and colleagues17 showed
that patients can self-administer ETMS in the
clinic with minimal training and realize motor
improvements.
The current study
As noted above, recently developed motor interventions,2 Á 4 including ETMS,15 Á 20 show promise
in stroke patients who initially exhibit affected arm
active movement. It would be valuable to discern
whether ETMS can be efficacious in more impaired patients. However, to our knowledge, no
intervention has shown promise in stroke patients
with flaccid affected arms. Furthermore, although
stroke patients can don an ETMS machine in the
clinic,17 no studies have examined the feasibility
and efficacy of ETMS when used at home in the
most impaired patients. This information is fundamental to managed care reimbursement of homebased ETMS for community-dwelling stroke patients.
Using a randomized, cross-over design, purposes of this study were to: (1) determine the
feasibility of a home-based ETMS programme
when implemented with a frequency and duration
similar to aforementioned ETMS clinical studies;
and (2) determine ETMS efficacy in increasing
affected wrist and finger extension and reducing
affected arm impairment.
Method
Inclusion/exclusion criteria
Subjects for this study were recruited using
advertisements placed in therapy clinics, and given
to therapists and physiatrists, in the Midwestern
United States. A research team member screened
volunteers using the following inclusion criteria:
(1) stroke experienced between one year and 18
years prior to study enrollment; (2) no cognitive
deficits, as evidenced by a score !/70 points on the
3. EMG-triggered stimulation
Modified Mini-Mental Status Examination18; (3)
age !/18B/85; (4) a detectable surface electromyography signal using the ETMS of !/0.2 mV from
the extensor carpi radialis of the more affected
limb; (5) inability to actively extend the affected
wrist (i.e., operationalized as trace movement, or
palpable muscle contraction in the extensors but
not movement); (6) passive range of motion to
extension in the affected wrist to 458 from neutral,
as well as passive movement without difficulty in
the distal intercarphalangeal joints of the affected
fingers, both as measured by goniometry; and (7)
completely discharged from all forms of physical
rehabilitation. We also applied the following exclusion criteria: (1) excessive pain in the affected
upper limb or wrist as measured by a score of ]/5
on a visual analogue scale; (2) neurologic comorbidity that impairs strength in the affected upper
limb; (3) being administered medication that impairs neuromuscular performance (e.g., botulinum
toxin A;); (4) pregnant; (5) pacemaker or other
implanted stimulator; (6) nonstroke-related wrist
or finger pathologies (e.g., sprained wrist); and (7)
participating in any other experimental studies.
Apparatus
The Neuromove 900 (NM 900) (Stroke Recovery
Systems Inc., Littleton, CO, USA) is an electromyography monitored neuromuscular electrical
stimulation device approved by the federal Food
and Drug Administration for use by stroke
survivors. The NM 900 uses three reusable, selfadhering, 2.0’’ (diameter), round surface electrodes
(one ground over a bony protrusion; two active
electrodes over the motor point of the targeted
muscle). One active electrode is placed on the
posterior forearm (on the extensor group) 1 in
(2 cm) from the elbow crease while the other is
placed approximately 1 in (2 cm) below the first
active electrode. The ground electrode is placed
anywhere on the forearm as long as it is at least
3 in (8 cm) away from either active electrode. The
goal of the electrodes is to detect electromyography
in the affected muscles, and to provide stimulation
to them. A computer inside the device evaluates
the amount of activity present in the muscle, and
determines whether the patient’s muscle activity
meets or exceeds a preset threshold. If the subject
attains the threshold, the NM 900 activates the
muscle with its own biphasic waveform with pulse
739
width ranging between 100 and 400 ms. The on
signal duration can be adjusted to be between 0.5 s
and 10 s, but research suggests 10 s is the optimal19
duration and was, thus, used in this study. The NM
900’s safety and efficacy have been repeatedly
demonstrated with no side-effects.
Instruments
A pluri-dig, hyperextension finger goniometer
(Sammons-Preston, Cederburg, WI, USA) was
used to measure active wrist extension before and
after intervention. The small, plastic device can be
held and operated with one hand and, using a
protractor measuring from 08 to 1108 in 28
increments, is sensitive to small changes in active
extension. As noted previously, active wrist movement is fundamental to gaining access to several
promising interventions. Consequently, active wrist
extension was chosen as the only outcome to be
measured by goniometry.
In addition to goniometry, we applied the
following measures due to their sensitivity to
motor changes in chronic stroke20: (1) the
Fugl-Meyer Scale21 assesses several dimensions of
impairment. The upper extremity motor component, which consists of 66 points, was used in this
study, and has been shown to have impressive test Á/
retest reliability (total 0/0.98 Á/0.99; subtests 0/
0.87 Á/1.00), inter-rater reliability and construct
validity.22,23 (2) The Action Research Arm Test,24
a 19-item test divided into four categories (grasp,
grip, pinch, and gross movement), with each item
graded on a four-point ordinal scale (0 0/can
perform no part of the test; 1 0/performs test
partially; 20/completes test but takes abnormally
long time or has great difficulty; 30/performs test
normally) for a total score of 57. The ARA also
has high intra-rater (r 0/0.99) and retest (r0/0.98)
reliability and validity,24,25 and has been used
extensively in stroke intervention studies.
Design, pretesting and intervention
A randomized, single-blinded, pre/post test
cross-over case series design was applied. After
screening and signing consent forms approved by
the local institutional review board, the FuglMeyer and Action Research Arm Test were
administered on two occasions one week apart by
a research team member. Following the second
pretesting session, patients were randomly assigned
4. 740 U Gabr et al.
Figure 1 Flow diagram for this study.
to one of two groups using a random numbers
table: (1) ETMS/home exercise programme; (2)
home exercise programme/ETMS. Our study design is depicted in Figure 1.
ETMS/home exercise programme
One week after the second pretesting session,
patients assigned to the ETMS/home exercise
programme group received a 30-min, individualized education session in which they were taught
how to use the device by a research team member.
At the conclusion of the session, patients were
given written directions, as well as a picture
depicting proper electrode placement. Patients
were also given sample electrodes to take home
and practice electrode placement. One week later,
patients returned to the laboratory and were tested
on placement by a physician team member. Patients were then given an ETMS device and a home
use diary in which they were to record their use of
the device.
At home, ETMS/home exercise programme
patients used the ETMS device twice every weekday in 35-min increments during a eight-week
period. The duration, frequency, and number of
weeks of sessions was based on manufacturer
recommendations. Furthermore, previous ETMS
studies had used comparable parameters, such as
the 10-s cycles recommended by Cauraugh and
colleagues.19 During times of device use, surface
5. EMG-triggered stimulation
electrodes were placed on the wrist extensors, and a
ground electrode was placed on the olecronon
process. While practising ETMS at home, subjects
practised extension exercises without participation
in any actual activity. After 8 weeks, ETMS/home
exercise programme patients returned to the laboratory and a physician team member checked
skin integrity. During this visit, patients also
returned the device, their ETMS home use diaries,
and were administered goniometry, the FuglMeyer, and the Action Research Arm Test. Lastly,
subjects were given a sheet with a list of home
exercises for the more affected limb, and a home
use diary to record their compliance with the home
exercise programme. The exercise sheet, which also
provides pictures and written descriptions of each
exercise, was commonly administered at discharge
from outpatient physical therapy and was thus
identical to those exercises that discharged stroke
patients would normally be practising at home. As
such, this was an adequate reference condition.
After being shown how to perform each exercise by
a team member, subjects were instructed to perform the home exercises twice every weekday for
35 min. The entire visit took approximately 1 h.
Specific affected limb exercises in the home exercise programme included: supination/pronation
exercises; flexion and extension of the individual
fingers; wrist extension and flexion exercises;
elbow flexion and extension exercises; and
shoulder adduction and abduction exercises.
Home exercise programme/ETMS
Patients randomly assigned to the home exercise
programme/ETMS group participated in the two,
above-described programmes (ETMS and home
exercise programme), but in the opposite order.
That is, they received a 1-h testing and education
session concerning the home exercise programme,
and performed the programme for eight weeks
(35 min; twice/weekday). After eight weeks of
participation in the home exercise programme,
subjects returned to the laboratory, where the
outcome measures were again administered and
the patients were taught how to use the ETMS
device. After one week of practising electrode
placement, they returned to the laboratory, were
given an ETMS device, and used the device at
home for eight weeks according to the abovedescribed parameters.
741
Posttesting
After 17 weeks, each patient returned to the
laboratory and the Fugl-Meyer, Action Research
Arm Test and goniometry were again administered
by the same team member who initially administered the instruments. He was blinded to group
assignment throughout the study.
Results
Using the above inclusion/exclusion criteria,
12 individuals were included (7 males; mean
age0/59.75 years, age range 44 Á/75 years; mean
time since stroke 0/52.75 months, range 13Á/131
months; seven strokes exhibiting upper limb hemiparesis on dominant side) (Table 1).
Before intervention, subjects uniformly exhibited inability to functionally use their more
affected wrists and fingers. Indeed, an ARA
mean score of 1.428 was observed in the ETMS/
home exercise programme group (Table 2), which
reflected ability to partially perform 1Á/2 ARA
items. Similarly, a mean Action Research Arm Test
score of 0 was observed in home exercise programme/ETMS subjects before intervention
(Table 2). Mean Fugl-Meyer group scores were
also nearly identical between groups before intervention; the mean Fugl-Meyer score for the
ETMS/home exercise programme group was 12.0;
the mean Fugl-Meyer score for the home exercise
programme/ETMS group was 15.83 (Table 2).
Subjects in both groups exhibited selected proximal function as measured by the Fugl-Meyer
(e.g., shoulder abduction; elbow flexion), but
limited distal function.
Preintervention more affected wrist extension
levels were also similar for both groups; the mean
affected wrist extension level for the ETMS/home
exercise programme group was 15.1258 before
intervention; the mean affected wrist extension
level for the home exercise programme/ETMS
group was 12.758 before intervention (Table 3).
All subjects’ affected upper limb motor function
had not changed since outpatient occupational
therapy discharge, per their medical records, and
as confirmed by their physicians.
After participating in ETMS, subjects in the
ETMS/home exercise programme group exhibited
6. 742 U Gabr et al.
Table 1 Subject characteristics
Gender
Age
Months since CVA
Side affected
Group
M
M
F
F
F
F
M
M
M
F
M
M
54
60
65
65
75
58
70
55
59
44
62
50
52
68
131
36
60
29
127
42
46
13
16
13
L
R
L
L
R
R
L
R
R
R
L
L
ETMS/HEP
ETMS/HEP
ETMS/HEP
ETMS/HEP
ETMS/HEP
ETMS/HEP
ETMS/HEP
ETMS/HEP
HEP/ETMS
HEP/ETMS
HEP/ETMS
HEP/ETMS
HEP, home exercise programme; ETMS, electromyography-triggered neuromuscular stimulation.
a 6.875 point increase on the Fugl-Meyer, an
increase of B/0.1 points on the Action Research
Arm Test, and an increase of 21.258 in active wrist
extension, all compared to preintervention levels.
After subsequently participating in the home
exercise programme, subjects in the ETMS/home
exercise programme group lost many of the gains
that they had exhibited via ETMS. Specifically,
they exhibited a (/8.8 point decrease on the
Fugl-Meyer, a (/1.5 point decrease on the Action
Research Arm Test, and (/4.098 decrease in
affected wrist extension.
Subjects in the home exercise programme/ETMS
group exhibited similar reactions to the two
interventions as those in the ETMS/home exercise
programme group. Specifically, after eight weeks of
home exercise programme participation, FuglMeyer scores increased by 0.55 points, Action
Research Arm Test scores increased by 0 points
(Table 2), and active affected wrist extension
decreased by 1.758 (Table 3). Conversely, after
ETMS participation, Fugl-Meyer scores and
Action Research Arm Test scores changed nominally, but active wrist extension increased by 21.258.
Discussion
Stroke patients are often unable to perform valued
activities with their affected arms due to diminished active, distal movement. Few motor therapies
are available for patients exhibiting minimal distal
movement in their affected arms, and no homebased therapies have shown efficacy for this group.
This study examined the efficacy of home-based
electromyography triggered neuromuscular stimulation (ETMS) on the motor function of chronic
stroke patients’ affected arms.
An advantageous feature of the NM 900 is its
ability to quantify the amount of device use in
which subjects engaged. In this study, subjects were
highly compliant with ETMS use, as shown by the
device. Moreover, on days in which ETMS was
employed, patients used the device for the entire
duration. Patients and their caregivers also each
reported high compliance with the ETMS protocol
in their home use diaries; only four instances of
nonuse reported during the ETMS portion of the
protocol. Subjects and their caregivers, who had
been educated on device use as part of study
Table 2 Patient mean scores on the Fugl-Meyer and Action Research Arm Test before and after intervention
Group
FM
ARA
Pre
ETMS/HEP (n 0/8)
HEP/ETMS (n 0/4)
After 8 weeks
After 16 weeks
Pre
After 8 weeks
After 16 weeks
12.0
15.83
18.875
16.38
11.0
16.54
1.428
0
1.571
0
0
0
HEP, home exercise programme; ETMS, electromyography-triggered neuromuscular stimulation.
7. EMG-triggered stimulation
743
Table 3 Pre Á/post changes in affected wrist extension using goniometry
Group
Preintervention
extension
After 8 weeks
Change from pre
After 16 weeks
Change from week 8
ETMS/HEP
HEP/ETMS
15.1258
12.758
36.3758
11.008
'/21.258
(/1.758
32.2858
32.258
(/4.098
'/21.258
HEP, home exercise programme; ETMS, electromyography-triggered neuromuscular stimulation.
participation, also reported no problems using the
NM 900 at home. Together, these data suggest that
home ETMS use is feasible with high compliance.
Home use logs also suggested that subjects were
compliant, although to a lesser degree, with the
home exercise programme. Specifically, 27 instances of not performing the programme as
scheduled were reported in the home use diaries.
Lack of compliance with the home programme
may be a partial explanation for the subsequent
losses of motor function that subjects exhibited.
However, we also suspect that the ETMS intervention is substantially more motivating and
robust, particularly given previous ETMS research
findings.
Before intervention, subjects displayed stable
motor deficits and consistent impairment levels,
fine motor function levels (Table 2), and more
affected wrist extension levels (Table 3), regardless
of group assignment. According to their physicians
and/or their medical records, their motor levels
had not changed since discharge from outpatient
motor therapy. Subjects uniformly reported inability to perform functional activities.
After ETMS participation, ETMS/home exercise programme subjects exhibited a 7.875-point
increase on the Fugl-Meyer (Table 2), primarily
due to increased voluntary movement in the distal
areas (e.g., wrist extension). This change was
supported by increased active extension of the
affected wrist increased by !/218 (Table 3). Interestingly, some subjects in this group also showed
increased shoulder movement on the Fugl-Meyer
(e.g., abduction, retraction). We believe that this
improvement was because, when attempting to
extend the fingers, many subjects also moved their
shoulders and arms (although instructed not to by
research team members). ETMS/home exercise
programme subjects exhibited no changes on the
Action Research Arm Test after ETMS participation. After home exercise programme participa-
tion, subjects in this group exhibited no changes on
the Fugl-Meyer, Action Research Arm Test, or in
goniometry. Thus, only ETMS participation
caused motor changes, and these changes, while
not functional, were quite large in terms of ability
to actively extend the affected wrist.
Subjects in the second study group received a
home exercise programme first, followed by
ETMS. Like their counterparts in the other study
group, members of the home exercise programme/
ETMS group showed no changes, or nominal
changes, on the Fugl-Meyer, Action Research
Arm Test or goniometry after home exercise.
However, after ETMS participation, subjects in
the home exercise programme/ETMS group exhibited a mean increased active extension in their
affected wrists by !/218 (Table 3). This finding was
consistent with the direction and magnitude of
active extension changes observed in the other
group following ETMS use. Interestingly, participants in the second group did not exhibit the
Fugl-Meyer changes exhibited by members of the
first group. We are uncertain why this difference
occurred.
Together, our data suggest that ETMS conveys
limited impairment reduction and functional improvements for flaccid chronic stroke patients,
regardless of its timing. Indeed, stroke patients,
when asked after ETMS application, were not able
to perform any new valed activities as a result of
participation. However, ETMS appears to substantially increase active affected wrist extension in
flaccid stroke patients, regardless of the timing of
its administration. This is an important discovery,
given that, to our knowledge, no intervention has
shown promise in increasing active affected wrist
extension in this group. In fact, ETMS may be a
pathway whereby stroke patients exhibiting minimal active extension can regain needed extension
to participate in other interventions. Consistent
with this suggestion, active extension increases
8. 744 U Gabr et al.
from ETMS enabled several subjects to participate
in modified constraint-induced therapy and realize
additional motor gains in their more affected
wrists and fingers. We recognize that a study
limitation is lack of formal measurement of functional improvement and we recommend that future
authors examine this possibility. We also recognize
that, as often happens, the randomization pattern
happened to lead to unequal numbers in the
groups (see Figure 1). This shortcoming argues
for additional ETMS studies with more robust
sample sizes and equal groups before substantive
conclusions can be drawn.
Data by Kimberley and colleagues26 suggest a
relationship between ETMS provision, improvements on laboratory measures, and cortical
changes. However, recent reviews27,28 note several
shortcomings of ETMS studies, including small
sample sizes, limited use of functional outcome
measures, and unequal ETMS treatment durations. Similarly, although only a pilot study,
findings of this study need to be replicated with a
larger sample size and equal numbers in each study
condition, each of which would overcome limitations of the current study. The optimal ETMS
duration for flaccid stroke patients also needs to be
identified in future work, particularly in relation to
less impaired patients. Indeed, it seems reasonable
that flaccid stroke patients may require a longer
ETMS programme with more sessions of longer
durations than less impaired patients. In the
current study, we believe that repeated ETMS use
caused cortical changes that resulted in changes in
extension as described earlier. We are currently
investigating this hypothesis and resolving the
above limitations by examining the functional
and neural effects of several ETMS durations
using functional magnetic resonance imaging at 4
Tesla.
Conclusion
ETMS does not appear to convey a functional
benefit to flaccid chronic stroke patients. However,
ETMS consistently and markedly increases active
wrist extension, providing a potential pathway by
which patients could participate in other promising
interventions. More research is needed concerning
the optimal duration, timing, and mechanisms of
ETMS in flaccid chronic stroke.
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. Electromyography triggered neuromuscular
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active wrist extension.
. ETMS does, however, appear to increase
active wrist extension, regardless of time of
presentation.
. ETMS may be a pathway by which patients
exhibiting no movement may become eligible for other protocols, such as modified
constraint-induced therapy.
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