Morgan H, Abood C. Disc herniation at T1-2. A working differential diagnosis can guide management. Herniated Disc Symptoms in the Lumbar Spine The most common symptom associated with a herniated disc in the lumbar spine is leg pain (also known as sciatica). Approximately 90% of herniated discs occur at L4-L5 and L5-S1, causing pain in the L5 or S1 nerve that radiates down the sciatic nerve. Again, the specific symptoms of a cervical herniated disc will depend on the affected pinched nerves. Tokuhashi Y, Matsuzaki H, Uematsu Y, Oda H. Spine (Phila Pa 1976). Postoperative MR imaging (MRI) studies in the first two patients showed adequate cord decompression following placement of T1T2 anterior interbody cages [Figures 1 and 2 ]. Ruptured thoracic discs. (a) T2-weighted sagittal magnetic resonance imaging (MRI) shows T1T2 disc herniation. Kuzma SA, Doberstein ST, Rushlow DR. Postfixed brachial plexus radiculopathy due to thoracic disc herniation in a collegiate wrestler:A case report. (e) Showing removal of the sequestrated disc fragment. Background: Careful radiographic analysis is needed preoperatively to identify the upper limit of the sternum. Its not easy figuring out how to sleep with a herniated disc. Rahimizadeh A, Sami SH, Rahimizadeh S, Williamson WL, Amirzadeh M. Surg Neurol Int. Thoracic disc herniation:Operative approaches and results. Pain is the most common symptom of a thoracic herniated disc and may be isolated to the upper back or radiate in a dermatomal (single nerve root) pattern. 24-Apr-2019;10:56, How to cite this URL: Abolfazl Rahimizadeh, Amir Hossein Zohrevand, Nima Mohseni Kabir, Naser Asgari. Biousse V, Touboul PJ, D'Anglejan-Chatillon J, Levy C, Schaison M, Bousser MG: Ophthalmologic manifestations of internal carotid artery dissection. (c) Reconstructed sagittal computed tomography (CT) scan of the CT region showing T1T2 hard disc, indicating that the compression, also note that CT angle is 10. official website and that any information you provide is encrypted According to Dr. Good, here are some healthy habits you can build that will help keep your discs healthy. You may have pain in your lower back, numbness or pain in your leg, or loss of bladder control. Rossitti S, Stephensen H, Ekholm S, von Essen C. The anterior approach to high thoracic (T1-T2) disc herniation. Informed consent to present the data concerning the case for publication was obtained by the patient. 2022 Jan;212:107062. doi: 10.1016/j.clineuro.2021.107062. Objective: To present the unique case of a collegiate wrestler with C7 neurologic symptoms due to T1-T2 disc herniation. 88: 623-33, 35. To report a rare thoracic intervertebral disc herniation followed by acutely progressing paraplegia. T1-T2 disc herniation:Two cases. one or two days) and activity modification (eliminating the activities and positions that worsen or cause the thoracic back pain). This displacement can cause inflammation and compression to the spinal nerves or spinal cord, resulting in pain and possible neurological deficits like tingling, numbness, or weakness somewhere down the nerve. Surgery should occur only when objective findings of structural defects are correlated with the patients symptoms and signs. Arseni C, Nash F. Thoracic intervertebral disc protrusion:A clinical study. After literature review, 39 cases of T1-2 disk herniation were discovered.1 Only seven of these cases presented with an associated Horner syndrome (Table 1). When we discuss about D1-D2 disc problem or T1-T2 disc problem, symptoms are more like- cervical disc herniation. An official website of the United States government. Pain is often described as sharp or burning. For more information, please refer to our Privacy Policy. A case of the patient with severe neurological deficits, caused by intradural thoracic disc herniation at T1-T2 interspace, which required surgical treatment and the symptoms were relieved immediately after surgery. This pain might shoot into your arm or leg when you cough, sneeze or move into certain positions. 13. But they can also happen after more severe trauma in the absence of osteoporosis or as a result of tumors on your spine. When there is a change in the consistency of the jelly of disc, this falls under condition of slip disc or disc protrusion. Pain is usually the first symptom. Although anhydrosis was not explicitly tested, Horner syndrome was strongly suspected. Delineating the location of nerve compression begins with assessing sites of peripheral compression with physical examination. The location of the pain depends on the location of the herniated disc. Carr DA, Volkov AA, Rhoiney DL, Setty P, Barrett RJ, Claybrooks R, Bono PL, Tong D, Soo TM. Kurz LT, Pursel SE, Herkowitz HN. Recommended Reading: Heart Disease Symptoms In Dogs. Rahimizadeh A, Saghri M. Spontaneous resolution of sequestrated lumbar disc herniation:A prospective cohort study. Posterior approach surgery has most commonly been used for laminectomy and/or foraminotomy.1,5,11-13 Adequate disk access of more central disk herniations may not be accomplished without excessive facet resection leading to hypermobility. One of the main differences between thoracic vertebrae and vertebrae in other levels of the spine is that each thoracic vertebra has joints that connect it to the rib bone on each side of the spine. (g) Post-operative CT AP X-ray: shows the cage in T1T2 disc space. This typically breaks down as such: Herniated discs are very common, but they usually occur in the lumbar spine as opposed to the thoracic region. Pain can radiate in the upper 2nd and 3rd ribs , just below the shoulder joint. 11: 30-, 10. Sekhar LN, Jannetta PJ. (e) Intraoperative clearance of the disc space from both hard disc and osteophytes. Posted by mlerin @mlerin, Nov 4, 2019. Muscle weakness in certain muscles of one or both legs. Arts MP, Bartels RH: Anterior or posterior approach of thoracic disc herniation? So there is no difference in T1-T2 and D1-D2 discs. Some research has shown that herniated discs run in families, suggesting that your genes can make it more likely that you will develop a herniated thoracic disc. Asian Spine Journal, 2012 (evidence level 3A) T2 radiculopathy: A differential screen for upper extremity radicular pain. If the herniation compresses a thoracic spinal nerve, it can cause radiculopathypain that radiates down the nerve and away from the spinewith pain, numbness, and tingling. Apply an ice pack or cold compress to the affected area for 15- to 20-minute intervals every two hours. Due to the location of the thoracic spine, a herniated disc can cause pain to the mid-back, unilateral or bilateral chest wall, or abdominal areas around the affected vertebrae. For example, T3 radiculopathy could radiate pain and other symptoms into the chest via the branch of the nerve root that becomes an intercostal nerve traveling along the route between the third and fourth ribs. 24-Apr-2019;10:56. 18. Trauma, such as a motor vehicle crash or fall can also cause a thoracic herniated disc. (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up. 14: 103-6, 15. 1955. Vaidya Dr. Pardeep Sharma is Chief Ayurvedic Physician at Sukhayu Ayurved Jaipur. Winter RB, Siebert R. Herniated thoracic disc at T1-T2 with paraparesis. T1-T2 Pinched Nerve: The T1 spinal nerve is responsible for the ring and pinky fingers and the area at the first rib. This is possible through panchakarma procedures and Rasyana therapies later on. Thoracic disc herniations are rare conditions compared with other disc herniations seen at cervical and lumbar spine levels. Excruciating pain from cervical (C7/T1) radiculopathy. Carson J, Gumpert J, Jefferson A. The one interesting aspect about a bulge is that it is an MRI finding that can correlate with an annular tear that causes deep midline low back pain. Spine (Phila Pa 1976) 1991;16(10 suppl):S542-S547. The symptoms of a herniated disc in the thoracic area usually include: Pain that travels around the body and into one or both legs. These are same. After talking about your symptoms and . MRI provides the diagnosis. Bransford RJ, Zhang F, Bellabarba C, Lee MJ. She underwent T1-T2 anterior discectomy and fusion. 10. . The levels affected are often T11 and T12, with 75% occurring below T8comparatively closer to the more flexible lumbar spine. J Neurosurg 1998;88:623-633. Conclusions:We reviewed 4 cervical T1T2 disc herniations; two central/anterolateral lesions warranting anterior surgical approaches/cages, and 2 lateral discs treated with a posterolateral transfacet, pedicle-sparing procedure and no surgery respectively. Micheli LJ, Hood RW: Anterior exposure of the cervicothoracic spine using a combined cervical and thoracic approach. 6: 1-10, 2. Thoracic spinal cord injuries are rare and only account for 10 15 percent of all spinal cord injuries. Central disk herniations or those that compromise up to 50% across the disk space are often approached through an anterior approach as effective decompression cannot be completed from a posterior only approach. The patient understand that her name and initial will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Case Description:Here, we reviewed four cases of symptomatic T1T2 disc herniations; two patients were paraparetic due to central discs and underwent anterior surgery utilizing a cage construct. Treating thoracic-disc herniations: Do we always have to go anteriorly? An MRI showing a herniated thoracic disc compressing the spinal cord.An MRI from the same patient shown above after minimally invasive lateral thoracic discectomy and fusion. In a systematic review and meta-analysis by Brooks et al, disk height index, Modic changes, and sagittal range of motion were found to be significantly correlated with an increased rate of recurrent lumbar disk herniation. Experiencing pain in your thoracic region could be due to many conditions that can affect these tissues, including: More common causes of thoracic spine pain that directly involve your spinal column include: Conditions that specifically affect your vertebrae, spinal cord and/or nerve roots in your thoracic spine, include: Other conditions that can affect any region of your spine, including your thoracic region, include: You may have had a medical exam that revealed an underlying health problem. 30: 152-4, 6. J Neurosurg. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. (b) Sagittal cervical fat saturated MRI shows the same. Movement the inner soft part of the disc jelly- nucleus pulposus tears the annular ligament and starts coming out in the spinal canal or in lateral foramina. Herniated Thoracic Disc. Barrow Neurological Institute, August 3, 2022. The same decay can be age related too. Please enable scripts and reload this page. There is no medicine or procedure to reverse the process of ageing. Horner's syndrome secondary to intervertebral disc herniation at the level of T1-2. Copyright Surgical Neurology International. Sometimes, there may be difficulty in breathing if the first rib or rib muscles are injured. Please try again soon. J Neurosurg 1998;88:148-150. Herniated thoracic disc at T1-2 level associated with horner's syndrome. Conclusion: Adjacent-segment degeneration after cervical spine fusion may rarely occur even at T1-T2, and the unusual symptoms of a T1 . Spine (Phila Pa 1976). Preganglionic sympathetic neurons exit the spinal cord and ascend up the carotid sheath to the superior cervical ganglion at the level of the bifurcation of the common carotid artery. Turbo spin-echo T1 and T2-weighted sagittal and turbo spin-echo T2 axial 4 mm sections parallel to the disc spaces were taken. Available from: http://surgicalneurologyint.com/surgicalint-articles/9301/. Massage and acupuncture can be useful in managing pain. Due to the location of the thoracic spine, a herniated disc can cause pain to the mid-back, unilateral or bilateral chest wall, or abdominal areas around the affected vertebrae. 1986. doi: 10.1136/bcr-2014-204820. Anterior surgery can be achieved without sternotomy. Early experience treating thoracic disc herniations using a modified transfacet pedicle-sparing decompression and fusion. This fact is most likely explained by the restricted mobility and facet orientation of the thoracic spine. 9. Wolters Kluwer Health GUIDE: Physical Therapy Guide to Herniated Disk. Choose PT, August 26, 2021. Watch: Thoracic Herniated Disc Video With age, the soft disks that act as cushions between your spines vertebrae wear down, dry out and/or shrink. Local MD says he is not fimilar with T1-2. High thoracic disc herniation. Causes of T1 nerve root compression has been summarized in the literature (Table 2). posterolateral discs) and, in some cases, spontaneously resolved (2 of 36 cases). (e) Intraoperative clearance of the disc space from both hard disc and osteophytes. T2 sagittal and axial MR images with T1-T2 disk herniation (arrows). So the treatment is dependent on the following parameters-. (e) Axial CT scan shows a pedicle screw in an upper thoracic vertebra. The rest of the postganglionic fibers travel along the internal carotid artery and enter the cavernous sinus. Thoracic back pain may be exacerbated when coughing or sneezing. 4 ' 5 The first T1-2 disc herniation case was reported in 1954 by Sivien and Karavitis. Report of four cases and literature review. Along with this when we work with pronated shoulders and fixed neck- chances of problem with D1-D2 disc increases in same frequency. The further down the spine the injury occurs, the greater chance for at least partial recovery. AJR Am J Roentgenol. Experience in the surgical management of 82 symptomatic herniated thoracic discs and review of the literature. Bransford R, Zhang F, Bellabarba C, Konodi M, Chapman JR. He is an M.D. Horner syndrome with associated T1 weakness and paresthesias is representative of many etiologies (Table 2). 17. Objectives: To evaluate the clinical features of thoracolumbar junction disc herniation and to prepare a chart for the level diagnosis in the neurologic findings and symptoms. This process of desiccation starts due to the pressure on the spinal arteries. These symptoms typically follow a pattern as noted above, based on the affected nerve roots location and functions. 2). Anterior approach to the cervicothoracic junction by unilateral or bilateral manubriotomy. and transmitted securely. Symptoms can also include numbness, tingling, or muscle weakness in one or both lower extremities. 4: 366-7, 25. (a) T2-weighted sagittal image demonstrating, (a) T2-weighted sagittal image demonstrating a disc herniation at T1T2 level with considerable, (a) T2-weighted sagittal magnetic resonance, (a) T2-weighted sagittal magnetic resonance imaging (MRI) of the second case showing a, (a) T2-weighted sagittal magnetic resonance imaging (MRI) shows T1T2 disc herniation. The incidence of a herniated disc may disrupt activities of daily living and sleep. The goal of surgery is to remove all or part of the herniated disc that is compressing a nerve root. Accessibility 6. 92: 715-8, 9. Our patient had resolution of his back pain, paresthesias, and grip weakness at 6 weeks postoperatively, but his Horner syndrome persisted at latest follow-up. If the lower thoracic region is involved, a patient may encounter pain radiating to one or both lower extremities. The https:// ensures that you are connecting to the Asian Spine J 2012;6:199-202. Abbott KH, Retter RH. Bookshelf Spine (Phila Pa 1976). This pain is typically felt toward the back or side of the neck. This may be evident by sensory disturbances below the level of compression, difficulty with balance and walking, lower extremity weakness, or bowel or bladder dysfunction. The most common symptom of a thoracic herniated disc is pain. J Neurosurg 1950;7:62-69. (f) Postoperative T1-weighted MRI, at 3-year follow-up, note clearance of the cord. Neurology. Disclaimer. All but five intrinsic hand muscles are innervated by the ulnar nerve; abductor pollicus brevis, flexor pollicis brevis, opponens pollicis, and lateral lumbricals. to maintaining your privacy and will not share your personal information without However, the onset of paralysis in this condition is gradual. The most common areas to have a herniated disc are the cervical and lumbar areas of the spine. Eur Spine J. Thoracic region is the first segment of the thoracic or dorsal spine. Generally speaking, most neurosurgeons will advise against surgery if you are not experiencing pain or symptoms. Smoking wrecks your discs along with everything else, weakening and drying them out (in case you needed another reason to quit). Bookshelf Anterior approaches are useful, but more involved. A standard posterior approach with laminoforaminotomy and diskectomy was done. Over-the-counter or prescription meds such as acetaminophen and NSAIDs like ibuprofen are common medicinal treatments. There might be some other reasons like- some addiction or something like this, that causes the desiccation of the T1-T2 disc. Transthoracic excision and fusion, case report with 4-year follow-up. 1998. 1993. Thus if there are some brachial plexus injuries on lower side there will be impact on the same nerve root and its supply too. 8600 Rockville Pike -. J Athl Train. Degenerative disease and trauma are the most common causes of herniated discs in the thoracic spine. Left upper extremity motor was 5/5 in all myotomes except 4/5 finger abduction. 34: 68-77, 7. 1998 Jan;88(1):148-50. doi: 10.3171/jns.1998.88.1.0148. We report two cases of exceptional first thoracic disc herniation in a 60-year-old man and a 55-year-old woman. 1960. Your email address will not be published. 37: 541-2, 12. Posterior approaches may utilize transfacet pedicle-sparing techniques, while the less frequent central/anterolateral discs may warrant anterior surgery. Natalie Evenson MSN, BSN, RN is a health content writer. Methods: The visual analogue scale (VAS), Oswestry disability index (ODI), and MacNab scale were used to analyze the results collected during the . Increased reflexes in one or both legs that can cause spasticity in the legs. (c) Axial T2-weighted MRI shows a hyperintense disc on the left side. 73: 598-9, 13. 1960;17:41830. Herniated thoracic discs can cause paralysis. T1-T2 disc herniation: Report of four cases and review of the literature. 13: 240-5, 16. Negoveti L, Cerina V, Sajko T, Glavi Z. Intradural disc herniation at the T1-T2 level. The surgically treated patients all markedly recovered over an average of 3.87 years follow-up (range: 6 months7 years). 1980. To keep your spine neutral and avoid putting pressure on any herniated discs, place a small pillow under your head and knees. Despite having a long learning curve, the surgical technique described herein can be even used in patients with complex and calcified thoracic disc herniations. 6: s-0036, 28. Vertebral compression fractures are the most common injury to the thoracic spine. (d) Axial T2-weighted axial view also confirms disappearance of the disc. Oral steroids can also decrease inflammation, which will help alleviate pain. Two females aged 67 and 48 years presented with acute cord infarction and paraparesis, respectively; the modified Japanese Orthopaedic Association (JOA) score for thoracic myelopathy (maximum 11) was 6 and the second patient was 7 [ Table 1 ]. Symptoms such as these are primarily determined by the location of the cervical herniated disc. Most people dont need surgery for a thoracic herniated disc. Would you like email updates of new search results? Neurosurgical Developments on the Horizon, Leksell Gamma Knife Society Meeting Series, Dubai, 2018, Mayo Clinic Neuroscience Neurosurgery Lecture Series, http://surgicalneurologyint.com/surgicalint-articles/9301/, Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran. 2016. Pain just below the spine of the scapula. Thoracic Herniated Disc Symptoms. J Neurol Neurosurg Psychiatry. J Indiana State Med Assoc. (c) Manubrium line and cervicothoracic (CT) angle on T2-weight magnetic resonance imaging (MRI): manubrium line intersects T2 vertebral body near to T2T3 disc, CT angle is about 38. But they can happen. Symptomatic disc herniation in the upper thoracic spine from T1 to T4 is rare, with most occurring at T1T2 levels[ 3 , 6 , 19 , 28 , 30 , 34 ] [ Table 1 ]. The main concept ofAyurvedic treatment of T1-T2 slip disc problem is based on the cause of the problem. To complicate matters, sometimes fragments from the annulus may break away from the parent disc and drift into the spinal canal. The fibers ascend and synapse at the superior cervical ganglia at the level of the bifurcation of the common carotid artery (C3-C4). Please enable it to take advantage of the complete set of features! You May Like: Symptoms Of Hpa Axis Dysfunction. Unable to load your collection due to an error, Unable to load your delegates due to an error. This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. may email you for journal alerts and information, but is committed Maintaining a healthy weight will put less pressure on the discs and minimizes wear and tear to the spine. Recommended Reading: Chronic Bronchitis Signs And Symptoms, A limited description of the specific lumbar spinal nerves includes: L1 innervates the abdominal internal obliques via the ilioinguinal nerve L2-4 innervates iliopsoas, a hip flexor, and other muscles via the femoral nerve L2-4 innervates adductor longus, a hip adductor, and other muscles via the obturator nerve L5. Symptoms of thoracolumbar junction disc herniation. Int J Spine Surg. In one case, a central disc fragment extended through the dura. MRI provides the diagnosis. Modified anterior approach to the cervicothoracic junction. Bethesda, MD 20894, Web Policies This narrows the space between your vertebrae, causing certain issues. Avoid lifting, twisting, or straining the back. Had a cervical epidural injection last Thursday and so far no relief. 2013. T1-2 disk herniation diagnosis is often delayed because of its prevalence and misdiagnosis. routine T1 and T2 sequences were used to study the status of the endplate (1.5-T Optima GEM MRI, GE Healthcare, Buck- . Anterior surgery can be achieved without sternotomy. As people age, their thoracic intervertebral discs may lose their cushioning ability and become more likely to rupture. 2016 May;25 Suppl 1:204-8. doi: 10.1007/s00586-016-4402-y. Non-surgical treatment options for symptoms of a thoracic herniated disc will typically include one or a combination of the following: A short period of rest (e.g. Well tell you how, why, and what you can do to treat a thoracic herniated disc if you have one and prevent them in the future. Protrusions of thoracic intervertebral disks. T1 motor root innervates the flexor digitorum superficialis, flexor pollicis longus, flexor pollicis longus, flexor digitorum profundus, lumbricals, interossei, and the pectoralis major. 48: 768-72, 27. Correlating history, examination, and imaging will guide toward a successful diagnosis. Calcific discitis with giant thoracic disc herniations in adults. PMC At his follow-up appointment, there was no improvement of his symptoms; therefore, the decision was made to intervene surgically given his persistent pain, weakness, and Horner syndrome. 7: 189-92, 30. At 1-week postoperatively, he had near complete improvement in his left-hand strength with mild forearm paresthesias and persistent ptosis and miosis of the left eye. Compression fractures are especially common in the lower thoracic area, and they often result from osteoporosis and mild trauma. Unlike the usual calcification in the medioposterior position for middle or lower thoracic spine herniations, a soft posterolateral herniation was observed here. (b) Axial view shows the posterolaterally located disc is on the left side. The 2023 edition of ICD-10-CM M51.24 became effective on October 1, 2022. (b) Sagittal, (a) T2-weighted sagittal magnetic resonance imaging shows a T1T2 extruded disc migrated up., MeSH t1-2 disc herniation. The rest of the postganglionic fibers travel along the internal carotid artery and enter the cavernous sinus. 1983. According to the American Association of Neurological Surgeons, about 75 - 85% of people in the U.S. suffer from back pain at some point in their lifetime. J Neurosurg Spine. eCollection 2021. Surgery for T1T2 posterolateral herniated discs may require transfacet pedicle-sparing decompression with pedicle screw fixation. 2021 Mar 17;12:108. doi: 10.25259/SNI_941_2020. Upper thoracic spine arthroplasty via the anterior approach. Most studies report improvement in pain and neurologic dysfunction, but Horner syndrome can be refractory to surgical decompression.12,18 Similarly, our patient at 6 weeks postoperative had resolution of his pain, motor, and sensory deficits but persistent Horner syndrome at nine months postoperatively. The number one prevention is not smoking. When there is a compression on the disc, it starts decaying. Kanno H, Aizawa T, Tanaka Y, et al. Yale J Biol Med. Numbness or tingling in areas of one or both legs. Conclusions: We reviewed 4 cervical T1-T2 disc herniations; two central/anterolateral lesions warranting anterior surgical approaches/cages, and 2 lateral discs treated with a posterolateral transfacet, pedicle-sparing procedure and no surgery respectively. So that we can give the proper space to the disc and it can breathe normally and can remain its space. Back, Lower Limb, and Upper Limb Pain among U.S. Nakahara S, Sato T. First thoracic disc herniation with myelopathy. If you begin to experience symptoms, or if your mild symptoms like pain, radiculopathy, myelopathy become worse, it may be time to consider surgery. This condition can happen to anyone at any age but is more prevalent in older populations or with those who are involved in strenuous physical activity for extended periods of time. Neurology. 1986;19:44951. 24/36 patients). The pain may be centered over the injured disc but may spread to one or both sides of the mid-back. An orthopedic or neurologic physical therapist can customize a treatment plan of safe herniated disc exercises to help decrease pain, improve strength and posture, and increase mobility. Reflex examination was 2/4 in C 6, 7, and 8 roots. This is the least common location for radiculopathy. Barrow Neurological Institute. Caner H, Kilinoglu BF, Benli S, Altinrs N, Bavbek M. Magnetic resonance image findings and surgical considerations in T1-2 disc herniation. HHS Vulnerability Disclosure, Help Surg Neurol. Adults, 2019. NCHS Data Brief, Number 415,July 2021, July 2021. Evid Based Spine Care J 2010;1:21-28. Find out how, and what you can do to treat them. If you have a thoracic herniated disc, you may feel these symptoms circumferentially around your rib cage or upper abdominal area. 2016. Disc herniation can occur in the cervical, thoracic, or lumbar spine.
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