Nuclear Imaging and Tumor Analysis
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Questions and Answers

What does it indicate if the contour of the heart can be seen through an abnormal shadow in a chest X-ray?

  • The two structures must lie at different levels (front to back) in the chest.
  • The shadow is an artifact.
  • The possible tumor must lie outside the chest.
  • The shadow must have a different density from the heart, and ergo, is not a tumor. (correct)

    • Why can technetium be used in the imaging of various organs?

  • Because technetium emits so many different wavelengths, depending on the tissue composition.
  • Because technetium is so reactive, it will react with molecules in most cells when injected.
  • Because technetium is so reactive, it can be bound to many different chemical compounds that have affinity for different tissues.
  • Because technetium has different isotopes with affinity for different tissues. (correct)

    • What makes 99technetium particularly versatile in functional imaging?

  • Because it is highly reactive and can be bound to many different chemical substances.
  • Because it is a small molecule that readily permeates all cell membranes.
  • Because it has a short half-life (6 hours). (correct)
  • Because it is water soluble and will permeate the water in all body parts.

    • What is the fundamental principle of PET scans?

    <p>Positrons travel a micro distance before annihilation with electrons.</p> Signup and view all the answers

    Which statement best describes the detection process in a PET scan?

    <p>Gamma rays are detected by a ring of detectors around the patient.</p> Signup and view all the answers

    What is the primary function of technetium in conventional nuclear imaging?

    <p>To serve as a radiation source for visualization of various organs.</p> Signup and view all the answers

    Why is it crucial that the density of a tumor differs from that of the heart in diagnostic imaging?

    <p>It allows for the tumor to be visible in X-ray imaging.</p> Signup and view all the answers

    Which property of technetium contributes to its ability to bind to various chemicals for imaging?

    <p>Ability to form stable complexes with different ligands.</p> Signup and view all the answers

    What is the positive predictive value of the exercise ECG if the test shows a positive result?

    <p>24%</p> Signup and view all the answers

    What is the negative predictive value of the exercise ECG if the test shows a negative result?

    <p>98%</p> Signup and view all the answers

    What is the positive predictive value of the stress echocardiography if the test shows a positive result?

    <p>31.3%</p> Signup and view all the answers

    What is the negative predictive value of the stress echocardiography if the test shows a negative result?

    <p>99.0%</p> Signup and view all the answers

    What is the probability that a man aged in his fifties has prostate cancer given a PSA level of 10 ng/l?

    <p>2%</p> Signup and view all the answers

    What does 'downstream damage' from a diagnostic screening program refer to?

    <p>Over diagnosis resulting in unnecessary treatment with possible side effects</p> Signup and view all the answers

    What is the standard cutoff hemoglobin level for anemia in men?

    <p>13 g/dl</p> Signup and view all the answers

    Why did the doctor prescribe iron medication after finding a hemoglobin of 13.5 g/dl?

    <p>The drop in hemoglobin indicates iron deficiency.</p> Signup and view all the answers

    What does a specificity of 75% in the exercise ECG indicate?

    <p>75% of healthy individuals will test negative.</p> Signup and view all the answers

    What is the prevalence of prostate cancer in men aged 50 to 60 years?

    <p>1%</p> Signup and view all the answers

    What is the purpose of restriction fragment length polymorphism (RFLP)?

    <p>Break up the DNA strand into smaller pieces to compare DNA from different sources</p> Signup and view all the answers

    What enables cell differentiation?

    <p>Different genes are active in different tissues</p> Signup and view all the answers

    Which organelle contains DNA in addition to the nucleus?

    <p>Mitochondria</p> Signup and view all the answers

    What factor is crucial in the development of cancer tumors?

    <p>Accumulation of mutations</p> Signup and view all the answers

    What does an oncogene do?

    <p>Functions as a mutated growth regulator gene</p> Signup and view all the answers

    What instructs the sequence of amino acids in a protein?

    <p>The DNA base sequence in the gene</p> Signup and view all the answers

    What is the process called by which an immature cell develops specialized structures?

    <p>Cell differentiation</p> Signup and view all the answers

    What is a function of membrane proteins?

    <p>Binding of peptide hormones</p> Signup and view all the answers

    What triggers an action potential in a nerve cell?

    <p>A partial depolarization of the cell membrane</p> Signup and view all the answers

    How is genetic information transmitted in cells?

    <p>DNA – RNA – protein</p> Signup and view all the answers

    Where does the Krebs cycle take place in the cell?

    <p>In the mitochondria</p> Signup and view all the answers

    What is the major function of ribosomes in a cell?

    <p>Protein synthesis</p> Signup and view all the answers

    What are the major components of the cytoskeleton?

    <p>Protein filaments</p> Signup and view all the answers

    What defines the direction of genetic information flow according to the central dogma of molecular biology?

    <p>The flow is unidirectional; DNA – RNA – protein</p> Signup and view all the answers

    What is the most important event that happens during the synthesis (S) phase of the cell cycle?

    <p>DNA replication</p> Signup and view all the answers

    What is the primary function of the polymerase chain reaction (PCR)?

    <p>Amplifies small amounts of DNA into several thousand copies</p> Signup and view all the answers

    What does the method of restriction fragment length polymorphism (RFLP) accomplish?

    <p>Break up the DNA strand into smaller pieces to compare DNA from different sources</p> Signup and view all the answers

    What is the term for the process by which initial immature cells develop specialized structures and functions?

    <p>Cell differentiation</p> Signup and view all the answers

    Which of the following organelles also contains its own DNA?

    <p>The mitochondria</p> Signup and view all the answers

    What central factor is crucial in the development of cancer tumors?

    <p>Accumulation of mutations</p> Signup and view all the answers

    What defines an oncogene?

    <p>A mutated growth regulator gene</p> Signup and view all the answers

    What instructs the amino acid sequence of a particular protein?

    <p>The DNA base sequence in the gene</p> Signup and view all the answers

    Which factor contributes to the functionality of membrane proteins?

    <p>Binding of peptide hormones</p> Signup and view all the answers

    What triggers an action potential?

    <p>A partial depolarization of the cell membrane</p> Signup and view all the answers

    How can genetic information flow in cells be described?

    <p>DNA – RNA – protein</p> Signup and view all the answers

    If a patient has a resting cardiac output of 4.5 l/min and a heart rate of 60 beats per minute, what is the stroke volume?

    <p>75 ml</p> Signup and view all the answers

    What is the ejection fraction for a patient with a left ventricular end diastolic volume of 150 ml and a stroke volume of 60 ml?

    <p>60%</p> Signup and view all the answers

    During rest, if a cross-country skier has an end diastolic left ventricular volume of 250 ml and a cardiac output of 4.8 litres/min, what is the resting ejection fraction?

    <p>49%</p> Signup and view all the answers

    Which particle is the primary energy source utilized in a PET scan for imaging?

    <p>Positron</p> Signup and view all the answers

    Which component in an MR system is essential for spatial encoding of the signal?

    <p>The gradient coils</p> Signup and view all the answers

    Which imaging method should not be used to locate steel fragments in a child's body for safety reasons?

    <p>MRI</p> Signup and view all the answers

    What is the primary origin of the signal in clinical magnetic resonance imaging?

    <p>Hydrogen nuclei (protons)</p> Signup and view all the answers

    What does T1-relaxation refer to in MRI?

    <p>The regrowth of longitudinal magnetization towards the thermal equilibrium value</p> Signup and view all the answers

    What primarily distinguishes T1 from T2 relaxation in MRI?

    <p>Transverse magnetization loss involves dephasing due to longitudinal magnetization regrowth</p> Signup and view all the answers

    What is the primary function of the sodium-potassium pump?

    <p>Transporting sodium and potassium from low to high concentration using ATP</p> Signup and view all the answers

    What is a result of the sodium-potassium pump process?

    <p>Building a membrane potential due to potassium diffusion</p> Signup and view all the answers

    Where in the cell does the Krebs cycle take place?

    <p>The mitochondria</p> Signup and view all the answers

    What must the resting heart rate be to maintain a normal cardiac output of 4.5 l/min, given an end diastolic left ventricular volume of 300 ml and an ejection fraction of 21%?

    <p>142</p> Signup and view all the answers

    Given a cardiac output of 4.5 l/min and a heart rate of 92 beats/min with an end diastolic left ventricular volume of 250 ml, what is the ejection fraction?

    <p>49%</p> Signup and view all the answers

    What defines the location of anaerobic respiration in the cell?

    <p>The cytoplasm</p> Signup and view all the answers

    What is the main component that makes up the cytoskeleton?

    <p>Phospholipids</p> Signup and view all the answers

    For a cross country skier with an end diastolic left ventricular volume of 250 ml, what is the resting ejection fraction if his cardiac output is 4.8 l/min and heart rate is 42 beats/min?

    <p>78%</p> Signup and view all the answers

    What is the primary function of ribosomes in cells?

    <p>Protein synthesis</p> Signup and view all the answers

    What is the maximal cardiac output for a male endurance athlete whose maximal heart rate is 185 beats/min and who can increase his ejection fraction to 85%, given a constant end diastolic volume during exercise?

    <p>16 l/min</p> Signup and view all the answers

    What is the limit between high normal blood pressure (prehypertension) and manifest hypertension (stage 1)?

    <p>140/90</p> Signup and view all the answers

    During blood pressure measurement, what happens when the systolic pressure equals the pressure in the cuff?

    <p>The artery will just start to open.</p> Signup and view all the answers

    What is the most significant event during the S phase of the cell cycle?

    <p>DNA replication</p> Signup and view all the answers

    What does the polymerase chain reaction (PCR) method accomplish?

    <p>Amplifies small amounts of DNA into several thousand copies</p> Signup and view all the answers

    Which vessels are primarily responsible for peripheral resistance in the circulatory system?

    <p>Arterioles</p> Signup and view all the answers

    What is the main site for regulating peripheral resistance in blood vessels?

    <p>The arterioles</p> Signup and view all the answers

    What always happens to blood dynamics when there is a narrowing in a short segment of a blood vessel?

    <p>The blood velocity increases.</p> Signup and view all the answers

    What happens to blood dynamics through a calcified aortic valve during systole?

    <p>The blood velocity decreases.</p> Signup and view all the answers

    Given a blood vessel with a cross-sectional area of 1 cm² and a blood velocity of 1 m/s, what is the cross-sectional area of a stenosis where blood velocity increases to 4 m/s?

    <p>0.25 cm²</p> Signup and view all the answers

    Which statement is correct about excitation-contraction coupling in cardiac muscle?

    <p>The action potential causes intracellular release of Ca++, which binds to contractile proteins.</p> Signup and view all the answers

    What is the energy-demanding process in muscle cells responsible for relaxation?

    <p>The active removal of calcium from the cytoplasm.</p> Signup and view all the answers

    Which measure of repeatability would best compare the accuracy of different measures of left ventricular function?

    <p>Limits of agreement</p> Signup and view all the answers

    What is the maximal cardiac output for the endurance runner with an end diastolic left ventricular volume of 220 ml?

    <p>33 l/min</p> Signup and view all the answers

    What is the resting ejection fraction for the endurance athlete with a normal cardiac output of 5.5 litres/min and a heart rate of 42 beats/min?

    <p>66%</p> Signup and view all the answers

    What is the correct cutoff for high normal blood pressure (prehypertension) compared to manifest hypertension (stage 1)?

    <p>140/90</p> Signup and view all the answers

    During the measurement of blood pressure, what occurs when the systolic pressure equals the pressure in the cuff?

    <p>The artery will just start to open.</p> Signup and view all the answers

    Which vessels are primarily responsible for most of the peripheral resistance in the circulatory system?

    <p>Arterioles</p> Signup and view all the answers

    What is the primary site for regulating peripheral resistance within the cardiovascular system?

    <p>The arterioles</p> Signup and view all the answers

    What occurs to the blood velocity in a narrowed segment of a blood vessel?

    <p>The blood velocity increases.</p> Signup and view all the answers

    What happens to blood dynamics through a calcified and narrowed aortic valve during systole?

    <p>The blood velocity increases.</p> Signup and view all the answers

    If the cross-sectional area of the normal part of a blood vessel is 1 cm² and the blood velocity is 1 m/s, what is the cross-sectional area at the stenosis if the velocity increases to 4 m/s?

    <p>0.25 cm²</p> Signup and view all the answers

    What is correct regarding excitation-contraction coupling?

    <p>The action potential causes intracellular release of Ca++, which binds to contractile proteins.</p> Signup and view all the answers

    What is the resting ejection fraction of the male cross country skier with a left ventricular end diastolic volume of 250 ml?

    <p>58%</p> Signup and view all the answers

    Which of the following values indicates the limit between high normal blood pressure and manifest hypertension?

    <p>140/90</p> Signup and view all the answers

    What energy-demanding process in the cell is required for muscle relaxation?

    <p>The active removal of calcium from the cytoplasm.</p> Signup and view all the answers

    What is the stroke volume for a patient with a resting cardiac output of 4.5 l/min and a heart rate of 60 beats per minute?

    <p>75 ml</p> Signup and view all the answers

    What occurs to blood flow and dynamics through a narrowed segment of a blood vessel?

    <p>The blood velocity increases</p> Signup and view all the answers

    What ejection fraction would result in a left ventricular end diastolic volume of 150 ml and a stroke volume of 60 ml?

    <p>60%</p> Signup and view all the answers

    What is the ejection fraction of another endurance runner with an end diastolic left ventricular volume of 220 ml and a normal cardiac output of 4.7 litres/min?

    <p>47%</p> Signup and view all the answers

    Which vessels are primarily responsible for most of the peripheral resistance?

    <p>Arterioles</p> Signup and view all the answers

    When blood is passing through a narrowed aortic valve, what happens to blood velocity during systole?

    <p>The blood velocity increases</p> Signup and view all the answers

    What would be the correct cross sectional area of a stenosis segment in a blood vessel if the normal segment has an area of 1 cm² and a blood velocity increase from 1 m/s to 4 m/s?

    <p>0.25 cm²</p> Signup and view all the answers

    What is the stroke volume for a patient with a resting cardiac output of 4.5 l/min and a heart rate of 60 beats per minute?

    <p>75 ml</p> Signup and view all the answers

    During exercise, what is the maximum ejection fraction that the male cross country skier can achieve?

    <p>85%</p> Signup and view all the answers

    What happens to muscle during relaxation and what is the energy demanding process involved?

    <p>The active removal of calcium from the cytoplasm</p> Signup and view all the answers

    In a scenario where a patient has a left ventricular end diastolic volume of 150 ml and a stroke volume of 60 ml, what is the ejection fraction?

    <p>60%</p> Signup and view all the answers

    What is the ejection fraction for a patient with a left ventricular end diastolic volume of 150 ml, a cardiac output of 4.8 l/min, and a heart rate of 80 beats per minute?

    <p>50%</p> Signup and view all the answers

    What is the maximum cardiac output of another endurance runner during exercise with a maximal heart rate of 185 beats per minute?

    <p>16 l/min</p> Signup and view all the answers

    What conclusion can be drawn from an ejection fraction dropping from 45% to 38% in a patient with a history of infarct?

    <p>Incorrect because a change of 7% points is not a significant change with this method</p> Signup and view all the answers

    What is the sensitivity of a diagnostic test?

    <p>The probability of having a positive test if you are ill</p> Signup and view all the answers

    What is meant by the positive predictive value of a test?

    <p>The probability of being ill if the test shows the patient to be ill</p> Signup and view all the answers

    If a 50-year-old man has a positive exercise ECG result, what is the expected positive predictive value of this test given a 4% risk of significant coronary disease?

    <p>10%</p> Signup and view all the answers

    What will be the negative predictive value of a test that shows a negative result for coronary heart disease?

    <p>98%</p> Signup and view all the answers

    Given a positive result from a stress echocardiography, what is the positive predictive value provided the test has a sensitivity of 80% and specificity of 90%?

    <p>31.3%</p> Signup and view all the answers

    What is the negative predictive value if the stress echocardiography shows a negative result for coronary heart disease?

    <p>99.0%</p> Signup and view all the answers

    What is the probability that a 50-year-old man with an elevated PSA of 10 ng/l has cancer, given a cutoff of 4 ng/l?

    <p>2%</p> Signup and view all the answers

    What does 'downstream damage' refer to in the context of diagnostic screening programs?

    <p>Overdiagnosis leading to unnecessary treatment and side effects</p> Signup and view all the answers

    In the screening for anemia, if a patient's hemoglobin drops from 14.2 g/dl to 13.5 g/dl, what should the doctor conclude?

    <p>Incorrect, the change is irrelevant considering variability in measurements</p> Signup and view all the answers

    Based on the specificity and sensitivity of the exercise ECG, what is the impact of false positives in diagnosis?

    <p>They lead to unnecessary anxiety and further testing</p> Signup and view all the answers

    Which factor primarily affects the interpretation of screening tests in a general population?

    <p>The overall prevalence of the condition in the population</p> Signup and view all the answers

    What should be the approach to managing patients who have borderline ejection fractions?

    <p>Reassess ejection fraction using different methods before deciding</p> Signup and view all the answers

    What conclusion could be drawn about a man with a negative stress echocardiography despite high sensitivity and specificity?

    <p>There is still a possibility of having false negatives</p> Signup and view all the answers

    Study Notes

    Chest X-Ray Tumor Analysis

    • Abnormal shadow in chest X-ray resembling a tumor (indicated by arrows)
    • Solid tumor and heart have similar X-ray density
    • Observation: Heart contour visible through the tumor
    • Conclusion: The tumor likely lies at a different level (front to back) within the chest cavity, rather than outside the chest.

    Technetium in Nuclear Imaging

    • Technetium is versatile in functional imaging due to its varied isotopes with different tissue affinities.
    • Technetium isotopes are readily available, meaning they can be bound to many different molecules that target specific tissues.

    99mTc Versatility

    • 99mTc's versatility in functional imaging stems from its ability to bind to various chemical substances which have different affinities for different cells.

    PET Scan Principle

    • PET scans utilize positrons emitted from injected radioisotopes.
    • Positrons annihilate with electrons, producing two gamma photons traveling in opposite directions.
    • Detectors around the patient capture these gamma photons, allowing the concentration of the radioisotope to be mapped in a cross-section.

    X-Ray vs. PET Primary Energy Source

    • X-ray imaging uses electrons as the primary energy source.
    • PET scans use positrons.

    MRI Spatial Encoding

    • Gradient coils within the MRI machine enable spatial encoding of the signal produced by hydrogen nuclei.

    Imaging Methods for Steel Fragments

    • Ultrasound is a suitable method for locating steel fragments.
    • X-rays are appropriate to locate steel fragments.
    • MRI is appropriate for some cases.
    • Nuclear imaging is not recommended for steel fragment localization due to potential safety concerns.

    MRI Signal Origin

    • The signal in MRI originates from hydrogen nuclei (protons) in water molecules, not injected magnetic particles.

    T1-Relaxation in MRI

    • T1-relaxation refers to the regrowth of longitudinal magnetization towards its thermal equilibrium value.

    T1 vs. T2 Relaxation

    • T1-relation depends on the difference in energy states of the "up" and "down" states in the nucleus.
    • T2-relaxation includes dephasing of transverse magnetization due to different factors besides longitudinal magnetization.

    Sodium-Potassium Pump Function

    • The sodium-potassium pump actively transports sodium and potassium ions against their concentration gradients, using energy in the form of ATP.

    Sodium-Potassium Pump Result

    • The sodium-potassium pump establishes ion gradients across cell membranes.
    • These gradients contribute to the generation of resting membrane potentials.
    • The difference in concentration of intracellular versus extracellular potassium and sodium are the drivers of the membrane potential.

    Krebs Cycle Location

    • The Krebs cycle takes place within the mitochondria.

    Anaerobic Respiration Location

    • Anaerobic respiration, where glucose is broken down to lactic acid, occurs in the cytoplasm.

    Cytoskeleton Composition

    • The cytoskeleton is composed primarily of protein, not phospholipids, glycogen, or cholesterol.

    Ribosome Function

    • Ribosomes are responsible for protein synthesis.

    Central Dogma of Molecular Biology

    • The flow of genetic information is unidirectional: DNA → RNA → protein.

    S Phase of Cell Cycle

    • The most important event in the S phase of the cell cycle is DNA replication.

    PCR Method

    • PCR amplifies small amounts of DNA into multiple copies.

    RFLP Method

    • RFLP breaks up DNA strands into smaller fragments for comparison across different samples.

    Paternity Testing Probability

    • The most probable father is determined by comparing DNA profiles. The candidate that matches the child's profile would be the most probable father.

    Cell Differentiation

    • Cell differentiation is caused by different genes being active in different tissues, not by differing genes, replication mechanisms, or translation.

    Organelles with DNA

    • Mitochondria and nucleus contain DNA, excluding centrosomes, golgi, and endoplasmic reticulum.

    Cancer Tumor Development

    • Mutations are crucial in cancer development.

    Oncogene Definition

    • An oncogene is a mutated gene regulating cell growth and death.

    Protein Sequence Instructions

    • The DNA base sequence in a gene determines the amino acid sequence of a protein.

    Cell Differentiation Explanation

    • Cell differentiation is the process of an immature cell developing specialized structures and functions.

    Membrane Protein Function

    • Membrane proteins are responsible for binding peptide hormones to the cell surface.

    Action Potential Trigger

    • Action potentials are triggered by a partial depolarization of the cell membrane, not by calcium influx or outflux.

    Genetic Information Transmission

    • Genetic information is transmitted in cells via DNA → RNA → protein.

    DNA Cellular Location

    • DNA is found in the cell nucleus and mitochondria, not only the nucleus, ribosomes or sarcoplasmic reticulum.

    Cardiac Output Calculation

    • Cardiac output (CO) is calculated by multiplying heart rate (HR) by stroke volume (SV). CO = HR x SV.
    • Ejection fraction (EF) is the percentage of blood pumped out of the ventricle during each contraction. EF = (SV/EDV) x 100
    • Stroke volume (SV) = CO / HR

    Hypertension Definition

    • The limit between high normal blood pressure (prehypertension) and stage 1 hypertension is 140/90 mmHg.

    Blood Pressure Measurement

    • Systolic pressure being equal to the cuff pressure is the point where the artery starts to open.
    • Diastolic pressure is equal to the cuff pressure when the blood flow in the artery is continuous.

    Blood Pressure Regulation

    • Arterioles are the primary sites for regulating peripheral resistance.

    Blood Flow in Vessel Narrowing

    • As blood flow through a narrowing vessel segment, velocity will increase by the principle of continuity and flow will decrease.

    Aortic Valve Narrowing

    • A narrowing aortic valve will increase flow velocity and decrease flow during systole.

    Stenosis Cross Sectional Area

    • A narrowed section of a blood vessel will exhibit an increase in velocity. To maintain the blood flow, the cross-sectional area must decrease in proportion to the increase in velocity.

    Excitation-Contraction Coupling

    • The action potential triggers intracellular calcium release in muscle cells which binds to contractile (actin and myosin) proteins, causing contraction.

    Muscle Relaxation Energy Demands

    • The energy-demanding process for muscle relaxation is the active removal of calcium ions from the cytoplasm.

    Reproducibility in Measuring Left Ventricular Function

    • Limits of agreement is suitable to compare the variability of different measures.

    Judgment of Worsening Heart Failure and significance of Ejection Fraction (EF) Change

    • A 7% points drop in ejection fraction is not necessarily significant when the limits of agreement are ±10%.
    • An ejection fraction below 40% is considered a strong indication of reduced heart function, and should be treated.

    Diagnostic Test Sensitivity

    • Sensitivity is the probability of a positive test result when the condition is present.

    Diagnostic Test Positive Predictive Value

    • Positive predictive value is the probability of having a disease if a test is positive.

    Diagnostic Screening Program Downstream Damage

    • Downstream damage in screening programs is most often over-diagnosis, where harmless conditions are treated to the detriment of resources and the health of the patient.

    Hemoglobin Measurement Variability and Significance of Drop

    • A change in hemoglobin (Hb) measurement is not necessarily significant when measured variability is taken into account.

    Exercise ECG Positive Predictive Value

    • Positive predictive value is the probability that a person has a disease, given a positive test result.

    Stress Echocardiography Positive Predictive Value

    • Positive predictive value in stress echocardiography is the probability that a person has coronary artery disease given a positive result.

    PSA Test Positive Predictive Value

    • Positive predictive value is the probability a person will have a disease given a positive test result.

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    Description

    Explore the principles and applications of nuclear imaging, particularly focusing on chest X-ray tumor analysis and the role of Technetium isotopes in functional imaging. This quiz covers the basics of PET scan technology and the significance of various isotopes. Test your understanding of imaging techniques and their diagnostic capabilities.

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