Promotion of psychology as an integrated aspect of the diabetes team has been encouraged, with the aims of: reducing stigma felt by service users accessing this aspect of the multidisciplinary team, allowing for a biopsychosocial overview of patient care, and timely advising on appropriate signposting and onwards referral where necessary. To this end, a new care pathway was trialled, with psychology appointments offered as the third step in a new nurse‐ and dietitian‐led clinic structure.
{"title":"Adding psychology to the diabetes service ‘new patient’ pathway: an evaluation","authors":"J. Heath","doi":"10.1002/pdi.2458","DOIUrl":"https://doi.org/10.1002/pdi.2458","url":null,"abstract":"Promotion of psychology as an integrated aspect of the diabetes team has been encouraged, with the aims of: reducing stigma felt by service users accessing this aspect of the multidisciplinary team, allowing for a biopsychosocial overview of patient care, and timely advising on appropriate signposting and onwards referral where necessary. To this end, a new care pathway was trialled, with psychology appointments offered as the third step in a new nurse‐ and dietitian‐led clinic structure.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"29 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88931745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Raj Chandok, Ken Baynes, Maurice Birnbaum, G. Vanterpool, Adamma Okwu, Kanchan Bains, Diljit Sidhu, Mini Dhatt, S. Mehar, B. Chitra
In this paper, we present and analyse National Diabetes Audit (NDA) and diabetes‐related emergency admissions data in Ealing during the period 1 January 2020 to 31 March 2021. Care for diabetes and other long‐term conditions was disrupted and significantly impacted during this initial period of the COVID‐19 pandemic.
{"title":"Improving diabetes care in Ealing, London: an analysis of the NDA and diabetes‐related admissions data during first year of COVID‐19","authors":"Raj Chandok, Ken Baynes, Maurice Birnbaum, G. Vanterpool, Adamma Okwu, Kanchan Bains, Diljit Sidhu, Mini Dhatt, S. Mehar, B. Chitra","doi":"10.1002/pdi.2437","DOIUrl":"https://doi.org/10.1002/pdi.2437","url":null,"abstract":"In this paper, we present and analyse National Diabetes Audit (NDA) and diabetes‐related emergency admissions data in Ealing during the period 1 January 2020 to 31 March 2021. Care for diabetes and other long‐term conditions was disrupted and significantly impacted during this initial period of the COVID‐19 pandemic.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"11 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72514835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adam Waterworth, A. Hamilton, P. Johnston, A. Todd, Grainne M. Connolly, A. Nugent, P. Scullin, S. McKenna, S. Lawless, H. Wallace, I. Wallace
Patients undergoing systemic anti‐cancer treatment (SACT) often receive short courses of high dose steroids which may cause hyperglycaemia and potentially impact negatively on clinical outcomes. In this study we aimed to ascertain the prevalence of diabetes in a day‐case SACT cohort and secondly to compare practical methods of identifying patients with diabetes in a busy oncology service.
{"title":"Identifying patients with diabetes in a day‐case systemic anti‐cancer therapy population: the Belfast Regional Oncology Centre experience","authors":"Adam Waterworth, A. Hamilton, P. Johnston, A. Todd, Grainne M. Connolly, A. Nugent, P. Scullin, S. McKenna, S. Lawless, H. Wallace, I. Wallace","doi":"10.1002/pdi.2456","DOIUrl":"https://doi.org/10.1002/pdi.2456","url":null,"abstract":"Patients undergoing systemic anti‐cancer treatment (SACT) often receive short courses of high dose steroids which may cause hyperglycaemia and potentially impact negatively on clinical outcomes. In this study we aimed to ascertain the prevalence of diabetes in a day‐case SACT cohort and secondly to compare practical methods of identifying patients with diabetes in a busy oncology service.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"70 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88137677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Climate change – presaging heat waves and cold snaps – along with drivers for global warming are likely to affect the epidemiology and management of diabetes, warns Mark Greener in his examination here of the published evidence to date.
{"title":"The weather's no joke for people living with diabetes","authors":"M. Greener","doi":"10.1002/pdi.2459","DOIUrl":"https://doi.org/10.1002/pdi.2459","url":null,"abstract":"Climate change – presaging heat waves and cold snaps – along with drivers for global warming are likely to affect the epidemiology and management of diabetes, warns Mark Greener in his examination here of the published evidence to date.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"55 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76908912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aims: To audit eye screening attendance rates in children pre and post implementation of a screening service offered on the same day as their diabetes clinic appointment and to identify characteristics of non‐attenders.
{"title":"An eye opener: improving attendance rates of retinopathy screening within the paediatric diabetes clinic","authors":"M. Wolverson, P. O’Hare, V. Patel","doi":"10.1002/pdi.2433","DOIUrl":"https://doi.org/10.1002/pdi.2433","url":null,"abstract":"Aims: To audit eye screening attendance rates in children pre and post implementation of a screening service offered on the same day as their diabetes clinic appointment and to identify characteristics of non‐attenders.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"49 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90677207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
SURPASS trials The incretin hormones, glucose-dependent insulinotropic polypeptide (GIP) and glucagon line peptide 1 (GLP-1), are responsible for the increased insulin secretion from oral, as compared to intravenous, glucose administration which increases the amount of glucose ingested – known as the ‘incretin effect’. Incretins also slow down the digestion of food so that glucose from your meals takes longer to be absorbed, and thereby appetite is reduced with resulting weight loss. This has been exploited therapeutically by GLP-1 receptor agonists and dipeptidyl peptidase (DPP4) inhibitors. SURPASS is an array of double-blind, randomised phase 3 trials studying tirzepatide, a novel dual GIP and GLP-1 receptor agonist, a weekly subcutaneous injection in people with type 2 diabetes. The preceding 2018 phase 2 trials showed supportive results leading to much anticipation for this ‘twincretin’. Each trial included four arms of 5mg, 10mg and 15mg tirzepatide and placebo. The primary endpoint was mean change in HbA1c along with secondary outcomes of change in body weight and achieving target HbA1c. SURPASS-11 investigated tirzepatide monotherapy in 478 participants with a short duration of diabetes across 40 weeks (mean baseline HbA1c 63mmol/mol [7.9%], age 54, diabetes duration 4.7years, BMI 31.9kg/m2). HbA1c reductions were 21mmol/mol (1.9%), 21mmol/mol (1.9%) and 23mmol/mol (2%) with 5mg, 10mg and 15mg tirzepatide respectively. A dose dependent weight loss of 7–9.2kg was seen. SURPASS-22 was a 40-week head-to-head study of tirzepatide vs injectable semaglutide in 1879 people with a mean diabetes duration of 8.6 years. Tirzepatide showed improved outcomes with a 23–27mmol/mol (2.1–2.5%) vs 21mmol/mol (1.9%) HbA1c reduction and weight reductions of 7.6–11.2kg vs 5.7kg. Comparatively, the best weight loss seen in the phase 3 semaglutide SUSTAIN-7 trials was 6.5kg (mean baseline 95.2kg, duration of diabetes 7.4 years) and 20mmol/mol (1.8%) HbA1c drop. SURPASS-33 compared tirzepatide against the basal insulin degludec in 1444 participants taking metformin with or without an SGLT2 inhibitor. After 52 weeks, all three tirzepatide arms had decreased bodyweight (-7.5kg to -12.9kg), whereas insulin patients’ bodyweight increased by 2.3kg. Mean tirzepatide HbA1c reduction was 21–25mmol/mol(1.9–2.3%) vs 14mmol/mol (1.3%). The SURPASS-MRI sub-study4 involved participants with non-alcoholic fatty liver disease. Liver fat content was measured by MRI-proton density fat fraction with an absolute reduction of 8.1% in the pooled 10mg and 15mg tirzepatide groups vs 3.4% with insulin degludec. SURPASS-45 recruited a high cardiovascular risk cohort (87% had a previous event), who had lived with diabetes for a median of 10.5 years and mean HbA1c 69.7mmol/L (8.5%) despite multiple oral antihyperglycaemics. In a head-to-head 52-week trial vs insulin glargine U100, 5mg, 10mg and 15mg doses of tirzepatide led to HbA1c reductions of 24mmol/mol (2.2%), 26mmol/mol (2.4%) and 2
与静脉注射相比，肠促胰岛素激素、葡萄糖依赖性胰岛素性多肽(GIP)和胰高血糖素线肽1 (GLP-1)负责增加口服胰岛素分泌，从而增加摄入的葡萄糖量，这被称为“肠促胰岛素效应”。肠促胰岛素也会减缓食物的消化，这样你的食物中的葡萄糖就需要更长的时间才能被吸收，从而减少食欲，从而导致体重减轻。这已经被GLP-1受体激动剂和二肽基肽酶(DPP4)抑制剂用于治疗。超过是一系列双盲、随机iii期试验，研究替泽肽，一种新型的双GIP和GLP-1受体激动剂，每周皮下注射用于2型糖尿病患者。2018年之前的2期试验显示了支持性的结果，导致人们对这种“twincretin”充满期待。每个试验包括4个组，分别使用5mg、10mg和15mg替西帕肽和安慰剂。主要终点是HbA1c的平均变化以及体重变化和达到目标HbA1c的次要结局。surpass11研究了478名持续时间短的糖尿病患者的替西肽单药治疗，为期40周(平均基线HbA1c为63mmol/mol[7.9%]，年龄54岁，糖尿病持续时间4.7年，BMI为31.9kg/m2)。替西肽5mg、10mg和15mg组HbA1c分别降低21mmol/mol(1.9%)、21mmol/mol(1.9%)和23mmol/mol(2%)。剂量依赖性体重减轻7 ~ 9.2kg。SURPASS-22是一项为期40周的替西帕肽与注射用西马鲁肽的头对头研究，研究对象为1879名平均糖尿病病程8.6年的患者。替西帕肽显示出更好的结果，HbA1c降低23-27mmol /mol (2.1-2.5%) vs 21mmol/mol(1.9%)，体重减轻7.6-11.2kg vs 5.7kg。相比之下，在3期semaglutide SUSTAIN-7试验中，体重减轻的最佳效果为6.5kg(平均基线95.2kg，糖尿病持续时间7.4年)和20mmol/mol (1.8%) HbA1c下降。SURPASS-33对1444名服用二甲双胍或不服用SGLT2抑制剂的参与者进行了替西帕肽与基础胰岛素degludec的比较。52周后，所有三个替西帕肽组的体重都下降了(-7.5kg至-12.9kg)，而胰岛素组的体重增加了2.3kg。替西帕肽平均降低HbA1c为21-25mmol /mol(1.9-2.3%) vs 14mmol/mol(1.3%)。SURPASS-MRI亚研究4纳入了非酒精性脂肪肝患者。通过mri质子密度脂肪分数测量肝脏脂肪含量，10mg和15mg替西肽混合组绝对减少8.1%，而葡糖苷胰岛素组绝对减少3.4%。SURPASS-45招募了一组心血管高危人群(87%有既往事件)，他们患有糖尿病的中位时间为10.5年，尽管服用了多种口服降糖药，但平均HbA1c为69.7mmol/L(8.5%)。在一项与甘精胰岛素U100进行的为期52周的头对头试验中，5mg、10mg和15mg剂量的替西帕肽分别使HbA1c降低24mmol/mol(2.2%)、26mmol/mol(2.4%)和29mmol/mol(2.6%)，而胰岛素组为15mmol/mol(1.4%)。在78周(1166名参与者)和104周(199名参与者)时，替西帕肽的血糖和体重益处持续存在。SURPASS-56调查了那些在基础胰岛素治疗中加或不加二甲双胍超过40周的患者。共有475名参与者(平均基线HbA1c 67mmol/mol[8.3%]，年龄60岁，糖尿病病程13.4年，BMI 3.4kg/m2)接受替西肽或安慰剂治疗。平均HbA1c降低分别为23mmol/mol(2.1%)、26mmol/mol(2.4%)、24mmol/mol(2.3%)，而安慰剂组为10mmol/mol(0.9%)。平均体重减少5.4公斤、7.5公斤和8.8公斤，而安慰剂组增加1.6公斤。干预组过早终止治疗的比例高达10-18%，而安慰剂组为3%。替西帕肽除了改善血压读数外，在胆固醇方面也有统计学上的显著改善。在所有替西肽研究中观察到的不良反应主要是轻度至中度的胃肠道反应，并随着时间的推移而减少。在所有治疗组中，临床显著或严重低血糖事件发生率均低于1例/患者年，但在SURPASS-5组中较高，这可以理解为与基础胰岛素联合使用。6 . exceed系列共同为2型糖尿病治疗的未来指明了方向，特别是在最近的NICE指南中，目前基于肠促胰岛素的治疗被边缘化然而，2024年SURPASS-CVOT(以dulaglutide作为比较物的心血管结局试验)的关键数据预计将最终为未来的实践提供信息。最新的里程碑式糖尿病试验结果令人鼓舞:替西帕肽和芬芬酮备受关注
{"title":"Promising outcomes from latest landmark diabetes trials: tirzepatide and finerenone in the spotlight","authors":"Lakshmi Sankaran, L. Curtis","doi":"10.1002/pdi.2432","DOIUrl":"https://doi.org/10.1002/pdi.2432","url":null,"abstract":"SURPASS trials The incretin hormones, glucose-dependent insulinotropic polypeptide (GIP) and glucagon line peptide 1 (GLP-1), are responsible for the increased insulin secretion from oral, as compared to intravenous, glucose administration which increases the amount of glucose ingested – known as the ‘incretin effect’. Incretins also slow down the digestion of food so that glucose from your meals takes longer to be absorbed, and thereby appetite is reduced with resulting weight loss. This has been exploited therapeutically by GLP-1 receptor agonists and dipeptidyl peptidase (DPP4) inhibitors. SURPASS is an array of double-blind, randomised phase 3 trials studying tirzepatide, a novel dual GIP and GLP-1 receptor agonist, a weekly subcutaneous injection in people with type 2 diabetes. The preceding 2018 phase 2 trials showed supportive results leading to much anticipation for this ‘twincretin’. Each trial included four arms of 5mg, 10mg and 15mg tirzepatide and placebo. The primary endpoint was mean change in HbA1c along with secondary outcomes of change in body weight and achieving target HbA1c. SURPASS-11 investigated tirzepatide monotherapy in 478 participants with a short duration of diabetes across 40 weeks (mean baseline HbA1c 63mmol/mol [7.9%], age 54, diabetes duration 4.7years, BMI 31.9kg/m2). HbA1c reductions were 21mmol/mol (1.9%), 21mmol/mol (1.9%) and 23mmol/mol (2%) with 5mg, 10mg and 15mg tirzepatide respectively. A dose dependent weight loss of 7–9.2kg was seen. SURPASS-22 was a 40-week head-to-head study of tirzepatide vs injectable semaglutide in 1879 people with a mean diabetes duration of 8.6 years. Tirzepatide showed improved outcomes with a 23–27mmol/mol (2.1–2.5%) vs 21mmol/mol (1.9%) HbA1c reduction and weight reductions of 7.6–11.2kg vs 5.7kg. Comparatively, the best weight loss seen in the phase 3 semaglutide SUSTAIN-7 trials was 6.5kg (mean baseline 95.2kg, duration of diabetes 7.4 years) and 20mmol/mol (1.8%) HbA1c drop. SURPASS-33 compared tirzepatide against the basal insulin degludec in 1444 participants taking metformin with or without an SGLT2 inhibitor. After 52 weeks, all three tirzepatide arms had decreased bodyweight (-7.5kg to -12.9kg), whereas insulin patients’ bodyweight increased by 2.3kg. Mean tirzepatide HbA1c reduction was 21–25mmol/mol(1.9–2.3%) vs 14mmol/mol (1.3%). The SURPASS-MRI sub-study4 involved participants with non-alcoholic fatty liver disease. Liver fat content was measured by MRI-proton density fat fraction with an absolute reduction of 8.1% in the pooled 10mg and 15mg tirzepatide groups vs 3.4% with insulin degludec. SURPASS-45 recruited a high cardiovascular risk cohort (87% had a previous event), who had lived with diabetes for a median of 10.5 years and mean HbA1c 69.7mmol/L (8.5%) despite multiple oral antihyperglycaemics. In a head-to-head 52-week trial vs insulin glargine U100, 5mg, 10mg and 15mg doses of tirzepatide led to HbA1c reductions of 24mmol/mol (2.2%), 26mmol/mol (2.4%) and 2","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"50 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85288926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hannah Cooke, Stephen Craig, H. Kahal, F. Talbot, K. Lonnen
Aims: To examine the impact of using the Royal College of Obstetricians and Gynaecologists (RCOG) COVID‐19 Gestational Diabetes (GDM) criteria on identifying women with GDM.
{"title":"Impact of using fasting plasma glucose and HbA1c instead of OGTT as a screening tool for gestational diabetes: a retrospective study","authors":"Hannah Cooke, Stephen Craig, H. Kahal, F. Talbot, K. Lonnen","doi":"10.1002/pdi.2434","DOIUrl":"https://doi.org/10.1002/pdi.2434","url":null,"abstract":"Aims: To examine the impact of using the Royal College of Obstetricians and Gynaecologists (RCOG) COVID‐19 Gestational Diabetes (GDM) criteria on identifying women with GDM.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"48 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84869457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Inequalities in health care exist in many countries in the world. In 2008 the then UK Secretary of State for Health commissioned the Marmot review, ‘Fair Society, Healthy Lives’, to propose strategies to address health inequalities in the UK. Most of Marmot's proposals were not acted upon and in 2020, 10 years after the initial recommendations were published, Marmot found that there had been no improvement and some things were worse.
{"title":"Health inequalities and diabetes","authors":"A. Kilvert, C. Fox","doi":"10.1002/pdi.2435","DOIUrl":"https://doi.org/10.1002/pdi.2435","url":null,"abstract":"Inequalities in health care exist in many countries in the world. In 2008 the then UK Secretary of State for Health commissioned the Marmot review, ‘Fair Society, Healthy Lives’, to propose strategies to address health inequalities in the UK. Most of Marmot's proposals were not acted upon and in 2020, 10 years after the initial recommendations were published, Marmot found that there had been no improvement and some things were worse.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"46 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76328859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The prevalence of chronic kidney disease (CKD) is rising worldwide and is a major contributor to morbidity and mortality. It is estimated to affect over 800 million people globally.
{"title":"Chronic kidney disease awareness and updates on the management of diabetic kidney disease","authors":"Wigdan Hamza, J. Burton","doi":"10.1002/pdi.2454","DOIUrl":"https://doi.org/10.1002/pdi.2454","url":null,"abstract":"The prevalence of chronic kidney disease (CKD) is rising worldwide and is a major contributor to morbidity and mortality. It is estimated to affect over 800 million people globally.","PeriodicalId":20309,"journal":{"name":"Practical Diabetes","volume":"17 1","pages":""},"PeriodicalIF":0.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87514084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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