Brain News Roundup: ‘Seeing’ emotions, concussions and ‘multi-tasking’

Scientists can now see “sad” and “happy” in our brains. More news on the impact of concussions, including long-term impacts. And a roundup of more brain news, including fatherhood and our (mistaken) belief about how well we multi-task.

Scientists have discovered a way to “see” emotions with brain imaging technology, according to a recent study. Beyond being just plain fascinating, scientists hope the findings could bring a new way to analyze emotions beyond people’s self-reporting.

• People are becoming increasingly aware how often athletes are suffering concussions. Now scientists have measured the long-term effects of a basic soccer move — heading the ball — on  the brain. And the news is not good.

• Also, scientists have discovered how brain abnormalities linked to concussions are similar to abnormalities related to Alzheimer’s.

• Meanwhile, brain researchers are finding that it’s not just females hormones that change with motherhood; there are also very specific hormonal brain changes associated with fatherhood.

• And finally … multi-tasking? Talking on your cell phone while you’re driving your car? Or doing your real work while you’re reading this (for instance)?  You’re not as good at it as you think you are.

 

Todd Murphy
Senior Communications Specialist
OHSU Brain Institute

The continuing search for the answer to Alzheimer’s disease

Alois Alzheimer, a German physician in 1906, was studying a woman who came to his clinic complaining about memory loss, language problems, and behavioral changes. She ultimately died of complications from her illness. After her death, Dr. Alzheimer examined her brain and found abnormal protein clumps, now referred to as amyloid deposits, and bundles of fibers, now called neurofibrillary tangles. The dementia exhibited by this patient acquired the name Alzheimer’s dementia because of its discovery by Dr. Alzheimer.

In current studies of post mortem brains from patients who have died from Alzheimer’s disease, the research also revealed amyloid deposits and neurofibrillary tangles in almost all cases.  These two protein accumulations are considered the major hallmarks of Alzheimer’s disease.

At the beginning of the disease process, these protein accumulations appear mainly in the hippocampus, a brain region that is critical in learning and the formation of memories. As the disease spreads, so do these protein deposits to other brain regions. Other studies have revealed multiple cellular changes – including synapses that lose their ability to connect with synapses from other brain cells — in the brains of patients with early-onset familial Alzheimer’s and late-onset sporadic Alzheimer’s. Synaptic loss has been found to be the best correlate of cognitive decline in patients with Alzheimer’s.

During the last three decades, Alzheimer’s researchers have worked to better understand how both amyloid beta and another protein called tau are associated with cognitive decline in Alzheimer’s disease.

Some researchers believe amyloid beta plays the more important role; other researchers believe tau also plays a very important role.

Recent clinical trials that focused on using drug inhibitors to limit amyloid beta levels in the brain were disappointing; the drugs did not improve patients’ cognitive function.

But those trials raised important questions in Alzheimer’s research:

  • Are the drugs targeting the right kind of amyloid beta?
  • Might the drugs help if patients were given them earlier, before the disease had advanced so far?
  • What might be the long-term consequences of these drugs, and
  • Do we need to better understand how tau might be affecting brain synapses, before we see clinical symptoms of Alzheimer’s?

I also believe that to better understand synaptic loss in Alzheimer’s, the interaction of amyloid beta and tau with each other needs to be better researched. My colleague and I recently published an article in the Journal of Alzheimer’s Disease that explored that question. My laboratory looked for evidence of amyloid beta and tau interactions. And we found that the Alzheimer’s disease process was strongest where those interactions happened.

More research needs to focus on molecules that might prevent or affect that amyloid beta/tau interaction. Those molecules might end up being an important treatment for Alzheimer’s, as they could significantly improve cognitive and memory functions for people who have this debilitating disease.

Hemachandra Reddy, Ph.D.
Associate Scientist, Division of Neuroscience
Oregon National Primate Research Center, OHSU

Recovering from stroke — through music

In the early 2000s, as part of the OHSU Stroke Center, I saw disabled stroke patients make remarkable progress in their recoveries — simply by exerting a large amount of extra effort and determination in their rehab exercises.

The patients were part of a program led by an innovative OHSU physical therapist named Andrea Serdar. The program was within what is now known as the OHSU Outpatient Neurological Rehabilitation Department within the OHSU Brain Institute.

I loved to talk to Andrea about what might encourage more patients to put this kind of serious effort into their rehab.

And I thought about this later, when — of all things — I started to play ukulele and sing with friends on a weekly basis. Through trial and error, I started to learn what makes a recreational music group super successful, rewarding and long-lived. And it was not long before Andrea and I colluded to start a music group of our own — for stroke survivors.

We started the group in October 2011. And it did not take long to gain a regular group of about eight stroke survivors, and an amazing blues guitarist named Trace Wiren. The group, called Backstrokes, was just featured in a KOIN TV story.

About a year in, we realized that the speech of some of our members with expressive aphasia — the significantly decreased ability to use language, often because of a stroke — had noticeably improved, both in clarity of words and also the increased ability to get the words out. More recently, I have noticed that members with cognitive disabilities have noticeably improved in their ability to answer a question without wandering into another subject. When asked, members report an increased sense of independence, as well as the improvement with speech.

Because a large portion of the brain is used to experience music, scientists think that music is able to bypass the damaged area of the brain, and form new neural pathways.

On occasion, the beauty of our singing harmonies catches me by surprise. My favorite thing, by far, is when we finish a song, and we look around and we all know that we totally nailed it!

I look forward to the coming year, as we are determined to figure out how to find the financial and other support to reach more and more stroke survivors. We hope to accomplish this by taking our music group to stroke support groups and medical center inpatient units and skilled nursing facilities. Although people initially come to our group because they need help with their own recovery, it does not take long at all before they are able to help others in this way. This is an amazing transformation to witness, and is clearly empowering for the individuals in the group.

Anne Tillinghast
Administrative Coordinator, OHSU Stroke Center
OHSU Brain Institute

Stroke basics: Understand the symptoms, and call 911

“Dial 911 for emergencies.”

You think this is simple and obvious, right? It turns out that a recent study found that one-third of patients with stroke symptoms did not call 911 when they were having a stroke. Often, patients show up in the emergency room by having their families drive them or, even worse, by driving themselves.  Also, there are many instances that I know of personally where patients wait until the next day to call their primary care physician, especially if their symptoms have resolved.

It is important to seek emergent medical care quickly when it comes to stroke. As you have seen on this blog before, as well as on other stroke websites, the mantra of all stroke physicians is “Time is Brain.” The sooner one is assessed by medical professionals, the higher the chance that a stroke victim can get intravenous tPA, which is a clot-busting medication that can substantially improve one’s outcome after a stroke.

Calling 911 ensures that one gets the best stroke care possible. Emergency medical services knows to take patients to certified stroke centers — like OHSU’s — that have the proper tools necessary to treat stroke. In addition, having medical personnel assessing and starting treatment on a patient before he or she gets to the hospital can potentially save more brain cells. Lastly, families and patients can potentially drive dangerously when rushing to the hospital, which is an added risk.

It is also important to recognize stroke symptoms, as often they can be overlooked in family members, which can lead to delays in care. The American Stroke Association has been promoting stroke awareness during American Stroke Month in May. It promotes a F.A.S.T. checklist to recognize common symptoms:

Face Drooping — Does one side of the face droop, or is it numb?

Arm Weakness — If a person tries to raise both arms, does one drift downward?

Speech Difficulty — Is speech slurred, or hard to understand?

Time to call 911.

Other stroke symptoms: sudden numbness or weakness in a leg, sudden trouble seeing out of one or both eyes, dizziness, confused behavior and sudden severe headache with no apparent cause.

If you see anyone having a few of these symptoms at the same time — or if you are experiencing them yourself — immediately call 911 and get medical treatment. The time — and brain — you save could change the rest of your life.

Hormozd Bozorgchami, M.D.
Instructor, Oregon Stroke Center
OHSU Brain Institute

Scientists excited by new ‘see-through brain’

I am a neuroscientist who uses advanced microscopy techniques to understand the basic mechanisms of Parkinson’s disease. Throughout my career, I have always been interested in imaging and microscopy as a way to answer essential biological questions.  That’s why I (along with many other neuroscientists) am so excited about a new technique that creates fully intact, optically clear brains, allowing scientists to study how brain cells connect and communicate with each other in a completely revolutionary way.

A three-dimensional rendering of a clarified brain. (Image: Courtesy of the Deisseroth lab).

The CLARITY technique, designed by Kwanghun Chung and Karl Deisseroth at Stanford University and detailed last month in a study in the journal Nature, makes brains clear by removing lipid (fat) molecules, which are the number one substance that interferes with the ability of light to penetrate through biological tissue. Lipids are the major component of all cellular membranes, a structure that acts as the bag that holds everything together inside of a cell. The trick to CLARITY is removing the bag, but keeping the rest of the cell from falling apart.

The authors do this by replacing all the lipids with a chemically engineered hydrogel substance. The hydrogel serves the purpose of holding all the cellular structures in place, but it does not interfere with the passage of light as lipids do. CLARITY gives researchers access to all of the DNA, proteins, and other components of the cell as they would normally exist in the brain, without the lipids getting in the way. Better yet, the hydrogel is porous enough to allow the infusion of multiple fluorescent molecules that bind to specific cellular components. That color codes the nervous system in a comprehensive pattern.

In addition to producing stunningly beautiful pictures, the CLARITY technique revolutionizes our ability to track how neurons connect to one another across large spans of brain volume. In the past, neuroscientists have had to cut preserved mouse brains into very thin slices using a specialized cutting machine, then try to track a single neuron through each of these adjacent slices, and finally reconstruct a 3D picture from the individual pieces. With CLARITY, no cutting is necessary – you can basically stick a specially prepared mouse brain under a microscope and look at the whole brain, perfectly intact.

The authors use CLARITY to create clear mouse brains, and also show that it can be applied to a small piece of human autopsy tissue. In one of the images from the paper, the authors trace a single neuron from a small block of human brain across the entire tissue section – about 1 centimeter, or the width of your fingernail. This may seem like a small distance. But to a neuroscientist who deals with structures that are 10,000 times smaller, that is huge!

The whole field is excited to see this technique repeated by other investigators and in other brain tissue. The hope is that eventually this method will become commonplace in research labs around the world.

With the breakthrough of CLARITY, we will be able to learn about whole-brain changes associated with various neurological disorders, including Parkinson’s disease, in a way that was never before possible. We will also greatly expand our knowledge of basic brain function, which is essential to progressing forward in neuroscience.

Kateri Spinelli, Ph.D.

Post doctoral fellow, Dept. of Neurology
OHSU Brain Institute

Carotid Dissections, Stroke and Telestroke

New York Times reporter Andrew Revkin recently wrote an article that did a great job of describing a stroke from a patient’s perspective, as well as discussing some new advances in stroke treatment technology.

The first point his case illustrates is that stroke can occur at all ages, from babies to the elderly. It may be especially difficult for younger and fit patients to understand they are having a stroke. Since it’s an “an old age disease,” it can’t be happening to them. Knowing the warning signs of stroke — sudden onset of weakness or numbness on one side, difficulty in speaking, or sudden vision loss — is therefore important to everyone.

The type of stroke that Revkin had — one due to a dissection or tear in one of two carotid arteries in the neck — is actually one of the more common causes of stroke in a younger person. In a dissection, the inner lining of the blood vessel tears away, creating a flap where a blood clot can form inside the vessel. This in turn can break loose and go to the brain and cause a stroke.

It doesn’t have to be a major trauma that causes this tear. It can occur with regular activity — like running, in Revkin’s case. Other common causes we frequently see in patients at OHSU’s Oregon Stroke Center include neck chiropractor manipulation, extreme yoga neck extension, tilting the head back to get your hair washed, and extreme coughing fits. One of the more interesting cases we’ve seen had dissections in both carotid arteries from working in the local planetarium (looking up at the stars all day). Fortunately, in Revkin’s case — based on what he’s written — the doctors finally arrived at the correct diagnosis (with some assistance from the patient!) and he was placed on the appropriate blood thinning treatment that likely limited his stroke injury.

The good news is that in many cases of carotid dissection, the artery will eventually heal itself and reopen and the risk of a repeat dissection in a patient is very low. I hope this will be the case for him.

Dr. Clark consults via telemedicine console The second point Revkin’s blog article illustrates is the exciting potential of telestroke technology to deliver expert stroke care to patients in an area where a local stroke specialist is not available.

Oregon Health & Science University hospital currently has a nine-hospital “telestroke” network in Oregon where we can evaluate the patient and assist local hospitals around the state. At these “stroke ready” hospitals, patients with an ischemic stroke (no blood flow to the brain due to a blocked artery) can be evaluated and if appropriate given the “clot buster” stroke therapy tPA as quickly as possible under the direction of the telestroke specialist.

For many patients, however, intravenous tPA alone may not be sufficient. In these cases, more advanced “interventional” techniques are required to try to pull out the clot that is causing the stroke. In addition, there are other types of strokes that can be caused by an artery breaking inside the brain (a cerebral hemorrhage) or an artery popping on the surface of the brain (a subarachnoid hemorrhage). For these very critical patients, both specialized neurointerventionalists and cerebrovascular neurosurgeons are required to stop the bleeding using clips or coils. This is where a Comprehensive Stroke Center like OSHU’s is required. For these cases, the telestroke physician can help orchestrate transferring the patient. In addition they can reassure and update the family face to face.

Hopefully, everyone knows how important it is to seek immediate medical attention if you are having symptoms of a stroke. TPA is most effective when given within three hours of a stroke. And the newer clot removing devices (called stent retrievers) are approved for use up to eight hours after known stroke onset. However, there are times where the ability to get to an emergency room in time is beyond the patient’s or family’s control. Examples include if the stroke occurs while someone is asleep or if he or she is found with stroke symptoms and is unable to communicate when it started.

Image of a perfusion scan.

This means that these patients usually arrive too long after being normal to be able to treat them. However, new advances in brain imaging may be changing these strict time limits. Using a special brain CT or MRI perfusion scan allows us to determine how much of the brain is already too badly injured to save (core area) and how much is not getting enough blood but might still be saved if treated (low blood flow area). If the area of low blood flow is larger than the core damaged area, treatment might still help the patient, regardless of how many hours ago the patient was last normal.

Through improved stroke patient education about the need to seek immediate medical care and through telestroke technology and advanced imaging techniques, we hope in the future to have more of our patients to be able to return to writing blog articles!

Wayne Clark, M.D.
Director, Oregon Stroke Center
OHSU Brain Institute

A Healthy Body Makes for a Healthy Brain

It’s 1960. “Eat your vegetables. Don’t you want to grow up strong and smart?”

The boy’s mom dished out this unassailable logic at the dinner table along with the lima beans. What boy wouldn’t want to grow up “strong” and “smart?” And eating the dreaded lima beans surely must be good for you … why else would someone eat them?  But the boy became a young man and forgot his Mom’s dinner table wisdom.

Fast forward to the early 1980s and the young man is a neurologist studying multiple sclerosis, or MS. He knows about an elderly Portland neurologist named Dr. Roy Swank — who had been head of the Department of Neurology at OHSU for two decades — who has been treating MS with a low-fat diet since the year the young man was born. Surely this makes no sense. MS is an autoimmune disease that damages the insulating material of the brain and spinal cord. How could a low-fat diet help the immune system or protect the brain?

So he dives into learning about immunology, conducting research on how to control a rogue immune system and begins caring for people with MS. He looks forward to the day when he can treat his MS patients with drugs that can control their MS. His patients ask him about the Swank diet and he tells them a low-fat diet would help their hearts but probably won’t help their MS.

Fast forward to 1993. The young neurologist is now middle aged and the first drug for treating MS, beta interferon, is Food and Drug Administration approved. It is the first of seven classes of drugs that will receive FDA approval for treating MS over the next 20 years. All of the drugs modify the immune system. The middle-aged neurologist uses these drugs and sees that many of his patients do better. They have to deal with side effects and the medications are expensive but what he had dreamed about when he started his career is coming true. His patients still ask him about diet therapy and he recommends following a low-fat diet. “You will be healthier if you do so. Now here is your prescription.”

Fast forward to 2013. The neurologist is still middle aged — people are living longer after all. But he notices that, despite his armamentarium of drugs, not all of his patients want to take them. And even those who do take them want to do more. They ask him for guidance on diet. He tells them they should follow a low-fat diet because it will make their immune system and brains healthier. He recommends Dr. Roy Swank’s MS diet book, or to follow Dr. John McDougall’s low-fat vegan diet. He even helps organize programs for people with MS to find out how to eat right, exercise and manage stress. “Do this and it will help your MS,” he advises his patients.

So what happened between 1993 and 2013? There were two major changes.

First, the neurologist realized that the medications he was prescribing were helpful but weren’t enough. “Life style medicine” was needed — not just expensive, sometime toxic, medications.

Second, more and more scientific evidence began to accumulate indicating that obesity, smoking, lack of exercise, high blood pressure and diabetes made MS worse. And they made the immune system unbalanced and were bad for the brain. He also realized that adding more medications was not the right answer. Following a healthy diet, exercising, avoiding harmful habits and managing stress were a much more sensible approach. In addition, these approaches to a healthier life were being advocated for reducing the risk of developing a number of neurologic diseases, including stroke and dementia.

So eat your vegetables. Get off the couch and exercise. Don’t smoke. You want a healthy brain, don’t you!

Dennis Bourdette, M.D.
Executive Director, OHSU Multiple Sclerosis Center
Professor and Chair, Department of Neurology
OHSU Brain Institute

Pioneering scientist speaks about brain mapping

This is an example of an fMRI map produced from data collected on the OHSU Brain Institute’s 7 Tesla MRI instrument showing auditory brain areas activated during a passive listening task.

Those of us who work within the OHSU Brain Institute are honored to have Dr. Marcus Raichle visit us May 13 to present an evening seminar in the Brain Awareness Lecture Series, entitled “How Do We Peer Deeply into the Brain.”

Raichle has been at the forefront in the development and application of advanced brain imaging techniques to advance neuroscience for four decades. He is a pioneer in the use of innovative positron emission tomography, or PET, studies to explore brain structure and function relationships.

Functional neuroimaging studies – or studies that show real-time imaging of the human brain in action — have grown tremendously over the last two decades and have contributed substantially to understanding function in the living human brain. Functional magnetic resonance imaging, or fMRI, has found widespread application in neuroscience, surgical planning before brain surgery and even non-medical applications like marketing research.

The fundamental experimental design strategies inherent in these studies can be traced to work from Raichle and his colleagues, who have used water that has been scientifically “marked” to allow the researchers to watch and investigate changes in blood flow in various parts of the brain as it performs specific tasks.

Raichle’s work has consistently shifted neuroscience paradigms. Studies from Raichle’s group have quantified blood flow and glucose utilization and found that these increase to a greater extent than oxygen utilization in activated brain areas — a principle central to essentially all fMRI experiments.

Most recently, Raichle and his colleagues have turned their attention to studies of the “resting” brain — that is, the brain not engaged in any outward directed activity. Remarkably, these neuroimaging studies have revealed that the brain is quite active – even at rest.  Indeed, the amount of energy expended at rest is much greater than incremental energy change required to attend to a specific task. Additional studies have revealed common modes of activity in the resting brain — a “default mode” that is deactivated during task-specific demands.

These findings have generated substantial excitement in the neuroscience community. We at the OHSU Brain Institute are actively pursuing research based on what Raichle has discovered, as are other top neuroscience institutions throughout the world.

That research, and further advances that spring from it, could lead someday to better treatments — and even cures — for a wide range of brain diseases and disorders.

Raichle will speak at 7 p.m. Monday at the Newmark Theater, 1111 S.W. Broadway in downtown Portland.

Bill Rooney, Ph.D.
Director, Advanced Imaging Research Center
OHSU Brain Institute

 

Recovering from concussion: a long haul but I’m getting there

OHSU concussion patient Jamie Wirth

The first time I got hit was November 15, 2008, during my freshman year at Aloha High School, at basketball practice. I dove, a girl moved her knee and I smashed into it with my forehead. I was dizzy, confused, nauseated and my head was pounding.

Three weeks later, I was shooting around with a friend when a basketball hit me on the head. Since I was not symptom free from my first concussion, my symptoms only became worse. This is called second impact syndrome.

My first concussion was right before finals. I tried my best, but my grades slipped. I had problems with short-term memory, fatigue and concentration. Months passed and my pediatric neurologist (not at OHSU) prescribed bed rest and medication that caused awful side effects. Their approach was “time and rest.”

I had many different symptoms — lights and noise bothered me, and my eyes hurt whenever I used the computer or watched TV. I had a constant migraine, which caused me to wake up 10 to 12 times a night in pain. Nothing helped.

I went without any improvements for over a year. I often felt as if no one, not even the doctors, believed me when I described my problems. It became apparent during the few speech and physical therapy sessions I received that their philosophy was to teach me how to deal with my symptoms, not expect any improvements.

In January 2010, my family switched our insurance plan and we were able to go to Dr. James Chesnutt and the concussion rehab team at OHSU. For the first time, we felt there was hope. Dr. Chesnutt had me evaluated by a speech therapist and a physical therapist. I was also diagnosed with severe whiplash from my initial injury. This had never been diagnosed or treated, and I had to see a neck therapist who specialized in strengthening my neck. I went through seven months of intense physical therapy as well as 13 months of speech therapy.

The speech therapist gave me tools to help my memory, concentration and to improve my thought processing. Dr. Chesnutt also referred me to a neuro-ophthalmologist who discovered previously hidden vision problems. Six weeks of vision therapy and three months of at-home online vision therapy got my eyes working together, which further decreased my headache pain.

My OHSU therapists not only believed me — they believed in me. Instead of hoping I would get better, they actually made it happen. Although it took me two years to recover, Dr. Chesnutt’s first priority was my safety. Time was passing, but he was patient and made sure I didn’t rush back too soon. At the same time, he helped lead me back to a regular life again.

I ended up missing about a year of school altogether, and was told I would not graduate with my class because I was so far behind. It seemed impossible, but I was determined to work hard to catch up. I put in numerous extra hours throughout the year. And along with my regular classes, a combination of online classes, summer school and having a home tutor, I was able to graduate with my class in June of 2012.

In the fall of 2012, I started full time at Portland Community College. Community college was a perfect fit for my situation; I am slowly adjusting to the college routine. I am also working on writing a book about my concussion journey and turning all the pain I went through into a purpose. To give hope to those who feel hopeless.

Concussions change you emotionally, physically and mentally. In the two years of having this concussion I lost a lot, but I have gained even more. As strange as it sounds, I’m thankful this happened. The injuries helped shape me into a better person and have opened up many opportunities.

Jamie Wirth

Jamie Wirth, 19, is a patient of OHSU’s sports medicine program and James Chesnutt, M.D. She lives in Aloha.

Violence in the brain? And beer …

Physicians and researchers have some pretty amazing ways of peering inside the human brain.

And some of those methods — and what they might show us — have been in the news a lot lately.

A couple of neurosurgeons at Boston University, who have studied former NFL football players and others who have received repeated hits to the head, say that the brain of alleged Boston bomber Tamerlan Tsarnaev should be studied in a special autopsy procedure. Tsarnaev, who along with his brother is suspected to have planted bombs near the finish line of the April 15 Boston Marathon, was later killed in a shootout with police.

boxing and the brainThe Boston neurosurgeons’ previous research has found that people who sustain repeated hits to the head can develop a brain disease called chronic traumatic encephalopathy, or CTE. The disease can lead to depression, aberrant behavior, emotional instability and lack of impulse control, the researchers say. Tsarnaev was a former amateur boxer.

The researchers say they don’t necessarily believe CTE caused Tsarnaev’s behavior in the bombing, but believe his brain still should be studied.

Meanwhile, brain researchers led by New Mexico neuroscientist Kent Kiehl have published a study suggesting that brain scans of convicted felons can predict which of them are most likely to get arrested after they get out of prison.

The study tested the impulse control of a group of 96 male prison inmates and found that those with low impulse control were roughly twice as likely to get re-arrested after they were released from prison.

And finally, two physicians who were parents of one of the children killed in the Connecticut school shooting last December have formed a foundation that will fund brain research into the possible underpinnings of violent behavior. The Avielle Foundation, which will be guided by three internationally known brain researchers, is named for first-grader Avielle Richman, who was among the 20 children and six adults killed in the Dec. 14, 2012, shooting in Newtown, Conn.

And … neuroscientists are also finding ways to explore less tragic issues. In other words, beer.

Neuroscientists have just published a study that found that just a tiny taste of beer makes us — or at least men — want more. The study found that just a swig of beer — not nearly enough to cause intoxication — prompted the release of the neurotransmitter dopamine in the reward centers of male brains. The taste induced the brain to want more of that taste. Researchers say the results may suggest one mechanism for increased alcoholism risk.

Todd Murphy
Senior Communications Specialist
OHSU Brain Institute

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