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Gutke, Annelie
Publications (10 of 20) Show all publications
Gutke, A., Bullington, J., Lund, M. & Lundberg, M. (2018). Adaptation to a changed body. Experiences of living with long-term pelvic girdle pain after childbirth. Disability and Rehabilitation, 40(25), 3054-3060
Open this publication in new window or tab >>Adaptation to a changed body. Experiences of living with long-term pelvic girdle pain after childbirth
2018 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 40, no 25, p. 3054-3060Article in journal (Refereed) Published
Abstract [en]

Purpose: To explore how women experience living with long-term pregnancy-related pelvic girdle pain.

Materials and methods: Nine women with persistent pregnancy-related pelvic girdle pain of 2–13 years were recruited by means of purposive sampling from long-term follow-up studies. The women were 28–42 years of age and had given birth to 2–3 children. Audio-taped in-depth interview with open-ended questions were used with the guiding question 'How do you experience living with pregnancy-related pelvic girdle pain?'. The Empirical Phenomenological Psychological method was chosen for analysis.

Results: The pregnancy-related pelvic girdle pain syndrome has a profound impact on everyday life for many years after pregnancy. Three constituents were identified as central to the experience of living with pregnancy-related pelvic girdle pain: (1) the importance of the body for identity, (2) the understanding of pain, and (3) stages of change. The manner in which the women experienced their pain was interpreted in terms of two typologies: the ongoing struggle against the pain, and adaptation and acceptance.

Conclusion: The participants’ narratives highlighted that the pain led to severe functional limitations that threatened their capability to perform meaningful daily activities, and interfered with their sense of identity. It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome.

IMPLICATIONS FOR REHABILITATION

Chronic pregnancy-related pelvic girdle pain

  • Pregnancy-related pelvic girdle pain impairs women’s capacity to perform meaningful activities of daily life for many years after pregnancy.

  • The participants’ narratives highlighted that the pain interfered with their sense of identity.

  • It appears essential to meet with each patient individually and to manage long-term pregnancy-related pelvic girdle pain as a pain syndrome.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Chronic pregnancy-related pelvic girdle pain; interview; functioning; follow-up; identity
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-153354 (URN)10.1080/09638288.2017.1368724 (DOI)000450685100010 ()28835130 (PubMedID)2-s2.0-85028573225 (Scopus ID)
Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2019-01-09Bibliographically approved
Sjödahl, J., Gutke, A., Ghaffari, G., Strömberg, T. & Öberg, B. (2016). Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the Active Straight Leg Raise in women with and without pelvic girdle pain: An experimental study. Clinical Biomechanics, 35, 49-55
Open this publication in new window or tab >>Response of the muscles in the pelvic floor and the lower lateral abdominal wall during the Active Straight Leg Raise in women with and without pelvic girdle pain: An experimental study
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2016 (English)In: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 35, p. 49-55Article in journal (Refereed) Published
Abstract [en]

Background: The relationship between activation of the stabilizing muscles of the lumbopelvic region during the Active Straight Leg Raise test and pelvic girdle pain remains unknown. Therefore, the aim was to examine automatic contractions in relation to pre-activation in the muscles of the pelvic floor and the lower lateral abdominal wall during leg lifts, performed as the Active Straight Leg Raise test, in women with and without persistent postpartum pelvic girdle pain. Methods: Sixteen women with pelvic girdle pain and eleven pain-free women performed contralateral and ipsilateral leg lifts, while surface electromyographic activity was recorded from the pelvic floor and unilaterally from the lower lateral abdominal wall. As participants performed leg lifts onset time was calculated as the time from increased muscle activity to leg lift initiation. Findings: No significant differences were observed between the groups during the contralateral leg lift. During the subsequent ipsilateral leg lift, pre-activation in the pelvic floor muscles was observed in 36% of women with pelvic girdle pain and in 91% of pain-free women (P = 0.01). Compared to pain-free women, women with pelvic girdle pain also showed significantly later onset time in both the pelvic floor muscles (P = 0.01) and the muscles of the lower lateral abdominal wall (P amp;lt; 0.01). Interpretation: We suggest that disturbed motor activation patterns influence womens ability to stabilize the pelvis during leg lifts. This could be linked to provocation of pain during repeated movements. (C) 2016 Elsevier Ltd. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2016
Keywords
Chronic pelvic pain; Electromyography; Joint instability; Low back pain; Pelvic pain; Post-partum
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-130297 (URN)10.1016/j.clinbiomech.2016.04.007 (DOI)000378366900008 ()27128765 (PubMedID)
Note

Funding Agencies|Swedish Research Council [521-2019-3578]; Linkoping University, Sweden

Available from: 2016-07-31 Created: 2016-07-28 Last updated: 2017-05-07Bibliographically approved
Gutke, A., Betten, C., Degerskar, K., Pousette, S. & Fagevik Olsen, M. (2015). Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities. Acta Obstetricia et Gynecologica Scandinavica, 94(11), 1156-1167
Open this publication in new window or tab >>Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities
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2015 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 94, no 11, p. 1156-1167Article, review/survey (Refereed) Published
Abstract [en]

ObjectiveTo explore the effect of physiotherapeutic interventions on pregnancy-related lumbopelvic pain. Material and methodsData sources: MEDLINE, Cochrane Central Register of Controlled Trials, PEDro, CINAHL, AMED, and SCOPUS databases were searched up to December 2014 for studies written in English, French, German or Scandinavian languages that evaluated physiotherapeutic modalities for preventing and treating pregnancy-related lumbopelvic pain. ResultsFor lumbopelvic pain during pregnancy, the evidence was strong for positive effects of acupuncture and pelvic belts. The evidence was low for exercise in general and for specific stabilizing exercises. The evidence was very limited for efficacy of water gymnastics, progressive muscle relaxation, a specific pelvic tilt exercise, osteopathic manual therapy, craniosacral therapy, electrotherapy and yoga. For postpartum lumbopelvic pain, the evidence was very limited for clinic-based treatment concepts, including specific stabilizing exercises, and for self-management interventions for women with severe disabilities. No specific adverse events were reported for any intervention. No meta-analysis could be performed because of study heterogeneity. ConclusionsThe levels of evidence were strong for a positive effect of acupuncture and pelvic belts, but weak for an effect of specific exercises. Caution should prevail in choosing other interventions for pregnancy-related lumbopelvic pain.

Place, publisher, year, edition, pages
WILEY-BLACKWELL, 2015
Keywords
Pelvic girdle pain; low back pain; pregnancy; post-partum; physiotherapy
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-122514 (URN)10.1111/aogs.12681 (DOI)000362844400003 ()26018758 (PubMedID)
Available from: 2015-11-09 Created: 2015-11-06 Last updated: 2017-12-01
Gutke, A., Olsson, C. B., Vollestad, N., Öberg, B., Nilsson Wikmar, L. & Stendal Robinson, H. (2014). ASSOCIATION BETWEEN LUMBOPELVIC PAIN, DISABILITY AND SICK LEAVE DURING PREGNANCY - A COMPARISON OF THREE SCANDINAVIAN COHORTS. Journal of Rehabilitation Medicine, 46(5), 468-474
Open this publication in new window or tab >>ASSOCIATION BETWEEN LUMBOPELVIC PAIN, DISABILITY AND SICK LEAVE DURING PREGNANCY - A COMPARISON OF THREE SCANDINAVIAN COHORTS
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2014 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 5, p. 468-474Article in journal (Refereed) Published
Abstract [en]

Objective: To explore the association between disability and sick leave due to lumbopelvic pain in pregnant women in 3 cohorts in Sweden and Norway and to explore possible factors of importance to sick leave. A further aim was to compare the prevalence of sick leave due to lumbopelvic pain. Design/subjects: Pregnant women (n=898) from two cohorts in Sweden and one in Norway answered to questionnaires in gestational weeks 10-24; two of the cohorts additionally in weeks 28-38. Methods: Logistic regression models were performed with sick leave due to lumbopelvic pain as dependent factor. Disability, pain, age, parity, cohort, civilian status, and occupational classification were independents factors. Results: In gestational weeks 10-24 the regression model included 895 cases; 38 on sick leave due to lumbopelvic pain. Disability, pain and cohort affiliation were associated with sick leave. In weeks 28-38, disability, pain and occupation classification were the significant factors. The prevalence of lumbopelvic pain was higher in Norway than in Sweden (65%, vs 58% and 44%; pless than0.001). Conclusion: Disability, pain intensity and occupation were associated to sick leave due to lumbopelvic pain. Yet, there were significant variations between associated factors among the cohorts, suggesting that other factors than workability and the social security system are also of importance.

Place, publisher, year, edition, pages
Foundation for Rehabilitation Information, 2014
Keywords
low back pain; pelvic girdle pain; pregnancy; sick leave; disability
National Category
Physiotherapy
Identifiers
urn:nbn:se:liu:diva-107848 (URN)10.2340/16501977-1801 (DOI)000336472300013 ()
Available from: 2014-06-23 Created: 2014-06-23 Last updated: 2017-12-05
Sjödahl, J., Gutke, A. & Öberg, B. (2013). Predictors for long-term disability in women with persistent postpartum pelvic girdle pain. European spine journal, 22(7), 1665-1673
Open this publication in new window or tab >>Predictors for long-term disability in women with persistent postpartum pelvic girdle pain
2013 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 22, no 7, p. 1665-1673Article in journal (Refereed) Published
Abstract [en]

Purpose

The majority of prognostic studies on postpartum lumbopelvic pain have investigated factors during pregnancy. Since the majority of women recover within the first few months of delivery, it is unknown if the same predictors are valid for long-term consequences. It is also important to investigate predictors within subgroups of patients with pregnancy-related lumbopelvic pain due to their different clinical courses. The aim of this study was to identify predictors for disability 15 months postpartum in women with persistent postpartum pelvic girdle pain (PGP).

Methods

Data were obtained by clinical tests and questionnaires 3 months postpartum. The outcome 15 months postpartum was disability measured with the Oswestry Disability Index.

Results

A multiple linear regression analysis identified two significant two-way interaction effects that were predictive of disability 15 months postpartum: (a) age + trunk flexor endurance, and (b) disability + hip extensor strength.

Conclusions

Age, muscle function and disability seem to influence the long-term outcome on disability in women with persistent postpartum PGP. It may be important to consider the possibility of different variables impact on each other when predicting long-term disability. In addition, further studies are needed to investigate the impact of interaction effects on long-term consequences in women with persistent postpartum PGP.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2013
Keywords
Muscle function; Pregnancy-related low back pain; Prognostic factors; Risk factors
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-96181 (URN)10.1007/s00586-013-2716-6 (DOI)000321240600031 ()
Available from: 2013-08-14 Created: 2013-08-14 Last updated: 2017-12-06Bibliographically approved
Gutke, A., Lundberg, M., Ostgaard, H. C. & Öberg, B. (2011). Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms. EUROPEAN SPINE JOURNAL, 20(3), 440-448
Open this publication in new window or tab >>Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms
2011 (English)In: EUROPEAN SPINE JOURNAL, ISSN 0940-6719, Vol. 20, no 3, p. 440-448Article in journal (Refereed) Published
Abstract [en]

The majority of women recover from pregnancy-related lumbopelvic pain within 3 months of delivery. Since biomechanical and hormonal changes from pregnancy are largely reversed by 3 months postpartum, consequently, it is assumed that other factors might interfere with recovery. Relative to the fear-avoidance model and with reference to previous studies, we chose to investigate some pre-decided factors to understand persistent lumbopelvic pain. The evaluation of lumbopelvic pain postpartum is mostly based on self-administered questionnaires or interviews. Clinical classification of the lumbopelvic pain may increase our knowledge about postpartum subgroups. Two hundred and seventy-two consecutively registered pregnant women evaluated at 3 months postpartum, answered questionnaires concerning disability (Oswestry disability index), pain intensity on visual analog scale, health-related quality of life (HRQL, EQ5D), activity level, depressive symptoms (Edinburgh postnatal Depression Scale) and kinesiophobia (Tampa Scale for Kinesiophobia). Women were classified into lumbopelvic pain subgroups according to mechanical assessment of the lumbar spine, pelvic pain provocation tests, standard history, and pain drawings. Multiple linear regression analysis was performed to explain the variance of disability. Thirty-three percent of postpartum women were classified with lumbopelvic pain; 40% reported moderate to severe disability. The impacts were similar among subgroups. Pain intensity, HRQL and kinesiophobia explained 53% of postpartum disability due to lumbopelvic pain. In conclusion, one of three postpartum women still had some lumbopelvic pain and the impacts were equivalent irrespective of symptoms in lumbar or pelvic areas. The additional explanations of variance in disability by HRQL and kinesiophobia were minor, suggesting that pain intensity was the major contributing factor.

Place, publisher, year, edition, pages
Springer Science Business Media, 2011
Keywords
Postpartum, Disability, Prevalence, Pain intensity, Low back pain (LBP)
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-67023 (URN)10.1007/s00586-010-1487-6 (DOI)000288027500015 ()
Note
The original publication is available at www.springerlink.com: Annelie Gutke, Mari Lundberg, Hans Christian Ostgaard and Birgitta Öberg, Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms, 2011, EUROPEAN SPINE JOURNAL, (20), 3, 440-448. http://dx.doi.org/10.1007/s00586-010-1487-6 Copyright: Springer Science Business Media http://www.springerlink.com/ Available from: 2011-03-25 Created: 2011-03-25 Last updated: 2011-03-31
Gutke, A., Sjödahl, J. & Öberg, B. (2010). Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial. Journal of Rehabilitation Medicine, 42(10), 929-935
Open this publication in new window or tab >>Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial
2010 (English)In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 10, p. 929-935Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the efficacy of home-based specific stabilizing exercises focusing on the local stabilizing muscles as the only intervention in the treatment of persistent postpartum pelvic girdle pain (PGP).

Design: A prospective, randomized, single-blinded, clinically controlled study.

Subjects: Eighty-eight women with PGP were recruited 3 months after delivery.

Methods: The treatment consisted of specific stabilizing exercises targeting the local trunk muscles. The reference group had one telephone contact with a physiotherapist. Primary outcome was disability measured with Oswestry Disability Index. Secondary outcomes were pain, health-related quality of life (EQ-5D), symptom satisfaction, and muscle function.

Results: No significant differences between groups could be found at 3- or 6-month follow-up regarding primary outcome in disability. Within-group comparisons showed some improvement in both groups in terms of disability, pain, symptom satisfaction and muscle function compared to baseline although the majority still experienced PGP.

Conclusion: Treatment with this home-training concept of specific stabilizing exercises targeting the local muscles was no more effective in improving consequences of persistent postpartum PGP than the clinically natural course. Regardless of treatment with specific stabilizing exercises or not, the majority still experiences some back pain almost a year after pregnancy.

Place, publisher, year, edition, pages
Foundation for Rehabilitation Information, 2010
Keywords
Low back pain; postpartum; physical therapy; exercise therapy, pelvic floor; specific stabilizing exercises; trunk muscles
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-60189 (URN)10.2340/16501977-0615 (DOI)000284748600006 ()
Note
Original Publication: Annelie Gutke, Jenny Sjödahl and Birgitta Öberg, Specific muscle stabilizing as home exercises for persistent pelvic girdle pain after pregnancy: a randomized, controlled clinical trial, 2010, Journal of Rehabilitation Medicine, (42), 10, 929-935. http://dx.doi.org/10.2340/16501977-0615 Copyright: Foundation for Rehabilitation Information http://www.medicaljournals.se/jrm/ Available from: 2010-10-07 Created: 2010-10-07 Last updated: 2017-12-12
Gutke, A., Kjellby-Wendt, G. & Öberg, B. (2010). The inter-rater reliability of a standardised classification system for pregnancy-related lumbopelvic pain. MANUAL THERAPY, 15(1), 13-18
Open this publication in new window or tab >>The inter-rater reliability of a standardised classification system for pregnancy-related lumbopelvic pain
2010 (English)In: MANUAL THERAPY, ISSN 1356-689X, Vol. 15, no 1, p. 13-18Article in journal (Refereed) Published
Abstract [en]

Pregnancy-related lumbopelvic pain has varying clinical presentations and effects among subgroups. Different lumbopelvic pain subgroups require different specific management approaches which require the differentiation between lumbar and pelvic girdle pain (PGP). Thirty-one consecutive pregnant women with non-specific lumbopelvic pain were evaluated by two examiners and classified into lumbar pain, PGP, or combined pelvic girdle and lumbar pain. A standard history about different positions/activities of daily life such as bending, sitting, standing, walking, and lying, was followed by a standardised mechanical assessment of the lumbar spine (Mechanical Diagnosis and Therapy), including tests of repeated end-range movements to standing and lying, pelvic pain provocation tests (distraction test, posterior pelvic pain provocation test, Gaenslens test, compression test, and sacral thrust) a hip-rotation range-of-motion test, the active straight-leg-raising test, and a neurological examination. Agreement for the three syndromes (lumbar pain, PGP, or combined pelvic girdle and lumbar pain) was 87% (27/31), with a kappa coefficient of 0.79 (95% CI 0.60-0.98). It was possible to perform the classification procedure throughout pregnancy. There was substantial agreement between the two examiners for the classification of non-specific lUrnbopelvic pain into lumbar pain and PGP in pregnant women.

Keywords
Low back pain, Pregnancy, Classification, Reliability
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54501 (URN)10.1016/j.math.2009.05.005 (DOI)000275140700004 ()
Note
Original Publication: Annelie Gutke, Gunilla Kjellby-Wendt and Birgitta Öberg, The inter-rater reliability of a standardised classification system for pregnancy-related lumbopelvic pain, 2010, MANUAL THERAPY, (15), 1, 13-18. http://dx.doi.org/10.1016/j.math.2009.05.005 Copyright: Elsevier Science B.V., Amsterdam http://www.elsevier.com/ Available from: 2010-03-19 Created: 2010-03-19 Last updated: 2010-03-25
Gutke, A., Roos Hansson, E., Zetherstrom, G. & Christian Ostgaard, H. (2009). Posterior pelvic pain provocation test is negative in patients with lumbar herniated discs. EUROPEAN SPINE JOURNAL, 18(7), 1008-1012
Open this publication in new window or tab >>Posterior pelvic pain provocation test is negative in patients with lumbar herniated discs
2009 (English)In: EUROPEAN SPINE JOURNAL, ISSN 0940-6719, Vol. 18, no 7, p. 1008-1012Article in journal (Refereed) Published
Abstract [en]

The classification of pelvic girdle pain can only be reached after lumbar causes have been excluded by a clinical examination. During clinical examination, the posterior pelvic pain provocation test is a well-established method for verifying pelvic girdle pain. However, a criticism of pelvic pain provocation tests is that they may have an effect on lumbar structures, thus yielding false-positive results. The posterior pelvic pain provocation test was performed with four groups of patients: patients with computed tomography-verified disc herniations (1) on the waiting list for surgery (14 women; 9 men); (2) 6 weeks after disc surgery (18 women, 12 men); (3) pregnant women seeking care for pelvic girdle pain (n = 25); and (4) women with persistent pelvic girdle pain after delivery (n = 32). The sensitivity of the posterior pelvic pain provocation test was 0.88 and the specificity was 0.89. The positive predictive value was 0.89 and the negative predictive value was 0.87. Analysis of only women showed similar results. In our study, the posterior pelvic pain provocation test was negative in patients with a well-defined lumbar diagnosis of lumbar disc herniation, both before and after disc surgery. Our results are an important step toward the more accurate classification of lumbopelvic pain.

Keywords
The posterior pelvic pain provocation test; Sensitivity; Specificity; Predictive value of tests; Low back pain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-20181 (URN)10.1007/s00586-009-1003-z (DOI)
Available from: 2009-09-02 Created: 2009-08-31 Last updated: 2009-09-02
Fagevik Olsen, M., Gutke, A., Elden, H., Nordenman, C., Fabricius, L., Gravesen, M., . . . Kjellby-Wendt, G. (2009). Self-administered tests as a screening procedure for pregnancy-related pelvic girdle pain. EUROPEAN SPINE JOURNAL, 18(8), 1121-1129
Open this publication in new window or tab >>Self-administered tests as a screening procedure for pregnancy-related pelvic girdle pain
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2009 (English)In: EUROPEAN SPINE JOURNAL, ISSN 0940-6719, Vol. 18, no 8, p. 1121-1129Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate sensitivity and specificity of self-administrated tests aimed at pain provocation of posterior and/or anterior pelvis pain and to investigate pain intensity during and after palpation of the symphysis. A total of 175 women participated in the study, 100 pregnant women with and 25 pregnant women without lumbopelvic back pain and 50 non-pregnant women. Standard pain provocation tests were compared with self assessed tests. All women were asked to estimate pain during and after palpation of the symphysis. For posterior pelvic pain, the self-test of P4 and Bridging test had the highest sensitivity of 0.90 versus 0.97 and specificity of 0.92 and 0.87. Highest sensitivity for self-test for anterior pelvic pain was pulling a mat 0.85. Palpation of symphysis was painful and persistency of pain was the longest among women who fulfilled the criteria for symphyseal pain. There were overall significant differences between the groups concerning intensity and persistency of pain (P andlt; 0.001). Our results indicate that pregnant women can perform a screening by provocation of posterior pelvic pain by self-tests with the new P4 self-test and the Bridging test. Palpation of the symphysis is painful and should only be used as a complement to history taking, pain drawing and pulling a MAT-test.

Keywords
Low back pain, Pregnancy, Provocation tests, Pelvic girdle pain, Screening
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-20604 (URN)10.1007/s00586-009-0948-2 (DOI)
Available from: 2009-09-16 Created: 2009-09-15 Last updated: 2009-09-16
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