scholarly journals Branching pattern of tibial nerve in the tarsal tunnel - a cadaveric study

2017 ◽  
Vol 06 (02) ◽  
pp. 120-125
Author(s):  
Kalpana Ramadoss ◽  
Komala Nanjundaiah
Keyword(s):  
Tibial Nerve ◽  
Lower Limbs ◽  
Medial Malleolus ◽  
Tarsal Tunnel ◽  
Terminal Branch ◽  
Type I ◽  
Medical College ◽  
Lateral Plantar Nerve ◽  
Tarsal Bones ◽  
The Mean

Abstract Background and aims: Tibial nerve is the larger terminal branch of sciatic nerve, ends by dividing into medial and lateral plantar nerves beneath the flexor retinaculum [Tarsal tunnel]. The level of bifurcation of the tibial nerve is differently quoted in text books and articles. The aim of the present study is to localize the level of bifurcation of tibial nerve. Materials and methods: 50 lower limbs from 25 cadavers available in the Department of anatomy, M.S. Ramaiah medical college and Bangalore medical college were used for the study. A reference line of 1 cm width ‘Medio Malleolar Calcaneal axis’ [MMC axis] made with OHP sheet was placed from tip of the medial malleolus of tibia to the medial tubercle of calcaneus and used as grid to classify the level of bifurcation of tibial nerve into 3 types. Type I, II, III represented the bifurcation proximal to, deep to and distal to this axis respectively. Results: Tibial nerve bifurcation was found to be type I in 92%, type II in 6%, type III in 2% of specimens. Most of the cases [32.6%] bifurcated between 5.1 to 10 mm proximal to MMC axis. The median distance of medial plantar nerve from medial malleolus was 21.28mm on left side and 20.735mm on right side. The mean of lateral plantar nerve from medial tubercle of calcaneus was 29.61mm on left side, and 28.6mm on right side. Conclusion: Detailed anatomical knowledge of tibial nerve prevents the damage to tibial nerve during various surgical procedures like fixation of fractures with external nailing of tarsal bones, medial displacement osteotomies and in tarsal tunnel surgeries.

scholarly journals MRI Study on Tibial Nerve of the Ankle Canal and Its Branches: A method of multiplanar reconstruction with 3D-FIESTA-C sequences

2020 ◽  
Author(s):  
Yan Zhang ◽  
Xucheng He ◽  
Juan Li ◽  
Ju Ye ◽  
Wenjuan Han ◽  
...  
Keyword(s):  
Tibial Nerve ◽  
Three Dimensional ◽  
The Body ◽  
Multiplanar Reconstruction ◽  
Medial Malleolus ◽  
Cross Sectional ◽  
Medial Plantar Nerve ◽  
Lateral Plantar Nerve ◽  
Good Imaging ◽  
Starting Point

Abstract Background The display of tibial nerve and its branches in the ankle canal is helpful for the diagnosis of local lesions and compression, and also for clinical observation and surgical planning.The aim of this study was to investigate the feasibility of three-dimensional dual-excitation balanced steady-state free precession sequence (3D-FIESTA-C) multiplanar reconstruction (MPR) display of tibial nerve and its branches of the ankle canal. Methods The subjects were 20 healthy volunteers (40 ankles), aged 22–50, with no history of ankle joint desease. 3D-FIESTA-C sequence was used in the 3.0t magnetic resonance equipment for imaging. During the scanning, each foot was at a 90-degree angle to the tibia.The tibial nerve of the ankle canal and its branches were displayed and measured at the same level through multiplanar reconstruction. Results Most of the tibial nerve bifurcation points were located in the ankle canal (57.5%), few (42.5%) were located at the proximal end of the ankle canal, and none was found away from the distal end. The bifurcation between the medial plantar nerve and the lateral plantar nerve is on the line between the tip of the medial malleolus and the calcaneus, and it’s angle is between 6° and 35°.The average cross-sectional diameter of the medial plantar nerve is about mm, and the lateral plantar nerve about mm. In MPR images, the display rates of both the medial calcaneal nerve and the subcalcaneal nerve were 100%, and the starting point of the subcalcaneal nerve was always at the distal end of the starting point of the medial calcaneal nerve. In 55% of cases, there were more than 2 medial calcaneal nerve innervations. Conclusion The 3D-FIESTA-C MPR can display the morphological features and positions of tibial nerve and its branches and the bifurcation point’s projection position on the body surface can be marked. This method not only benefited the imaging diagnosis of tibial nerve and branch-related lesions of the ankle canal, but also provided a good imaging basis to plan the clinical operation of the ankle canal and avoid surgical injury.

A Cadaveric Study on the Variation in the Level of Division of Sciatic Nerve in Nepalese Population

2020 ◽  
Vol 9 (1) ◽  
pp. 12-16
Author(s):  
Diwakar Kumar Shah ◽  
Sanzida Khatun
Keyword(s):  
Sciatic Nerve ◽  
Ischial Tuberosity ◽  
Lower Limbs ◽  
Pelvic Cavity ◽  
Terminal Branch ◽  
Middle Region ◽  
Common Site ◽  
Greater Trochanter ◽  
Cross Sectional ◽  
Medical College

Background: Sciatic nerve, the thickest nerve of our body (around 2cm wide at its origin), leaves the pelvic cavity from the greater sciatic foramina below the piriformis muscle and between the greater trochanter of femur and ischial tuberosity. As variations have been reported in the level of division of sciatic nerve into its terminal branches, the current study aims to determine the most common site of division of sciatic nerve in Nepalese population. Materials and Methods: The current study is a cross-sectional and descriptive study which was carried out in the Department of Anatomy, Nobel Medical College, where twenty-three cadavers were used and both the lower limbs were examined. Depending upon the level of division of the sciatic nerve into its terminal branches, it was categorized into six different groups (A-F). Results: It was seen that the sciatic nerve had already divided into its terminal branches before its exit into the gluteal regionin 23.91% extremities. The second commonestsite for the termination of sciatic nerve into its terminal branch was found to be at the middle region of the back of the thigh in 19.57% followed by its division in the popliteal fossa in 17.39%. Conclusion: From the current study we conclude that the level of division of sciatic nerve was variable and it is wise to go for other means to find out the level of termination of sciatic nerve before performing any procedure in that area.

scholarly journals MRI Study on Tibial Nerve of the Ankle Canal and Its Branches:A method of multiplanar reconstruction with 3D-FIESTA-C sequences

2021 ◽  
Author(s):  
Yan Zhang ◽  
Xucheng He ◽  
Juan Li ◽  
Ju Ye ◽  
Wenjuan Han ◽  
...  
Keyword(s):  
Tibial Nerve ◽  
Three Dimensional ◽  
The Body ◽  
Medial Malleolus ◽  
Bifurcation Points ◽  
Lateral Plantar Nerve ◽  
Good Imaging ◽  
Starting Point ◽  
History Of ◽  
Mri Study

Abstract Background: The visualization of the tibial nerve and its branches in the ankle canal is helpful for the diagnosis of local lesions and compression, and it is also useful for clinical observation and surgical planning.The aim of this study was to investigate the feasibility of three-dimensional dual-excitation balanced steady-state free precession sequence (3D-FIESTA-C) multiplanar reformation (MPR) display of the tibial nerve and its branches in the ankle canal.Methods:The subjects were 20 healthy volunteers (40 ankles), aged 22-50 years, with no history of ankle joint desease. The 3D-FIESTA-C sequence was used in the 3.0T magnetic resonance equipment for imaging. Duringscanning, each foot was at an angle of 90 degrees to the tibia.The tibial nerve of the ankle canal and its branches were displayed and measured at the same level throughMPR.Results: Most of the tibial nerve bifurcation points were located in the ankle canal (57.5%), few bifurcation points (42.5%) were located at the proximal end of the ankle canal, and none of them were found away from the distal end. The bifurcation between the medial plantar nerve and the lateral plantar nerve was on the line between the tip of the medial malleolus and the calcaneus, and it’s angle ranged between 6° and 35°. In MPR images, the display rates of both the medial calcaneal nerve and the subcalcaneal nerve were 100%, and the starting point of the subcalcaneal nerve was always at the distal end of the starting point of the medial calcaneal nerve. In 55% of cases, there were more than two medial calcaneal nerve innervations.Conclusion: The 3D-FIESTA-C MPR can display the morphological features and positions of the tibial nerve and its branches and the bifurcation point’s projection position can be marked on the body surface. This method not only benefited the imaging diagnosis of the tibial nerve and branch-related lesions in the ankle canal, but it also provided a good imaging basis to plan a clinical operation of the ankle canal and avoid surgical injury.

scholarly journals MRI Study on Tibial Nerve of the Ankle Canal and Its Branches:A method of multiplanar reconstruction with 3D-FIESTA-C sequences

2020 ◽  
Author(s):  
Yan Zhang ◽  
Xucheng He ◽  
Juan Li ◽  
Ju Ye ◽  
Wenjuan Han ◽  
...  
Keyword(s):  
Tibial Nerve ◽  
Three Dimensional ◽  
The Body ◽  
Joint Disease ◽  
Medial Malleolus ◽  
Multiplanar Reformation ◽  
Lateral Plantar Nerve ◽  
Good Imaging ◽  
Starting Point ◽  
Mri Study

Abstract Background: The display of tibial nerve and its branches in the ankle canal is helpful for the diagnosis of local lesions and compression, and also for clinical observation and surgical planning. The aim of this study was to investigate the feasibility of three-dimensional dual-excitation balanced steady-state free precession sequence (3D-FIESTA-C) multiplanar reformation (MPR) display of tibial nerve and its branches of the ankle canal.Methods: The subjects were 20 healthy volunteers (40 ankles), aged 22-50, with no history of ankle joint disease. 3D-FIESTA-C sequence was used in the 3.0t magnetic resonance equipment for imaging. During the scanning, each foot was at a 90-degree angle to the tibia. The tibial nerve of the ankle canal and its branches were displayed and measured at the same level through multiplanar reformation.Results: Most of the tibial nerve bifurcation points were located in the ankle canal (57.5%), few (42.5%) were located at the proximal end of the ankle canal, and none was found away from the distal end. The bifurcation between the medial plantar nerve and the lateral plantar nerve is on the line between the tip of the medial malleolus and the calcaneus, and it’s angle is between 6° and 35°. In MPR images, the display rates of both the medial calcaneal nerve and the subcal caneal nerve were 100%, and the starting point of the subcal caneal nerve was always at the distal end of the starting point of the medial calcaneal nerve. In 55% of cases, there were more than 2 medial calcaneal nerve innervations.Conclusion: The 3D-FIESTA-C MPR can display the morphological features and positions of tibial nerve and its branches and the bifurcation point’s projection position on the body surface can be marked. This method not only benefited the imaging diagnosis of tibial nerve and branch-related lesions of the ankle canal, but also provided a good imaging basis to plan the clinical operation of the ankle canal and avoid surgical injury.

scholarly journals MRI Study on Tibial Nerve of the Ankle Canal and Its Branches: A method of multiplanar reconstruction with three-dimensional dual-excitation balanced steady-state free precession sequence

2020 ◽  
Author(s):  
Yan Zhang ◽  
Xucheng He ◽  
Juan Li ◽  
Ju Ye ◽  
Wenjuan Han ◽  
...  
Keyword(s):  
Steady State ◽  
Steady State Free Precession ◽  
Tibial Nerve ◽  
Three Dimensional ◽  
Multiplanar Reconstruction ◽  
Medial Malleolus ◽  
Free Precession ◽  
Medial Plantar Nerve ◽  
Lateral Plantar Nerve ◽  
Starting Point

Abstract Background: The display of tibial nerve and its branches in the ankle canal is helpful for the diagnosis of local lesions and compression, and also for clinical observation and surgical planning.The aim of this study was to investigate the feasibility of three-dimensional dual-excitation balanced steady-state free precession sequence (3D-FIESTA-C) multiplanar reconstruction (MPR) display of tibial nerve and its branches of the ankle canal.The subjects were 20 healthy volunteers (40 ankles), aged 22-50, with no history of ankle joint desease. 3D-FIESTA-Csequence was used in the 3.0t magnetic resonance equipment for imaging. During the scanning, each foot was at a 90-degree angle to the tibia so that the results of measurement are more accurate .The tibial nerve of the ankle canal and its branches were displayed and measured at the same level through multiplanar reconstruction.Results: Most of the tibial nerve bifurcation points were located in the ankle canal (57.5%), few (42.5%) were located at the proximal end of the ankle canal, and none was found away from the distal end. The bifurcation between the medial plantar nerve and the lateral plantar nerve is on the line between the tip of the medial malleolus and the calcaneus, and it’s angle is between 6° and 35°.The average cross-sectional diameter of the medial plantar nerve is about mm, and the lateral plantar nerve about mm. In MPR images, the display rates of both the medial calcaneal nerve and the subcalcaneal nerve were 100%, and the starting point of the subcalcaneal nerve was always at the distal end of the starting point of the medial calcaneal nerve. In 55% of cases, there were more than 2 medial calcaneal nerve innervations.Conclusion: The 3D-FIESTA-C MPR can display the morphological features and positions of tibial nerve and its branches. By measuring the distance between each bifurcation point, the tip of the medial malleolus and the angle between this line and the horizontal line that passes the tip of the medial malleolus, the bifurcation point’s projection position on the body surface can be accurately marked. This method not only benefited the imaging diagnosis of tibial nerve and branch-related lesions of the ankle canal, but also provided a good imaging basis to plan the clinical operation of the ankle canal and avoid surgical injury.

scholarly journals The Effect of Calcaneal Displacement Osteotomies on Tarsal Tunnel Pressures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0032
Author(s):  
Gregory I. Pace ◽  
Patrick M. Kennedy ◽  
Umur Aydogan
Keyword(s):  
Tibial Nerve ◽  
Lateral Displacement ◽  
Osteotomy Site ◽  
Medial Malleolus ◽  
Tarsal Tunnel ◽  
Icp Monitoring ◽  
Calcaneal Osteotomy ◽  
Lateral Osteotomy ◽  
Lateral Incision ◽  
Significant Difference

Category: Basic Sciences/Biologics Introduction/Purpose: Calcaneal displacement osteotomies are frequently utilized procedures to correct hindfoot varus and valgus deformities and are frequently used in conjunction with other procedures to restore normal alignment of the foot. Complications associated with this procedure include overcorrection, undercorrection, iatrogenic fracture, wound dehiscence, and infection. Additionally, neurologic deficit associated with lateralizing calcaneal osteotomy has been documented in the literature. Changes in ankle alignment have been shown to significantly alter tarsal tunnel pressure and volume, and a MRI study by Bruce et. al showed that lateral osteotomy fragment displacement results in significant reduction of tarsal tunnel volume. We hypothesized that a lateral displacement calcaneal osteotomy would result in an increase in tarsal tunnel pressure compared baseline tarsal tunnel pressures or those with a medial displacement calcaneal osteotomy. Methods: We performed cadaveric dissections on five foot and ankle cadavers. The laciniate ligament covering the tarsal tunnel was visualized at 2 cm proximal to the medial malleolus and a nick incision was made to insert the ICP monitoring probe; the tunnel was left intact distally. A 45 degrees lateral incision was made in line with the osteotomy site and a calcaneal osteotomy was performed in line with the incision approximately 1 cm anterior to the attachment of the achilles tendon. A Codman ICP monitoring probe was then used to measure baseline tarsal tunnel pressure measurements prior to calcaneal displacement. The osteotomy was then displaced medially and laterally and fixed in place in place with a K-wire (Figure 1). Tarsal tunnel pressures were measured at 5 mm and 8 mm displacement in both directions. Results: Average tarsal tunnel pressures at baseline were 2.8 mmHg (range, 1-5 mmHg). Average tarsal tunnel pressures with 5 mm and 8 mm of medial calcaneal displacement were 1.0 mmHg (range, 0-4 mmHg) and 0.8 mmHg (range, 0-3 mmHg), and with lateral calcaneal displacement were 7.4 mmHg (range, 3-13 mmHg) and 14.4 mmHg (range, 10-22 mmHg). There was no significant difference in tarsal tunnel pressures with either 5 mm (p=.067) or 8 mm (P=.067) of medial calcaneal displacement compared to baseline. There was, however, a significant increase in tarsal tunnel pressures with both 5 mm (p=.039) and 8 mm (p=.001) of lateral calcaneal displacement compared to tarsal tunnel pressures at baseline and with 5 mm (p=.002) and 8 mm (p=.001) of medial calcaneal displacement. Conclusion: Tibial nerve palsy following lateral displacement calcaneal osteotomy has recently been shown to have an incidence as high as 34%. Osteotomies decreasing volume in the tarsal tunnel could cause iatrogenic compression of the tibial nerve. Based on the results of our study, displacing the calcaneus laterally increases the tarsal tunnel pressures on average five times above baseline tarsal tunnel pressures. Medial displacement, however, does not appear to have any significant effect on pressures within the tunnel. The findings in this study provide further clinical evidence in support of prophylactic tarsal tunnel release prior to performing a lateralizing calcaneal osteotomy.

Vascular Supply of Nerves in the Tarsal Tunnel

1997 ◽  
Vol 18 (5) ◽  
pp. 288-292 ◽  
Author(s):  
David C. Flanigan ◽  
Martin Cassell ◽  
Charles L. Saltzman
Keyword(s):  
Tibial Nerve ◽  
Posterior Tibial Artery ◽  
Vascular Supply ◽  
Tarsal Tunnel ◽  
Lateral Plantar Nerve ◽  
Nutrient Artery ◽  
Vascular Compromise ◽  
Tunnel Syndrome ◽  
Nutrient Vessel ◽  
Branching Point

The normal vascular supply of nerves in the tarsal tunnel was studied by intra-arterial injection of latex. In general, the blood supply to the tibial nerve and its branches came directly from corresponding arteries. Each nutrient artery to the tibial nerve bifurcated on the surface of the lateral plantar nerve fasciculus to create longitudinal vessels that made anastomoses with bifurcating nutrient vessels proximally and distally. This primary longitudinal system supplied intersubfascicular vessels to the medial plantar fasciculus. The last nutrient artery from the posterior tibial artery usually supplied the terminal branching point of the tibial nerve midway through the tarsal tunnel. The lateral and medial plantar nerves received most of the nutrient vessels from their corresponding arteries in shorter intervals. In 65% of cases, the lateral plantar nerve received a nutrient vessel from the medial plantar artery. Potential anatomical areas of vascular compromise in the etiology or surgical release of tarsal tunnel syndrome are discussed.

scholarly journals Effect of Lateral Sliding Calcaneus Osteotomy on Tarsal Tunnel Pressure

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142093101
Author(s):  
Sebastian Halm ◽  
Paul G. Fairhurst ◽  
Stefan Tschanz ◽  
Fluri A. M. Wieland ◽  
Valentin Djonov ◽  
...  
Keyword(s):  
Nerve Palsy ◽  
Tibial Nerve ◽  
Biomechanical Study ◽  
Pressure Increase ◽  
Tarsal Tunnel ◽  
Neutral Position ◽  
Specific Patient ◽  
Flexor Retinaculum ◽  
The Mean ◽  
Calcaneal Tuberosity

Background: Lateral sliding calcaneus osteotomies are common procedures to correct hindfoot varus deformities. Shifting the calcaneal tuberosity laterally (lateralization) can lead to tarsal tunnel pressure increase and tibial nerve palsy. The purpose of this cadaveric biomechanical study was to investigate the correlation of lateralization and pressure increase underneath the flexor retinaculum. Methods: The pressure in the tarsal tunnel of 12 Thiel-fixated human cadaveric lower legs was measured in different foot positions and varying degrees of calcaneal lateralization. Results: The mean pressure increased from plantarflexion (PF) to neutral position (NP) and from NP to hindfoot dorsiflexion (DF), and with increasing amounts of lateralization of the calcaneal tuberosity. The mean baseline pressure in PF was 1.5, in NP 2.2, and in DF 6.5 mmHg and increased to 8.1 in PF, 18.4 in NP, and 33.1 mmHg with 12 mm of lateralization. The release of the flexor retinaculum significantly lowered the pressure. Conclusion: Increasing pressures were found in the tarsal tunnel with increasing lateralization of the tuberosity and with both dorsiflexion and plantarflexion of the ankle. Clinical Relevance: A pre-emptive release of the flexor retinaculum for a lateralization of the calcaneal tuberosity of more than 8 mm should be considered, especially if specific patient risk factors are present. No tibial nerve palsy should be expected with 4 mm of lateralization.

scholarly journals An MRI study of the tibial nerve in the ankle canal and its branches: a method of multiplanar reformation with 3D-FIESTA-C sequences

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yan Zhang ◽  
Xucheng He ◽  
Juan Li ◽  
Ju Ye ◽  
Wenjuan Han ◽  
...  
Keyword(s):  
Tibial Nerve ◽  
Three Dimensional ◽  
The Body ◽  
Joint Disease ◽  
Medial Malleolus ◽  
Multiplanar Reformation ◽  
Bifurcation Points ◽  
Lateral Plantar Nerve ◽  
Good Imaging ◽  
Starting Point

Abstract Background The visualization of the tibial nerve and its branches in the ankle canal is helpful for the diagnosis of local lesions and compression, and it is also useful for clinical observation and surgical planning. The aim of this study was to investigate the feasibility of three-dimensional dual-excitation balanced steady-state free precession sequence (3D-FIESTA-C) multiplanar reformation (MPR) display of the tibial nerve and its branches in the ankle canal. Methods The subjects were 20 healthy volunteers (40 ankles), aged 22–50 years, with no history of ankle joint disease. The 3D-FIESTA-C sequence was used in the 3.0 T magnetic resonance equipment for imaging. During scanning, each foot was at an angle of 90° to the tibia. The tibial nerve of the ankle canal and its branches were displayed and measured at the same level through MPR. Results Most of the tibial nerve bifurcation points were located in the ankle canal (57.5%), few bifurcation points (42.5%) were located at the proximal end of the ankle canal, and none of them were found away from the distal end. The bifurcation between the medial plantar nerve and the lateral plantar nerve was on the line between the tip of the medial malleolus and the calcaneus, and it’s angle ranged between 6° and 35°. In MPR images, the display rates of both the medial calcaneal nerve and the subcalcaneal nerve were 100%, and the starting point of the subcalcaneal nerve was always at the distal end of the starting point of the medial calcaneal nerve. In 55% of cases, there were more than two medial calcaneal nerve innervations. Conclusion The 3D-FIESTA-C MPR can display the morphological features and positions of the tibial nerve and its branches and the bifurcation point’s projection position can be marked on the body surface. This method not only benefited the imaging diagnosis of the tibial nerve and branch-related lesions in the ankle canal, but it also provided a good imaging basis to plan a clinical operation of the ankle canal and avoid surgical injury.

scholarly journals Cadaveric Study of the Neurovascular Bundle in Tarsal Tunnel Region among Sudanese - 2020

2021 ◽  
Author(s):  
yasser seddeg ◽  
Elfarazdag Ismail
Keyword(s):  
Tibial Nerve ◽  
Posterior Tibial Artery ◽  
Neurovascular Bundle ◽  
Medial Malleolus ◽  
Tarsal Tunnel ◽  
Nerve Blocks ◽  
Bifurcation Points ◽  
Posterior Tibial ◽  
Tibial Artery ◽  
Displacement Osteotomy

Abstract Background: Tarsal tunnel is situated medial to the ankle lying deep to the flexor retinaculum. Within which lies the neurovascular bundle in separate compartments. This study examines the level of bifurcation points of tibial nerve and posterior tibial artery, and the location of medial and lateral plantar nerves in the tarsal tunnel. As well as the origin of the medial calcaneal nerves. Methods: This study was a descriptive observational cross sectional study. Step by step dissections of the tarsal tunnel were performed on 30 Sudanese cadavers, the contents of the tarsal tunnel were explored. Results: The tibial nerve was found to bifurcate before the the medial malleolus calcaneal axis (MMCA) in (n=4/30, 13.3%) specimens , and inside the tunnel (n=26/30, 86.7%). The branching point of the posterior tibialartery was found before the MMCA in (n=10/28, 35.7%) of specimens, at the MMCA in (n=16/28, 57.1%), and after the MMCA in (n= 2/28, 7.1%). Medial calcaneal nerves were found to be derived from the LPN plus the TN in (n=13/30, 43.3%), while in (n=6/30, 20%) were derived from LPN plus MPN plus TN. only (n=5/30, 16.7 %) were derived from LPN alone. Conclusion: anatomical knowledge of the bifurcation points of tibial nerve and posterior tibial artery is of great importance in many medical procedures like external fixation of medial malleolus fractures, medial displacement osteotomy and nerve blocks in podiatric medicine.

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