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A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: 30 March 2026 | Viewed by 12946

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Dr. Janos Szederjesi

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Department of Intensive Care, George Emil Palade University of Medicine, Pharmacy, Science and Technology, 540139 Târgu-Mureș, Romania
Interests: intensive care; medical simulation; anesthesiology; sepsis; TIVA-TCI

Special Issue Information

Dear Colleagues,

Intensive care medicine faces several critical issues that impact patient outcomes, healthcare delivery, and resource management. One key issue is the rising demand for intensive care due to an aging population, the increased prevalence of chronic diseases, and critical illnesses. This has led to higher ICU requirements, and challenges in staffing as well as bed availability.

The management of infections and the rise of antibiotic-resistant pathogens are other challenges. ICUs are hotspots for healthcare-associated infections, which can severely affect critically ill patients.

Innovations in technology, while offering new tools for monitoring and treatment, pose challenges regarding their cost, implementation, and the need for continuous training.

This Special Issue aims to enhance patient management in intensive care settings by sharing authors’ experiences and research on critical challenges encountered in daily practice.

We especially encourage the submission of original articles, reviews, and case reports that investigate physiological pathology, diagnostics, and treatments for critically ill patients.

Topics of interest include, but are not limited to, the following: managing elderly patients, high-risk individuals with multiple comorbidities, addressing hospital-acquired infections and sepsis, managing acute respiratory failure, evaluating and treating hemodynamic instability, navigating end-of-life care, and adapting to new technologies in intensive care.

Dr. Janos Szederjesi
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Life is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

critical issues
intensive care
co-morbidities in ICUs
new technology issues in ICUs
hospital-acquired infections
end of life

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Published Papers (10 papers)

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Research

Jump to: Review, Other

14 pages, 759 KB

Open AccessArticle

The Relationship Between Preoperative Serum Ionized Calcium, Vitamin D, and Postoperative Bleeding After Major Cardiac Surgery

by Adrian Stef, Constantin Bodolea, Aurelia Georgeta Solomonean, Nadina Tintiuc, Alexandru Oprea, Oana Antal, Gabriel Cismaru and Emanuel Palade

Life 2025, 15(9), 1460; https://doi.org/10.3390/life15091460 - 17 Sep 2025

Viewed by 205

Abstract

Objective: The role of calcium in coagulation homeostasis is well established, although the relationship between calcium levels and postoperative bleeding in major cardiac surgery remains largely unexplored. Methods: This retrospective, single-center study investigated the correlations between ionized calcium levels measured at several timepoints: preoperatively (after induction of anesthesia), immediately after cardiopulmonary bypass (CPB) weaning, on the first postoperative day measured three times at 8 h intervals, preoperative vitamin D values, and several significant bleeding outcomes. These outcomes included the volume of blood in the drainage bag (measured in milliliters on days 1 and 2), the need for surgical or medical hemostasis, the requirement for blood transfusion (red blood cells, fresh frozen plasma, or platelets), and the occurrence of extracardiac hemorrhagic complications. A multivariable logistic regression analysis was performed, with a two-sided p-value of <0.00625 considered significant after applying Bonferroni correction. Results: The study included 83 patients with a mean age of 64.9 ± 8.5 years, with 49 (59%) being male. The most common procedures were aortic valve replacement (26 patients, 31%) and coronary artery bypass grafting (26 patients, 31%). The multivariable regression analysis demonstrated a trend toward an association between low levels of preoperative calcium and increased bleeding volume immediately after CBP and on the first day after the intervention (r = 0.30; p = 0.08 for day 1 and r = 0.24; p = 0.03 for day 2). Similar trends were observed for the association between low levels of preoperative calcium, use of medical hemostasis (r = 0.30; p = 0.009), and red blood cell transfusion (r = 0.24; p = 0.03). Additionally, we observed a trend towards a positive correlation between lower serum vitamin D levels and increased postoperative blood loss on both day 1 (r = 0.32; p = 0.07) and day 2 (r = 0.29; p = 0.04). The subgroup analysis of valve procedures vs. coronary procedures showed no statistically difference between preoperative ionized calcium levels, postoperative bleeding (289 27 vs. 283 mL, p = 0.87), the need for surgical hemostasis (p = 0.5), or blood transfusion requirement (p = 0.57). Conclusions: In our study, preoperative calcium levels were consistently associated with increased bleeding after major cardiac surgery. Post-CPB ionized calcium levels did not influence bleeding outcomes. The role of calcium in coagulation homeostasis during major cardiac surgery warrants further research, ideally with more robust data, as our study’s small sample limits robust evidence. Further larger studies will conclude on the importance of calcium levels in cardiac surgery related to hemostasis and bleeding outcomes. Lower preoperative ionized calcium and vitamin D levels showed exploratory associations with increased bleeding-related outcomes following major cardiac surgery. These findings are hypothesis-generating, and larger prospective studies are needed to confirm these potential relationships and clarify their clinical implications. Full article

(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)

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13 pages, 856 KB

Open AccessArticle

Outcomes of Traumatic Liver Injuries at a Level-One Tertiary Trauma Center in Saudi Arabia: A 10-Year Experience

by Nawaf AlShahwan, Saleh Husam Aldeligan, Salman T. Althunayan, Abdullah Alkodari, Mohammed Bin Manee, Faris Abdulaziz Albassam, Abdullah Aloraini, Ahmed Alburakan, Hassan Mashbari, Abdulaziz AlKanhal and Thamer Nouh

Life 2025, 15(7), 1138; https://doi.org/10.3390/life15071138 - 19 Jul 2025

Viewed by 872

Abstract

Traumatic liver injury remains a significant contributor to trauma-related morbidity and mortality worldwide. In Saudi Arabia, motor vehicle accidents (MVAs) are the predominant mechanism of injury, particularly among young adults. This study aimed to evaluate the clinical characteristics, management strategies, and outcomes of patients with liver trauma over a ten-year period at a tertiary academic level-one trauma center. A retrospective cohort study was conducted from January 2015 to December 2024. All adult patients (aged 18–65 years) who sustained blunt or penetrating liver injuries and underwent a pan-CT trauma survey were included. Demographic data, Injury Severity Scores (ISSs), imaging timelines, management approach, and clinical outcomes were analyzed. Statistical analysis was performed using JASP software with a significance threshold set at p < 0.05. A total of 111 patients were included, with a mean age of 33 ± 12.4 years; 78.1% were male. MVAs were the leading cause of injury (75.7%). Most patients (80.2%) had low-grade liver injuries and received non-operative management (NOM), with a high NOM success rate of 94.5%. The median time to CT was 55 ± 64 min, and the mean time to operative or IR intervention was 159.9 ± 78.8 min. Complications occurred in 32.4% of patients, with ventilator-associated pneumonia (19.8%) being most common. The overall mortality was 6.3%. Multivariate analysis revealed that shorter time to CT significantly reduced mortality risk (OR = 0.5, p < 0.05), while a positive e-FAST result was strongly associated with increased mortality (OR = 3.3, p < 0.05). Higher ISSs correlated with longer monitored unit stays (ρ = 0.3, p = 0.0014). Traumatic liver injuries in this cohort were predominantly low-grade and effectively managed conservatively, with favorable outcomes. However, delays in imaging and operative intervention were observed, underscoring the requirement for streamlined trauma workflows. These findings highlight the requirement for continuous trauma system improvement, including protocol optimization and timely access to imaging and surgical intervention. Full article

(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)

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16 pages, 743 KB

Open AccessArticle

Morbidity and Mortality Trends in Preterm Neonates at the Limits of Viability: Retrospective Observations from One Greek Hospital

by Dimitra Maria Apostolidi, Maria Kapetanidi, Eleni Vretou, Antigoni Sarantaki, Katerina Lykeridou, Grigorios Karampas, Athina Diamanti, Maria Vlachou, Nikoleta Pantelaki, Anna Deltsidou, Christina Nanou, Stavroula Charoni, Panagiota Katti, Aikaterini Fotiou, Iraklis Salvanos and Dimitra Metallinou

Life 2025, 15(5), 708; https://doi.org/10.3390/life15050708 - 27 Apr 2025

Cited by 1 | Viewed by 1290

Abstract

The survival and health outcomes of extremely preterm neonates (PNs) remain a critical challenge in neonatal intensive care. This 5-year retrospective, observational study evaluated morbidity and mortality trends in PNs born at the limits of viability and identified survival patterns and associated risk factors. It was conducted from 2017 to 2022 on a dataset of PNs born between 22 + 0 and 26 + 0 weeks of gestation in a tertiary public hospital in Greece. A total of 73 PNs were included. The mortality rate was 56.2%. The median gestational age was 24.3 weeks, and the mean birth weight was 603.6 g. Survival improved significantly with a higher gestational age and birth weight. Respiratory distress syndrome was the most prevalent morbidity (71–94%), followed by late-onset sepsis (35.3%) and patent ductus arteriosus (29.4%). The use of antenatal corticosteroids and enteral feeding were associated with improved survival rates. Survivors required prolonged respiratory support and demonstrated better outcomes with early and adequate nutritional support. We conclude that the gestational age, birth weight, and effective respiratory and nutritional interventions are critical determinants of survival in neonates at the limits of viability. Enhancing neonatal care protocols with targeted interventions, such as antenatal corticosteroid use and evidence-based nutritional practices, could significantly improve outcomes in this vulnerable population. Full article

(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)

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8 pages, 221 KB

Open AccessArticle

Target-Controlled Sedation with Propofol Infusion for PEG-J Placement in Advanced Parkinson’s Disease: A Prospective Observational Study on Safety and Feasibility

by Janos Szederjesi, Irina Săplăcan, Alexandra Lazăr, Matild Keresztes, Georgiana-Mihaela Muller-Șerban, Jozsef Attila Szasz and Bianca Liana Grigorescu

Life 2025, 15(3), 492; https://doi.org/10.3390/life15030492 - 18 Mar 2025

Cited by 2 | Viewed by 681

Abstract

Introduction: The management of sedation during percutaneous endoscopic gastrojejunostomy (PEG-J) placement in patients with advanced Parkinson’s disease (PD) is challenging due to the complex interactions between PD treatment, anesthetic agents, and the disease’s motor and non-motor symptoms. This study evaluates the effectiveness and safety of a target-controlled infusion (TCI) propofol protocol in the context of PEG-J placement in advanced PD patients. Materials and Methods: This prospective study included 169 patients diagnosed with advanced Parkinson’s disease (Hoehn and Yahr stages 4 and 5) who underwent PEG-J placement at Târgu Mureș County Emergency Clinical Hospital, Romania. Sedation was induced and maintained using TCI propofol, with additional benzodiazepines and short-acting opioids, while muscle relaxants were not used. Procedural success rates and adverse outcomes were assessed for 30 days post-procedure. Results: The sedation protocol demonstrated a high procedural success rate. No deaths were reported within 30 days post-procedure. Conclusion: This study highlights the feasibility and clinical applicability of a TCI propofol protocol for PEG-J placement in patients with advanced PD (stages 4 and 5). While no deaths were recorded within the 30-day follow-up, the sample size is insufficient to draw definitive conclusions regarding long-term safety. Full article

(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)

13 pages, 1201 KB

Open AccessArticle

Fluid Resuscitation and Initial Management in Patients Presenting with Sepsis in the General Ward

by Sung Won Chang, Juwhan Choi, Jee Youn Oh, Young Seok Lee, Kyung Hoon Min, Gyu Young Hur, Sung Yong Lee, Jae Jeong Shim and Jae Kyeom Sim

Life 2025, 15(1), 124; https://doi.org/10.3390/life15010124 - 18 Jan 2025

Viewed by 1482

Abstract

The optimal management of hospital-presenting sepsis remains poorly understood. We investigated the initial management in patients presenting with sepsis in the general ward, the association between fluid resuscitation and clinical outcomes, and the factors affecting fluid resuscitation. A retrospective study was conducted on patients who presented with sepsis-induced hypotension in the general ward. Patients were divided into Less 30 (fluid resuscitation less than 30 mL/kg) and More 30 (fluid resuscitation 30 mL/kg or more) groups. Multivariable logistic regression analysis was performed. The median resuscitation fluid volume was 500 mL (9.2 mL/kg) and 2000 mL (35.9 mL/kg) in the Less 30 (n = 79) and More 30 (n = 11) groups, respectively. The intensive care unit (ICU) mortality was similar between the two groups (43.0% vs. 45.5%). Twenty-two patients received continuous renal replacement therapy (CRRT) in the Less 30 group, whereas none received it in the More 30 group (27.8% vs. 0%). Fluid resuscitation ≥30 mL/kg was not associated with ICU mortality. Low body weight and systolic blood pressure were associated with fluid resuscitation ≥30 mL/kg. Most hospital-presenting sepsis patients received less than 30 mL/kg of fluid, and fluid resuscitation was not associated with ICU mortality. Full article

(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)

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Review

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13 pages, 2522 KB

Open AccessReview

Vein of Galen Malformation—Experience of the Last 13 Years in a Reference Center from South-Eastern Europe

by Ana Mihaela Bizubac, Maria Alexandra Fleaca, Mariana Carmen Herișeanu, Carmina Nedelcu, Alexandra Bratu, Veronica Marcu, Cristina Filip and Cătălin Cîrstoveanu

Life 2025, 15(10), 1536; https://doi.org/10.3390/life15101536 - 30 Sep 2025

Abstract

The vein of Galen malformations (VoGMs) is mainly correlated with the retention of an embryonic pattern of vascularity, inducer of vein of Galen dilation, and formation of arteriovenous communications that give rise to the risk of systemic shunting, causing cardiac dysfunction, vascular steal, and venous hypertension. This is a rare cerebral vascular malformation in the newborn, accounting for 1% of all cerebral arteriovenous malformations and occurring in approximately 1 in 25,000–50,000 live births. We review nine cases of newborns diagnosed with vein of Galen malformations (VoGMs) to assess whether this pathology demonstrates a marked improvement over the past 13 years in diagnostic accuracy, treatment approaches, and patient survival rates within our clinic. Medical treatment was focused on providing inotropic support and tightly controlled peripheral and pulmonary vasodilation with the aim of overriding the effects of high output heart failure. Most of the patients underwent liver failure and flow-mediated pulmonary hypertension, while half of the newborns expressed anomalies of the nervous system due to impaired cerebral hemodynamics. Given the unavailability of endovascular treatment in our unit, which predisposes the newborns to a higher vital risk, we recognize the importance of delivering tailored intensive care aimed at maintaining cardiorespiratory and hemodynamic stability until a curative intervention can be performed in a specialized center. Full article

(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)

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17 pages, 1223 KB

Open AccessReview

Diagnostic and Therapeutic Particularities of Sepsis in Hemodialysis Patients

by Maria-Daniela Tanasescu, Andrei-Mihnea Rosu, Alexandru Minca, Andreea-Liana Rosu, Maria-Mihaela Grigorie, Delia Timofte and Dorin Ionescu

Life 2025, 15(9), 1488; https://doi.org/10.3390/life15091488 - 22 Sep 2025

Viewed by 126

Abstract

Background: Sepsis is a leading cause of morbidity and mortality among patients receiving maintenance hemodialysis (HD), reflecting a unique combination of immunologic dysfunction, comorbidities, and healthcare-related exposures. Despite advances in dialysis technology and infection control, outcomes for septic HD patients remain disproportionately poor. Objective: This review aims to synthesize current evidence on the epidemiology, risk factors, diagnostic challenges, and treatment considerations of sepsis in HD patients, highlighting persistent vulnerabilities and areas for clinical improvement. Methods: A structured narrative review was conducted, focusing on high-quality cohort studies, surveillance data, and pharmacologic analyses published over the past two decades. The literature search was performed using PubMed, Web of Science, and Google Scholar. A total of 37 studies were included in the final synthesis. Key themes were organized around epidemiologic trends, infection sources, risk modifiers, treatment outcomes, and antimicrobial considerations in the dialysis population. Results: The review found that sepsis in HD patients is multifactorial and systemic. Diabetes, advanced age, and central venous catheters remain strong risk factors, while a substantial proportion of infections arise from non-access-related sources. Mortality rates remain high, often due to delays in recognition, inappropriate empiric therapy, and challenges in antimicrobial dosing. Pharmacokinetic alterations in renal replacement therapy complicate treatment, requiring individualized approaches. Despite variations in infection rates across centers, systemic vulnerabilities—rather than dialysis modality alone—drive outcomes. Conclusions: Sepsis in hemodialysis patients is not solely a hardware-related complication but reflects deeper systemic and immunologic challenges. Improving outcomes will require earlier recognition, tailored antimicrobial strategies, standardized infection control protocols, and broader attention to patient-specific risk factors. Future research should focus on ESRD-adapted sepsis diagnostics and interventional models to reduce infection-related mortality in this high-risk group. Full article

(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)

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17 pages, 957 KB

Open AccessReview

A New Perspective on Overfeeding in the Intensive Care Unit (ICU): Challenges, Dangers and Prevention Methods

by Vlad-Dimitrie Cehan, Alina-Roxana Cehan, Mihai Claudiu Pui and Alexandra Lazar

Life 2025, 15(5), 828; https://doi.org/10.3390/life15050828 - 21 May 2025

Viewed by 4087

Abstract

Overfeeding, currently defined as providing excessive energy and nutrients beyond metabolic requirements, is a common yet often overlooked issue in the intensive care unit (ICU) setting. Understanding the factors contributing to overfeeding and implementing strategies to prevent it is essential for optimizing patient care in the ICU. Several factors contribute to overfeeding in the ICU, including inaccurate estimation of energy requirements, formulaic feeding protocols, and failure to adjust nutritional support based on individual patient needs. Prolonged overfeeding can lead to insulin resistance and hepatic dysfunction, exacerbating glycemic control, increasing the risk of infectious complications, and worsening clinical outcomes. Clinically, overfeeding has been linked to delayed weaning from mechanical ventilation, prolonged ICU stay, and increased mortality rates. Regular review and adjustment of feeding protocols, incorporating advances in enteral and parenteral nutrition strategies, are essential for improving patient outcomes. Clinicians must be proficient in interpreting metabolic data, understanding the principles of energy balance, and implementing appropriate feeding algorithms. Interdisciplinary collaboration among critical care teams, including dieticians, physicians, and nurses, is crucial for ensuring consistent and effective nutritional management. Overfeeding remains a significant concern in the ICU after discharge as well, implying further complications for patient safety and integrity. By understanding the causes, consequences, and strategies for the prevention of overfeeding, healthcare providers can optimize nutrition therapy and mitigate the risk of metabolic complications. Through ongoing education, interdisciplinary collaboration, and evidence-based practice, the ICU community can strive to deliver personalized and precise nutritional support to critically ill patients. Full article

(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)

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Other

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13 pages, 908 KB

Open AccessCase Report

Too Late to Reverse: An Atypical Postpartum Case of Acute Necrotizing Pancreatitis with Refractory ARDS Despite ECMO Support

by Mihaly Veres, Sanziana Flamind Oltean, Sorin Pascanu, Mihaela Butiulca, Oana Elena Branea, Alexandra Elena Lazar and Bianca Liana Grigorescu

Life 2025, 15(9), 1347; https://doi.org/10.3390/life15091347 - 26 Aug 2025

Cited by 1 | Viewed by 597

Abstract

During pregnancy and in the postpartum period, several diseases may arise or become exacerbated. Acute pancreatitis incidence during pregnancy is similar to the general population but increases in the first two years after delivery. This case report describes the evolution of necrotizing acute pancreatitis in a 30-year-old woman five months postpartum, with an atypical debut of acute pancreatitis, where the high levels of triglycerides caused by hormonal changes in the late postpartum period overlapped with an underlying hyperlipemia. Despite aggressive, multidisciplinary care, including surgical necrosectomy, continuous renal replacement therapy (CRRT), protective ventilation, and venovenous extracorporeal membrane oxygenation (VV-ECMO), the prognosis was influenced by the hormonal changes both secondary to hypothalamic–pituitary–adrenal dysregulation and the postpartum hormonal changes, leading to an altered inflammatory response, evolution to MODS, ultimately resulting in death. The case highlights the complex interplay between postpartum immune and hormonal changes and the systemic inflammatory response of pancreatitis, emphasizing the critical need for postpartum-specific guidelines in managing acute pancreatitis, particularly regarding early risk stratification in order to prevent this pathology and its complications. Full article

(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)

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10 pages, 1847 KB

Open AccessCase Report

Methadone-Induced Toxicity—An Unexpected Challenge for the Brain and Heart in ICU Settings: Case Report and Review of the Literature

by Buzatu Georgiana Cristina, Sebastian Isac, Geani-Danut Teodorescu, Teodora Isac, Cristina Martac, Cristian Cobilinschi, Bogdan Pavel, Cristina Veronica Andreescu and Gabriela Droc

Life 2025, 15(7), 1084; https://doi.org/10.3390/life15071084 - 10 Jul 2025

Viewed by 658

Abstract

Introduction: Methadone, a synthetic opioid used for opioid substitution therapy (OST), is typically associated with arrhythmias rather than direct myocardial depression. Neurological complications, especially with concurrent antipsychotic use, have also been reported. Acute left ventricular failure in young adults is uncommon and often linked to genetic or infectious causes. We present a rare case of reversible cardiogenic shock and cerebellar insult due to methadone toxicity. Case Presentation: A 37-year-old man with a history of drug abuse on OST with methadone (130 mg/day) was admitted to the ICU with hemodynamic instability, seizures, and focal neurological deficits. Diagnostic workup revealed low cardiac output syndrome and a right cerebellar insult, attributed to methadone toxicity. The patient received individualized catecholamine support. After 10 days in the ICU, he was transferred to a general ward for ongoing cardiac and neurological rehabilitation and discharged in stable condition seven days later. Conclusions: Methadone-induced reversible left ventricular failure, particularly when accompanied by cerebellar insult, is rare but potentially life-threatening. Early recognition and multidisciplinary management are essential for full recovery in such complex toxicological presentations. Full article

(This article belongs to the Special Issue Critical Issues in Intensive Care Medicine)

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