EMB SEC 2 NOTES

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EMB SEC 2 NOTES
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  1. the cavity of a tubular organ or part
    lumen
  2. these have a lumen

    are creamy white in color

    have thick walls (lots of collagen)

    you can palpate

    vasovasorum can be seen (which must be removed from these)

    remain open when cut

    are usually empty of blood at death
    arteries
  3. these have a lumen

    are transparent but look bluish in color if engorged with blood

    have little collagen and collapse easily after death

    cannot be palpated

    vasovasorum is not visible

    close/collapse when cut

    usually have some blood or clotted material present after death
    veins
  4. these are solid structures comprised of tubular strands or cords

    are silvery white

    their solid structure can be palpated

    have no vasovasorum visible

    are solid when cut and the ends tend to fray

    have no blood present
    nerves
  5. a line drawn or visualized on the surface of the skin to represent the approximate location of some deeper-lying structure (such as an artery or vein)
    linear guide
  6. a descriptive reference for locating arteries and veins by means of anatomical structures, which are known
    anatomical guide
  7. points of origin and points of termination in relation to adjacent structures

    used to designate the boundaries of arteries
    anatomical limits

    anatomical extents
  8. the idealized location for an incision to be made through the subcutaneous layers of the skin, corresponding largely to the liner and anatomical guides of the desired vessel being raised
    place of incision
  9. These are the three most commonly used topographical areas

    anterior cervical triangle (ACT)

    axilla triangle

    femoral triangles
    These are the three most commonly used topographical areas

    anterior cervical triangle (ACT)

    axilla triangle

    femoral triangles
  10. located on each side of the neck

    medial border: along the midline of the neck between tip of mandible and sternum

    lateral borders: along the anterior margin of the sternocleidomastoid muscle

    superior border/base of triangle: along the lower margin of the body of the mandible

    MAJOR CONTENTS

    Common carotid artery

    Internal jugular vein

    Vagus nerve (smaller than artery)
  11. located in the armpit between the anterior and posterior axillary folds

    MAJOR CONTENTS

    axillary artery and its 6 branches

    axillary vein

    brachial plexus
    Axillary Triangle

  12. this is found in the axillary triangle

    a bundle of nerves that surround and partially obscure the axillary artery

    a network of the last four cervical and the first thoracic spinal nerves supplying the arm, forearm and hand
    brachial plexus
  13. this is found within the upper thigh

    base: along the inguinal ligament

    lateral: along the sartorius muscle

    medial: along the adductor longus muscle

    MAJOR CONTENTS

    femoral artery

    femoral vein

    femoral nerve
  14. Arteries of the head and neck

    common carotid artery

    facial artery
    Arteries of the head and neck

    common carotid artery

    facial artery
  15. An imaginary line extending from the sternoclavicular articulation to the anterior lobe of the ear
    common carotid linear guide artery
  16. the artery is located along the posterior medial aspect of the lower third of the sternocleidomastoid muscle
    common carotid anatomical guide
  17. anatomical limits of the RIGHT common carotid artery

    begins at the level of the sternoclavicular articulation

    terminates at the level of the superior border of the thyroid cartilage of the larynx
    anatomical limits of the RIGHT common carotid artery

    begins at the level of the sternoclavicular articulation

    terminates at the level of the superior border of the thyroid cartilage of the larynx
  18. anatomical limits of the LEFT common carotid artery

    begins at the level of the second costal cartilage

    terminates at the superior border of the thyroid cartilage of the larynx
    anatomical limits of the LEFT common carotid artery

    begins at the level of the second costal cartilage

    • terminates at the superior border of the thyroid cartilage of the larynx
  19. the left common carotid artery is located slightly deeper than the right common carotid artery
    the left common carotid artery is located slightly deeper than the right common carotid artery
  20. supraclavicular incision (aka anterior lateral) the transverse incision is made along the superior margin of the medial one-third of the clavicle

    located along the superior border of the clavicle

    medial one-third of the clavicle (preferred) (1/3 the distance from the sternoclavicular articulation moving laterally)

    middle one-third of the clavicle

    anterior vertical (anterior parallel: the incision is made from a point near the sternoclavicular articulation and is directed upward of sternocleidomastoid muscle

    posterior vertical (posterior parallel): the incision is made along the posterior border of the inferior (below) 1/3 of the sternocleidomastoid muscle

    anterior horizontal: the incision is made at the base of the neck from a point on the sternocleidomastoid muscle and is directed posteriorly

    TWO OTHER POSSIBLE INCISIONS HERE:

    strap-line incision

    half moon (semilunar) incision - extensive in nature/not recommended
    common carotid artery place of incision

  21. COMMON CAROTID PROS

    direct distribution to the face

    close to the center of venous drainage (can inject and drain from the same opening)

    close to the center of circulation

    face may possibly be embalmed by using restricted cervical injection (RCI) with mild solution while the remaining portions of the body can be injected with a stronger solution. Tie off both carotids and inject the body, then inject UP each carotid individually - LEFT first, then RIGHT

    the common carotid has no branches except its terminal branches

    there is no bifurcation into the internal carotid artery and the external carotid artery
    COMMON CAROTID CONS

    incision may be visible after dressing

    injection tubes may leave marks on the face

    face may be over-injected
  22. the accompanying vein for drainage when using the COMMON CAROTID ARTERY is the INTERNAL JUGULAR VEIN

    the veins relative location is lateral and superficial to the common carotid artery

    making the artery medial and deep in relation to the vein
    the accompanying vein for drainage when using the COMMON CAROTID ARTERY is the INTERNAL JUGULAR VEIN

    the veins relative location is lateral and superficial to the common carotid artery

    making the artery medial and deep in relation to the vein
  23. the facial artery is a branch of the external carotid artery

    it is good for embalming the lower facial areas not receiving fluid directly via the common carotid artery
    the facial artery is a branch of the external carotid artery

    it is good for embalming the lower facial areas not receiving fluid directly via the common carotid artery
  24. an imaginary line extending along the inferior border of the mandible just anterior to the angle of the mandible
    facial artery linear guide
  25. the artery is located along the inferior border of the mandible just anterior to the angle of the mandible

    the artery is along the inferior border of the mandible just anterior to the angle of the mandible, in the mandibular arc
    facial artery anatomical guide
  26. the transverse incision is made along the arc of the mandible
    facial artery place of incision
  27. Arteries of the upper extremity

    brachial

    radial

    ulnar
    Arteries of the upper extremity

    • brachial
    • radial

    • ulnar
  28. an imaginary line extending from the center of the base of the axillary space to the center of the forearm just below the bend of the elbow
    brachial artery linear guide
  29. the artery lies posterior to the medial border of the belly of the biceps brachii muscle

    the artery is located along the medial bicipital groove between the biceps brachii muscle and the triceps brachii mucle
    brachial artery anatomical guide
  30. anatomical limits of the brachial artery

    begins at the inferior border of the tendon of the teres major muscle

    terminates at the point just inferior to the antecubital fossa
    anatomical limits of the brachial artery

    begins at the inferior border of the tendon of the teres major muscle

    terminates at the point just inferior to the antecubital fossa
  31. the parallel incision is made in the upper third of the arm along the liner guide in the medial bicipital groove of the humerus

    the place of incision is along the linear guide
    brachial artery place of incision
  32. BRACHIAL ARTERY PROS

    close to the face

    close to the center of circulation

    close to the center of venous drainage

    vessels are relatively superficial
    BRACHIAL ARTERY CONS

    there is a danger of over-injecting the face, particularly if there is any obstruction present in the other trunk arteries of the body

    anomalies (a deviation from the normal) of both artery and vein are common

    if the arm is not reated properly, it will not appear natural when the body is placed in the casket

    there are numerous branches
  33. the accompanying vein for drainage when using the BRACHIAL ARTERY is the BASILIC VEIN

    there are also two brachial vena comitantes

    the vein's relative location is medial and superficial to the brachial artery
    the accompanying vein for drainage when using the BRACHIAL ARTERY is the BASILIC VEIN

    there are also two brachial vena comitantes

    the vein's relative location is medial and superficial to the brachial artery
  34. an imaginary line extending from the center of the antecubital fossa to the center of the base of the second digit

    an imaginary line extending from the antecubital fossa to a point at the base of the index finger or base of the thumb
    radial artery linear guide
  35. the artery is located just lateral ot the tendon of the flexor carpi radialis muscle and just medial to the tendon of the brachioradialis muscle
    radial artery anatomical guide
  36. the parallel incision is made just lateral to the tendon of the flexor carpi radialis muscle, a few inches above the wrist where the pulse is commonly taken
    radial artery place of incision
  37. there is no accompanying vein associated with the radial artery

    instead two vena comitantes are present which are too small to drain from
    there is no accompanying vein associated with the radial artery

    instead two vena comitantes are present which are too small to drain from
  38. an imaginary line extending from the center of the antecubital fossa to a point located midway between the fourth and fifth digits (third and fourth fingers)
    ulnar artery linear guide
  39. the artery is located lateral to the tendon of the flexor carpi ulnaris muscle and medial to the tendon of the flexor digitorum superfacialis muscle
    ulnar artery anatomical guide
  40. the parallel incision is made (along the linear guide) between the tendons of the flexor caripi ulnaris muscle and the flexor digirotum superfacialis muscle, a few inches above the wrist
    ulnar artery place of incision
  41. there is no accompanying vein associated with the ulnar artery

    instead two vena comitantes are present which are too small to drain from
    there is no accompanying vein associated with the ulnar artery

    instead two vena comitantes are present which are too small to drain from
  42. Arteries of the trunk

    axillary

    common iliac

    externarl iliac

    internal iliac
    Arteries of the trunk

    axillary

    common iliac

    externarl iliac

    internal iliac
  43. an imaginary line extending thrugh the center of the base of the axillary space, parallel to the long axis of the abducted upper extremity

    an imaginary line extending from the base of the aillary space parallel to the long axis of the abducted upper extremity
    axillary artery linear guide
  44. the artery is located posteriror to the medial border of the coracobrachialis muscle
    axillary artery anatomical guide
  45. anatomical limits of the axillary artery

    begins at the lateral border of the first rib

    terminates at the inferior border of the tendon of the teres major muscle
    anatomical limits of the axillary artery

    begins at the lateral border of the first rib

    terminates at the inferior border of the tendon of the teres major muscle
  46. the parallel incision is made along the anterior hairline of the axilla

    the parallel incision is made along the anterior hairline of the axilla, within the axillary space
    axillary artery place of incision
  47. AXILLARY ARTERY PROS

    close to the face

    close to the center of circulation

    close to the center of venous drainage

    vessels are relatively superficial
    AXILLARY ARTERY CONS

    there is a dnager of over-injecting the face, particularly if there is an obstruction present in the other trunk arteries of the body

    anomalies of both the artery and vein are common

    if the arm is not treated properly, it will not appear natural when the body is placed in the casket

    there are numerous branches
  48. the accompanying vein for drainage when using the AXILLARY ARTERY is the AXILLARY VEIN

    the vein's relative location is medial and superficial to the axillary artery
    the accompanying vein for drainage when using the AXILLARY ARTERY is the AXILLARY VEIN

    the vein's relative location is medial and superficial to the axillary artery
  49. anatomical limits of the common iliac artery

    the common iliac artery is one of the terminal branches of the abdominal aorta
    anatomical limits of the common iliac artery

    the common iliac artery is one of the terminal branches of the abdominal aorta
  50. the accompanying vein of the COMMON ILIAC ARTERY is the COMMON ILIAC VEIN
    the accompanying vein of the COMMON ILIAC ARTERY is the COMMON ILIAC VEIN
  51. the EXTERNAL ILIAC ARTERY is a branch of the COMMON ILIAC ARTERY

    as the external iliac artery passes through the inguinal ligament it becomes the femoral artery
    the EXTERNAL ILIAC ARTERY is a branch of the COMMON ILIAC ARTERY

    as the external iliac artery passes through the inguinal ligament it becomes the femoral artery
  52. an imaginary line extending upward from the linear guide of the femoral artery
    external iliac artery linear guide
  53. the artery is located (lies) along the medial border of the psoas major muscle
    external iliac artery anatomical guide
  54. except in the case of obesity, normally there is not an incision made on the surface of the skin. The artery is injected from within the abdominal cavity of an autopsied body
    external iliac anatomical guide
  55. the accompanying vein of the EXTERNAL ILIAC ARTERY is the EXTERNAL ILIAC VEIN
    the accompanying vein of the EXTERNAL ILIAC ARTERY is the EXTERNAL ILIAC VEIN
  56. the INTERNAL ILIAC ARTERY is another branch of the common iliac artery

    it passes through the pelvic area
    the INTERNAL ILIAC ARTERY is another branch of the common iliac artery

    it passes through the pelvic area
  57. the accompanying vein of the INTERNAL ILIAC ARTERY is the INTERNAL ILIAC VEIN
    the accompanying vein of the INTERNAL ILIAC ARTERY is the INTERNAL ILIAC VEIN
  58. Arteries of the lower extremity

    femoral

    popliteal

    anterior tibial

    posterior tibial

    dorsalis pedis
    Arteries of the lower extremity

    femoral

    popliteal

    anterior tibial

    posterior tibial

    dorsalis pedis
  59. an imaginary line extending from the center of the inguinal ligament ot the medial margin of the condyle of the femur
    femoral artery linear guide
  60. the artery courses through the center of the femoral triangle. the artery is bounded laterally by the sartorious muscle and medially by the adductor longus muscle
    femoral artery anatomical guide
  61. anatomical limits of the femoral artery

    begins at a point posetiror to the center of the inguinal ligament

    terminates at the opening in the adductor magnus muscle
    anatomical limits of the femoral artery

    begins at a point posetiror to the center of the inguinal ligament

    terminates at the opening in the adductor magnus muscle
  62. the parallel incision is made along the linear guide about one-third the distance from the pubis symphisis to the anterior superior spine of the iliac crest, a few inches below the inguinal ligament

    ...along the linear portion of the superior two-thirds of the linear guide
    femoral artery place of incision
  63. FEMORAL ARTERY PROS

    it is large in diametric size

    the lower portion of the body can be embalmed without concern of distention of the face

    provides even fluid distribution to both sides of the face
    FEMORAL ARTERY CONS

    vessels are deep-seated in obese cases

    drainage is sometimes difficult to establish and maintain

    this is the first site where arteriosclirosis develops which happens more here than in the common carotid
  64. the accompanying vein for drainage when using the FEMORAL ARTERY is the FEMORAL VEIN

    generally, the vein is medial and deep with its relative location medial to the femoral artery at the inguinal ligament and progressing to immediately posterior to the femoral artery at the apex of the femoral triangle

    the artery is lateral and superficial

    this is the opposite relationship between the common carotid and internal jugular being opposite of this
    the accompanying vein for drainage when using the FEMORAL ARTERY is the FEMORAL VEIN

    generally, the vein is medial and deep with its relative location medial to the femoral artery at the inguinal ligament and progressing to immediately posterior to the femoral artery at the apex of the femoral triangle

    the artery is lateral and superficial

    this is the opposite relationship between the common carotid and internal jugular being opposite of this
  65. an imaginary line extending through the center of the popliteal space (back of the knee) parallel to the long axis of the lower extremity
    popliteal artery linear guide
  66. the artery courses throught he center of the popliteal space
    popliteal artery anatomical guide
  67. anatomical limits of the popliteal artery

    begins at the opening of the adductor magnus muscle

    terminates at the inferior border of the popliteus muscle
    anatomical limits of the popliteal artery

    begins at the opening of the adductor magnus muscle

    terminates at the inferior border of the popliteus muscle
  68. the parallel incision is made on the posteromedial aspect of the lower third of the thigh, just superior to the popliteal space
    popliteal artery place of incision
  69. an imaginary line extending from the lateral border of the patella to the center of the anterior ankle joint
    anterior tibial artery linear guide
  70. the artery is located along the lateral border of the crest of the tibia
    anterior tibial artery anatomical guide
  71. the parallel incision is made along the linear guide lateral ot the tibial crest in the lower third of the foreleg
    anterior tibial artery place of incision
  72. anatomical limits of the anterior tibial artery

    terminates at the dorsalis pedis artery
    anatomical limits of the anterior tibial artery

    terminates at the dorsalis pedis artery
  73. there is no accompanying vein associated with the anterior tibial artery

    while the anterior tibial vein is found close to the knee, only small vena comitantes are found at our incision site
    there is no accompanying vein associated with the anterior tibial artery

    while the anterior tibial vein is found close to the knee, only small vena comitantes are found at our incision site
  74. an imaginary line extending from the center of the popliteal space to a point midway between the medial maleolus and the calcaneus bone
    posterior tibial artery linear guide
  75. the artery is located midway between the medial maleolus and the calcaneal tendon
    posterior tibial artery anatomical guide
  76. the parallel or transverse incision is made midway between the medial maleolus and the calcaneal tendon
    posteiror tibial artery place of incision
  77. there is no accompanying vein associaed with the posterior tibial artery

    there is a posterior tibial vein found close to the knee but it does not continue to our incision site

    instead there are only small vena comitantes at the location where the vessel is raised making drainage from this site impractical
    there is no accompanying vein associaed with the posterior tibial artery

    there is a posterior tibial vein found close to the knee but it does not continue to our incision site

    instead there are only small vena comitantes at the location where the vessel is raised making drainage from this site impractical
  78. an imaginary line extending from the center of the anterior ankle joint to a point midway between the first toe and the adjacent toe (big toes count as toes making 5 per foot)
    dorsalis pedis artery linear guide
  79. the artery is located lateral to the tendon of the extensor hallicus longus muscle (the tendon for the big toe
    dorsalis pedis artery anatomical guide
  80. the parallel incision is made along the superior one-third of the linear guide just lateral to the tendon of the extensor hallicus longus muscle
    dorsalis pedis artery place of incision
  81. there is no accompanying vein for drainage associated with the dorsalis pedis artery

    instead vena comitantes are present, thus making the drainage from this site impractical
    there is no accompanying vein for drainage associated with the dorsalis pedis arteryinstead vena comitantes are present, thus making the drainage from this site impractical
  82. Other arteries

    subclavian

    brachiocephalic

    aorta
    Other arteries

    subclavian

    brachiocephalic

    aorta
  83. the clavicle (collarbone)
    subclavian artery anatomical guide
  84. anatomical limits of the RIGHT subclavian artery

    begins at the sternoclavicular articulation

    terminates at the lateral border of the first rib
    anatomical limits of the RIGHT subclavian artery

    begins at the sternoclavicular articulation

    terminates at the lateral border of the first rib
  85. anatomical limits of the LEFT subclavian artery

    begins at the level of the second costal cartilage

    terminates at the lateral border of the first rib
    anatomical limits of the LEFT subclavian artery

    begins at the level of the second costal cartilage

    terminates at the lateral border of the first rib
  86. BRACHIOCEPHALIC ARTERY

    aka innominate artery

    only one artery exists

    it arises directly from the arch of the aorta to the right

    there is no left brachiocephalic artery even though there is a left brachiocephalic vein
    BRACHIOCEPHALIC ARTERY

    aka innominate artery

    only one artery exists

    it arises directly from the arch of the aorta to the right

    there is no left brachocephalic artery even though there is a left brachiocephalic vein
  87. the accompanying vein is for the BRACHICEPHALIC ARTERY is the RIGHT BRACHIOCEPHALIC VEIN

    even though a left brachiocephalic vein exist it does not have an accompanying artery
    the accompanying vein is for the BRACHICEPHALIC ARTERY is the RIGHT BRACHIOCEPHALIC VEIN

    even though a left brachiocephalic vein exist it does not have an accompanying artery
  88. AORTA

    It is divided into three sections

    1) ascending aorta

    2) arch of aorta

    3) descending aorta (this has two divisions)
    AORTA

    It is divided into three sections

    1) ascending aorta

    2) arch of aorta

    3) descending aorta (this has two divisions)
  89. ascending aorta

    first section of the aorta

    the inital portion of the aorta

    it leaves the heart's left ventricle (lower chamber)

    it can be used for embalming an infant
    ascending aorta

    first section of the aorta

    the inital portion of the aorta it leaves the heart's left ventricle (lower chamber)

    it can be used for embalming an infant
  90. arch of aorta

    the curved cener part
    arch of aorta

    the curved cener part
  91. descending aorta

    divided into two sections/subsections (thoracic/abdominal)

    it can be used as a point of arterial injection for an adult in cases where a partial autopsy has been performed
    descending aorta

    divided into two sections/subsections (thoracic/abdominal)

    it can be used as a point of arterial injection for an adult in cases where a partial autopsy has been performed
  92. thoracic aorta

    the portion of the descending aorta from the arch to the diaphragm
    abdominal aorta

    the portion of the descending aorta below the diaphragm

    this also can be used form embalming an infant
  93. the accompanying vein for the AORTA is the SUPERIOR VENA CAVA which drains blood from the UPPER portion of the body

    it empties into the heart's right atrium (upper chamber)
    the accompanying vein for the AORTA is the INFERIOR VENA CAVA which drains blood from the LOWER portion of the body

    it empties into the right atrium

    located below the diaphragm to the right of the abdominal aorta
  94. Considerations and precautions for each artery are based upon each vessel's pros and cons associated with it

    1) accessibility

    2) arterial occlusion
    Considerations and precautions for each artery are based upon each vessel's pros and cons associated with it

    1) accessibility

    2) arterial occlusion
  95. Considerations - accessability

    1) superficial is easier to get to or access

    2) will any other structures be in the way?

    3) the closer to the aorta the better to imitate blood flow (circulation) during life

    4) the larger the artery, the better for injection results, plus bigger size/ease of arterial tube insertion

    5) can you achieve a desirable position for the body during embalming? it is best to imitate the final position for viewing buring injection

    6) will your incisions be exposed after dressing the body?

    7) practicability of draining from corresponding veins - are there major veins or 2 vena comitantes? vena comitantes will not produce adequate drainage fro the entire body
    Considerations - arterial occlusion

    when this occurs, the artery's lumen is blocked and fluid cannot pass through

    the embalmer generally needs to access a major artery beyond the blockage

    last resort is to hypodermically inject the tissue by using a small trocar and apply a topical preservative
  96. other factors governing selection of arteries to be used for injection

    age: adult v infant - size of vessels

    sex: if using common carotid arteries for females, consider clothing neckline

    weight: vessels tend to be deeper and smaller on obese cases making drainage difficult

    fat distribution: will vessels be excessively deep?

    disfigurations: arthritis - do not break joints or tumors - may put pressure on vessels or be in the way

    disease: may make it difficult to access some vessels

    edema: may present the problem of leaking incisions, suturing may be difficult

    location obstruction/congestion: will possibly effect distribution

    trauma: the following may produce a break in the vascular system. perform a case by case analysis. severed arteries may be clamped, use common carotid then secondary points of injection. mutilation/accidents/surgery

    medico-legal requirements: autopsy protocol - use multiple point injection technique. medical examiner/coroner - may delay embalming process

    cause of death: perform a case by case analysis

    manner of death: perform a case by case analysis
    proper technique for raising vessels

    shave the area if necessary; trapped hair can cause leakage

    select instruments and prepare ligature

    locate place of incision using the appropriate linear guide for the vessel

    make proper incision through skin, superficial fascia and deep fascia

    use blunt dissection through superficial fascia, fat deep fascia. use aneurysm needles (hooks) for this procedure. undercutting allows you to open your incision wider

    find vessels by use of anatomical guide and relative position of vein

    clean off by blunt dissection and ligate artery and vein loosely

    make incision in vessels: be careful not to cut the vessel in half. support the vessel underneath by using a separator
  97. most common incision, cut from the center straight out to one edge of the vessels
    transverse
  98. cut from the center at an angle out to one edge of the vessel
    diagonal
  99. cut along the length of the vessel. often used to open veins, but not recommmended for sclerotic arteries
    longitudinal
  100. a combination of the transverse and longitudinal incisions
    t-incision & double t-incision
  101. two diagonal incisions

    not recommended for sclerotic arteries
    triangular

    wedge
  102. longitudinal incision is not good to use for sclerotic vessels because...

    if an artery has been compromised by sclerotic deposits from within the lumen, a longitudinal incision tends to make insertion of the arterial tube more difficult as the layers of deposits “cave-in” and block insertion

    the lumen of a sclerotic artery tends to stay open better using a diagonal or transverse incision (less “cave-in”)
    longitudinal incision is not good to use for sclerotic vessels because...

    if an artery has been compromised by sclerotic deposits from within the lumen, a longitudinal incision tends to make insertion of the arterial tube more difficult as the layers of deposits “cave-in” and block insertion

    the lumen of a sclerotic artery tends to stay open better using a diagonal or transverse incision (less “cave-in”)

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