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1. Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort

Author

Wendel Garcia, P, Aguirre-Bermeo, H, Buehler, P, Alfaro-Farias, M, Yuen, B, David, S, Tschoellitsch, T, Wengenmayer, T, Korsos, A, Fogagnolo, A, Kleger, G, Wu, M, Colombo, R, Turrini, F, Potalivo, A, Rezoagli, E, Rodriguez-Garcia, R, Castro, P, Lander-Azcona, A, Martin-Delgado, M, Lozano-Gomez, H, Ensner, R, Michot, M, Gehring, N, Schott, P, Siegemund, M, Merki, L, Wiegand, J, Jeitziner, M, Laube, M, Salomon, P, Hillgaertner, F, Dullenkopf, A, Ksouri, H, Cereghetti, S, Grazioli, S, Burkle, C, Marrel, J, Fleisch, I, Perez, M, Baltussen Weber, A, Ceruti, S, Marquardt, K, Hubner, T, Redecker, H, Studhalter, M, Stephan, M, Selz, D, Pietsch, U, Ristic, A, Heise, A, Meyer zu Bentrup, F, Franchitti Laurent, M, Fodor, P, Gaspert, T, Haberthuer, C, Colak, E, Heuberger, D, Fumeaux, T, Montomoli, J, Guerci, P, Schuepbach, R, Hilty, M, Roche-Campo, F, Algaba-Calderon, A, Apolo, J, Aslanidis, T, Babik, B, Boroli, F, Brem, J, Brenni, M, Brugger, S, Camen, G, Catena, E, Ceriani, R, Chau, I, Christ, A, Cogliati, C, Concha, P, Delahaye, G, Drvaric, I, Escos-Orta, J, Fabbri, S, Facondini, F, Filipovic, M, Gamez-Zapata, J, Gerecke, P, Gommers, D, Hillermann, T, Ince, C, Jenni-Moser, B, Jovic, M, Jurkolow, G, Klarer, A, Lambert, A, Laurent, J, Lavanchy, J, Lienhardt-Nobbe, B, Locher, P, Losser, M, Lussman, R, Magliocca, A, Margarit, A, Martinez, A, Mauri, R, Mayor-Vazquez, E, Meier, J, Moret-Bochatay, M, Murrone, M, Naon, D, Neff, T, Novy, E, Petersen, L, Pugin, J, Ramelet, A, Rilinger, J, Rimensberger, P, Sepulcri, M, Shaikh, K, Sieber, M, Simonini, M, Spadaro, S, Sridharan, G, Stahl, K, Staudacher, D, Taboada-Fraga, X, Tellez, A, Urech, S, Vitale, G, Vizmanos-Lamotte, G, Welte, T, Zalba-Etayo, B, Zellweger, N, Wendel Garcia P. D., Aguirre-Bermeo H., Buehler P. K., Alfaro-Farias M., Yuen B., David S., Tschoellitsch T., Wengenmayer T., Korsos A., Fogagnolo A., Kleger G. -R., Wu M. A., Colombo R., Turrini F., Potalivo A., Rezoagli E., Rodriguez-Garcia R., Castro P., Lander-Azcona A., Martin-Delgado M. C., Lozano-Gomez H., Ensner R., Michot M. P., Gehring N., Schott P., Siegemund M., Merki L., Wiegand J., Jeitziner M. M., Laube M., Salomon P., Hillgaertner F., Dullenkopf A., Ksouri H., Cereghetti S., Grazioli S., Burkle C., Marrel J., Fleisch I., Perez M. -H., Baltussen Weber A., Ceruti S., Marquardt K., Hubner T., Redecker H., Studhalter M., Stephan M., Selz D., Pietsch U., Ristic A., Heise A., Meyer zu Bentrup F., Franchitti Laurent M., Fodor P., Gaspert T., Haberthuer C., Colak E., Heuberger D. M., Fumeaux T., Montomoli J., Guerci P., Schuepbach R. A., Hilty M. P., Roche-Campo F., Algaba-Calderon A., Apolo J., Aslanidis T., Babik B., Boroli F., Brem J., Brenni M., Brugger S. D., Camen G., Catena E., Ceriani R., Chau I., Christ A., Cogliati C., Concha P., Delahaye G., Drvaric I., Escos-Orta J., Fabbri S., Facondini F., Filipovic M., Gamez-Zapata J., Gerecke P., Gommers D., Hillermann T., Ince C., Jenni-Moser B., Jovic M., Jurkolow G., Klarer A., Lambert A., Laurent J. -C., Lavanchy J., Lienhardt-Nobbe B., Locher P., Losser M. -R., Lussman R. F., Magliocca A., Margarit A., Martinez A., Mauri R., Mayor-Vazquez E., Meier J., Moret-Bochatay M., Murrone M., Naon D., Neff T., Novy E., Petersen L., Pugin J., Ramelet A. -S., Rilinger J., Rimensberger P. C., Sepulcri M., Shaikh K., Sieber M., Simonini M. S., Spadaro S., Sridharan G. O., Stahl K., Staudacher D. L., Taboada-Fraga X., Tellez A., Urech S., Vitale G., Vizmanos-Lamotte G., Welte T., Zalba-Etayo B., Zellweger N., Wendel Garcia, P, Aguirre-Bermeo, H, Buehler, P, Alfaro-Farias, M, Yuen, B, David, S, Tschoellitsch, T, Wengenmayer, T, Korsos, A, Fogagnolo, A, Kleger, G, Wu, M, Colombo, R, Turrini, F, Potalivo, A, Rezoagli, E, Rodriguez-Garcia, R, Castro, P, Lander-Azcona, A, Martin-Delgado, M, Lozano-Gomez, H, Ensner, R, Michot, M, Gehring, N, Schott, P, Siegemund, M, Merki, L, Wiegand, J, Jeitziner, M, Laube, M, Salomon, P, Hillgaertner, F, Dullenkopf, A, Ksouri, H, Cereghetti, S, Grazioli, S, Burkle, C, Marrel, J, Fleisch, I, Perez, M, Baltussen Weber, A, Ceruti, S, Marquardt, K, Hubner, T, Redecker, H, Studhalter, M, Stephan, M, Selz, D, Pietsch, U, Ristic, A, Heise, A, Meyer zu Bentrup, F, Franchitti Laurent, M, Fodor, P, Gaspert, T, Haberthuer, C, Colak, E, Heuberger, D, Fumeaux, T, Montomoli, J, Guerci, P, Schuepbach, R, Hilty, M, Roche-Campo, F, Algaba-Calderon, A, Apolo, J, Aslanidis, T, Babik, B, Boroli, F, Brem, J, Brenni, M, Brugger, S, Camen, G, Catena, E, Ceriani, R, Chau, I, Christ, A, Cogliati, C, Concha, P, Delahaye, G, Drvaric, I, Escos-Orta, J, Fabbri, S, Facondini, F, Filipovic, M, Gamez-Zapata, J, Gerecke, P, Gommers, D, Hillermann, T, Ince, C, Jenni-Moser, B, Jovic, M, Jurkolow, G, Klarer, A, Lambert, A, Laurent, J, Lavanchy, J, Lienhardt-Nobbe, B, Locher, P, Losser, M, Lussman, R, Magliocca, A, Margarit, A, Martinez, A, Mauri, R, Mayor-Vazquez, E, Meier, J, Moret-Bochatay, M, Murrone, M, Naon, D, Neff, T, Novy, E, Petersen, L, Pugin, J, Ramelet, A, Rilinger, J, Rimensberger, P, Sepulcri, M, Shaikh, K, Sieber, M, Simonini, M, Spadaro, S, Sridharan, G, Stahl, K, Staudacher, D, Taboada-Fraga, X, Tellez, A, Urech, S, Vitale, G, Vizmanos-Lamotte, G, Welte, T, Zalba-Etayo, B, Zellweger, N, Wendel Garcia P. D., Aguirre-Bermeo H., Buehler P. K., Alfaro-Farias M., Yuen B., David S., Tschoellitsch T., Wengenmayer T., Korsos A., Fogagnolo A., Kleger G. -R., Wu M. A., Colombo R., Turrini F., Potalivo A., Rezoagli E., Rodriguez-Garcia R., Castro P., Lander-Azcona A., Martin-Delgado M. C., Lozano-Gomez H., Ensner R., Michot M. P., Gehring N., Schott P., Siegemund M., Merki L., Wiegand J., Jeitziner M. M., Laube M., Salomon P., Hillgaertner F., Dullenkopf A., Ksouri H., Cereghetti S., Grazioli S., Burkle C., Marrel J., Fleisch I., Perez M. -H., Baltussen Weber A., Ceruti S., Marquardt K., Hubner T., Redecker H., Studhalter M., Stephan M., Selz D., Pietsch U., Ristic A., Heise A., Meyer zu Bentrup F., Franchitti Laurent M., Fodor P., Gaspert T., Haberthuer C., Colak E., Heuberger D. M., Fumeaux T., Montomoli J., Guerci P., Schuepbach R. A., Hilty M. P., Roche-Campo F., Algaba-Calderon A., Apolo J., Aslanidis T., Babik B., Boroli F., Brem J., Brenni M., Brugger S. D., Camen G., Catena E., Ceriani R., Chau I., Christ A., Cogliati C., Concha P., Delahaye G., Drvaric I., Escos-Orta J., Fabbri S., Facondini F., Filipovic M., Gamez-Zapata J., Gerecke P., Gommers D., Hillermann T., Ince C., Jenni-Moser B., Jovic M., Jurkolow G., Klarer A., Lambert A., Laurent J. -C., Lavanchy J., Lienhardt-Nobbe B., Locher P., Losser M. -R., Lussman R. F., Magliocca A., Margarit A., Martinez A., Mauri R., Mayor-Vazquez E., Meier J., Moret-Bochatay M., Murrone M., Naon D., Neff T., Novy E., Petersen L., Pugin J., Ramelet A. -S., Rilinger J., Rimensberger P. C., Sepulcri M., Shaikh K., Sieber M., Simonini M. S., Spadaro S., Sridharan G. O., Stahl K., Staudacher D. L., Taboada-Fraga X., Tellez A., Urech S., Vitale G., Vizmanos-Lamotte G., Welte T., Zalba-Etayo B., and Zellweger N.

Abstract

Background: Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates. Methods: Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups. Results: Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016). Conclusion: In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in

Published
2021

2. Machine learning using the extreme gradient boosting (XGBoost) algorithm predicts 5-day delta of SOFA score at ICU admission in COVID-19 patients

Author

Montomoli, J, Romeo, L, Moccia, S, Bernardini, M, Migliorelli, L, Berardini, D, Donati, A, Carsetti, A, Bocci, M, Wendel Garcia, P, Fumeaux, T, Guerci, P, Schupbach, R, Ince, C, Frontoni, E, Hilty, M, Alfaro-Farias, M, Vizmanos-Lamotte, G, Tschoellitsch, T, Meier, J, Aguirre-Bermeo, H, Apolo, J, Martinez, A, Jurkolow, G, Delahaye, G, Novy, E, Losser, M, Wengenmayer, T, Rilinger, J, Staudacher, D, David, S, Welte, T, Stahl, K, Pavlos, A, Aslanidis, T, Korsos, A, Babik, B, Nikandish, R, Rezoagli, E, Giacomini, M, Nova, A, Fogagnolo, A, Spadaro, S, Ceriani, R, Murrone, M, Wu, M, Cogliati, C, Colombo, R, Catena, E, Turrini, F, Simonini, M, Fabbri, S, Potalivo, A, Facondini, F, Gangitano, G, Perin, T, Grazia Bocci, M, Antonelli, M, Gommers, D, Rodriguez-Garcia, R, Gamez-Zapata, J, Taboada-Fraga, X, Castro, P, Tellez, A, Lander-Azcona, A, Escos-Orta, J, Martin-Delgado, M, Algaba-Calderon, A, Franch-Llasat, D, Roche-Campo, F, Lozano-Gomez, H, Zalba-Etayo, B, Michot, M, Klarer, A, Ensner, R, Schott, P, Urech, S, Zellweger, N, Merki, L, Lambert, A, Laube, M, Jeitziner, M, Jenni-Moser, B, Wiegand, J, Yuen, B, Lienhardt-Nobbe, B, Westphalen, A, Salomon, P, Drvaric, I, Hillgaertner, F, Sieber, M, Dullenkopf, A, Petersen, L, Chau, I, Ksouri, H, Sridharan, G, Cereghetti, S, Boroli, F, Pugin, J, Grazioli, S, Rimensberger, P, Burkle, C, Marrel, J, Brenni, M, Fleisch, I, Lavanchy, J, Perez, M, Ramelet, A, Weber, A, Gerecke, P, Christ, A, Ceruti, S, Glotta, A, Marquardt, K, Shaikh, K, Hubner, T, Neff, T, Redecker, H, Moret-Bochatay, M, Bentrup, F, Studhalter, M, Stephan, M, Brem, J, Gehring, N, Selz, D, Naon, D, Kleger, G, Pietsch, U, Filipovic, M, Ristic, A, Sepulcri, M, Heise, A, Franchitti Laurent, M, Laurent, J, Schuepbach, R, Heuberger, D, Buhler, P, Brugger, S, Fodor, P, Locher, P, Camen, G, Gaspert, T, Jovic, M, Haberthuer, C, Lussman, R, Colak, E, Montomoli J., Romeo L., Moccia S., Bernardini M., Migliorelli L., Berardini D., Donati A., Carsetti A., Bocci M. G., Wendel Garcia P. D., Fumeaux T., Guerci P., Schupbach R. A., Ince C., Frontoni E., Hilty M. P., Alfaro-Farias M., Vizmanos-Lamotte G., Tschoellitsch T., Meier J., Aguirre-Bermeo H., Apolo J., Martinez A., Jurkolow G., Delahaye G., Novy E., Losser M. -R., Wengenmayer T., Rilinger J., Staudacher D. L., David S., Welte T., Stahl K., Pavlos A., Aslanidis T., Korsos A., Babik B., Nikandish R., Rezoagli E., Giacomini M., Nova A., Fogagnolo A., Spadaro S., Ceriani R., Murrone M., Wu M. A., Cogliati C., Colombo R., Catena E., Turrini F., Simonini M. S., Fabbri S., Potalivo A., Facondini F., Gangitano G., Perin T., Grazia Bocci M., Antonelli M., Gommers D., Rodriguez-Garcia R., Gamez-Zapata J., Taboada-Fraga X., Castro P., Tellez A., Lander-Azcona A., Escos-Orta J., Martin-Delgado M. C., Algaba-Calderon A., Franch-Llasat D., Roche-Campo F., Lozano-Gomez H., Zalba-Etayo B., Michot M. P., Klarer A., Ensner R., Schott P., Urech S., Zellweger N., Merki L., Lambert A., Laube M., Jeitziner M. M., Jenni-Moser B., Wiegand J., Yuen B., Lienhardt-Nobbe B., Westphalen A., Salomon P., Drvaric I., Hillgaertner F., Sieber M., Dullenkopf A., Petersen L., Chau I., Ksouri H., Sridharan G. O., Cereghetti S., Boroli F., Pugin J., Grazioli S., Rimensberger P. C., Burkle C., Marrel J., Brenni M., Fleisch I., Lavanchy J., Perez M. -H., Ramelet A. -S., Weber A. B., Gerecke P., Christ A., Ceruti S., Glotta A., Marquardt K., Shaikh K., Hubner T., Neff T., Redecker H., Moret-Bochatay M., Bentrup F. Z., Studhalter M., Stephan M., Brem J., Gehring N., Selz D., Naon D., Kleger G. -R., Pietsch U., Filipovic M., Ristic A., Sepulcri M., Heise A., Franchitti Laurent M., Laurent J. -C., Schuepbach R., Heuberger D., Buhler P., Brugger S., Fodor P., Locher P., Camen G., Gaspert T., Jovic M., Haberthuer C., Lussman R. F., Colak E., Montomoli, J, Romeo, L, Moccia, S, Bernardini, M, Migliorelli, L, Berardini, D, Donati, A, Carsetti, A, Bocci, M, Wendel Garcia, P, Fumeaux, T, Guerci, P, Schupbach, R, Ince, C, Frontoni, E, Hilty, M, Alfaro-Farias, M, Vizmanos-Lamotte, G, Tschoellitsch, T, Meier, J, Aguirre-Bermeo, H, Apolo, J, Martinez, A, Jurkolow, G, Delahaye, G, Novy, E, Losser, M, Wengenmayer, T, Rilinger, J, Staudacher, D, David, S, Welte, T, Stahl, K, Pavlos, A, Aslanidis, T, Korsos, A, Babik, B, Nikandish, R, Rezoagli, E, Giacomini, M, Nova, A, Fogagnolo, A, Spadaro, S, Ceriani, R, Murrone, M, Wu, M, Cogliati, C, Colombo, R, Catena, E, Turrini, F, Simonini, M, Fabbri, S, Potalivo, A, Facondini, F, Gangitano, G, Perin, T, Grazia Bocci, M, Antonelli, M, Gommers, D, Rodriguez-Garcia, R, Gamez-Zapata, J, Taboada-Fraga, X, Castro, P, Tellez, A, Lander-Azcona, A, Escos-Orta, J, Martin-Delgado, M, Algaba-Calderon, A, Franch-Llasat, D, Roche-Campo, F, Lozano-Gomez, H, Zalba-Etayo, B, Michot, M, Klarer, A, Ensner, R, Schott, P, Urech, S, Zellweger, N, Merki, L, Lambert, A, Laube, M, Jeitziner, M, Jenni-Moser, B, Wiegand, J, Yuen, B, Lienhardt-Nobbe, B, Westphalen, A, Salomon, P, Drvaric, I, Hillgaertner, F, Sieber, M, Dullenkopf, A, Petersen, L, Chau, I, Ksouri, H, Sridharan, G, Cereghetti, S, Boroli, F, Pugin, J, Grazioli, S, Rimensberger, P, Burkle, C, Marrel, J, Brenni, M, Fleisch, I, Lavanchy, J, Perez, M, Ramelet, A, Weber, A, Gerecke, P, Christ, A, Ceruti, S, Glotta, A, Marquardt, K, Shaikh, K, Hubner, T, Neff, T, Redecker, H, Moret-Bochatay, M, Bentrup, F, Studhalter, M, Stephan, M, Brem, J, Gehring, N, Selz, D, Naon, D, Kleger, G, Pietsch, U, Filipovic, M, Ristic, A, Sepulcri, M, Heise, A, Franchitti Laurent, M, Laurent, J, Schuepbach, R, Heuberger, D, Buhler, P, Brugger, S, Fodor, P, Locher, P, Camen, G, Gaspert, T, Jovic, M, Haberthuer, C, Lussman, R, Colak, E, Montomoli J., Romeo L., Moccia S., Bernardini M., Migliorelli L., Berardini D., Donati A., Carsetti A., Bocci M. G., Wendel Garcia P. D., Fumeaux T., Guerci P., Schupbach R. A., Ince C., Frontoni E., Hilty M. P., Alfaro-Farias M., Vizmanos-Lamotte G., Tschoellitsch T., Meier J., Aguirre-Bermeo H., Apolo J., Martinez A., Jurkolow G., Delahaye G., Novy E., Losser M. -R., Wengenmayer T., Rilinger J., Staudacher D. L., David S., Welte T., Stahl K., Pavlos A., Aslanidis T., Korsos A., Babik B., Nikandish R., Rezoagli E., Giacomini M., Nova A., Fogagnolo A., Spadaro S., Ceriani R., Murrone M., Wu M. A., Cogliati C., Colombo R., Catena E., Turrini F., Simonini M. S., Fabbri S., Potalivo A., Facondini F., Gangitano G., Perin T., Grazia Bocci M., Antonelli M., Gommers D., Rodriguez-Garcia R., Gamez-Zapata J., Taboada-Fraga X., Castro P., Tellez A., Lander-Azcona A., Escos-Orta J., Martin-Delgado M. C., Algaba-Calderon A., Franch-Llasat D., Roche-Campo F., Lozano-Gomez H., Zalba-Etayo B., Michot M. P., Klarer A., Ensner R., Schott P., Urech S., Zellweger N., Merki L., Lambert A., Laube M., Jeitziner M. M., Jenni-Moser B., Wiegand J., Yuen B., Lienhardt-Nobbe B., Westphalen A., Salomon P., Drvaric I., Hillgaertner F., Sieber M., Dullenkopf A., Petersen L., Chau I., Ksouri H., Sridharan G. O., Cereghetti S., Boroli F., Pugin J., Grazioli S., Rimensberger P. C., Burkle C., Marrel J., Brenni M., Fleisch I., Lavanchy J., Perez M. -H., Ramelet A. -S., Weber A. B., Gerecke P., Christ A., Ceruti S., Glotta A., Marquardt K., Shaikh K., Hubner T., Neff T., Redecker H., Moret-Bochatay M., Bentrup F. Z., Studhalter M., Stephan M., Brem J., Gehring N., Selz D., Naon D., Kleger G. -R., Pietsch U., Filipovic M., Ristic A., Sepulcri M., Heise A., Franchitti Laurent M., Laurent J. -C., Schuepbach R., Heuberger D., Buhler P., Brugger S., Fodor P., Locher P., Camen G., Gaspert T., Jovic M., Haberthuer C., Lussman R. F., and Colak E.

Abstract

Background: Accurate risk stratification of critically ill patients with coronavirus disease 2019 (COVID-19) is essential for optimizing resource allocation, delivering targeted interventions, and maximizing patient survival probability. Machine learning (ML) techniques are attracting increased interest for the development of prediction models as they excel in the analysis of complex signals in data-rich environments such as critical care. Methods: We retrieved data on patients with COVID-19 admitted to an intensive care unit (ICU) between March and October 2020 from the RIsk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry. We applied the Extreme Gradient Boosting (XGBoost) algorithm to the data to predict as a binary outcome the increase or decrease in patients’ Sequential Organ Failure Assessment (SOFA) score on day 5 after ICU admission. The model was iteratively cross-validated in different subsets of the study cohort. Results: The final study population consisted of 675 patients. The XGBoost model correctly predicted a decrease in SOFA score in 320/385 (83%) critically ill COVID-19 patients, and an increase in the score in 210/290 (72%) patients. The area under the mean receiver operating characteristic curve for XGBoost was significantly higher than that for the logistic regression model (0.86 vs. 0.69, P < 0.01 [paired t-test with 95% confidence interval]). Conclusions: The XGBoost model predicted the change in SOFA score in critically ill COVID-19 patients admitted to the ICU and can guide clinical decision support systems (CDSSs) aimed at optimizing available resources.

Published
2021

3. Implications of early respiratory support strategies on disease progression in critical COVID-19: a matched subanalysis of the prospective RISC-19-ICU cohort

Author

Wendel Garcia P. D., Aguirre-Bermeo H., Buehler P. K., Alfaro-Farias M., Yuen B., David S., Tschoellitsch T., Wengenmayer T., Korsos A., Fogagnolo A., Kleger G. -R., Wu M. A., Colombo R., Turrini F., Potalivo A., Rezoagli E., Rodriguez-Garcia R., Castro P., Lander-Azcona A., Martin-Delgado M. C., Lozano-Gomez H., Ensner R., Michot M. P., Gehring N., Schott P., Siegemund M., Merki L., Wiegand J., Jeitziner M. M., Laube M., Salomon P., Hillgaertner F., Dullenkopf A., Ksouri H., Cereghetti S., Grazioli S., Burkle C., Marrel J., Fleisch I., Perez M. -H., Baltussen Weber A., Ceruti S., Marquardt K., Hubner T., Redecker H., Studhalter M., Stephan M., Selz D., Pietsch U., Ristic A., Heise A., Meyer zu Bentrup F., Franchitti Laurent M., Fodor P., Gaspert T., Haberthuer C., Colak E., Heuberger D. M., Fumeaux T., Montomoli J., Guerci P., Schuepbach R. A., Hilty M. P., Roche-Campo F., Algaba-Calderon A., Apolo J., Aslanidis T., Babik B., Boroli F., Brem J., Brenni M., Brugger S. D., Camen G., Catena E., Ceriani R., Chau I., Christ A., Cogliati C., Concha P., Delahaye G., Drvaric I., Escos-Orta J., Fabbri S., Facondini F., Filipovic M., Gamez-Zapata J., Gerecke P., Gommers D., Hillermann T., Ince C., Jenni-Moser B., Jovic M., Jurkolow G., Klarer A., Lambert A., Laurent J. -C., Lavanchy J., Lienhardt-Nobbe B., Locher P., Losser M. -R., Lussman R. F., Magliocca A., Margarit A., Martinez A., Mauri R., Mayor-Vazquez E., Meier J., Moret-Bochatay M., Murrone M., Naon D., Neff T., Novy E., Petersen L., Pugin J., Ramelet A. -S., Rilinger J., Rimensberger P. C., Sepulcri M., Shaikh K., Sieber M., Simonini M. S., Spadaro S., Sridharan G. O., Stahl K., Staudacher D. L., Taboada-Fraga X., Tellez A., Urech S., Vitale G., Vizmanos-Lamotte G., Welte T., Zalba-Etayo B., Zellweger N., Graduate School, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, AII - Inflammatory diseases, RISC-19-ICU Investigators, Wendel Garcia, P.D., Aguirre-Bermeo, H., Buehler, P.K., Alfaro-Farias, M., Yuen, B., David, S., Tschoellitsch, T., Wengenmayer, T., Korsos, A., Fogagnolo, A., Kleger, G.R., Wu, M.A., Colombo, R., Turrini, F., Potalivo, A., Rezoagli, E., Rodríguez-García, R., Castro, P., Lander-Azcona, A., Martín-Delgado, M.C., Lozano-Gómez, H., Ensner, R., Michot, M.P., Gehring, N., Schott, P., Siegemund, M., Merki, L., Wiegand, J., Jeitziner, M.M., Laube, M., Salomon, P., Hillgaertner, F., Dullenkopf, A., Ksouri, H., Cereghetti, S., Grazioli, S., Bürkle, C., Marrel, J., Fleisch, I., Perez, M.H., Baltussen Weber, A., Ceruti, S., Marquardt, K., Hübner, T., Redecker, H., Studhalter, M., Stephan, M., Selz, D., Pietsch, U., Ristic, A., Heise, A., Meyer Zu Bentrup, F., Franchitti Laurent, M., Fodor, P., Gaspert, T., Haberthuer, C., Colak, E., Heuberger, D.M., Fumeaux, T., Montomoli, J., Guerci, P., Schuepbach, R.A., Hilty, M.P., Roche-Campo, F., Algaba-Calderon, A., Apolo, J., Aslanidis, T., Babik, B., Boroli, F., Brem, J., Brenni, M., Brugger, S.D., Camen, G., Catena, E., Ceriani, R., Chau, I., Christ, A., Cogliati, C., Concha, P., Delahaye, G., Drvaric, I., Escós-Orta, J., Fabbri, S., Facondini, F., Filipovic, M., Gámez-Zapata, J., Gerecke, P., Gommers, D., Hillermann, T., Ince, C., Jenni-Moser, B., Jovic, M., Jurkolow, G., Klarer, A., Lambert, A., Laurent, J.C., Lavanchy, J., Lienhardt-Nobbe, B., Locher, P., Losser, M.R., Lussman, R.F., Magliocca, A., Margarit, A., Martínez, A., Mauri, R., Mayor-Vázquez, E., Meier, J., Moret-Bochatay, M., Murrone, M., Naon, D., Neff, T., Novy, E., Petersen, L., Pugin, J., Ramelet, A.S., Rilinger, J., Rimensberger, P.C., Sepulcri, M., Shaikh, K., Sieber, M., Simonini, M.S., Spadaro, S., Sridharan, G.O., Stahl, K., Staudacher, D.L., Taboada-Fraga, X., Tellez, A., Urech, S., Vitale, G., Vizmanos-Lamotte, G., Welte, T., Zalba-Etayo, B., Zellweger, N., Wendel Garcia, P, Aguirre-Bermeo, H, Buehler, P, Alfaro-Farias, M, Yuen, B, David, S, Tschoellitsch, T, Wengenmayer, T, Korsos, A, Fogagnolo, A, Kleger, G, Wu, M, Colombo, R, Turrini, F, Potalivo, A, Rezoagli, E, Rodriguez-Garcia, R, Castro, P, Lander-Azcona, A, Martin-Delgado, M, Lozano-Gomez, H, Ensner, R, Michot, M, Gehring, N, Schott, P, Siegemund, M, Merki, L, Wiegand, J, Jeitziner, M, Laube, M, Salomon, P, Hillgaertner, F, Dullenkopf, A, Ksouri, H, Cereghetti, S, Grazioli, S, Burkle, C, Marrel, J, Fleisch, I, Perez, M, Baltussen Weber, A, Ceruti, S, Marquardt, K, Hubner, T, Redecker, H, Studhalter, M, Stephan, M, Selz, D, Pietsch, U, Ristic, A, Heise, A, Meyer zu Bentrup, F, Franchitti Laurent, M, Fodor, P, Gaspert, T, Haberthuer, C, Colak, E, Heuberger, D, Fumeaux, T, Montomoli, J, Guerci, P, Schuepbach, R, Hilty, M, Roche-Campo, F, Algaba-Calderon, A, Apolo, J, Aslanidis, T, Babik, B, Boroli, F, Brem, J, Brenni, M, Brugger, S, Camen, G, Catena, E, Ceriani, R, Chau, I, Christ, A, Cogliati, C, Concha, P, Delahaye, G, Drvaric, I, Escos-Orta, J, Fabbri, S, Facondini, F, Filipovic, M, Gamez-Zapata, J, Gerecke, P, Gommers, D, Hillermann, T, Ince, C, Jenni-Moser, B, Jovic, M, Jurkolow, G, Klarer, A, Lambert, A, Laurent, J, Lavanchy, J, Lienhardt-Nobbe, B, Locher, P, Losser, M, Lussman, R, Magliocca, A, Margarit, A, Martinez, A, Mauri, R, Mayor-Vazquez, E, Meier, J, Moret-Bochatay, M, Murrone, M, Naon, D, Neff, T, Novy, E, Petersen, L, Pugin, J, Ramelet, A, Rilinger, J, Rimensberger, P, Sepulcri, M, Shaikh, K, Sieber, M, Simonini, M, Spadaro, S, Sridharan, G, Stahl, K, Staudacher, D, Taboada-Fraga, X, Tellez, A, Urech, S, Vitale, G, Vizmanos-Lamotte, G, Welte, T, Zalba-Etayo, B, Zellweger, N, and Intensive Care

Subjects
Male, ARDS, Time Factors, medicine.medical_treatment, Old age, Critical Care and Intensive Care Medicine, law.invention, 0302 clinical medicine, law, Oxygen therapy, Noninvasive mechanical ventilation, Intubation, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, Registries, Prospective cohort study, 610 Medicine & health, Unitats de cures intensives, Intensive care units, Medical emergencies. Critical care. Intensive care. First aid, Middle Aged, Intensive care unit, Intensive Care Units, Treatment Outcome, Vellesa, High flow oxygen therapy, Disease Progression, Female, Standard oxygen therapy, medicine.medical_specialty, Respiratory Therapy, Critical Illness, NO, 03 medical and health sciences, Intensive care, medicine, Humans, Invasive mechanical ventilation, Critically ill, Patient self-inflicted lung injury, Aged, Retrospective Studies, Mechanical ventilation, COVID-19/mortality, COVID-19/therapy, Critical Illness/mortality, Critical Illness/therapy, Respiratory Therapy/methods, Respiratory Therapy/statistics & numerical data, COVID-19, Respiratory support, business.industry, RC86-88.9, Research, Retrospective cohort study, medicine.disease, Malalts en estat crític, 030228 respiratory system, Emergency medicine, business
Abstract

Background Uncertainty about the optimal respiratory support strategies in critically ill COVID-19 patients is widespread. While the risks and benefits of noninvasive techniques versus early invasive mechanical ventilation (IMV) are intensely debated, actual evidence is lacking. We sought to assess the risks and benefits of different respiratory support strategies, employed in intensive care units during the first months of the COVID-19 pandemic on intubation and intensive care unit (ICU) mortality rates. Methods Subanalysis of a prospective, multinational registry of critically ill COVID-19 patients. Patients were subclassified into standard oxygen therapy ≥10 L/min (SOT), high-flow oxygen therapy (HFNC), noninvasive positive-pressure ventilation (NIV), and early IMV, according to the respiratory support strategy employed at the day of admission to ICU. Propensity score matching was performed to ensure comparability between groups. Results Initially, 1421 patients were assessed for possible study inclusion. Of these, 351 patients (85 SOT, 87 HFNC, 87 NIV, and 92 IMV) remained eligible for full analysis after propensity score matching. 55% of patients initially receiving noninvasive respiratory support required IMV. The intubation rate was lower in patients initially ventilated with HFNC and NIV compared to those who received SOT (SOT: 64%, HFNC: 52%, NIV: 49%, p = 0.025). Compared to the other respiratory support strategies, NIV was associated with a higher overall ICU mortality (SOT: 18%, HFNC: 20%, NIV: 37%, IMV: 25%, p = 0.016). Conclusion In this cohort of critically ill patients with COVID-19, a trial of HFNC appeared to be the most balanced initial respiratory support strategy, given the reduced intubation rate and comparable ICU mortality rate. Nonetheless, considering the uncertainty and stress associated with the COVID-19 pandemic, SOT and early IMV represented safe initial respiratory support strategies. The presented findings, in agreement with classic ARDS literature, suggest that NIV should be avoided whenever possible due to the elevated ICU mortality risk.

Published
2021
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5. A randomized controlled trial on pharmacological preconditioning in liver surgery using a volatile anesthetic

Author

Beck-Schimmer, B, Breitenstein, S, Urech, S, De Conno, E, Wittlinger, M, Puhan, Milo A, Jochum, W, Spahn, D R, Graf, R, Clavien, P A, and University of Zurich

Subjects
10216 Institute of Anesthesiology, 10076 Center for Integrative Human Physiology, 570 Life sciences, biology, 610 Medicine & health, 10029 Clinic and Policlinic for Internal Medicine, 10052 Institute of Physiology, 2746 Surgery
Published
2008
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8. Machine learning using the Extreme Gradient Boosting (XGBoost) algorithm predicts 5-day delta of SOFA score at ICU admission in COVID-19 patients

Author

Marie M. Jeitziner, Iris Drvaric, Jan Wiegand, Abele Donati, Janina Apolo, Emanuele Rezoagli, Jesús Escós-Orta, Herminia Lozano-Gómez, Mirko Brenni, Giovanni Camen, Frank Hillgaertner, Sara Moccia, Antje Heise, Alexander Dullenkopf, Michael Stephan, Can Ince, Marcus Laube, Julien Marrel, Michele Bernardini, Barbara Lienhardt-Nobbe, Hernán Aguirre-Bermeo, Alberto Fogagnolo, Dorothea M. Heuberger, Severin Urech, Reto A. Schuepbach, Andrea Glotta, Samuele Ceruti, Isabelle Fleisch, Marc P. Michot, Alice Nova, Matthias P. Hilty, Tomislav Gaspert, Gianfilippo Gangitano, Savino Spadaro, Ivan Chau, Daniele Berardini, Tiziana Perin, Andrea Westphalen, Marie-Reine Losser, Hatem Ksouri, Marie-Hélène Perez, Theodoros Aslanidis, Christoph Haberthuer, Gerardo Vizmanos-Lamotte, Jorge Gámez-Zapata, Filippo Boroli, Adriana Lambert, Serge Grazioli, Petra Salomon, Christian Bürkle, Didier Naon, Philipp Bühler, Dawid L. Staudacher, Miodrag Filipovic, Hermann Redecker, Mario Alfaro-Farias, Massimo Antonelli, Rolf Ensner, Jerome Lavanchy, Lukas Merki, Roberto Ceriani, Anette Ristic, Chiara Cogliati, Reto Andreas Schüpbach, Daniela Selz, Begoña Zalba-Etayo, Anne-Sylvie Ramelet, Thierry Fumeaux, Andrea Carsetti, Peter Gerecke, Riccardo Colombo, Marilene Franchitti Laurent, Fabrizio Turrini, Tobias Wengenmayer, Tobias Welte, Philippe Guerci, Antonella Potalivo, Lucia Migliorelli, Barna Babik, Reza Nikandish, Pedro D. Wendel Garcia, Alberto Martínez, Maria Sole Simonini, Diederik Gommers, Xiana Taboada-Fraga, Jerome Pugin, Peter C. Rimensberger, Angela Algaba-Calderon, FriederikeMeyer zu Bentrup, Agios Pavlos, Thomas Tschoellitsch, Marianne Sieber, Karim Shaikh, Nuria Zellweger, Silvio Brugger, Geoffrey Jurkolow, Anja Baltussen Weber, Maria C. Martín-Delgado, Anita Korsós, Gian-Reto Kleger, Alexander Klarer, Emmanuel Novy, Diego Franch-Llasat, Adrian Tellez, Peter Schott, Jonathan Rilinger, Andreas Christ, Bernd Yuen, Jean-Christophe Laurent, Nadine Gehring, Pedro Castro, Sascha David, Francesca Facondini, Arantxa Lander-Azcona, Maria Grazia Bocci, Maddalena Alessandra Wu, Mallory Moret-Bochatay, Sara Cereghetti, Urs Pietsch, Martina Murrone, Gauthier Delahaye, Luca Romeo, Pascal Locher, Pedro David Wendel Garcia, Michael Sepulcri, Marija Jovic, Katharina Marquardt, Emanuele Frontoni, Patricia Fodor, Emanuele Catena, Tobias Hübner, Thomas Neff, Roger F. Lussman, Matteo Giacomini, Govind Oliver Sridharan, Beatrice Jenni-Moser, Jan Brem, Michael Studhalter, Elif Colak, Raquel Rodríguez-García, Silvia Fabbri, Jens Meier, Lina Petersen, Jonathan Montomoli, Ferran Roche-Campo, Klaus Stahl, Montomoli, J, Romeo, L, Moccia, S, Bernardini, M, Migliorelli, L, Berardini, D, Donati, A, Carsetti, A, Bocci, M, Wendel Garcia, P, Fumeaux, T, Guerci, P, Schupbach, R, Ince, C, Frontoni, E, Hilty, M, Alfaro-Farias, M, Vizmanos-Lamotte, G, Tschoellitsch, T, Meier, J, Aguirre-Bermeo, H, Apolo, J, Martinez, A, Jurkolow, G, Delahaye, G, Novy, E, Losser, M, Wengenmayer, T, Rilinger, J, Staudacher, D, David, S, Welte, T, Stahl, K, Pavlos, A, Aslanidis, T, Korsos, A, Babik, B, Nikandish, R, Rezoagli, E, Giacomini, M, Nova, A, Fogagnolo, A, Spadaro, S, Ceriani, R, Murrone, M, Wu, M, Cogliati, C, Colombo, R, Catena, E, Turrini, F, Simonini, M, Fabbri, S, Potalivo, A, Facondini, F, Gangitano, G, Perin, T, Grazia Bocci, M, Antonelli, M, Gommers, D, Rodriguez-Garcia, R, Gamez-Zapata, J, Taboada-Fraga, X, Castro, P, Tellez, A, Lander-Azcona, A, Escos-Orta, J, Martin-Delgado, M, Algaba-Calderon, A, Franch-Llasat, D, Roche-Campo, F, Lozano-Gomez, H, Zalba-Etayo, B, Michot, M, Klarer, A, Ensner, R, Schott, P, Urech, S, Zellweger, N, Merki, L, Lambert, A, Laube, M, Jeitziner, M, Jenni-Moser, B, Wiegand, J, Yuen, B, Lienhardt-Nobbe, B, Westphalen, A, Salomon, P, Drvaric, I, Hillgaertner, F, Sieber, M, Dullenkopf, A, Petersen, L, Chau, I, Ksouri, H, Sridharan, G, Cereghetti, S, Boroli, F, Pugin, J, Grazioli, S, Rimensberger, P, Burkle, C, Marrel, J, Brenni, M, Fleisch, I, Lavanchy, J, Perez, M, Ramelet, A, Weber, A, Gerecke, P, Christ, A, Ceruti, S, Glotta, A, Marquardt, K, Shaikh, K, Hubner, T, Neff, T, Redecker, H, Moret-Bochatay, M, Bentrup, F, Studhalter, M, Stephan, M, Brem, J, Gehring, N, Selz, D, Naon, D, Kleger, G, Pietsch, U, Filipovic, M, Ristic, A, Sepulcri, M, Heise, A, Franchitti Laurent, M, Laurent, J, Schuepbach, R, Heuberger, D, Buhler, P, Brugger, S, Fodor, P, Locher, P, Camen, G, Gaspert, T, Jovic, M, Haberthuer, C, Lussman, R, Colak, E, Biomedical Engineering and Physics, ACS - Microcirculation, Translational Physiology, ACS - Atherosclerosis & ischemic syndromes, Graduate School, AII - Infectious diseases, and University of Zurich

Subjects
610 Medicine & health, Organ dysfunction score, Machine learning, computer.software_genre, Logistic regression, Clinical decision support system, law.invention, law, Medicine, Clinical decision support system (CDSS), Receiver operating characteristic, RC86-88.9, business.industry, Clinical decision support systems, COVID-19, Medical emergencies. Critical care. Intensive care. First aid, Extreme Gradient Boosting (XGBoost), Intensive care unit, Multiple organ failure, Cohort, Population study, SOFA score, Original Article, Artificial intelligence, 10023 Institute of Intensive Care Medicine, business, Algorithm, computer, Predictive modelling
Abstract

Background : Accurate risk stratification of critically ill patients with coronavirus disease 2019 (COVID-19) is essential for optimizing resource allocation, delivering targeted interventions, and maximizing patient survival probability. Machine learning (ML) techniques are attracting increased interest for the development of prediction models as they excel in the analysis of complex signals in data-rich environments such as critical care. Methods : We retrieved data on patients with COVID-19 admitted to an intensive care unit (ICU) between March and October 2020 from the RIsk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry. We applied the Extreme Gradient Boosting (XGBoost) algorithm to the data to predict as a binary outcome the increase or decrease in patients’ Sequential Organ Failure Assessment (SOFA) score on day 5 after ICU admission. The model was iteratively cross-validated in different subsets of the study cohort. Results : The final study population consisted of 675 patients. The XGBoost model correctly predicted a decrease in SOFA score in 320/385 (83%) critically ill COVID-19 patients, and an increase in the score in 210/290 (72%) patients. The area under the mean receiver operating characteristic curve for XGBoost was significantly higher than that for the logistic regression model {0.86 vs. 0.69, P

Published
2021

9. Endogenous cortisol and conditioned placebo effects on pain - A randomized trial.

Author

Gaab J, Bürgin D, Locher C, Werner C, Urech S, Bratschi C, Garcia LB, Hauke M, Bitter S, Bohny M, and Bentz D

Subjects
Adolescent, Adult, Female, Humans, Male, Middle Aged, Single-Blind Method, Young Adult, Anti-Inflammatory Agents adverse effects, Hydrocortisone adverse effects, Pain drug therapy, Pain Management methods, Placebo Effect
Abstract

Placebo effects can be induced by learning and conditioning processes, which in turn are influenced and modulated by glucocorticoids. Accordingly, previous research has shown that intervention-related associative learning can be modulated through exogenous as well as endogenous glucocorticoids. Thus, the aim of this study was to elucidate whether placebo effects induced by conditioning is modulated by daily fluctuations of endogenous cortisol levels in healthy male and female subjects. Overall 77 participants underwent a two-phased placebo conditioning paradigm for pain analgesia. Subjects were randomized in two groups, which underwent placebo preconditioning either in the morning (08:00-10:00, i.e. with high endogenous cortisol levels) or in the afternoon (16:00-18:00, i.e. with low endogenous cortisol levels). Placebo effects were assessed two days later at noontime (12:00-13:00), with possible differences between groups as an indicator of glucocorticoid modulation on the placebo learning. Results indicated a significant conditioned placebo-induced analgesia, resulting in a placebo effect of small to medium size. Cortisol levels on conditioning day significantly differed between groups and cortisol levels were similar during assessment of placebo effects. Groups did not differ in their mean reduction in pain sensation, thus the placebo effect was not affected by differences in cortisol levels during the conditioning of placebo effects. The present study does not indicate a moderation of placebo conditioning by endogenous glucocorticoid levels., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Published
2019
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10. A randomized controlled trial on pharmacological preconditioning in liver surgery using a volatile anesthetic.

Author

Beck-Schimmer B, Breitenstein S, Urech S, De Conno E, Wittlinger M, Puhan M, Jochum W, Spahn DR, Graf R, and Clavien PA

Subjects
Adult, Aged, Alanine Transaminase blood, Aspartate Aminotransferases blood, Colorectal Neoplasms pathology, Comorbidity, Echinococcosis, Hepatic epidemiology, Echinococcosis, Hepatic surgery, Fatty Liver epidemiology, Female, Hepatectomy methods, Humans, Length of Stay, Liver metabolism, Liver Neoplasms epidemiology, Liver Neoplasms secondary, Liver Neoplasms surgery, Male, Middle Aged, Nitric Oxide Synthase Type II metabolism, Reperfusion Injury prevention & control, Sevoflurane, Anesthetics, Inhalation pharmacology, Ischemic Preconditioning methods, Methyl Ethers pharmacology
Abstract

Objective: To evaluate the effects of pharmacological preconditioning with a volatile anesthetic in patients undergoing liver resection with inflow occlusion., Background: In liver surgery, ischemic preconditioning and intermittent clamping are the only established protective strategies to reduce tissue damage due to ischemia during inflow occlusion. Preconditioning with volatile anesthetics has provided protection against cardiac and renal ischemic injury in several animal models through NO and HO-1 pathways. But pharmacological preconditioning has never been tested in patients undergoing liver surgery in a randomized trial., Methods: Sixty-four patients undergoing liver surgery with inflow occlusion were randomized intraoperatively for preconditioning with sevoflurane or not (ClinicalTrials.gov NCT00516711). Anesthesia was performed intravenously with propofol. Thirty minutes before inflow occlusion propofol was replaced by sevoflurane in the preconditioning group. Primary endpoint was postoperative liver injury assessed by peak values of liver transaminases. Postoperative complications were recorded according to an established scoring system., Results: Sevoflurane preconditioning significantly limited the postoperative increase of serum transaminase levels by 261 U/L (95% CI, 65 to 458; P = 0.01) for the ALT and by 239 (95% CI, -2 to 480; P = 0.05) for the AST corresponding to decreases of baseline levels of 35% and 31%, respectively. Patients with steatosis had an even better benefit than patients without steatosis. The rates of any complication (risk ratio 0.46; 95% CI, 0.25 to 0.85; P = 0.006) and of severe complications requiring invasive procedures (risk ratio 0.25; 95% CI, 0.06 to 1.08; P = 0.05) were also lowered by preconditioning., Conclusion: This first randomized trial of pharmacological preconditioning in liver surgery in humans showed a protective effect of preconditioning with volatile anesthetics. This strategy may provide a new and easily applicable therapeutic option to protect the liver and to lower complication rates.

Published
2008
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