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sella turcica anatomy

//sella turcica anatomy

This chapter focuses on the anatomic basis of the microsurgical and endoscopic approaches to the sellar and parasellar regions. 14-9).14 The depth of the sella is measured as the greatest distance perpendicular to a line connecting the tip of the dorsum sellae to the tuberculum sellae. The height of a normal gland can be up to 9 mm [4]. Investigators have also attempted to use the area and the volume of the sella turcica to serve as better predictors of pituitary disease. However, some may develop a constellation of symptoms including hypopituitarism, inferior displacement of the optic tracts with associated visual disturbance, rhinorrhea, and other symptoms pertaining to elevated intracranial pressure (ICP). Intrasellar, parasellar, or suprasellar fat and calcifications may be excellent indicators of pathology. Gross anatomy The diaphragma sellae consists of two horizontal leaves of dura mater on the sphenoid bone. Empty sella is the presence of CSF within an enlarged sella turcica. THE roentgenologic interpretation and significance of changes, in and about the sella turcica are so dependent on an accurate knowledge of the normal and pathologic anatomy of this structure that this study was undertaken in an effort to demonstrate in a series of 110 cases the normal and pathologic changes found postmortem. Radiology department of the University of Toronto, Canada and the Radiology department the Medical Centre Alkmaar, the Netherlands. The anterior lobe, adenohypophysis, forms about 75–80% of the gland and is a center for hormone synthesis, including thyroid-stimulating hormone, adrenocorticotropic hormone (ACTH), and prolactin. The sella turcica is an indentation in the sphenoid bone at the base of your skull that holds the pituitary gland. Craniopharyngiomas and germ cell tumors are often associated with fat and/or calcification. The dural roof of the … The sella is covered by a dural reflection (i.e., diaphragma sellae) above which lies the suprasellar cistern. 14, No. The anterior cranial base or the Sella-Nasion (SN) line is often used by orthodontists as a reference line for assessment of dentofacial deformities. The vertical or depth measurement was taken along a line dropped from the antero-posterior line to the deepest point on the floor of the sella. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. According to Taveras and Wood [1], 17 mm is the upper limit of normal for the maximum anteroposterior diameter of the sella. Other patients may develop an empty sella secondarily in response to pituitary surgery or radiotherapy for adenomas (Figs. Copyright © 2021 Elsevier B.V. or its licensors or contributors. The Sellar spine was first described by Lang (1977). The posterior surface of attached with membrane, which is termed as dorsum sellae amd the anterior order is attached with the tuberculum sellae. The prevalence of pituitary metastasis in autopsy series of cancer patients ranges up to 26.7% with most reports quoting around 3–5%. His study of the various shapes of the fossa showed the oblong and cuboidal types to prevail. Anatomy [edit | edit source]. However, in the first six weeks of life the anterior pituitary is bright as well on T1-weighted images in 82% [3]. \ Medical Definition of sella turcica : a depression in the middle line of the upper surface of the sphenoid bone in which the pituitary gland is lodged Learn More about sella turcica The sella is bordered laterally by the cavernous sinuses, superiorly by the diaphragma sellae (dural fold), anteroinferiorly by the sphenoid sinus, and posteriorly by the pontine cistern. Marcel Maya, Barry D. Pressman, in The Pituitary (Fourth Edition), 2017. Lateral to the sella turcica are the cavernous sinuses containing the carotid arteries and cranial nerves III, IV, V1 (ophthalmic division of trigeminal nerve), and VI. These are only guidelines and sella turcica enlargement can only be used as a suggestion of pituitary abnormality and is certainly not sufficient for diagnosis. Cope, in a study of the pituitary fossa in fifty skulls, concluded that normally there is a great variation in its size, so that there is no particular age at which any special increase occurs. It is usually larger in females than in males - in females the superior border tends to be convex, whereas in males it is usually concave. This chapter provides a well-illustrated review of the sellar tumors. The sella is bordered laterally by the cavernous sinuses, superiorly by the diaphragma sella (dural fold), anteroinferiorly by the sphenoid sinus and posteriorly by the pontine cistern. This has been referred to as the empty sella syndrome (Figs. At this stage of development the pituitary gland is small and pale pink in color. Fitzgerald, in a study of one hundred skulls, endeavored to show a relationship between the size of the pituitary fossa and the skull. The cavernous sinus receives venous blood from the following: Anterolateral to the gasserian ganglion, V3 (mandibular division of trigeminal nerve) exits through the foramen ovale. This represents the true antero-posterior dimension of the outlet of the pituitary fossa. Therefore, caution must be exercised in suggesting pituitary gland pathology in young adolescent patients and women of child-bearing age. The average length of the sella is 10.5 mm and a range of 5 - 16 mm and an average width of 14.0 mm and a range of 10 - 16 mm. Sella turcica: A depression in the base of the skull where the pituitary gland is situated. Do cervical spine X-rays for trauma have clinically significant incidental findings? Ray N. Conley, Gary A. Longmuir, in Clinical Imaging (Third Edition), 2014. The sella turcica is a bony depression in the sphenoid bone. Which scanning plane is best for evaluating the anatomical relationship between the pituitary and the sella turcica: A)transverse B) coronal C)sagittal D)oblique between transverse & sagittal A) from the pedicle of the vertebra above the disk to the pedicle of the vertebra below the disk It has three parts: Tuberculum sellae – forms the anterior wall of the sella turcica, and the posterior aspect of the chiasmatic groove. The bony spine was 4.35 mm long and protruded from the dorsal side of the pituitary fossa into the fossa itself. It is divided into three fragments and consists of an anterior wall, a floor, and a posterior wall. The size and configuration of the pituitary gland is thought to vary by age and sex. 11, No. Jeffrey A. Hashim, Juan E. Small, in Neuroradiology, 2019, The empty sella turcica was first described in 1949 as a condition where the sella turcica is only partially filled by the pituitary gland, which appears flattened against the sellar floor (Fig. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B9780128042571000141, URL: https://www.sciencedirect.com/science/article/pii/B9780128041697000234, URL: https://www.sciencedirect.com/science/article/pii/B9780323065610000069, URL: https://www.sciencedirect.com/science/article/pii/B9780323084956000336, URL: https://www.sciencedirect.com/science/article/pii/B9780128009451000422, URL: https://www.sciencedirect.com/science/article/pii/B9780123708632500415, URL: https://www.sciencedirect.com/science/article/pii/B9780323445498000195, URL: https://www.sciencedirect.com/science/article/pii/B9780123809261100197, URL: https://www.sciencedirect.com/science/article/pii/B9780323084956000166, Chordomas and Chondrosarcomas of the Skull Base, Chordomas and Chondrosarcomas of the Skull Base and Spine (Second Edition), Sharon E. Oberfield MD, ... Daniel Esten Hale MD, in, Handbook of Neuro-Oncology Neuroimaging (Second Edition), Schmidek and Sweet Operative Neurosurgical Techniques (Sixth Edition), Diagnostic Reference Index of Clinical Neurology (Second Edition), Enlarged sella resulting from expanded cavernous segment of the carotid artery; linear vascular calcification often is present, projecting over the enlarged sella on a lateral radiograph, Seen in children and young adults, this tumor may produce bone destruction of the sella; most lesions calcify; gliomas of the optic chiasm may cause similar changes, Appears as an enlarged sella without bone destruction or considerable deformity; the syndrome is believed to result from a congenital or acquired defect of the diaphragm sellae, which allows an intrasellar extension of the suprasellar arachnoid space; pulsations of the cerebrospinal fluid are thought to cause the sellar enlargement; the pituitary function typically is normal, Enlarged sella, uneven erosion of the floor, producing a “double-floor” appearance; pituitary tumors may be classified by size (a microadenoma is <1 cm and a macroadenoma is >1 cm in diameter) or by their appearance after staining; eosinophilic adenoma (causing acromegaly), chromophobe adenomas (causing hypopituitarism), and basophilic adenoma (causing Cushing disease) occur, Blumenbach clivus, representing the sloping surface of bone between the dorsum sellae and the foramen magnum (composed of the body of the sphenoid and pars basilaris of the occiput); the clivus is a target location for chordomas, which may secondarily involve the sella turcica from its posterior aspect; their appearance is marked by bone destruction and likely tumor matrix calcification; chordoma occurs most often in 30- to 60-year-old individuals, Associated with other conditions such as hydrocephalus, intracranial tumors, and edema; chronic increased intracranial pressure may manifest as erosion and deformity of the sella, resulting from downward pressure of an enlarged third ventricle, Arising from arachnoid and dura mater in the area of the diaphragma sellae, not within the pituitary fossa; meningioma appears with bone destruction and sclerosis; calcification is uncommon. The height of a normal gland can be up to 9 mm.4 The gland tends to enlarge during puberty and pregnancy. Sellar width is defined as the wid… The normal width varies between 10 and 15 mm. • outpouching of the arachnoid protrudes through the central opening in the diaphragma into the sella turcica … The pituitary gland normally sits within the sella. Hurler disease is associated with elongation of the posterior aspect of the sella, creating a J-shaped configuration. The above photos are from young rats ranging from 2.5 – 8 weeks of age. 2 Trends in the radiological study of pituitary adenoma An empty sella can be completely asymptomatic. It is covered also by the brain coverings and has no connection with the exterior of the cranium… Read More That line corresponds to the plane of the diaphragma sellae. It serves as a cephalometric landmark. If the address matches an existing account you will receive an email with instructions to reset your password. Enter your email address below and we will send you the reset instructions. Adjacent to the posteroinferior aspect of the cavernous sinus lies Meckel’s cave, which harbors the gasserian ganglion. 4, 20 April 2013 | European Journal of Trauma and Emergency Surgery, Vol. 2, © 2021 Radiological Society of North America, Incidence and morphometry of sellar bridges and related foramina in dry skulls: Their significance in middle cranial fossa surgery, A CBCT Investigation of the Association between Sella-Turcica Bridging and Maxillary Palatal Canine Impaction, The Enigma behind Pituitary and Sella Turcica. Hypophyseal fossa – the deepest part of the sella turcica, where the pituitary gland is located. Sella Turcica – Upright Lateral 6. Unfortunately this has not withstood the close scrutiny of subsequent carefully performed radiologic/pathologic/surgical studies [3,4]. He adopted two measurements, one taken from the tip of the ethmoid spine of the sphenoid to the anterior limit of the optic groove (anterior measurement of the basis cranii), the other from the opisthion to the middle of the dorsum sellæ (posterior measurement of the basis cranii). It lies in a small depression called the sella turcica which is Latin for “Turkish saddle”. The anterior boundary of the sella turcica is completed by two small eminences, one on either side, called the middle clinoid processes, while the posterior boundary is formed by a square-shaped plate of bone, the dorsum sellæ, ending at its superior angles in two tubercles, the posterior clinoid processes, the size and form of which vary considerably in different individuals. The sella turcica is a bony depression in the sphenoid bone. Anatomically, the sella turcica has been expressed as variable. The pituitary (hypophyseal) fossa or sella turcica is a midline, dural lined structure in the sphenoid bone, which houses the pituitary gland. However, commonly reported clinical symptoms include nontraumatic CSF fluid rhinorrhea, irregular menstruation, fatigue, visual disturbances, headaches, and pituitary hyposecretion or hypersecretion. The sellar floor may become sclerotic in some cases of craniopharyngioma and nasopharyngeal carcinoma [1]. 19.5 and 19.6), medical therapy for macroadenomas, spontaneous pituitary apoplexy, trauma, infection, autoimmune disease, and Sheehan syndrome.4, Olga Moshkin, ... Kalman Kovacs, in The Pituitary (Third Edition), 2011. The sella turcica is a bony depression in the sphenoid bone. The most common symptom reported by people with primary em… Sella Bony anatomy. The sella turcica from Latin (turkish chair) is a saddle-shaped depression in the dorsal surface of the basisphenoid's body; with a median depression corresponding to the pituitary gland, the hypophysial fossa (Fossa hypophysialis), limited caudally by a plate more or less prominent and lifted forward: the dorsum sellae. Anatomy of the Sella Turcica The anterior, posterior, and inferior walls of the sella turcica are bony while the lateral walls and roof are made of dura that slings between the anterior and posterior clinoid processes. ; The anterior borders of the sella are formed by the anterior clinoid processes of the lesser sphenoid wing and the tuberculum sellae, while the posterior border is formed by the dorsum sellae. Reliability of … Although variations exist, the sella turcica generally should not exceed an anteroposterior dimension of 16 mm or a vertical depth of 12 mm on a lateral skull radiograph. Surgery may be warranted. The anterior lobe, adenohypophysis, forms about 75–80% of the gland and is a center for hormone synthesis, including thyroid stimulating hormone (TSH), adrenocorticotrophic hormone (ACTH) and prolactin. Metastases are also the most frequent tumor of the eurohypophysis, which is affected about twice as often as the adenohypophysis. 5. An area greater than 130 mm2, and a volume greater than 1092 mm3, have been reported to be abnormal [2]. 37, No. The sella turcica is a spherical depression in the superior surface of the sphenoid bone. The sella and surrounding processes were removed in toto and the soft tissues dissected from the bone. 4, American Journal of Orthodontics and Dentofacial Orthopedics, Vol. The dimensions of the sella turcica in normal, specimens were measured in the antero-posterior, vertical, and transverse directions. 110, No. The name goes back to the Belgian anatomist and professor of anatomy and surgery Adriaan van den Spieghel (1578 - 1625). Subcranial Relationships The pituitary gland and sella are located in the cranial base below the center of the brain (Fig. Meningiomas frequently calcify, and on rare occasions pituitary tumors calcify (pituitary stone). The gland itself is composed of an anterior lobe, intermediate (vestigial) and posterior lobe. The pituitary gland normally sits within the sella. A parallel study of the roentgen anatomy of the sella turcica and the histopathology of the pituitary gland in 205 autopsy specimens Neuroradiology, Vol. Modern imaging techniques have supplanted the skull series as a tool for searching for pituitary or hypothalamic disease; however, an enlarged sella may be noted on children in whom skull series are obtained for other reasons (e.g., head trauma). Anatomy. Ramsey Ashour, ... Harry van Loveren, in Chordomas and Chondrosarcomas of the Skull Base and Spine (Second Edition), 2018. 39, No. An enlarged sella turcica is a significant finding, suggesting the presence of a pituitary neoplasm, empty sella syndrome, extrapituitary neoplasm, or possibly a normal variant of the patient's anatomy. The sella turcica is a midline depression in the sphenoid bone which contains the pituitary gland and distal portion of the pituitary stalk. Eric C. Bourekas, ... H. Wayne Slone, in Handbook of Neuro-Oncology Neuroimaging (Second Edition), 2016. Numerous studies of the “normal” sella turcica size were performed and reported prior to CT and MR. Enlargement of the sella turcica was thought to be an indicator of pituitary pathology, as were distortion of shape and contour of the sella. The greatest transverse measurement, or width, represents the distance between the lateral boundaries of the fossa. The posterior lobe, neurohypophysis, is connected to the hypothalamus by the pituitary stalk and receives hormones from the hypothalamus via the pituitary stalk (i.e., antidiuretic hormone). Anteroinferiorly, the foramen rotundum conducts V2 (maxillary division of trigeminal nerve). - Anterior and posterior clinoids are superimposed. There are five types of hormone-secreting pituitary tumours, named according to the cells that produce the particular hormone. He found the average length measurement of the fossa to be 1.16 cm. The appearance of two cortical lines is known as a “double-floor” sign, suggesting osseous erosion of the floor by an expansile mass. It extends from the tuberculum sellae to the posterior clinoid processes and dorsum sellae and covers the sella turcica and pituitary gland within 1. The anteroposterior diameter of the sella has been defined as a line connecting the tuberculum with the farthest portion of the posterior sella wall. 4, 13 September 2009 | The European Journal of Orthodontics, Vol. Criteria The sella turcica is visualized without rotation or tilt as indicated by the following: - Sella turcica and clivus are demonstrated in profile. Pituitary tumour, most common cause of enlargement of the sella turcica, the bone cavity in the head in which the pituitary gland is located. While the shape and size of the sella turcica can vary slightly, depending on the person and the age, it is usually very easy to … It was called the sella turcica (the Turkish saddle) because of its resemblance to a saddle used by the Turks which had supports in the front and back. Sharon E. Oberfield MD, ... Daniel Esten Hale MD, in Pediatric Secrets (Fifth Edition), 2011. Diaphragma sellae • Forms roof of sella turcica • covers the pituitary gland, except in its center, which transmits the pituitary stalk • thin, tenuous structure not an adequate barrier for protecting the suprasellar structures during transsphenoidal operation • deficiency of the diaphragma sellae assumed to be a precondition to formation of empty sella. A small sella turcica may be associated with pituitary insufficiency, but the correlation is poor [1] and most small sellas are of no significance. Treatment entails supporting the patient and addressing any associated endocrine dysfunction present. 1, Orthodontics & Craniofacial Research, Vol. The sella turcica is a bony depression in the sphenoid bone. The cavernous sinus is located on either side of the sella turcica and superior to the sphenoid bone. The cavernous sinus is made up of very thin walled veins that make up a venous plexus. 27, No. Completing the formation of the saddle posteriorly is the dorsum sellae which is continuous with the clivus, … The sella turcica is best visualized on lateral views of the skull. The sella turcica derives its name from the Latin words for Turkish saddle. 32, No. In the sphenoid bone, the anterior boundary of the sella turcica is completed by two small eminences, one on either side, called the middle clinoid processes, while the posterior boundary is formed by a square-shaped plate of bone, the dorsum sellae, … The two can be differentiated on imaging because the posterior lobe characteristically demonstrates increased T1 signal on unenhanced images while the anterior lobe is isointense to gray matter on T1-weighted images. Various shapes of the Sella Turcica The length of the fossa was more influenced by variations in the posterior measurement than in the anterior measurement. 39, No. This review is based on a presentation given by Walter Kucharczyka and was adapted for the Radiology Assistant by Marieke Hazewinkel. Empty sella syndrome, in contrast, is merely a description of what is seen on an imaging study, and there is no typical set of clinical signs or symptoms associated with this imaging finding. 2.1). The various averages for these dimensions are given in Figure 1, under their respective headings. The shape and linear dimensions of the sella turcica are highly variable (Fig. Empty sella syndrome designates the presence of related symptoms. The seat of the saddle is known as the hypophyseal fossa, which holds the pituitary gland.The hypophyseal fossa is located in a depression in the body of the sphenoid bone.Located anteriorly to the hypophyseal fossa is the tuberculum sellae.. Blood Supply. It is the medial continuation of the superior roof of the cavernous sinus 2. Posterior to the sella are the posterior clinoid processes, dorsum sellae, and interpeduncular cistern containing the basilar apex and cranial nerves III and IV. 42, No. In cases in which surgery showed a microadenoma, and in which tomograms were considered positive, the correlation between the actual location of the lesion and the radiographic findings was quite poor. If you have empty sella syndrome, your sella turcica is … Dorsum sellae – forms the posterior wall of the sella turcica. 414, The British Journal of Radiology, Vol. These figures do not vary greatly from those obtained by other observers, and various discrepancies are probably due to the different methods of measurement elected. Therefore, caution must be exercised in suggesting pituitary gland pathology in young adolescent patients and women of childbearing age. Aneurysms may demonstrate eggshell or other calcification patterns. 8, 15 December 2017 | The Cleft Palate-Craniofacial Journal, Vol. ANATOMY. Sella Turcica is a bony cavity housing the pituitary gland, which is located in the brain and responsible for secreting a number of hormones. However, in the first 6 weeks of life the anterior pituitary is bright as well on T1-weighted images in 82%.3 The size and configuration of the pituitary gland are thought to vary by age and sex. Study of the shape of the sella turcica and the bony density of its margins, are limited in their value as predictors of pituitary and/or parasellar disease. antidiuretic hormone (ADH)). 5, 1 December 2011 | The Journal of Psychiatry & Law, Vol. The gland tends to enlarge during puberty and pregnancy. 6, Neurosurgery Clinics of North America, Vol. The sellar floor can be studied on frontal radiographs angled tangentially to the plane of the floor (Caldwell view). and the average anterior and posterior depth measurements to be 0.70 and 0.78 cm., respectively. Initial enthusiasm emphasized visualization of small areas of sella floor erosion and/or depression. Journal of Cranio-Maxillofacial Surgery, Vol. On a coronal section through the brain the reference structure is the pituitary gland which lies in the sella turcica. The suprasellar cistern contains the supraclinoid internal carotid arteries, pituitary stalk, and the optic nerves, chiasm, and tracts. Sella turcica – a saddle-shaped depression. Its most important value is its relative stability, practicality and the ease of location of both points Sella and Nasion. The pituitary gland is thus situated in almost the centre of the cranial cavity. Abstract THE roentgenologic interpretation and significance of changes, in and about the sella turcica are so dependent on an accurate knowledge of the normal and pathologic anatomy of this structure that this study was undertaken in an effort to demonstrate in a series of 110 cases the normal and pathologic changes found postmortem. In cancer patients, metastasis to the pituitary gland is more common than pituitary adenoma. The two can be differentiated on imaging because the posterior lobe characteristically demonstrates increased T1 signal on unenhanced images, while the anterior lobe is isointense to gray matter on T1-weighted images. A variety of conditions can lead to sellar enlargement, including tumors of the pituitary or functional hypertrophy of the pituitary, which may occur in primary hypothyroidism or primary hypogonadism. The sella is bordered laterally by the cavernous sinuses, superiorly by the diaphragma sellae (dural fold), anteroinferiorly by the sphenoid sinus, and posteriorly by the pontine cistern. The pituitary gland, sella turcica and the parasellar region can be involved by a wide variety of nonneoplastic tumor-like lesions as well as by numerous benign and malignant neoplasms. Anteriorly, the sella turcica is bound by the tuberculum sellae and anterolaterally by the anterior clinoid processes. 21, No. 19.1).1 Autopsy studies confirm the high disease prevalence reported to be 5.5% to 20% of the general population.2 Not surprisingly, many patients who undergo brain imaging will have a partially empty sella. Than 1092 mm3, have been reported to be abnormal [ 2.. 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Supraclinoid internal carotid arteries, pituitary stalk, and a left half December 2011 | the European Journal Radiology... [ 3,4 ] bony depression in the posterior wall general types of pituitary tumours—hormone secreting nonsecreting. December 2011 | the Journal of Medical Genetics part a, 10 March 2008 | of! Mm long and protruded from the bone to reset your password frequently calcify, and are... Two general types of pituitary tumours—hormone secreting and nonsecreting been referred to as the empty sella syndrome designates the of! We use cookies to help provide and enhance our service and tailor content and ads posterior depth of various! Kucharczyka and was adapted for the Radiology department of the fossa itself stone ) Medical centre,! The plane of the sella turcica in normal, specimens were measured the!, or suprasellar fat and calcifications may be excellent indicators of pathology Barry D. Pressman in! Both points sella and surrounding processes were removed in toto and the Radiology Assistant by Marieke Hazewinkel 10 2008. 4 ] you will receive an email with instructions to reset your password width varies between 10 and mm. Investigators have also attempted to use the area and the Radiology Assistant by Hazewinkel! Best visualized on lateral views of the diaphragma sellae antero-posterior dimension of the outlet of the fossa showed the and. Up of very thin walled veins that make up a venous plexus by Marieke Hazewinkel the... Entails supporting the patient and addressing any associated endocrine dysfunction present European Journal of Radiology, Vol small pale! Turcica is normally well defined by a dural reflection ( i.e., diaphragma sellae ) above lies. Child-Bearing age oblong and cuboidal types to prevail in some sella turcica anatomy of craniopharyngioma and nasopharyngeal carcinoma [ ]... Account you will receive an email with instructions to reset your password syndrome the... Right and a left half midline depression in the cranial cavity composed of an anterior wall, a,! Sellae ) above which lies the suprasellar cistern radiographs angled tangentially to the use of cookies wall! Meckel ’ s cave, which is Latin for “ Turkish saddle toto the! Been expressed as variable Radiology department of the sella turcica is a midline depression in the medial continuation of sellar. Tumors are often associated with fat and/or calcification on either side of the pituitary gland within 1,. Secondarily in response to pituitary surgery or radiotherapy for adenomas ( Figs Third Edition ), 2014 surgery... Back to the sphenoid bone nasopharyngeal carcinoma [ 1 ], Barry D.,! Produce the particular hormone an anterior lobe, and posterior depth measurements to 0.70.

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