First Disposable Single Use HD Endocopic System-DITM Exclusive

Docinthemachine first exclusive report!

Olive Medicalhas developed a single use HD endoscopic camera system for surgical applications.  Traditional endoscopic camera systems consist of a camera head with a coupler to attach it to the scope and a camera control unit.  Camera head and control systems typically cost in the $30, 000 range.  olive’s approach is to make the camera had single use and delivered in a sterile peel pack ready for the operating room.  They intend to deliver such a system at under $300 per case — less than 1% of a current cost to purchase a system.  What’s more the system is native HD at up to 1080 resolution.   I had a chance to speak with them about the system and they claim they are using a native HD imaging sensor chip.  if so, they would be the first surgical camera system to do so.  All other HD systems available today do not natively sense in 1080 but rather employ post imaging processing to upscale and modify the image.  Their camera unit also includes integrated still image capture software eliminating the need for yet another $10,000-$30,000 box – although with obviously less features (no video, printer, etc).  Their fulls specs include :

  • Full 1080p Video Output
  • 2 DVI and 2 HDMI Outputs
  • Touch Screen LCD Interface
  • Integrated Storage of 40 Images

Following the disposable razor model, they would provide the camera control box to the facility for minimal (or no cost) and camera heads would be purchased per use.  Following the green bandwagon they intend to accept the cameras back after use for reprocessing.  Of course the obvious thought would be for a facility to just buy a few $300 cameras and use them over and over again.  They have addressed this issue with some novel patented software that recognizes if the unit is shut off and watches and limits use until its factory reset.  The team at Olive includes several ex-stryker hardware and software engineers so they know the traditional market well.

The idea of disposable systems is not new.  Over the years I have seen many disposable laparoscopes and hysteroscopes and even limited use imaging systems.   Many years ago I presented at the AAGL conference the first ever fully digital scope with a cmos image sensor and LED illumination.  At that time I predicted that such a set up by eliminated camera control and illumination box requirements would enable the entire thing to become wireless and disposable.  More recently more recently an Italian group wrote about such a disposable system viewed through a PC that achieved only VGA resolution.  Olive has upped the ante by designing something at a fraction of the cost at true HD definition!  They have some video on their website but its not labeled which one is recorded with which camera so I can’t link here yet.

This is a totally logical progression as Moore’s law gets applied to medical imaging in the OR. Chip fabrication follows Moore’s Law with dropping cost and doubling performance every 2 years.  The expensive parts of these systems are now basically computer chips and related hardware.  Therefore as technology accelerates we’ll see exponential advances in performance and miniaturization for lower costs.  Given Imaging and others have produced disposable self-contained pill-cams that have a low cost cmos chip and LED illumination in a swallowable capsule.  Chip CMOS sensors with integrated processing leverages consumer-based electronic technology advances (and economies of scale) as well as trickle-down military imaging technology.  HD (and beyond) sensors are going to get very cheap in the future for these markets- not to mention the demand for real time HD video imaging on cell-phone cameras as wireless bandwidth goes beyonf 3G.  The sensors really are basically the same. 

The unit is not yet FDA approved.  While I have seen videos I have not yet had he unit in a live lab evaluation so the final grading will ultimately rest of real world image quality, resolution, color fIdelity, and light sensitivity.  I know several of the major traditional manufacturers have seen the unit.  I can only imagine them buying to squash it.  Such a low cost device certainly does not fit in with the traditional low volume high cost + service contract scope camera model used today.

What’s the Sensor?–They obviously would not verify to me the sensor inside the unit– no company ever does.  I usually find out once the camera is released and a competitor cuts one open and sends me detailed photos and spec sheets.  I did do some hunting around and was able to verify there are now American company produced CMOS imaging chips natively 1080p60.  They make a standard 2/3 inch chip imaging max at 2112 x 1188.  The ones I saw are 2.1-2.5 megapixel.  The same fabricators also produce a 1/3 inch version.  Researching this i got quite excited about he prospects for using these chips for consumer electronics in ultra-low cost HD camcorder/still devices.  Flipvideo has some competition coming!  

Such a device if the quality and reliability is there could be very attractive to many facilities battling down time service and sterilization issues.  This could enable higher throughput in the OR with less capital outlay and lower manpower.  The other (even larger in my opinion) potential market is office-based facilities which now primarily bag or high level disinfect such systems.  This would be a very attractive alternative for them.  Until now capital equipment requirements have been a barrier to entry for many doctor’s (and vet) offices.   Ob Gyn , urology, orthopedics, ENT, general surgery, ICU’s and the ER  among others are specialties are those where there is currently a significant application for imaging in the non-OR setting.  This low cost idea is not alone- several companies have introduced low cost integrated camera-view- display units based on cmos- such as the tower-free hysteroscopy system with LED LCD screen and CMOS.  The difference with Olive’s approach is single use eliminates the sterilization costs and they are offereing it for less than 10% of the cost of even the ultra-low cost systems coming out.  Just look at the price of computer LCD panels and HD camcorders (10% where they were recently) and you can appreciate the technology price advances pushing this model. 

Don’t underestimate the difficulty of sterilization.  While many current ystems are labelled as autoclavable most facilities have found that significantly reduces the lifespan.  In january the FDA shut down the use of one of the most common OR scope-camera disinfection systems from Steris used in 23,000 sites.  This whole issue is a subject of an upcoming post but basically the FDA said Steris made too many changes since approval of the device– so it not the same device anymore and shut the thing down!  While the issue is being resolved it has been a nightmare for case preparation and opens up the reexamination of sterilization.  Up until now disposable of resposable systems have not been attractive because they were priced at >10% of system costs.  Now Olive is getting to the <1% price point – and that’s a different story. 

I look forward to some hands on testing…

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DITM Podcast on Future of Video for Entertainment & Medicine With Sony Exec

I have been getting great feedback on my DITM medical technology podcast which starts the podcast series I’ll be doing regularly.  Several people wrote to ask if I could post a version with just the interview since they loved it so much and wanted to share that segment.  The original podcast starts with FDA approvals then has an interview with Sony Exec Bob Ott on the future of video technology in entertainment and medicine that we did a the NAB broadcast meeting in Vegas.

Here’s an edit version with just the interview enjoy and share with your friends!

 

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Docinthemachine MedTech Podcast!

Here’s the latest installment of the docinthemachine podcast.  In this installment I review new FDA device approvals and then present an interview about HD technology for entertainment and medicine with Bob Ott (vice president of broadcast and professional audio/video products for Sony Electronics) recorded at the National Association of Broadcasters (NAB).

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First Ever Surgical Video in 4k Ultra High Def- Hollywood and Doctor Team Up for Revolutionary Projects on Future Visualization in Medicine

4k and 3d control and projectorsour digital cinema control room- Sony controls

For the first time ever Hollywood’s digital vanguard has teamed up with a surgeon to use tomorrow’s cinematic tools to revolutionize visualization in the operating room. We successfully filmed produced and played a 4k digital cinema movie of a live human surgery.  This was an amazing collaboration between a fertility surgeon, the AAGL endoscopy society, Sony Medical & Broadcast divisions, Red Digital Cinema Camera Company, FotoKem, Vincent Pace films, USC professor Richard Weinberg, and the NBA just to name a few!  We also showed the largest medical 3d displays ever.

The AAGL reported on this groundbreaking session today .   Further details are here and here.

 

dual-sxrd-3d projectors from Sony for 3DDual Sony SXRD 4k projectors in 3D scaffold

New cinematic technologies are transforming the film business today.  The two major revolutionary developments are 1) ultrahigh definition “4k” technology – which brings resolution to 4 times that of HD and 2) realistic immersive high definition 3D. I set out to introduce these technologies to the medical world and to see if we could for the first time apply them to surgical practice- setting the goal to once again use technological innovation to improve our patient outcomes.

Virtually all of my surgery is endoscopic- performed through tiny telescopes and viewed on a TV monitor. In 2001 I performed the world’s firs HDTV surgery and demonstrated how increased resolution improved the surgeon’s visualization and performance of procedures.  For those interested in the history of HDTV surgery and the details of its development further details of my work are here from the New York Times and here from Science Daily and here from MIT Technology Review.   Over the past two years I refined this work with even better performing camera systems and this work was featured on 20/20 and on the National Geographic Channel’s first ever HD medical show – Inside the Living Body.

Hollywood is embracing its digital future by adopting (with $1 billion in financing and a follow-up deal by Sony) planned conversion of 20,000 theaters to ultrahigh definition 4k (4096x 2048) video.  The revolutionary Red One camera is one of the few that can natively record this type of file.   Having heard about it I went to vegas for NAB in April and saw with my own eyes the amazing realistic movies  being made with it.  While there I met with Ted Schilowitz, Red’s “Leader of the Rebellion” and was ecstatic with his desire to help with with a proof of concept- to film surgery with a 4k camera. I also partnered with Sony’s Medical and Broadcast Divisions who eagerly helped me set up a 4k and 3dHD digital cinema in an international medical conference hall in the Las Vegas Paris Hotel.  The theme of my Keynote lecture was “Film and Medicine: From the Past to the Future- Through the 4th Wall.”  In this, I traced how cinematic film  technology has transformed the teaching and performance of surgery- and how the future will again have revolutionary changes in physician visualization.  Our Hollywood partners allowed me to first show jaw-dropping pro-sports and theatrical demos of the technology.

Sony’s digital cinemas allow the next generation of film to be projected at these previously impossible resolutions.  We used dual SXRD 4k projectors with linear polarizing filters for 3D HD then went to a single projector for the 4k.  4k footage has to be played off a dedicated media block digital server  and we used an LMT-100 like a movie theater would and FotoKem converted the 4k files into a DCP digital cinema package that can be played.  For 3d footage we played off an HD SR tape dual stream deck.  I’ll post a follow-up explaination of each of these technologies in detail.

By increasing resolution to this level we allow the surgeon to be actually immersed in images that surpass the live surgical experience. The progress from regular surgical film technology is like comparing sitting in an HD home theater to watching a video on a cell phone.

Ultra high resolution digital cameras are transforming the art of cinema. Leading Hollywood directors such as Peter Jackson and Stephen Soderbergh today have just started filming the next generation of cinema blockbusters using cameras with “4K” resolution, four times the resolution of High Definition (HD) with 4096 lines of resolution to give audiences unprecedented realism. The Red One digital cinema camera is the at the forefront of the revolution.  Director Soderberg previously described this technology as “This is the camera I’ve been waiting for my whole career: Red is going to change everything….Shooting with Red is like hearing The Beatles for the first time. Red sees the way I see.” 

Amazingly, the surgeons in the conference were able to visualize the surgery they were watching better than if they had been in the operating room live. If it can transform the immersive experience of the movies with unprecedented realism wouldn’t you want that degree of vision in your surgeon’s hands? By combining unprecedented resolution and magnification the surgical images were beyond what a surgeon would have standing live in the operating room. Those in the audience predicted this technology would further revolutionize minimally invasive surgery as it becomes incorporated into the OR of the future.

We then projected the largest high definition (HD) 3d surgical images ever. Wearing glasses reminiscent of today’s 3d Hollywood blockbusters U23D and Journey to the Center of the Earth a standing-room only crowd of 1600 surgeons felt as if they could “reach out and join the operation”. These images were enabled by converting Sony’s ultrahigh definition and 3d theatrical systems to show medical footage in what the AAGL called the “Theater of Tomorrow.”  A Vince Pace 3D demo reel showed where Hollywood is going as well with Gwen Stefani concert footage, underwater vistas, and movie clips.

Since laparoscopic surgery is performed by a surgeon watching on a video monitor making the images “better than live” may facilitate teaching and procedures in the future.

The 4K system, manufactured by RED Digital Cinema Camera Company, was used to film Jumper, Crossing the Line, and The Argentine. This recording represents its first use for medicine and biology in the world.  In addition to a surgery we showed the first ever 4k microscopy images of single cell organisms ever recorded (from USC).

Stay tuned a for a series of posts coming up this week that will review the session, how we managed the collaborations, the difficulty in executing each of the technologies, and where I predict this is going in surgical visualization.

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OLED: The Future of Display Technology- NAB 2008 Update

oled sony front displayThis is my second post in a series of updates of exciting new media technology I saw at the 2008 National Association of Broadcasters (NAB) meeting just finishing up in Las Vegas. My intro to the meeting can be found here.

In this post I want to review the most exciting new display technology I saw on multiple fronts at the meeting- and share with you my predictions of how it will be used in medicine in the future. This technology is OLED

OLED represents the next step in the future of video display technology. I have previously written about what the technology is and how it works here. The technology was introduced commercially by Sony at the 2007 CES meeting also in Vegas (the home of all new media conventions). Currently flat panel technology is dominated by LCD’s and plasma displays – the limitations of which have been extensively reviewed elsewhere,

The Importance of Display Technology and its Market:

The display used to watch video is the final link that determines ultimate picture quality. The size of the current consumer flat panel TV market is estimated at $80-$100 Billion. I don’t have to say that number twice to convince you why consumer electronics giants will push the limit of display technologies creating the raw materials for medical displays in the process. This happened with CRT’s, LCD’s , and plasmas in the OR.

Let me be the first to predict- OLED will 100% dominate OR surgical displays as the technology matures. Not to mention the potential for their use in head mounted displays (HMD’s) and alternate display technologies.

I was enormously impressed by several features of the first OLED displays I laid my hands on. – my favorites are highlighted below

  1. Fantastic brightness and contrast ratio. This 11″ model i looked at had a contrast ration greater than 1,000,000:1 (not a typo).
  2. Excellent grayscale
  3. Full-motion video without ghosting
  4. Wide viewing angles from all directions
  5. A wide range of pixel sizes
  6. Low power consumption
  7. Low operating voltages
  8. Wide operating temperature range
  9. Long operating lifetime
  10. A thin and lightweight form factor
  11. Cost-effective manufacturability

oled side viewHere is an an example of the unbelievable wide viewing angle of OLED displays. When you look at standard LCD displays the brightness and ultimately entire image falls off as you start to look from the side angle. This has been a big problem for me with LCD displays in the OR for endoscopic surgery. When we operate as a team often the assistant or nurse need their own separate monitors since they are unable to get a bright clear image viewing my image from a tangential angle.

The OLED looked even better than this since there is a bit of a glare reflection from my camera’s flash.

thin oled display

Here is a view of just how thin these displays are. The screens themselves can be made 0.3 mm thick in current implementations.

sony pro oled

This was Sony’s implementation of OLED for the broadcast pros demo’d at NAB 2008. The HDVF-EL100 is an OLED viewfinder for pro video TV cameras. The same wide viewing angle, incredibly thin dimensions and low heat that will benefit it in the OR went into choosing it for this use as well.

As Engadget HD said- you can see these OLED displays from a mile away.

I had an opportunity to chat with the engineers about OLED and what is delaying its dominance of the market. They said that currently maufacturing becomes problematic as sizes increase leading also to cost escalations.  In addition they are produced in totally new types of production factories which are currently being built- such as the Samsung 8G LCD factory.  There is no doubt these issues will be overcome with current development.

Update:  for those interested in truely amazing future potential for OLED read here about a version that is on a flexible material that can simply be rolled up in testing now by the US Army.

Also – it appears mainstream OLEDs will hit the consumer markets in large number in 2009-2011.  Samsung predicts 2008/2009 while LG predicts a 32 inch version in 2011.  Details are here.

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The Future of Medical Video: DITM Reports From NAB 2008

I had the distinct pleasure of attending the 2008 National Association of Broadcasters (NAB) meeting last week in Las Vegas. As the foremost event for the TV, broadcast, and media industries this is the venue to see and explore the future of all things video and media.

The Floor of the Meeting and a Sea of Humanity- Why I Went

the floor of the nab 2008 meetingBeing probably the only physician in a sea of 105,000 TV and media folks raises the inevitable question- why did I go?

Endoscopic surgery (laparoscopy hysteroscopy arthroscopy etc) all share the common use of video equipment. Since the late 70′s these procedures are performed as remote surgery looking through a thin telescope inserted into a body cavity and observed on a TV monitor.

The progress we make in medical video surgery is a direct trickle down of innovations from the broadcast arena. From the first CCD camera hooked to a laparoscope and suspended from the ceiling via a jerry-rigged boom to the first use of HDTV in the OR – broadcast and TV technology drives innovation in surgical video.

I thrive on researching new technology and then extrapolating new solutions to medical problems using these developments. This meeting provides the raw material for my creative process.

I was honored to accept invitations from several major broadcast, video, computer, and even surgical companies to attend the meeting, walk the floor with them, brainstorm new ways of helping patients with new devices and predict future needs and uses for technology in medicine.

Everybody kept asking me: What was the most important development I saw at the show? What future technology do I predict is poised to transform medicine?

Beyond the entire rooms filled with the latest newschoppers and remote satellite trucks

I was most impressed with the following technologies which have the potential to transform both consumer entertainment and medical devices- I will be posting further about each of these and what I saw (including a series of interviews):

  1. Beyond HDTV- “ultra HD” 4k cameras and displays
  2. 3D video technology in SD and HD
  3. OLED display technology
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New FDA 510(k) Approvals for March 2008-(pt.1) New Video Monitor Screens

The FDA has published its 510(k) approval letters for March 2008. In terms of surgery, endoscopy, and imaging a few items caught my eye. The first is a pair of high resolution monitors from Eizo.

Eizo is upgrading both monchrome and color workstations to 5-megapixel units. This will be useful for radiologic workstations.

Here is the text from the FDA

DEVICE: 5 MEGAPIXEL MONOCHROME LCD MONITOR, MODEL RADIFORCE GS520 EIZO NANAO CORPORATION 510(k) NO: K080422(SPECIAL)
ATTN: HIROAKI HASHIMOTO PHONE NO : 81 76 2742468 153 SHIMOKASHIWANO-CHO SE DECISION MADE: 10-MAR-08 HAKUSAN, ISHIKAWA-KEN, JAPAN 924-8510(k)

DEVICE: COLOR LCD MONITOR, MODEL RADIFORCE RX211 EIZO NANAO CORPORATION 510(k) NO: K080457(SPECIAL)
ATTN: HIROAKI HASHIMOTO PHONE NO : 817 627 42468 153 SHIMOKASHIWANO-CHO SE DECISION MADE: 20-MAR-08 HAKUSAN, ISHIKAWA-KEN, JAPAN 924-8510(k)

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Retraction From Pointe Conception Medical

As a practicing physician, consultant to industry and the investment community, and medical technology blogger, my independence is of utmost importance to me.

Pointe Conception Medical issued the following statement today:

“Pointe Conception Medical (PCM) regrets the use of the quote from Dr. Steven Palter in our presentation materials.  Dr. Steven Palter did not provide PCM permission to use his name or any type of endorsement from him in any of our promotional materials.  Steven Palter is not affiliated in any way with Pointe Conception Medical.”.

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New HD Disk Format

EngadgetHD reports on New 3xDVD;

Comin’ straight outta Thuringia is the first news we’ve heard in a year about HD DVD’s red-laser cousin, 3X DVD. CDA Datenträger Albrechts GmbH has announced its started production of 3X DVDs, which are basically HD content, compressed with VC-1 or MPEG-4 and AACS DRM, on a standard red laser DVD that is readable only by HD DVD players. The advantage is that it costs the same to produce as a regular DVD, and CDA is apparently producing dual-sided DVD-10 discs, with standard DVD content on one side, and HD on the other. Of course, with several German studios dropping HD DVD support (along with a few others you may have heard of) its hard to see who will take advantage of CDA’s new capabilities.

Someone needs to step up and put a recordable HD format onto the HD endoscopy sets in the OR.  Even the HD systems record in SD.  I am waiting for recordable Blu-ray or even better a flash or disk based AVCHD solution.

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Next Gen Mini-PS3 Cell Chips -Next Medicine Imaging Revolution?

ps3cell.jpg

“ Though sold as a game console, what will in fact enter the home is a Cell-based computer. ” – Ken Kutaragi

“Cell-based computers will revolutionize medical imaging” – Docinthemachine

The IBM Cell graphics processor at the heart of the PS3 is a remarkable chip.  Cell is shorthand for Cell Broadband Engine Architecture.  It has been described as “seemingly obscene computing capabilities for what will rapidly become a very low price.” 

A newer miniaturized lower power version has just been announced by ars technica that I predict will make it to medical video and VR processing.  I recently led a session on the use of VR in medicine where Andy Van Dam (VR pioneer , professor of computer science at Brown, and founder of Siggraph) and I spoke about the future of VR processing.  He predicted that the video grame industry hardware innovations will make the most dramatic strides and that this technology will then trickle down to VR due to its sheer massive computational power- beyond that of the old CAVEs of DARPA.

You may be unaware that this represent a new form of computer processing: 

The Cell concept was originally thought up by Sony Computer Entertainment inc. of Japan, for the PlayStation 3.  The genesis of the idea was in 1999 when Sony’s Ken Kutaragi  “Father of the PlayStation” was thinking about a computer which acted like Cells in a biological system.  A patent was applied for listing Masakazu Suzuoki and Takeshi Yamazaki as the inventors in 2002

The architecture as it exists today was the work of three companies: Sony, Toshiba and IBM.  Sony and Toshiba previously co-operated on the PlayStation 2 but this time the plan was more ambitious and went beyond chips for video games consoles.  The aim was to build a new general purpose processor for a computer.

In lay terms here is the muscle behind the processor:   

The setup of the Cell processor is like having a team of processors all working together on one chip to handle the large computational workload needed to run next-generation video games. In order to understand how the Cell processor works, it helps to look at each of the major parts that comprise this processor.

The “Processing Element” of the Cell is a 3.2-GHz PowerPC core equipped with 512 KB of L2 cache. The PowerPC core is a type of microprocessor similar to the one you would find running the Apple G5. It’s a powerful processor on its own and could easily run a computer by itself; but in the Cell, the PowerPC core is not the sole processor. Instead, it’s more of a “managing processor.” It delegates processing to the eight other processors on the chip, the Synergistic Processing Elements.

The computational workload comes in through the PowerPC core. The core then assesses the work that needs to be done, looks at what the SPEs are currently processing and decides how.

Watch out for our robot PS3 overloards.  This Chip has the potential to expand itself and distribute workloads over networks.  Don’t worry this is not some Singularity scenario where the chips start to think on their own.  Here is a review of the potnetial of the chip:

Chip giants such as Intel have already started working on dual-core chips, but Cell goes several steps further by giving processing units a measure of independence. Current multicore chips typically chop a single computing task into parts, which are distributed among processing units. Cell’s processing units–called “software cells”–can handle completely separate jobs.

“The software cells are designed to be kind of self-contained–they can kind of roam around,” Halfhill said.

Cells can even roam over a network, allowing the processor to perform a type of distributed or grid computing, an increasingly popular enterprise technique in which demanding tasks are divvied up among a gang of networked computers. A PlayStation 3 could borrow unused processing power from other consoles on a network, for example, to complete a demanding task such as delivering streaming video.

“The Cell architecture is designed to make grid computing almost universal,” Halfhill said. “It makes distributed processing part of the design. If you have several of these machines on a network, the work can be spread across a network.”

The cell design can allow cooperation between video devices:  “This architecture is not fixed, if you have a computer, PS3 and HDTV which have Cell processors they can co-operate on problems.  They’ve been talking about this sort of thing for years of course but the Cell is actually designed to do it.  According to IBM the Cell performs 10x faster than existing CPUs on many applications.  This may sound ludicrous but GPUs (Graphical Processors Units) already deliver similar or even higher sustained performance in many non-graphical applications.”

Medical uses:  We are at the cusp of a revolution due to the integration of computer video processing and surgical and radiological imaging.  Details of this concept of mine are here and a podcast here.  As we move ahead with virtual imaging and newer forms of optical processing it is the computational power of these kinds of chips that will be enabling.

Disclosure:  As I previously wrote, I was chosen to be a Sony Medical HD Luminary Site.  I receive no financial payment for this relationship which is only with Sony’s Medical division and is part of my medical research work on surgical tools and imaging.  Heck- I had to buy my PS3 at Best Buy just like anybody else. 

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