Research progress on risk factors and management strategies of dysphagia in Parkinson’s disease_West China Medical Journal

Authors：

WANG Tianqi ¹ , GONG Siyuan ² , HU Wangjuan ¹ , LIU Jihong ² , LI Jia ² ,  LIAO Chunlian ^1,2

1. College of Nursing, Chongqing Medical University, Chongqing 400010, P. R. China;
2. Department of Neurology Medicine, the Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, P. R. China;

Corresponding author：

LIAO Chunlian, Email: 300259@hospital.cqmu.edu.cn

Keywords：

Parkinson’s disease; dysphagia; risk factors; management strategies

DOI：

10.7507/1002-0179.202503089

Video：

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Abstract Full text Figures/Tables Video References Cited by

Dysphagia is a common non-motor symptom in Parkinson’s disease (PD), with a high incidence and insidious progression. It can lead to complications such as dehydration, malnutrition, aspiration pneumonia, and even death, seriously affecting the quality of life and prognosis of patients. Therefore, early screening, assessment, and intervention are crucial for improving the quality of life and prognosis of PD patients with dysphagia. This article mainly reviews the risk factors and management strategies of dysphagia in PD, with the aim of providing a reference for healthcare professionals to conduct subsequent evaluations and develop targeted interventions.

1.	Kalia LV, Lang AE. Parkinson’s disease. Lancet, 2015, 386(9996): 896-912.
2.	Armstrong MJ, Okun MS. Diagnosis and treatment of Parkinson disease: a review. JAMA, 2020, 323(6): 548-560.
3.	Simons JA. Swallowing dysfunctions in Parkinson’s disease. Int Rev Neurobiol, 2017, 134: 1207-1238.
4.	Gong S, Gao Y, Liu J, et al. The prevalence and associated factors of dysphagia in Parkinson’s disease: a systematic review and meta-analysis. Front Neurol, 2022, 13: 1000527.
5.	Kalf JG, de Swart BJ, Bloem BR, et al. Prevalence of oropharyngeal dysphagia in Parkinson’s disease: a meta-analysis. Parkinsonism Relat Disord, 2012, 18(4): 311-315.
6.	王萍, 王波, 熊冰, 等. 帕金森病患者吞咽障碍评估的研究进展. 中华神经科杂志, 2023, 56(3): 351-358.
7.	Cardoso AR, Guimarães I, Santos H, et al. Cross-cultural adaptation and validation of the Swallowing Disturbance Questionnaire and the Sialorrhea Clinical Scale in Portuguese patients with Parkinson’s disease. Logoped Phoniatr Vocol, 2021, 46(4): 163-170.
8.	Dilmaghani S, Atieh J, Khanna L, et al. Severity of dysphagia is associated with hospitalizations and mortality in patients with Parkinson’s disease. Neurogastroenterol Motil, 2022, 34(6): e14280.
9.	帕金森病患者吞咽障碍康复中国专家共识编写组, 中国康复医学会吞咽障碍专业委员会. 帕金森病患者吞咽障碍康复中国专家共识(2024 版). 中华物理医学与康复杂志, 2024, 46(7): 587-592.
10.	中国康复医学会吞咽障碍康复专业委员会. 中国吞咽障碍康复管理指南(2023 版). 中华物理医学与康复杂志, 2023, 45(12): 1057-1072.
11.	Cosentino G, Avenali M, Schindler A, et al. A multinational consensus on dysphagia in Parkinson’s disease: screening, diagnosis and prognostic value. J Neurol, 2022, 269(3): 1335-1352.
12.	中华医学会神经病学分会帕金森病及运动障碍学组, 中国医师协会神经内科医师分会帕金森病及运动障碍学组. 中国帕金森病消化道症状管理专家共识. 中华神经科杂志, 2022, 55(11): 1225-1235.
13.	Claus I, Muhle P, Suttrup J, et al. Predictors of pharyngeal dysphagia in patients with Parkinson’s Disease. J Parkinsons Dis, 2020, 10(4): 1727-1735.
14.	Rofes L, Arreola V, Romea M, et al. Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol Motil, 2010, 22(8): 851-858.
15.	Wang P, Wang B, Chen X, et al. Six-year follow-up of dysphagia in patients with Parkinson’s disease. Dysphagia, 2022, 37(5): 1271-1278.
16.	Curtis JA, Molfenter SM, Troche MS. Pharyngeal area changes in Parkinson’s disease and its effect on swallowing safety, efficiency, and kinematics. Dysphagia, 2020, 35(2): 389-398.
17.	Picillo M, Nicoletti A, Fetoni V, et al. The relevance of gender in Parkinson’s disease: a review. J Neurol, 2017, 264(8): 1583-1607.
18.	Nóbrega AC, Pinho P, Deiró M, et al. Levodopa treatment in Parkinson’s disease: how does it affect dysphagia management?. Parkinsonism Relat Disord, 2014, 20(3): 340-341.
19.	Jost ST, Kaldenbach MA, Antonini A, et al. Levodopa dose equivalency in Parkinson’s disease: updated systematic review and proposals. Mov Disord, 2023, 38(7): 1236-1252.
20.	Ding X, Gao J, Xie C, et al. Prevalence and clinical correlation of dysphagia in Parkinson disease: a study on Chinese patients. Eur J Clin Nutr, 2018, 72(1): 82-86.
21.	石小雪, 郑晋华, 马建军, 等. 帕金森病患者发生吞咽困难的危险因素研究. 中国全科医学, 2022, 25(6): 669-674.
22.	Mu L, Chen J, Li J, et al. Mechanisms of swallowing, speech and voice disorders in Parkinson’s disease: literature review with our first evidence for the Periperal Nervous System Involvement. Dysphagia, 2024, 39(6): 1001-1012.
23.	Mohamed AB, Mohamed GF, Elnady HM, et al. Evaluation of dysphagia in different phenotypes of early and idiopathic Parkinsonism. Egypt J Neurol Psychiatr Neurosurg, 2018, 54(1): 28.
24.	Burtscher J, Moraud EM, Malatesta D, et al. Exercise and gait/movement analyses in treatment and diagnosis of Parkinson’s disease. Ageing Res Rev, 2024, 93: 102147.
25.	Walker RW, Dunn JR, Gray WK. Self-reported dysphagia and its correlates within a prevalent population of people with Parkinson’s disease. Dysphagia, 2011, 26(1): 92-96.
26.	Miller N, Allcock L, Hildreth AJ, et al. Swallowing problems in Parkinson disease: frequency and clinical correlates. J Neurol Neurosurg Psychiatry, 2009, 80(9): 1047-1049.
27.	谢朝艳, 丁雪萍, 高吉祥, 等. 帕金森病患者流涎与吞咽困难的关系研究. 中华神经科杂志, 2016, 49(11): 856-863.
28.	Wang P, Chen X, Chen M, et al. Dysphagia pattern in early to moderate Parkinson’s disease caused by abnormal pharyngeal kinematic function. Dysphagia, 2024, 39(5): 905-915.
29.	Vogel A, Claus I, Ahring S, et al. Endoscopic characteristics of dysphagia in multiple system atrophy compared to Parkinson’s disease. Mov Disord, 2022, 37(3): 535-544.
30.	Mu L, Sobotka S, Chen J, et al. Altered pharyngeal muscles in Parkinson disease. J Neuropathol Exp Neurol, 2012, 71(6): 520-530.
31.	Silbergleit AK, Schultz L, Hamilton K, et al. Self-perception of voice and swallowing handicap in Parkinson’s disease. J Parkinsons Dis, 2021, 11(4): 2027-2034.
32.	Polychronis S, Dervenoulas G, Yousaf T, et al. Dysphagia is associated with presynaptic dopaminergic dysfunction and greater non-motor symptom burden in early drug-naïve Parkinson’s patients. PLoS One, 2019, 14(7): e0214352.
33.	Nakamori M, Toko M, Yamada H, et al. Association between motor symptoms of Parkinson’s disease and swallowing disorders. Neurol Sci, 2024, 45(5): 2021-2026.
34.	Yatabe N, Takeuchi K, Izumi M, et al. Decreased cognitive function is associated with dysphagia risk in nursing home older residents. Gerodontology, 2018, 35(4): 376-381.
35.	Kim JS, Youn J, Suh MK, et al. Cognitive and motor aspects of Parkinson’s disease associated with dysphagia. Can J Neurol Sci, 2015, 42(6): 395-400.
36.	Labeit B, Claus I, Muhle P, et al. Effect of cognitive and motor dual-task on oropharyngeal swallowing in Parkinson’s disease. Eur J Neurol, 2021, 28(3): 754-762.
37.	Van Wamelen DJ, Leta V, Johnson J, et al. Drooling in Parkinson’s disease: prevalence and progression from the non-motor international longitudinal study. Dysphagia, 2020, 35(6): 955-961.
38.	Leentjens AF, Dujardin K, Pontone GM, et al. The Parkinson Anxiety Scale (PAS): development and validation of a new anxiety scale. Mov Disord, 2014, 29(8): 1035-1043.
39.	Han M, Ohnishi H, Nonaka M, et al. Relationship between dysphagia and depressive states in patients with Parkinson’s disease. Parkinsonism Relat Disord, 2011, 17(6): 437-439.
40.	Xu S, Cai WW, Li CY, et al. Prevalence and influencing factors of dysphagia in community-dwelling elderly: a cross-sectional study. Chin Gen Med, 2024, 27(17): 2083-2090.
41.	Kobylecki C, Shiderova I, Boca M, et al. Falls risk is predictive of dysphagia in Parkinson’s disease. Neurol Sci, 2022, 43(2): 1415-1417.
42.	Sleeman I, Lawson RA, Yarnall AJ, et al. Urate and homocysteine: predicting motor and cognitive changes in newly diagnosed Parkinson’s disease. J Parkinsons Dis, 2019, 9(2): 351-359.
43.	Soares NM, Pereira GM, Dutra ACL, et al. Low serum uric acid levels and levodopa-induced dyskinesia in Parkinson’s disease. Arq Neuropsiquiatr, 2023, 81(1): 40-46.
44.	Chen J, Ye W, Zheng X, et al. Predictors of medical staff’s knowledge, attitudes and behavior of dysphagia assessment: a cross-sectional study. PloS One, 2024, 19(4): e0301770.
45.	Patel B, Legacy J, Hegland KW, et al. A comprehensive review of the diagnosis and treatment of Parkinson’s disease dysphagia and aspiration. Expert Rev Gastroenterol Hepatol, 2020, 14(6): 411-424.
46.	Bhidayasiri R, Phuenpathom W, Tan AH, et al. Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice - balancing pharmacological and non-pharmacological approaches. Front Aging Neurosci, 2022, 14: 979826.
47.	Ko JY, Shin DY, Kim TU, et al. Effectiveness of chin tuck on laryngeal penetration: quantitative assessment. Dysphagia, 2021, 36(6): 1054-1062.
48.	Schindler A, Pizzorni N, Cereda E, et al. Consensus on the treatment of dysphagia in Parkinson’s disease. J Neurol Sci, 2021, 430: 120008.
49.	Grider HS, Douglas SM, Raynor HA. The influence of mindful eating and/or intuitive eating approaches on dietary intake: a systematic review. J Acad Nutr Diet, 2021, 121(4): 709-727.
50.	Troche MS, Curtis JA, Sevitz JS, et al. Rehabilitating cough dysfunction in Parkinson’s disease: a randomized controlled trial. Mov Disord, 2023, 38(2): 201-211.
51.	Claus I, Muhle P, Czechowski J, et al. Expiratory muscle strength training for therapy of pharyngeal dysphagia in Parkinson’s disease. Mov Disord, 2021, 36(8): 1815-1824.
52.	Park JS, Oh DH, Hwang NK, et al. Effects of neuromuscular electrical stimulation in patients with Parkinson’s disease and dysphagia: a randomized, single-blind, placebo-controlled trial. NeuroRehabilitation, 2018, 42(4): 457-463.
53.	Sun Y, Chen X, Qiao J, et al. Effects of transcutaneous neuromuscular electrical stimulation on swallowing disorders: a systematic review and meta-analysis. Am J Phys Med Rehabil, 2020, 99(8): 701-711.
54.	Gandhi P, Steele CM. Effectiveness of interventions for dysphagia in Parkinson disease: a systematic review. Am J Speech Lang Pathol, 2022, 31(1): 463-485.
55.	Theodoros D. Telerehabilitation for communication and swallowing disorders in Parkinson’s Disease. J Parkinsons Dis, 2021, 11(S1): S65-S70.
56.	Burns CL, Ward EC, Hill AJ, et al. Conducting real-time videofluoroscopic swallow study via telepractice: a preliminary feasibility and reliability study. Dysphagia, 2016, 31(3): 473-483.
57.	Kim MK, Kantarcigil C, Kim B, et al. Flexible submental sensor patch with remote monitoring controls for management of oropharyngeal swallowing disorders. Sci Adv, 2019, 5(12): eaay3210.

1. Kalia LV, Lang AE. Parkinson’s disease. Lancet, 2015, 386(9996): 896-912.
2. Armstrong MJ, Okun MS. Diagnosis and treatment of Parkinson disease: a review. JAMA, 2020, 323(6): 548-560.
3. Simons JA. Swallowing dysfunctions in Parkinson’s disease. Int Rev Neurobiol, 2017, 134: 1207-1238.
4. Gong S, Gao Y, Liu J, et al. The prevalence and associated factors of dysphagia in Parkinson’s disease: a systematic review and meta-analysis. Front Neurol, 2022, 13: 1000527.
5. Kalf JG, de Swart BJ, Bloem BR, et al. Prevalence of oropharyngeal dysphagia in Parkinson’s disease: a meta-analysis. Parkinsonism Relat Disord, 2012, 18(4): 311-315.
6. 王萍, 王波, 熊冰, 等. 帕金森病患者吞咽障碍评估的研究进展. 中华神经科杂志, 2023, 56(3): 351-358.
7. Cardoso AR, Guimarães I, Santos H, et al. Cross-cultural adaptation and validation of the Swallowing Disturbance Questionnaire and the Sialorrhea Clinical Scale in Portuguese patients with Parkinson’s disease. Logoped Phoniatr Vocol, 2021, 46(4): 163-170.
8. Dilmaghani S, Atieh J, Khanna L, et al. Severity of dysphagia is associated with hospitalizations and mortality in patients with Parkinson’s disease. Neurogastroenterol Motil, 2022, 34(6): e14280.
9. 帕金森病患者吞咽障碍康复中国专家共识编写组, 中国康复医学会吞咽障碍专业委员会. 帕金森病患者吞咽障碍康复中国专家共识(2024 版). 中华物理医学与康复杂志, 2024, 46(7): 587-592.
10. 中国康复医学会吞咽障碍康复专业委员会. 中国吞咽障碍康复管理指南(2023 版). 中华物理医学与康复杂志, 2023, 45(12): 1057-1072.
11. Cosentino G, Avenali M, Schindler A, et al. A multinational consensus on dysphagia in Parkinson’s disease: screening, diagnosis and prognostic value. J Neurol, 2022, 269(3): 1335-1352.
12. 中华医学会神经病学分会帕金森病及运动障碍学组, 中国医师协会神经内科医师分会帕金森病及运动障碍学组. 中国帕金森病消化道症状管理专家共识. 中华神经科杂志, 2022, 55(11): 1225-1235.
13. Claus I, Muhle P, Suttrup J, et al. Predictors of pharyngeal dysphagia in patients with Parkinson’s Disease. J Parkinsons Dis, 2020, 10(4): 1727-1735.
14. Rofes L, Arreola V, Romea M, et al. Pathophysiology of oropharyngeal dysphagia in the frail elderly. Neurogastroenterol Motil, 2010, 22(8): 851-858.
15. Wang P, Wang B, Chen X, et al. Six-year follow-up of dysphagia in patients with Parkinson’s disease. Dysphagia, 2022, 37(5): 1271-1278.
16. Curtis JA, Molfenter SM, Troche MS. Pharyngeal area changes in Parkinson’s disease and its effect on swallowing safety, efficiency, and kinematics. Dysphagia, 2020, 35(2): 389-398.
17. Picillo M, Nicoletti A, Fetoni V, et al. The relevance of gender in Parkinson’s disease: a review. J Neurol, 2017, 264(8): 1583-1607.
18. Nóbrega AC, Pinho P, Deiró M, et al. Levodopa treatment in Parkinson’s disease: how does it affect dysphagia management?. Parkinsonism Relat Disord, 2014, 20(3): 340-341.
19. Jost ST, Kaldenbach MA, Antonini A, et al. Levodopa dose equivalency in Parkinson’s disease: updated systematic review and proposals. Mov Disord, 2023, 38(7): 1236-1252.
20. Ding X, Gao J, Xie C, et al. Prevalence and clinical correlation of dysphagia in Parkinson disease: a study on Chinese patients. Eur J Clin Nutr, 2018, 72(1): 82-86.
21. 石小雪, 郑晋华, 马建军, 等. 帕金森病患者发生吞咽困难的危险因素研究. 中国全科医学, 2022, 25(6): 669-674.
22. Mu L, Chen J, Li J, et al. Mechanisms of swallowing, speech and voice disorders in Parkinson’s disease: literature review with our first evidence for the Periperal Nervous System Involvement. Dysphagia, 2024, 39(6): 1001-1012.
23. Mohamed AB, Mohamed GF, Elnady HM, et al. Evaluation of dysphagia in different phenotypes of early and idiopathic Parkinsonism. Egypt J Neurol Psychiatr Neurosurg, 2018, 54(1): 28.
24. Burtscher J, Moraud EM, Malatesta D, et al. Exercise and gait/movement analyses in treatment and diagnosis of Parkinson’s disease. Ageing Res Rev, 2024, 93: 102147.
25. Walker RW, Dunn JR, Gray WK. Self-reported dysphagia and its correlates within a prevalent population of people with Parkinson’s disease. Dysphagia, 2011, 26(1): 92-96.
26. Miller N, Allcock L, Hildreth AJ, et al. Swallowing problems in Parkinson disease: frequency and clinical correlates. J Neurol Neurosurg Psychiatry, 2009, 80(9): 1047-1049.
27. 谢朝艳, 丁雪萍, 高吉祥, 等. 帕金森病患者流涎与吞咽困难的关系研究. 中华神经科杂志, 2016, 49(11): 856-863.
28. Wang P, Chen X, Chen M, et al. Dysphagia pattern in early to moderate Parkinson’s disease caused by abnormal pharyngeal kinematic function. Dysphagia, 2024, 39(5): 905-915.
29. Vogel A, Claus I, Ahring S, et al. Endoscopic characteristics of dysphagia in multiple system atrophy compared to Parkinson’s disease. Mov Disord, 2022, 37(3): 535-544.
30. Mu L, Sobotka S, Chen J, et al. Altered pharyngeal muscles in Parkinson disease. J Neuropathol Exp Neurol, 2012, 71(6): 520-530.
31. Silbergleit AK, Schultz L, Hamilton K, et al. Self-perception of voice and swallowing handicap in Parkinson’s disease. J Parkinsons Dis, 2021, 11(4): 2027-2034.
32. Polychronis S, Dervenoulas G, Yousaf T, et al. Dysphagia is associated with presynaptic dopaminergic dysfunction and greater non-motor symptom burden in early drug-naïve Parkinson’s patients. PLoS One, 2019, 14(7): e0214352.
33. Nakamori M, Toko M, Yamada H, et al. Association between motor symptoms of Parkinson’s disease and swallowing disorders. Neurol Sci, 2024, 45(5): 2021-2026.
34. Yatabe N, Takeuchi K, Izumi M, et al. Decreased cognitive function is associated with dysphagia risk in nursing home older residents. Gerodontology, 2018, 35(4): 376-381.
35. Kim JS, Youn J, Suh MK, et al. Cognitive and motor aspects of Parkinson’s disease associated with dysphagia. Can J Neurol Sci, 2015, 42(6): 395-400.
36. Labeit B, Claus I, Muhle P, et al. Effect of cognitive and motor dual-task on oropharyngeal swallowing in Parkinson’s disease. Eur J Neurol, 2021, 28(3): 754-762.
37. Van Wamelen DJ, Leta V, Johnson J, et al. Drooling in Parkinson’s disease: prevalence and progression from the non-motor international longitudinal study. Dysphagia, 2020, 35(6): 955-961.
38. Leentjens AF, Dujardin K, Pontone GM, et al. The Parkinson Anxiety Scale (PAS): development and validation of a new anxiety scale. Mov Disord, 2014, 29(8): 1035-1043.
39. Han M, Ohnishi H, Nonaka M, et al. Relationship between dysphagia and depressive states in patients with Parkinson’s disease. Parkinsonism Relat Disord, 2011, 17(6): 437-439.
40. Xu S, Cai WW, Li CY, et al. Prevalence and influencing factors of dysphagia in community-dwelling elderly: a cross-sectional study. Chin Gen Med, 2024, 27(17): 2083-2090.
41. Kobylecki C, Shiderova I, Boca M, et al. Falls risk is predictive of dysphagia in Parkinson’s disease. Neurol Sci, 2022, 43(2): 1415-1417.
42. Sleeman I, Lawson RA, Yarnall AJ, et al. Urate and homocysteine: predicting motor and cognitive changes in newly diagnosed Parkinson’s disease. J Parkinsons Dis, 2019, 9(2): 351-359.
43. Soares NM, Pereira GM, Dutra ACL, et al. Low serum uric acid levels and levodopa-induced dyskinesia in Parkinson’s disease. Arq Neuropsiquiatr, 2023, 81(1): 40-46.
44. Chen J, Ye W, Zheng X, et al. Predictors of medical staff’s knowledge, attitudes and behavior of dysphagia assessment: a cross-sectional study. PloS One, 2024, 19(4): e0301770.
45. Patel B, Legacy J, Hegland KW, et al. A comprehensive review of the diagnosis and treatment of Parkinson’s disease dysphagia and aspiration. Expert Rev Gastroenterol Hepatol, 2020, 14(6): 411-424.
46. Bhidayasiri R, Phuenpathom W, Tan AH, et al. Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice - balancing pharmacological and non-pharmacological approaches. Front Aging Neurosci, 2022, 14: 979826.
47. Ko JY, Shin DY, Kim TU, et al. Effectiveness of chin tuck on laryngeal penetration: quantitative assessment. Dysphagia, 2021, 36(6): 1054-1062.
48. Schindler A, Pizzorni N, Cereda E, et al. Consensus on the treatment of dysphagia in Parkinson’s disease. J Neurol Sci, 2021, 430: 120008.
49. Grider HS, Douglas SM, Raynor HA. The influence of mindful eating and/or intuitive eating approaches on dietary intake: a systematic review. J Acad Nutr Diet, 2021, 121(4): 709-727.
50. Troche MS, Curtis JA, Sevitz JS, et al. Rehabilitating cough dysfunction in Parkinson’s disease: a randomized controlled trial. Mov Disord, 2023, 38(2): 201-211.
51. Claus I, Muhle P, Czechowski J, et al. Expiratory muscle strength training for therapy of pharyngeal dysphagia in Parkinson’s disease. Mov Disord, 2021, 36(8): 1815-1824.
52. Park JS, Oh DH, Hwang NK, et al. Effects of neuromuscular electrical stimulation in patients with Parkinson’s disease and dysphagia: a randomized, single-blind, placebo-controlled trial. NeuroRehabilitation, 2018, 42(4): 457-463.
53. Sun Y, Chen X, Qiao J, et al. Effects of transcutaneous neuromuscular electrical stimulation on swallowing disorders: a systematic review and meta-analysis. Am J Phys Med Rehabil, 2020, 99(8): 701-711.
54. Gandhi P, Steele CM. Effectiveness of interventions for dysphagia in Parkinson disease: a systematic review. Am J Speech Lang Pathol, 2022, 31(1): 463-485.
55. Theodoros D. Telerehabilitation for communication and swallowing disorders in Parkinson’s Disease. J Parkinsons Dis, 2021, 11(S1): S65-S70.
56. Burns CL, Ward EC, Hill AJ, et al. Conducting real-time videofluoroscopic swallow study via telepractice: a preliminary feasibility and reliability study. Dysphagia, 2016, 31(3): 473-483.
57. Kim MK, Kantarcigil C, Kim B, et al. Flexible submental sensor patch with remote monitoring controls for management of oropharyngeal swallowing disorders. Sci Adv, 2019, 5(12): eaay3210.

West China Medical Journal

Latest ArticlesResearch progress on risk factors and management strategies of dysphagia in Parkinson’s disease

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