Cryotherapy, the new hot-topic on faster recovery

Jason Jet Terry cooled down after the 2011 Nba title

You may have heard of cryotherapy, the practice of exposing athletes to extremely low temperatures to improve recovery. If you google it, the outputs are countless from ‘Wales indebted to cryotherapy for Warburton’s return’ to ‘Phoenix Suns freeze players’ or ‘Dallas Mavs disclose their cryotherapy secret’. Let’s cut this to the chase: believe the hype?

First things first, I started sifting the literature a bit biased; scepticism was infused in my opinion on the matter. While my doubts still stand, I must admit some research suggested me this topic deserves some attention and, mostly, more tailored studies. I’ll try not to convey my negative mind set, I’ll try my best.

Why should the exposure to cold temperature improve recovery, meaning force recovery and feeling of pain after an intense workout session?

Cold should constrict muscle blood vessels, reducing the inflammatory state and the formation of oedema which comes from muscle damage, naturally occurring after intense training with a high volume of eccentric contractions. This damage consists in the usual aching pain sensation you feel up to a few days after that heavy training day when you pushed far too hard. With the mechanism described cold should limit the inflammatory state which brings further damage, reducing muscle breakdown and pain. The same principle when you put ice on a twisted ankle.

Besides, some authors suggest that cold could also stimulate a soothing endorphin release, improving anti-oxidant protection, decrease pro-inflammatory cytokines while increasing anti-ones (See this previous post).

Even more interesting, cold exposure could increase sympathetic firing and raise noradrenalin levels, which in turn could affect creatine kinase (CK) metabolism. CK is a marker of muscle damage and its cold-prompted decrease might suggest a lowered muscle breakdown.

So my doubts?

Rises from the fact that those inflammatory processes are also those which drive muscle repair and growth, so even in the case cold exposure could reduce muscle inflammation, would we want it? (Check this post on anti-oxidants)

I focused the inquest on those studies using the most fashionable Whole body cryotherapy system (WBC), the one Steve Nash and Miroslav Klose like so much. You enter in a chamber in minimal clothing, where you familiarize with a -60 °C for some 30 second, then into a -110 for 3 minutes. Sure it’ll be refreshing.

  • Costello et al study: cold exposure 24h after an eccentric training protocol, no change in strength recovery or pain when compared to passive (doing nothing) recovery. Also, proprioception was not altered, suggesting that WBC does not compromise kinaesthetic sense which could lead to higher injury chance.

On the contrary, two other studies found WBC beneficial for faster recovery. The most interesting data is a difference in the selection of subjects and protocol. While on the Costello’s paper they used ordinary guys, on the WBC-positive ones well-trained if not pro players were picked and WBC was repeated in multiple sessions.

  • Hausswirth: WBC at 1, 24 and 48 hours  post training, strength recovery already evident only one hour after the effort when using WBC and better than passive recovery at 24 and 48h.
  • Banfi compared the inflammatory state of Italian Rugby national players in a hectic training period on two consecutive Monday mornings before and after 5 WBC sessions on alternate days. Not only pro-inflammatory cytokines were reduced and anti-inflammatory enhanced, but the muscle breakdown marker CK was decreased.

Could it be that a systematic WBC protocol could reduce the inflammatory state and improve strength and soreness recovery on highly trained subjects?

Indeed aptness to muscle trauma can be ‘trained’ (the repeated bout effect), as you notice when you start the first workouts after a long summer break. The first workout makes you cry for days, while the same workout a few weeks later could pass unnoticed and give no pain at all. Higher trained athletes could establish an interaction between the repeated bout effect and cryotherapy, making it effective in quickening recovery.

Final word, athletes are renown superstitious. The psychological effect of a recovery habit that resembles sci-fi chambers and the word of mouth spread by top guns may do the work.

There’s definitely a need of new studies simulating more ‘real-world’ conditions and taking account of various athletes status and repeated WBC exposures.



Costello 2011 Effects of whole body cryotherapy (-110) on proprioception and indices of muscle damage
Hausswirth 2011 Effects of whole body cryotherapy…
Sellwood 2007 Ice water immersion and DOMS
Banfi 2009 Effects of whole body cryotherapy on serum mediators of inflammation

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Enhancing performance and learning in your sleep: Lucid dreaming

Rousseau was already practicing the flute in his dreams

It happens that when learning something new, whether a language, a concept or a sport skill you get to a point where you are exhausted, resignedand you just call it a day leaving with a hint of disappointment and the feeling you could have done more and better. Then you wake up in the morning and after a shy start expecting the worst, you find out it’s not so bad, if not better than before.

This is why the wise minted the concept of ‘Sleeping on a problem’. All sayings are, at least in part, always right and recent research confirms that sleep has a central role in the sorting of recently acquired information and the elaboration of clues collected during our day, a kind of off-line process necessary to learn. This is also true for motor skills and during sleep movement data is reorganized. It is fundamental for post-training consolidation, as a wake period after practice brought about no improvement in a new acquired motor sequence while an equivalent period of sleep did, according to data.

An old time fashion most of us have tried sooner or later in life is the dream of learning by just playing a tape while sleeping. It is curious that we desire so much to avoid trouble when we want to learn something new or we have a project in mind, while in reality it is actually the learning process itself which constitutes the higher feeling of accomplishment and arousal, but this is another story.

The ideal that in dreaming we are able to project a world that mirrors our own self without the need of any external clues from the ‘real’ world has always suggested us there is a higher mind state while dreaming, hence at such a level of brain mystic activation it shouldn’t be hard to pick up the whole history of WWII or Arabic just by listening to it. Maybe it works for you.

Every time I watch Inception I get excited and surf the net with the scope of ‘Lucid dreaming’. This is quite an interesting topic and I think that, drugs apart I dunno, is the closest mean of living the dream. Lucid dreaming is when you are in a dream and you are conscious of it, you know it is a dream and you are suddenly endowed with the superpowers of your wish and you can do everything. Although most people experienced it, it is normally not frequent but there are techniques to acquire this ability and believe me when it happens to you, you just want more. Living the dreamer’s world.

Lucid dreaming happens during the rapid eye movement (REM) sleep and studies on the brain found activation patterns similar to those of wake consciousness and self-awareness. Particularly, when lucid dreamers were instructed to perform certain sequences of movements such as right-left fist clenches while lucid dreaming, experimenters recorded actual electromyographic activity in the corresponding body parts. Activation of the motor cortex and heart rate increase were also found in some studies, suggesting that lucid dreaming might represent a simulation machine of the real world.

As many studies showed that mental rehearsal when awake generally enhances performance, an interesting question in the Sports Science world then is: could we use lucid dreaming for rehearsing sports skills while sleeping, with the aim of tweaking them?

Some studies were performed and in these trials subjects were able to improve their ability in specific skills, such as aiming tasks when these were rehearsed in a lucid night compared to sleep without lucid dreaming. Other studies claim to have improved sports specific technique and the lucid dreamers found no difficulty in reproducing the skill during the dream, in a vivid environment that includes kinaesthetic sensations and with ‘A far greater potential of control over body, environment and actions than waking life’ as pointed out by Erlacher and Chaplin.

One of the experimenters, Tholey, reports: “Not every single movement I do practice in my lucid dreams. In lucid dreams I rather work on my body feeling and the orientation in the three dimensional space. For example I do somersaults and feel every single muscle twitch in my dreamed body”.

To know whether these results are true or not we will have to wait for new research involving advanced imaging instruments. In the meanwhile these science fiction findings drive my imagination.

Could I use it to improve languages skills? Practice high jump without soreness? Simulating events not yet happened? Could working out in a dream develop physiological parameters such as strength or change phenotype aspects? Drive higher metabolism when sleeping?

Could sleep be a new frontier of performance enhancement? This might all be fantasy but lucid dreaming is so pleasant that really there’s no reason not to try.


Lucid dreaming How to –


Kalia 2006, Neurobiology of sleep
Hobson 2002, the cognitive neuroscience of sleep: neuronal systems, consciousness and learning.
Erlacher 2010, Lucid dreaming: neural virtual reality as a mechanism for performance enhancement.

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The truth of warming-up on injuries and performance

30+°C in Daegu 2011. Why getting warmer?

First things first, they say, “warm up! It’s very important”, the speaking subject being your PE teacher, personal trainer, your mum, whatever. And there we go with the advocated 10++ minutes on the tread, speed walk to light jog to get to the final aim of breaking sweat and beyond.

Then you usually move to the mats area and you begin stretching all your segments, 20+ seconds per position. Now you feel ready to lift, jump and throw. Have you ever asked why doing all such routine?

The answer sounds to you quite straightforward: warm and long muscles are less likely to injure and they are more performing.  Sure? One of my lecturers would say “I don’t think wolves warm up and stretch before a hunt”.

The real answer, as often happens, lies in between the two extremes.

On one hand studies are controversial when analysing the ability of a warm up routine of reducing injuries. A stretched, warm muscle is more resilient and has the ability of absorbing more energy before failure, meaning that it is harder to tear it. Although, stretching a muscle may impair its contracting ability and muscle tension is what actively protects joints and muscles themselves from impacts. As a conclusion, we cannot rule out that stretching could actually increase injuries rates.

On the other hand, a warm muscle has been shown to contract faster and more powerfully. This could save joints from oblivion and make us perform better. Is it enough to jog before an upper body strength session or a long jump contest and is it all about having your muscles warm?

The heat which warms muscles is a consequence of the muscle contraction itself that like all efficient engines cannot be 100% efficient, turning some energy into heat. Temperature is not the only thing that changes in the muscle after a series of contractions and the intensity, type and duration of contractions is ultimately affecting muscle functioning, as it is the case with fatigue after exhausting efforts.

Naming it in a more pompous fashion, contractile history affects muscle performance.

If a contractile history of 10 minutes of light jog might be enough to warm up at least some of the muscles involved in your following, main event of the day, this does not get you ready to perform at your max power and allow you to clear your new PB.

Good news is that a hectic contractile history does not necessarily lead to fatigue but may improve performance as well. Muscles have a property called Post-Activation Potentiation (PAP) in which a conditioning activity (a previous heavy effort) temporarily increases rate of force development, allowing you to throw farther, jump higher and whatever requires power.

Rather than a tedious and endless cycle at 20 rpm and stretch to death I would suggest you get specific, with dynamic efforts involving similar movements to those you are going to perform later in your menu, building up intensity.

Be aware that a conditioning activity is fatiguing and if exaggerated the strain may offset the PAP benefit. Follow the advice of a brand new meta-analysis: perform a few reps at 60-80% of your max, 7-10 minutes before the main power training session. In jargon this is called complex training and allows you to develop greater power and to stimulate faster fibres.

In a competition like high jump this occurs naturally as lower precedes higher bars, usually in a progressive manner and if you design your plan well you might take advantage of PAP when you most need it without getting too tired.

So is warm up all about warming your muscles up, or is this its real meaning?


Wanna now more of PAP and complex training?

Wilson et al 2012 Meta-Analysis of Post Activation Potentiation and Power: Effects of Conditioning Activity, Volume, Gender, Rest Periods, and Training Status
Sale 2002 Postactivation potentiation: Role in human performance

Injuries and warm up:

Woods et al 2007, Warm up and stretching in the prevention of muscular injury
Shrier 2008 Warm up and stretching in the prevention of muscular injury: Reply

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Is progress progress?

Always respect a purist

Our feet are a continuous proof of the ability of our body to adapt to the environment. They represent the link that connects us to the ground on our daily activities and they withstandthe burden of gravitational forces. Luckily enough, shoes support and mediate this interaction between us and the earth, often softening our relationship with massive pleasant cushioning while providing a fashionable interface with others.

I often wondered what we would be if Nike did not invent Air, Zoom, Shox and counting, those devices which act as a pillow for our heels, making its impact more comfortable. Reality is that we are no longer hunters and apart from few exceptions we need to run and jump just for pleasure and to feel alive.

So how did our ancestors cope with their feet in complete or almost nudity and the poor heels having to sustain all the pressures of hunting a wild beast among the rocks of a forgotten valley?

There is a chance they coped quite well. And us? It seems that tendinitis, overuse injuries and uncomfortable pain have certainly not left our limbs after the introduction of cushioned shoes.

Here there is something missing, but as naturally happens in human business rather than individuating the source of a problem it is often more convenient to act on its consequences, working on the effects of it. Not only shoe brands benefit of this fashion but this also creates the niche of therapists and sorts whose intent is stopping the discomfort, first.

I’m talking about that lovely cushioning that cuddles your feet. Indeed the resilient material inserted in the sole of a running shoe assists the heel in absorbing those forces produced with the ground contact, especially when running.

Problem is that heel-first contact should not happen at all, according to Lieberman et al, who studied the biomechanics of shod and barefoot running. The study was performed comparing regular shod runners to Kenyan barefoot runners or to regular US shod runners using minimal footwear (Vibram, Nike Free…), so it was also possible to understand if there was any difference between those who grew up barefoot and those who did not but now opted for minimal shoes.

The clear finding is that those with cushioned footwear strike the ground with the heel first (rear foot), while those running barefoot land with the front foot or flat foot, in a more plantar flexed stance.

Looking at the forces in play, barefoot running results in smaller collision forces with the ground and front foot impacts generate ground reaction forces lacking of a transient, which is a sudden collision force occurring in rear foot strikers in the first 50 milliseconds of contact and corresponding to 1.5-3 times body mass.

Thick soles hinder proprioceptors, decreasing mechanical sensitivity of the foot, which may in turn influence postural control and affect foot strike. A large study on marathon runners curiously found that the rate of injury was negatively correlated to shoes cost, in other words those wearing the most expensive shoes were also those who had the higher injury chance, perhaps suggesting that more sophisticated cushioning technologies are not necessarily better.

A final remark is on performance. Every action has a reaction and every time we hit the ground ideally we should receive an equal force from the ground, although in the real world part of this energy is dissipated. When fore-striking, the foot’s longitudinal arch is passively stretched much earlier than when rear-striking, meaning that in the first case more energy is returned to the foot. This means that front-strikers are more energy efficient and their run has a lower energetic cost, with an estimated 5% difference in a study by Divert et al and barefoot, front-striker runners, might benefit of a better running economy.

Perhaps going back to the past can be a good idea sometimes.





Lieberman et al 2010 Foot strike patterns and collision forces in habitually barefoot versus shod runners

Marti et al 1988 On the epidemiology of running injuries. The 1984 Bern Grand Prix Study

Divert et al 2005 Mechanical comparison of barefoot and shod running

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Training to the flu

Flu game. Sick

I remember my coach always recommending to cover my head and wear my coat tight when getting off the changing rooms on frosty, wintery evenings. After practice you feel so hot you could run naked on a January night. But there’s a warning in the air, you don’t want to catch a flu do you?

Jordan scored 38 with a 38 °C fever in the ’97 finals, maybe flu is not so bad.

Look again, even minor infections were linked to a drop in performance and training capacity, unless you are Michael but maybe he would have scored 58 he wasn’t sick…Let’s assume human beings want to stay healthy to perform at their best, as research kindly suggests.

Core topic: does exercise play a role on your immune system? The answer is not straightforward.

There seems to be an agreement in the field distinguishing the effect of moderate from heavy exercise on immune function. Moderate activity boosts your defences and when compared to sedentary individuals the incidence of upper respiratory tract infections (URTI) is decreased by 25-50%. On the other hand, heavy exercisers report an increased chance of contracting URTI, with their immunity temporarily depressed.

On prolonged exhausting efforts the body is under stressful conditions that may create an open window for infections to thrive and cautious behaviour is advised to reduce this risk (I’m not saying you shouldn’t have a dip in the icy ocean after a marathon, you deserve that).

Getting into the subtleties, I find interesting what causes these fluctuations in your own protective field. This is to be sought in the effects that exercise has in the production of hormones, substances released by specific tissues which act to bring an effect on targeted tissues, such as cells with immune function.

Exercise was found to affect the inflammatory state of the body, this through the effect of hormones released during exercise by tissues like muscles. Particularly, interleukin-6 (IL-6) has is one of the main determinant of the anti-inflammatory effect that makes exercise the best cure against chronic diseases in which there is a persistent inflammatory state, such as atherosclerosis.


Moderate exercise is also acutely increasing the recirculation of immunoglobulins, neutrophils and natural killer cells for a period of 3 hours post exercise and URTI symptoms decrease when training regularly for 12-15 weeks. This are the possible mechanisms that may account for an enhanced immune function of regular exercisers.

When training hard things are different. A great effort produces a much larger release of cytokines IL-6, IL-1ra and IL-10, to the extent that these substances affect the balance of the immune cells by inhibiting type 1 T-cells cytokine production. The latter represent the cell-mediated response of the immune system and are the main defence from infections and viruses. Overall, strenuous exercise decreases pathogens protection and inflammatory state acutely for a period of 3-24 hours post exercise, after which immune function is restored.

We might want to restrain IL-6 release to avoid this post-exercise black hole and keep infections out of the body. This is possible with vitamin C supplementation or other nutritional strategies. Indeed ultramarathon runners had lower URTI incidence with vitamin C long term intake and this may account for the reduced production of IL-6, but there’s a catch.

IL-6 plays a key role in exercise adaptation to training and limiting its production may affect performance by impairing recovery. Even worse, IL-6 is probably the crucial anti-inflammatory substance that promotes the optimal health of a regular exerciser and altering its concentration might prevent one of exercise greatest benefits.

This is indeed a double-edged sword where on one hand you might improve your protection from infections while on the other you might impair body healing, training improvements and increase your whole-body inflammation state.

Think about it.





Nieman 2011 Clinical implications of exercise immunology

Gleeson 2011 Influence of training load on upper respiratory tract infection incidence and antigen-stimulated cytokine production

Gleeson 2007 Immune function in sports and exercise

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Why Kobe likes the german summer?

Rewind. The saga continues..

Kobe Bryant will hit Dusseldorf again this summer to get another (the 16th) evergreen season despite his knee threatening the aggressiveness of his game only a couple years ago.

Just like many other pros, Kobe was suffering knee pain probably due to an underlying process of osteoarthritis, a degenerative disease that affects joints common in the elderly but that annoys also younger highly competitive athletes, due to the great amount of strain and physicality of modern sports.

Overuse osteoarthritis in young individuals occur as a consequence of the relentless strain that is placed on the athlete’s body on daily basis, causing ‘wear and tear’ injuries that ultimately result in damage of the cartilage so the cushioning effect between bones at a joint level is compromised, causing pain and degeneration of the tissue.

Strict conventional medicine has not come to a final solution to the problem yet, with osteoarthritis being one of the biggest healthcare burdens, other than ruining sport careers.

One of the great ideas of recent medicine is ‘if we can’t fix, let’s see if we can make the body fix it for us’, maybe we just need to give it a kick start and the body repairing machine will turn on and do what we cannot. And so Biologic medicine was born, the main interest of which is understanding how the body’s own healing mechanisms could be triggered to repair a worn tissue.

Ligament and tendon ruptures are considered serious injuries because often the blood supply to these tissues is limited and their healing capacity is not as prompt as in muscles or other tissues.

Growth factors regulate the growth and healing of a tissue. Because systemic growth factors are delivered via the blood these organs have difficulty to undergo the repair process and are easily re-injured.

Biologic therapies have addressed these problems by a direct delivery of growth factors in the site of injury –platelet rich plasma (PRP) technique is one of them.

The evidence in favor of these treatments is controversial with mixed results in different trials, although in same cases anecdotes seem to blindly support the mean with pro athletes swearing to have witnessed the orthopedic miracle. Reality is that apparently these methods are subjective and they work on some, while for some they don’t, raising doubts on the placebo benefits affecting some minds.

Here is Kobe Bryant, one of the toughest and most respected sportsman of all time, going back for treatment 2 after an individually-speaking awesome season when he almost removed the crown of scoring champion from the 10 years younger rising star Kevin Durant, this at the verge of his 34th birthday.

Media are confused on the technicalities of the therapy Kobe undergone in Germany –PRP? autologus conditioned serum? Stem cells? Well, you can’t blame them because the patented therapy is called Regenokin and its secrets are reveled to few elects. I’m not one of them but I’ll try to pass you what I understood.

The therapy addresses the pain problem from different sides.

Tissue degeneration and the inflammatory process partly responsible for the pain are driven by cytokines like interleukin-1 that are also involved in healing processes. Limiting the action of IL-1 is therefore one of the strategies of the orthokin therapy. They do so by increasing the expression of IL-1 receptor antagonist (ra), creating a competitive inhibition of IL-1; reworded, it means that they increase the quantity of receptors in the cell that do NOT provoke inflammation, so that most IL-1 binds to these harmless receptors and not much is left free to produce the inflammatory effect that causes pain.

How they do so then? Apparently in many ways.

The patient’s whole blood is incubated with CRSO4-coated glass beads, technique which stimulates the production of IL-1ra and other anti-inflammatory cytokines that are then separated. This serum is then re-injected in the injured joint, in an auto logus procedure meaning that something is transplanted into the same individual it originally belonged to.

Alternatively, IL-1ra is delivered by gene transfer. Auto logus synovial fibroblasts (cells of the connective tissue extracted from the patient himself) are genetically modified with a retro virus to contain the DNA of human IL-1ra protein. When injected in the artrithic joint, a study showed that in some cases this process increases IL-1ra expression up to 4 weeks after the procedure and decreased joint pain and swelling.

Both methods are supported only by incomplete evidence, but Regenokin seems to include them both and possibly other unconfirmed beneficial tools, such as stem cells.

Science is not built on tales but more and more influential people have created a great hype that could probably increase the interest on this fascinating field even more and with it the number of experiments designed to understand whether to believe, or not.

Lastly, if these aids are proven not to work but their patients are happy anyway, should they really know?


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Muscle memory remembers doping?

Another shadow cast on the olympic ideal?

I’ve always been a basketball boy, though I haven’t played competitively for a few years. When I’m home for the summer it’s hard to resist the playground temptation so I lace up my kicks and cycle for some hoops. My younger life was characterised by a single obsession: jumping higher. Well, you don’t care about this intro but it’s the natural setting for this post.

So, back to the playground after an entire year of little or no jumping, expecting the worse and ready to consider my 23 old body for retirement. Not really, time a few sessions and my jumping is back to all time standards and rising, if I add some specific training.

The tale might be explained with a phenomenon that seems to occur within muscles, or rather a quality that was named ‘Muscle memory’. Pretty intuitive as it sounds, the locomotors of your body probably remember they were trained in the past and they are able to quickly recover that status, so your original ability is back in the game.

How we store this information?

Most believed this was the central nervous system learning particular movement patterns which are retained somewhere in the brain and kept latent until you need them again and this is easily noticed in specific movements like shooting/kicking a ball or riding a bike. This might also affect the skill of generating force, accounting for muscle memory and the rapid recovery of strength after long periods of detraining.

Is this telling the whole story?

Probably not. It was found that muscle strength and hypertrophy (enlargement) after a resistance training program is preserved for long detraining periods, meaning that even long after stopping a training program, your muscles may be stronger than if you never trained at all. Local happenings within the muscle may determine muscle memory, changes in the muscle cell that reflect a long lasting training effect.

In the gym a muscle is overloaded and this stimulates an adaptation that should result in increased strength and size. The mechanisms regulating the translation between the mechanical input (moving the weight) and its effect are not completely understood. One theory preaches that for enlargement to occur there is a need of increasing the number of myonuclei in the muscle cell (google ‘satellite cells’ to learn more).

Bruusgaard et al found that the number of myonuclei increased after an overload (representing training) and was probably leading to muscle growth. The interesting bit is that when trained animals were denervated, a process that leads to the loss of muscle mass-atrophy, the number of myonuclei did not decrease. The muscles were atrophied, shrinked and weak but their nuclei count was maintained as right after the overload, with more nuclei than a healthy-non atrophic muscle that had never been trained.

Does the storage of a high number of nuclei in the muscle represent muscle memory?

It is indeed possible and when in need the previously-trained muscle may grow quickly back to how it was before the period of detraining, skipping the step of increasing the number of myonuclei, as these exist already. This is a sort of shortcut that accelerates re-training and strength recovery.

A final doubt on sports ethics arises: If the muscles of athletes with a history of doping ‘remember’ some of the effects of the enhancing drug, even after a long period of disqualification, this might result in cheating even when the athlete is presently clean. Should these competitors be banned for life? Only future research can tell.


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