
Delayed screening, diagnosis, and intervention for hearing impairment can significantly hinder the development of speech-language, cognitive, and communication abilities in children. Over the past two decades, China has made substantial progress in establishing a comprehensive system for pediatric hearing screening, diagnosis, treatment, and rehabilitation (referred to as the “screen-diagnose-treat-rehabilitate” system). This review focuses on national policies, key technologies, and service models across the entire continuum of care for childhood hearing impairment—from early screening and diagnosis to intervention and rehabilitation, as well as emerging roles of artificial intelligence, telemedicine, and genetic screening in improving screening efficiency and enhancing service accessibility. The paper further proposes a future-oriented pediatric hearing healthcare system characterized by interdepartmental coordination, intelligent and precise service delivery, scalability, and full-process management.
Early and precise diagnosis of hearing impairment in infants and young children is the essential prerequisite and foundation for the effectiveness of hearing intervention and rehabilitation. Achieving such diagnosis scientifically and efficiently remains a subject of ongoing focus within the fields of audiology and otolaryngology. This article provides a comprehensive and in-depth exploration across three key dimensions: from "precision diagnosis" to "personalized intervention", and finally "systematic follow-up". The aim is to offer insights and guidance for the diagnosis and management of hearing impairment in this pediatric population.
The diagnosis and management of pediatric dizziness/vertigo represent a complex clinical challenge involving multiple disciplines. The primary difficulties stem from two key aspects: firstly, children's limited expressive ability often leads to unclear symptom description; and secondly, the vestibular-emotional-cognitive network interactions during development are more complex than in adults. Consequently, conducting appropriate psychological assessments for children with dizziness/vertigo, particularly when comorbid anxiety or depression is suspected, remains particularly challenging. This article integrates international evidence-based findings from the past decade with the author's clinical experience in multidisciplinary clinics to systematically analyze differences and blind spots in assessment objectives, tool selection, and referral timing among otolaryngology, neurology, and psychiatry/psychology departments. Current major issues include the inappropriate application of adult assessment scales in younger populations, insufficient recognition of emotional comorbidities, and inadequate inter-specialty communication. The paper proposes establishing a symptom duration-, frequency-, and functional impairment-based staged assessment model to balance underdiagnosis versus premature labeling of psychosomatic conditions. It recommends implementing a three-tier collaborative pathway of "neurology initial consultation - otology vestibular assessment - psychology consultation" and adopting a clinician-child-parent "triangular" communication approach to minimize information bias. Future work should focus on establishing nationwide multicenter norms for neuropsychological assessment and referral standards for pediatric dizziness/vertigo, thereby providing evidence-based foundation for developing Chinese expert consensus.
Objective To analyze the air-conduction click (c-ABR) and tone burst auditory brainstem response (Tb-ABR) thresholds in infants and young children with otitis media with effusion (OME) and explore the clinical significance of air-conduction Tb-ABR thresholds in frequency-specific hearing assessment for OME infants and young children. Methods A retrospective analysis was conducted on the ABR threshold test results of OME infants and young children aged 0~24 months and normal control infants from January 2018 to December 2022. The air-conduction click, Tb-500 Hz, Tb-1000 Hz, Tb-2000 Hz, and Tb-4000 Hz ABR thresholds were compared between the two groups. The correlation between c-ABR and Tb-ABR thresholds within the OME group was analyzed. Results The OME group consisted of 43 patients (28 boys and 15 girls), with a median age of 8 (3-14) months. The following testing was completed: air-conduction click for 43 cases (60 ears), Tb-500 Hz for 32 cases (45 ears), Tb-1000 Hz for 27 cases (39 ears), Tb-2000 Hz for 11 cases (17 ears), and Tb-4000 Hz for 11 cases (17 ears). The control group included 21 patients (10 boys and 11 girls), with a median age of 6 (4-8.25) months. The following tests were completed for the control group: air-conduction click, Tb-500 Hz, Tb-1000 Hz, Tb-2000 Hz, and Tb-4000 Hz for 21 cases (42 ears). The air-conduction click and Tb-ABR thresholds at Tb-500 Hz, Tb-1000 Hz, Tb-2000 Hz, and Tb-4000 Hz in the OME group were all significantly higher than those in the normal control group (P<0.01). In the OME group, the air-conduction c-ABR threshold was lower than the thresholds for Tb-ABR at all four frequencies (P<0.05). A positive correlation was found between the thresholds at different frequencies (P<0.05), and the correlation coefficient between Tb-2000 Hz and Tb-4000 Hz was 0.925. Conclusions Infants and young children with OME may experience hearing loss across a range of frequencies, from low to high. Compared to air-conduction c-ABR, Tb-ABR thresholds provide more information about frequency-specific hearing. In clinical settings with limited testing time, Tb-2000 Hz or Tb-4000 Hz might be selected for threshold testing, in addition to 500 Hz and 1000 Hz.
Objective To construct the latency-intensity functions of air conduction click auditory brainstem response (c-ABR) and tone-burst ABR (Tb-ABR) waves in infants with varying degrees of sensorineural hearing loss (SNHL), providing a reference for the judgment of clinical ABR thresholds. Methods Infants aged 3 to 12 months who visited the Hearing Impairment and Vertigo Diagnosis and Treatment Center from January 2023 to May 2025 were selected as the research subjects. Wave Ⅴ latencies were compared among the three groups (normal hearing, mild SNHL, and moderate SNHL groups) under both 70 dB nHL and threshold-level intensities using c-ABR and Tb-ABR (500 Hz and 1000 Hz). Latency-intensity function models were then constructed. Results A total of 120 infants were enrolled, including 52 boys and 68 girls, with a median age of 6 (5-9) months. All infants were divided into three groups based on their air-conduction c-ABR thresholds: 90 ears in the normal hearing group, 90 ears in the mild SNHL group, and 60 ears in the moderate SNHL group. At 70 dB nHL and threshold intensity levels, significant differences in wave Ⅴ latencies were found among the three groups for c-ABR, Tb-500 Hz, and Tb-1000 Hz (P<0.01). Latency-intensity function models at 70 dB nHL were as follows, c-ABR: Y=0.013X+6.07; Tb-500 Hz: Y=0.032X+9.09; Tb-1000 Hz: Y=0.022X+8.05. Latency-intensity function models at threshold intensity levels were as follows, c-ABR: Y=-0.026X+8.98; Tb-500 Hz: Y=-0.057X+15.59; Tb-1000 Hz: Y=-0.052X+13.22. Conclusions Wave Ⅴ latencies in c-ABR, Tb-500 Hz, and Tb-1000 Hz are associated with the degree of hearing loss. The latency-intensity function models developed in this study can serve as objective references to aid clinical threshold estimation using ABR.
Objective To establish a range of clinical reference values for each component of P1, N1, P2, N2, and P3 in auditory event related potentials (AERPs) in normal children aged 6-17 years, and to provide an assessment of cognitive impairments caused by clinically relevant diseases in children. Methods Healthy children with normal hearing who visited the Diagnosis and Treatment Center for Hearing Impairment and Vertigo between January 2024 and January 2025 were selected as study participants. AERPs were recorded using the auditory Oddball paradigm. Differences in AERP waveform components between both ears were compared, and normative values for the latency and amplitude of each AERP component were established. Results A total of 28 healthy children (56 ears) with normal hearing aged 6 to 17 years were included, with an average age of (8.75±2.40) years, including 15 boys (30 ears) and 13 girls (26 ears). The normal latency of each wave component of AERP in children is as follows: P1 (56.00±13.11) ms, N1 (106.36±15.26) ms, P2 (183.29±26.77) ms, N2 (229.21±26.28) ms and P3 (329.89±22.32) ms. The 95% confidence intervals (CI) are: P1 (30.29-81.71) ms, N1 (76.44-136.27) ms, P2 (130.82-235.75) ms, N2 (177.71-280.72) ms, and P3 (286.14-373.64) ms. The amplitude values are as follows: P1 [6.91 (4.91 - 10.92)] μV, P1-N1 [9.26 (4.82 - 14.79)] μV, N1-P2 [9.90 (5.60-14.25)] μV, P2-N2 [6.21 (4.40-9.94)] μV and N2-P3 [10.68 (5.95-15.81)] μV; 95% confidence intervals are: P1 (5.37-10.43) μV, P1-N1 (6.06-11.79) μV, N1-P2 (6.96-12.98) μV, P2-N2 (5.20-8.80) μV and N2-P3 (9.15-14.93) μV. Conclusions This study initially established the normal reference values of each component of AERPs for children aged 6 to 17, which is helpful in providing data support for the clinical assessment of cognitive function impairment in children.
Objective To investigate the differences between children with slight-mild hearing loss (SMHL) and children with normal hearing (NH) on a variety of central auditory processing tasks, and to explore the necessity and possibility of early identification and intervention of auditory function in children with mild hearing loss. Methods The study adopted a case-control design and selected children aged 6 to 9 who visited the outpatient department of the Otorhinolaryngology Head and Neck Surgery Hearing and Speech Center and the Neonatal Hearing Impairment Diagnosis and Treatment Center from December 2023 to December 2024 as the research subjects. According to the pure tone audiometry results, the two groups of subjects were divided into the SMHL group and the NH group. The temporal resolution (using the gap-in-noise test), spatial resolution (using the sound source localization task), and speech recognition (using the binaural speech recognition rate test) of the two groups were compared. Results A total of 58 school-age children were included, with 29 children in the SMHL group and 29 children in the NH group. The male-to-female ratio in each group was 15:14. The age of the SMHL group was (89.7±12.0) months, and that of the NH group was (90.4±10.6) months. The binaural speech recognition rate of the SMHL group under different noise conditions was significantly lower than that of the NH group (P<0.05), and the lower the SNR, the worse the task performance. The minimum audible angle (P<0.01) and the root mean square error of pink noise source azimuth identification (P<0.01) in the SMHL group were significantly lower than those in the NH group. The threshold for gap-in-noise (GIN) recognition was higher in the SMHL group than that in the NH group but not significant (P=0.375). Conclusions Children with SMHL demonstrate significantly poorer performance in speech recognition and certain sound source localization tasks in noisy environments compared to NH children, suggesting the need for further research to evaluate whether these deficits may further impact their cognitive development and social adaptation, as well as the appropriateness of interventions.
Objective To investigate the pathophysiological role of oxidative stress in otitis media with effusion (OME) based on the physical properties of middle ear effusion, and to provide a theoretical basis for the etiology of OME. Methods Clinical data, otoscopic findings, and audiological test results were collected from pediatric OME patients undergoing tympanostomy tube placement in the Department of Otolaryngology-Head and Neck Surgery between July 2023 and December 2024. Concentrations of myeloperoxidase (MPO), catalase (CAT), and malondialdehyde (MDA) were measured in both middle ear effusions (intraoperatively collected) and serum samples (preoperatively collected). Participants were grouped according to effusion viscosity, disease duration, and degree of hearing loss. Differences in MPO, CAT, and MDA levels were compared across groups, as well as between middle ear effusions and matched serum samples. Results A total of 53 pediatric OME patients were included, with a median age of 5.6 (1-13 ) years, including 32 boys and 21 girls. Otoscopic examination confirmed middle ear effusion in all cases. The preoperative average pure-tone air conduction threshold was (36.51±1.31) dB HL. The concentrations of MPO and CAT in the viscous middle ear effusion group were significantly lower than those in the thin middle ear effusion group, while the concentration of MDA was significantly higher than that in the thin middle ear effusion group. The differences were statistically significant (P<0.05). The concentration levels of oxidative stress markers in the middle ear effusion and their own serum of 10 children with OME were compared. It was found that the concentrations of MPO, CAT and MDA in the middle ear effusion were significantly higher than those in their own serum, and the difference was statistically significant (P<0.001). No correlation was found between disease duration or degree of hearing loss and the concentrations of MPO, CAT, or MDA in middle ear effusions (P>0.05). Conclusions The physicochemical properties of middle ear effusion are related to oxidative stress. There are differences in the expression of oxidative stress between middle ear effusion and serum, and oxidative stress may be involved in the pathogenesis of OME.
Objective To construct latency-age function curves of waveⅤin bone-conducted auditory brainstem responses (BC-ABR) across different ages in normal-hearing infants and young children, thereby providing a reference for clinical assessment of BC-ABR thresholds. Methods Infants and young children with normal hearing who visited the Hearing Impairment and Vertigo Diagnosis and Treatment Center from January 2019 to December 2022 were selected as the research subjects. BC-ABRs were recorded at two stimulus intensities (30 dB nHL and threshold level) using click stimuli. The age-latency function model of infants and young children with normal hearing was established, and the Bland-Altman method was used to verify the model. Results A total of 210 infants and young children (410 ears) were included during the study period, including 113 boys (222 ears) and 97 girls (188 ears), with a median age of 5 (3-8) months. Among them, there were 126 ears in the 0-3 months age group, 168 ears in the 4-6 months age group, 66 ears in the 7-12 months age group, and 50 ears in the 13-36 months age group. Significant differences in wave Ⅴ latency were observed among different age groups under both 30 dB nHL and threshold stimulation (P<0.05). The latency-age function model at 30 dB nHL was: Y1=7.227+2.563×e-0.1596×x, with R2=0.44, and at threshold intensity: Y2=8.171+2.739×e-0.1432×x, with R2=0.33, where x is age in months. Bland-Altman analysis showed that the proportions of differences between measured and predicted values falling outside the 95% limits of agreement were 3.6% (4/110) and 2.7% (3/110), respectively. Conclusions Wave Ⅴ latency of BC-ABR shortens progressively with increasing age in infants and young children. The latency-age function models established in this study may serve as useful references for clinical applications.
Objective To investigate the correlation between auditory brainstem response (ABR) thresholds and behavioral hearing thresholds in infants and children with sensorineural hearing loss (SNHL), and to establish calibration factors for tone burst ABR (Tb-ABR) and behavioral thresholds across frequencies, providing clinical reference for predicting behavioral hearing thresholds. Methods From February 2014 to September 2022, children diagnosed with SNHL in the Department of Otorhinolaryngology-Head and Neck Surgery were enrolled as subjects. Each participant underwent click-ABR and Tb-ABR testing at 500, 1000, 2000, and 4000 Hz. Behavioral hearing thresholds were obtained during follow-up visits. Correlation analyses between ABR thresholds and behavioral thresholds were conducted across frequencies. Differences between Tb-ABR and behavioral thresholds were compared, and regression equations along with calibration factors were derived. Results A total of 61 children (118 ears) with SNHL were included, comprising 40 boys (77 ears) and 21 girls (41 ears). The median age at ABR testing was 1.9 (0.7-3.4) years, and the median age at behavioral testing was 3.4 (2.0-4.4) years. Click-ABR thresholds showed correlations of 0.73 and 0.74 with behavioral hearing thresholds at 2000 Hz and 4 000 Hz, respectively. Strong correlations were observed between Tb-ABR thresholds and behavioral thresholds at all tested frequencies (r=0.82~0.87, P<0.01). The linear regression equations for predicting behavioral thresholds based on Tb-ABR thresholds were as follows, 500 Hz: y=0.87x+2.55, 1 000 Hz: y=0.89x+4.29, 2 000 Hz: y=0.79x+14.70, 4 000 Hz: y=0.99x+0.84. When the Tb-ABR threshold is 50, 70 and 90 dB nHL at frequencies of 500, 1 000, 2 000 and 4 000 Hz, the calibration factors are 5, 10, 10 dB, 5, 5, 10 dB, 0, 5, 5 dB and 0, 0, 0 dB, respectively. Conclusions Tb-ABR thresholds are strongly correlated with behavioral hearing thresholds in young children with SNHL. The derived calibration factors and regression equations can effectively predict behavioral hearing thresholds, offering valuable guidance for the accurate fitting of hearing aids in this population.
Objective To explore the efficacy and prognostic factors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in the treatment of high-risk acute T-lymphoblastic leukemia (T-ALL) in children, compare the efficacy differences of different treatment regimens, and explore the influence of pretreatment regimens on allo-HSCT in T-ALL patients. To compare the effects of two conditioning regimens, one containing cladribine (Cla) and the other without (fludarabine, Flu), in umbilical cord blood transplantation (UCBT), as well as the differences between this and the peripheral blood hematopoietic stem cell transplantation (PBSCT) based on total body irradiation (TBI). Methods A retrospective analysis was conducted on the clinical data of children with high-risk T-ALL who underwent allo-HSCT from February 2017 to March 2023. The Kaplan-Meier method was used to analyze the 3-year overall survival (OS) rate, leukemia-free survival (LFS) rate, cumulative incidence of chronic graft-versus-host disease (cGVHD), cumulative incidence of relapse (CIR), and cumulative transplant-related mortality (TRM) of the children. The Log-rank test was used to analyze the factors influencing the prognosis of high-risk T-ALL children. The differences in pre-treatment related toxic reactions, post-transplant infections, and 3-year OS rates among different pre-treatment regimens (UCBT-Cla group, UCBT-Flu group, and PBSCT-TBI group) were compared. Results Among the 23 children with high-risk T-ALL, 19 were boys (82.6%) and 4 were girls (17.4%), with a median age of 9.5 (1.9-14) years, and the median time from diagnosis to transplantation was 7.5 (6-29) months. Among the 23 high-risk T-ALL children, neutrophil engraftment was successfully achieved in all cases. The median time to engraftment was 18 (12 - 38) days for UCBT patients and 12 (11 - 15) days for PBSCT patients. The median time to platelet engraftment was 36 (27-61) days in UCBT recipients, with one case failing to achieve platelet engraftment; all PBSCT recipients achieved platelet engraftment, with a median time of 13 (9-25) days. Five children (21.7%) experienced grade ≥3 conditioning-related toxicities (primarily manifested as gastrointestinal reactions, oral mucositis, and infections), 14 had grade 1-2 toxicities, and 4 had no toxicities. No deaths occurred within 100 days post-transplantation among the 23 children. The incidence of grade Ⅲ-Ⅳ aGVHD was 26.1% (6/23). The 3-year cumulative incidence of cGVHD was (27.15 ± 13.33) %. Eighteen children (78.3%) experienced infections of varying severity and locations after transplantation, primarily pneumonia (10 cases), BK polyomavirus-associated hemorrhagic cystitis (7 cases), and invasive fungal infections (6 cases). The median post-transplant follow-up time was 34 (5-92) months. LFS was observed in 18 children, and 5 children died. The 3-year OS and LFS rate were both (77.5 ± 8.9) %. The 3-year CIR and TRM were (13.04 ± 7.19) % and (9.21 ± 6.4)%, respectively. The neutrophil and platelet engraftment times in the PBSCT-TBI group were significantly shorter than those in the UCBT-Cla and UCBT-Flu groups (P<0.05). No statistically significant differences were observed among the UCBT-Cla, UCBT-Flu, and PBSCT-TBI groups in terms of conditioning-related toxicities, incidence of aGVHD and cGVHD, post-transplant infections, or 3-year OS rate (P>0.05). The log-rank test revealed that central nervous system (CNS) involvement at initial diagnosis may be a high-risk factor affecting the overall survival (OS) of children with high-risk T-ALL (P<0.05). Age≥10 years, CNS involvement at initial diagnosis, pre-transplant disease status in second complete remission (CR2), and meeting the criteria for refractory leukemia may be high-risk factors for post-transplant relapse in high-risk T-ALL (P<0.05). Conclusions Allo-HSCT can effectively improve long-term survival in children with high-risk T-ALL and is associated with low TRM. CNS involvement at initial diagnosis is an important marker of poor prognosis. The cla-containing conditioning regimen in UCBT demonstrates potential for reducing relapse rates and improving survival outcomes. The Cla-containing conditioning regimen demonstrates potential in UCBT to reduce relapse rates and improve survival. The UCBT-Cla regimen may be a promising alternative option worthy of further investigation.
Objective To explore the risk factors of early postnatal hypothermia in premature infants and whether the rewarming rate after the implementation of standard rewarming measures is a key factor affecting early clinical outcomes. Methods This study was a retrospective cohort study, selecting the clinical data of premature infants in the region who were treated by the hospital's neonatal transfer team from January 2022 to December 2024. According to the body temperature before transfer, they were divided into the normal body temperature group (≥36.5 ℃) and the hypothermia group (<36.5 ℃). The hypothermia group was given a unified rewarming strategy. According to the rewarming rate after insulation intervention, the hypothermia group was further divided into the slow rewarming group (<0.5 ℃/h) and the rapid rewarming group (≥0.5 ℃/h). Clinical outcomes within the first 7 days after birth (including mortality, pulmonary hemorrhage, severe intracranial hemorrhage, coagulation abnormalities, and the proportion requiring one or more vasoactive agents) and the proportion of infants still requiring invasive mechanical ventilation beyond 7 days were compared across different gestational age subgroups (<32+0 weeks and 32+0-36+6 weeks). Results A total of 1,016 preterm infants from 6 delivery institutions were included. Among the 250 infants with a gestational age of <32+0 weeks, 214 developed hypothermia (85.6%); among the 766 infants with a gestational age of 32+0-36+6 weeks, 530 developed hypothermia (69.2%). The incidence of hypothermia was significantly higher in the <32+0 weeks group compared to the 32+0-36+6 weeks group (P<0.001). The normal temperature group comprised 272 cases (26.8%), while the hypothermia group included 744 cases (73.2%). Within the hypothermia group, 338 cases were in the slow rewarming group and 406 in the rapid rewarming group. Among preterm infants with a gestational age of <32+0 weeks, compared with the normal body temperature group, the mothers in the hypothermia group were older, the gestational age of preterm infants at birth was smaller, the birth weight was lower, and the weight-for-gestational-age Z-score was lower. The differences were all statistically significant (P<0.05). Among preterm infants with gestational ages ranging from 32+0 to 36+6 weeks, the preterm infants in the hypothermia group had a lower birth weight (P<0.05) and a higher proportion of intubation in the delivery room (P<0.014). Further comparison was made between the slow rewarming group and the rapid rewarming group. Among preterm infants with a gestational age of <32+0 weeks, the proportion of assisted reproduction was lower and the proportion of males was higher in the slow rewarming group, and the differences were statistically significant (P<0.05). Among preterm infants with gestational ages ranging from 32+0 to 36+6 weeks, the slow rewarming group had a smaller gestational age at birth (P<0.05). In preterm infants with a gestational age of <32+0 weeks, the proportions of infants still requiring invasive mechanical ventilation beyond 7 days were higher in both the slow and rapid rewarming groups compared to the normal temperature group (P<0.014). Among preterm infants with a gestational age of 32+0 to 36+6 weeks, no significant differences in short-term outcome indicators were observed between the hypothermia group and the normal body temperature group. Among all preterm infants of gestational age, no significant differences were observed in the short-term clinical outcome indicators between the slow rewarming group and the rapid rewarming group. Conclusions The incidence of early hypothermia in preterm infants within the region is relatively high. Hypothermia in preterm infants with a gestational age of <32+0 weeks increases the probability of requiring invasive respiratory support 7 days after birth. It is particularly important to emphasize the prevention of hypothermia in extremely preterm infants immediately after birth in the delivery room. Under standard rewarming measures, the speed at which preterm infants' body temperature rises does not have a significant impact on their early clinical outcomes after birth.
Pulsed field ablation (PFA) represents a transformative non-thermal therapeutic approach in interventional electrophysiology, characterized by its mechanism of inducing irreversible electroporation (IRE) through the delivery of high-intensity, ultrashort electric field pulses to achieve precise myocardial tissue ablation. The safety and feasibility of this technology have been thoroughly validated in the treatment of adult atrial arrhythmias, particularly atrial fibrillation. However, clinical research and application in the pediatric field have significantly lagged behind. Key barriers to its pediatric application include a pronounced scarcity of dedicated clinical evidence, the unavailability of catheter technologies tailored to the anatomical peculiarities of the developing heart, and unique procedural and safety challenges associated with the dynamic and often congenitally abnormal cardiac anatomy in children. This review summarizes the mechanistic foundations and current clinical landscape of PFA, with an emphasis on analyzing the central challenges and potential strategic solutions for its implementation in pediatric arrhythmia management. Meanwhile, this short review is to facilitate a deeper understanding of this emerging technology among pediatric clinicians, and to accelerate its standardized and evidence-based integration into pediatric practice.
Single-sided deafness (SSD) refers to severe to profound sensorineural hearing loss in one ear, with normal or only mildly impaired hearing in the contralateral ear. Although affected children can maintain a certain level of daily communication through the normal-hearing ear, unilateral hearing presents significant limitations in sound localization and speech understanding in noisy environments. Over time, this can lead to delayed language development, reduced learning ability, and social difficulties. However, there is still insufficient awareness of SSD in children, and many children miss the critical window for intervention. This review summarizes the clinical manifestations and various intervention strategies for single-sided deafness in children, aiming to provide a reference for early diagnosis and clinical management.
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