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Blood Clots Can Be Serious and Life-Threatening

With Chris Bosh reportedly undergoing tests for a blood clot in his lung, Alex Kennedy shares his personal experience with clots.

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Chris Bosh is reportedly being held out of training camp because Miami HEAT doctors won’t clear him to play due to his blood clotting issues. Because of this news, I wanted to re-post this story that I wrote in 2013 when Anderson Varejao was diagnosed with a pulmonary embolism. Here is my story:

Anderson Varejao was on pace to have the best year of his career. However, in January of 2013, he suffered a quad injury that forced him to have routine surgery. That’s when things went downhill. Varejao developed a pulmonary embolism (a blood clot in his lung), which kept him sidelined for the entire season.

A pulmonary embolism isn’t a typical injury, one that heals on a specific timetable like a broken bone. This is a strange injury and one that can be difficult to bounce back from, as I learned from personal experience several years ago.

In August of 2012, I was flipping through television channels late at night when I noticed a deep pain that was shooting down my right shoulder. Shortly after, while watching ESPN, I started experiencing tightening in my lower back.

At first, I didn’t think much of these aches. After all, I had been horizontal in a hospital bed for six days so some soreness was somewhat expected. I had just undergone surgery due to Crohn’s Disease, which I’ve been battling for the last 13 years, and I was immobilized because a portion of my intestines had been removed along with part of my colon and appendix. Overall, my recovery was going well and I was set to be discharged soon, barring any complications. I told my nurse about the discomfort in my shoulder and lower back, but they chalked it up to the uncomfortable bed as well.

Throughout the next day, my pain worsened to the point that I wasn’t able to function. I had literally wrapped my shoulder and torso in heating pads and was trying to move my body in every possible position to get comfortable. No matter what I did, the pain persisted. By that night, I was in excruciating pain that I could no longer tolerate.

I was diagnosed with Crohn’s Disease when I was 12 years old. I’ve been dealing with flare-ups for over a decade and I’ve been hospitalized many times. I’ve had a wide array of ailments and complications due to my medical condition, so I have a relatively high pain tolerance (even dating back to my childhood). But this was by far the worst pain that I had ever experienced. Nurses often tell me that I’m one of their easiest patients because I’m calm, cool and collected, even when things are at their worst. I can typically tough out stomach cramping and sharp abdominal pain.

However, this was different. On this night, I was a mess. I was crying, punching the thin mattress and begging my nurse to page the doctor who was on call. After about an hour of this torture, the nurse returned to inform me that the doctor didn’t want to change my orders. Because I had been on pain medicine for the six days following my surgery and had just been taken off of it to prepare for discharge, he believed I was just trying to get some more pain medicine. The nurse, who felt terrible, said that she could only offer me Tylenol. Needless to say, it didn’t help. At this point, I was absolutely livid and in uncontrollable pain.

While I understand that there are addicts out there who will lie and deceive to get their hands on pain medicine, doctors shouldn’t automatically assume that they’re being duped. Some patients deserve the benefit of the doubt or, at the very least, a visit from the doctor. The message that I would have to continue suffering was told to the nurse over the phone and then relayed to me. I wouldn’t see a doctor for another 10 hours, which could’ve been the difference between me living or dying in hindsight.

The most painful night of my life continued, with seconds feeling like hours and hours feeling like days.

Eventually, my surgeon came in for his daily check-in at 7 a.m. and saw the state that I was in. He immediately knew that something was wrong, and ordered a chest x-ray as well as a CT scan. He also ordered a dose of IV pain medicine to be administered before these tests, which was one of the strangest experiences of my life. I went from one end of the pain spectrum all the way to the other. At one moment, my shoulder felt like it was being stabbed, my back was locked up and my body was convulsing. The next moment, I felt nothing and was smiling. It was such a weird sensations – going from perhaps the worst feeling of my entire life to one of the best feelings (complete relief) in several seconds.

The x-ray and scan showed that my pain wasn’t just from an uncomfortable bed (which would’ve been awfully embarrassing given the amount of agony I was in). It turns out I had developed a large pulmonary embolism (blood clot) in each lung. The larger of the two clots was so severe that a portion of my lung tissue died, which is called a pulmonary infarction. The infarction is what caused the bulk of my pain. According to my surgeon, the lung doesn’t have pain sensors so when something is going wrong such as a blood clot develops or lung tissue dies, the body starts to alert pain sensors in other body parts. This is why my shoulder and back hurt so badly; it was essentially my lung begging for help.

Not to sound dramatic, but I truly felt like I was going to die that night. That was unprecedented pain for me. Not to mention, pulmonary emboli usually cause patients to have anxiety and a feeling of doom. That perfectly sums up how I felt as I watched the clock tick slowly as my pain got worse and my mind raced. At that point, all I wanted was relief and answers, and I was genuinely scared that I wouldn’t get them soon enough. When I called my girlfriend in the morning and told her that I was diagnosed with a pulmonary embolism, she immediately started to cry. Apparently she had already known the severity of a blood clot to the lung; I was pretty much learning on the fly from my surgeon while in a pain medicine fog.

My doctor immediately started me on blood thinning injections called Lovenox, which is a shot I had to give myself in my stomach every morning and night. He also continued my pain medicine, since the excruciating pain wouldn’t persist until the clots eventually broke up and the lung tissue regenerated.

Later in the day, my gastroenterologist came in to check on me. She was almost in tears as she explained just how close I had come to dying. Considering she’s a gastroenterologist who specializes in young adults, she clearly wasn’t accustomed to losing patients and was visibly affected. Not to mention, she had known me for 10 years so she was understandably distraught, just like my family and friends.

“Had your surgeon come in any later, who knows if you’d still be alive?” she said, shaking her head. “It’s a good thing he does morning rounds. Otherwise, who knows? Thank God he came when he did, and recognized what was wrong almost immediately.”

It wasn’t until this point that I realized just how close I came to death, and just how pissed off I was at the doctor who was on call the night before and completely ignored me.

The next few months were brutal, as I dealt with complications related to the clot. From August to November, I was admitted into the hospital six times for a total of 53 days. I also had to go to the emergency room 15 times during that span. The mindset is ‘better safe than sorry’ when dealing with a potential clot. Every pain in my shoulder, back or chest had to be checked to ensure it wasn’t going to kill me.

These days, both clots are completely gone, but even a year afterward I still occasionally felt side effects. If I exerted myself, I would have chest pain and shortness of breath. Every now and then, my shoulder and back would start to hurt.

Not only did the clot affect me physically, it definitely affected my mental state. I went from feeling like an invincible kid to realizing that the painful moments in that hospital bed could’ve been my last. I was forced to confront my mortality and deal with some anxiety every time similar symptoms surfaced. To have something so serious come out of nowhere is terrifying. It did strengthen my relationships and taught me not to take life for granted, but there’s no question that the experience messed with my head a bit. Still, I know it could be so much worse I’m thankful every day that I’m still alive.

Let’s get back to Varejao. He developed the clot in his lower right lung as he was recovering from the quad surgery. He had trouble sleeping, pain in his back and discomfort in his chest. He informed someone from the Cavaliers’ medical staff (who I assume was much more attentive than my doctor), and a scan revealed the clot.

Much like myself, Varejao didn’t realize the gravity of the situation until hearing from others just how common death is in these types of cases.

“They told me stories like, ‘Oh my God, I had a friend who died of a blood clot in their lung,’” Varejao told Yahoo! Sports. “And then somebody else tells me the same thing. Then you start to think about it and realize that this is more serious than I thought. A week after the surgery I was at home thinking about how I could be gone right now.”

“I was having my best season, the best time of my life, and a week later I’m in the hospital and I could be dead,” Varejao added. “It’s crazy. I’m very lucky.”

The clotting issue required him to miss the remainder of the season because he would be on anticoagulants. It would be impossible for a basketball player to take the court while on blood-thinning medicine. When I get blood drawn, it looks like someone just amputated my arm. I can’t even imagine how bloody things would get on the court with some of the physical play that Varejao endures in the paint. It remains to be seen how Varejao will respond in his first season back since the pulmonary embolism. All cases are unique and everybody responds differently to physical exertion.

He says he has been pain free for months and was able to stop taking the blood-thinning medication in April, which is an excellent step since some patients – including myself – must remain on the medicine for a longer period of time. He has able to work out, but he’s the first to admit that he still doesn’t quite feel like himself, estimating that he’s at 70 percent heading into the starting of training camp.

He’ll have to be careful on long flights throughout the season, as that’s when most clots are developed. Once a person has developed a pulmonary embolism, they become more susceptible to future clots. A professional athlete who is constantly traveling the country must be extra diligent.

With all of that said, Varejao isn’t the first professional athlete to experience a pulmonary embolism. It’s not like this is uncharted territory.

Back in 2011, tennis superstar Serena Williams developed the same kind of clot in her lung. Unlike Varejao, she was extremely limited for over one year. In fact, at one point, thought she might die.

“I was on my death bed at one point – quite literally,” Williams said in a press conference. “It got to the stage where it felt like I could hardly breathe. Some days I didn’t get out of bed at all. I just laid on a couch thinking why has this happened to me? … This has given me a whole new perspective on life and my career – and not taking anything for granted. I’m just taking one day at a time.”

After taking a year off, Williams was eventually able to return to form and duplicate her pre-injury success. However, that’s not always the case.

Two offensive linemen – Cleveland Browns guard Jason Pinkston and New York Giants tackle Stacy Andrews – were hospitalized with pulmonary emboli in recent year. Neither player has returned to the field since the diagnosis, despite being starters prior to the injuries.

Varejao, Williams, Pinkston and Andrews were fortunate that their clots were detected early. Many athletes have died over the years from pulmonary emboli, including Mack Lee Hill of the Kansas City Chiefs, Harry Agganis of the Boston Red Sox and Derrick Thomas of the Kansas City Chiefs among others.

Even if a pulmonary embolism isn’t career-ending, it can still greatly affect the individual’s life. Even after recovering from a blood clot in the lung, it’s not uncommon for a patient to experience shortness of breath or chest pain, especially when exerting themselves physically.

Sometimes, I would feel slightly fatigued and short of breath when I was sitting on the couch in the year following my clot. I can’t even imagine how an NBA player feels when he’s running up and down the court, banging with the best athletes in the world.

Varejao won’t know how his body will respond until he takes the court, but at the end of the day, the fact that he’s alive and in a position to resume his career at all is a blessing in itself.

Alex Kennedy is the Managing Editor of Basketball Insiders and this is his 10th season covering the NBA. He is a member of the Professional Basketball Writers Association.

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NBA Daily: Examining Michael Porter Jr.’s Ascension

Since Jamal Murray’s season-ending knee injury, Michael Porter Jr. is averaging over 25 points per game and looks like a future All-NBA player. Bobby Krivitsky examines Porter’s ascent and the questions that come with it.

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Since Jamal Murray’s season-ending knee injury, Michael Porter Jr. has taken his game to new heights.

In the wake of Murray’s ACL tear in mid-April, Porter’s playing time has gone from 30.6 minutes per contest to 35.7, while his shots per game have risen from 12.6 per game to 16.5. The increased responsibility has fueled his ascent. He’s knocking down 56.3 percent of those attempts. He’s taking 8.2 threes per game and making a blistering 50 percent of them. As a result, Porter’s gone from averaging 17.5 points per game to 25.1. He’s also grabbing 6.1 rebounds and blocking almost one shot per contest.

At the time of Murray’s injury, the Denver Nuggets were in fourth place in the Western Conference. They remain there now, 9-4 in his absence, and they boast the eighth-highest net rating in the NBA.

The only way for the Nuggets to fall from fourth would be if they lost their four remaining games and the Dallas Mavericks won their final five contests because the Mavericks have the tiebreaker since they won the season series. On the more realistic end of the spectrum, Denver sits just 1.5 games back of the Los Angeles Clippers, who occupy the third seed in the West. The Nuggets won their season series against the Clippers, meaning they’d finish in third if the two teams ended the regular season with the same record.

There’s a bevy of questions surrounding Porter’s recent play that need to be asked but cannot get answered at the moment. That starts with whether this is anything more than a hot streak. While it’s impossible to say definitively, it’s reasonable to believe Porter can consistently and efficiently produce about 25 points per game. He was the second-ranked high school prospect in 2017 and entered his freshman year at Missouri firmly in the mix for the top pick in the 2018 NBA draft. That was thanks in large part to his offensive prowess as a 6-10 wing with a smooth shot that’s nearly impossible to block because of the elevation he gets when he shoots. 

A back injury cost him all but 53 minutes of his collegiate career and caused him to fall to the 14th pick in the draft. He ended up in an ideal landing spot, going to a well-run organization that’s also well aware of its barren track record luring star players looking to change teams, making it vital for the Nuggets to hit on their draft picks. 

Porter’s first year in the NBA was exclusively dedicated to the rehab process and doing everything possible to ensure he can have a long, healthy and productive career. Last season, finally getting a chance to play, he showed off the tantalizing talent that made him a top prospect but only took seven shots per game while trying to fit in alongside Nikola Jokic, Murray, Paul Millsap and Jerami Grant.

More experience, including battling against the Los Angeles Lakers in the Western Conference Finals, an offseason, albeit a truncated one, to prepare for a more substantial role with Grant joining the Detroit Pistons and Millsap turning 36 this year, helped propel Porter. 

But for the Nuggets, before Murray’s injury, the perception was that even though they weren’t the favorites to come out of the Western Conference, they were a legitimate title contender. How far can they go if Porter’s consistently contributing about 25 points and over six rebounds per game while effectively playing the role of a second star alongside Jokic? 

It seems fair to cross Denver off the list of title contenders. But, if Porter continues to capably play the role of a second star alongside Jokic when doing so becomes more challenging in the postseason, the Nuggets can advance past a team like the Mavericks or Portland Trail Blazers. And at a minimum, they’d have the ability to make life difficult for whoever they had to face in the second round of the playoffs.

Unfortunately, the timing of Murray’s ACL tear, which happened in mid-April, means there’s a legitimate possibility he misses all of next season. Denver’s increased reliance on Porter is already allowing a young player with All-NBA potential to take on a role that’s closer to the one he’s assumed his whole life before making it to the sport’s highest level. If the Nuggets are counting on him to be the second-best player on a highly competitive team in the Western Conference next season, it’ll be fascinating to see what heights he reaches and how far they’re able to go as a team.

Theoretically, Porter’s growth could make it difficult for Denver to reacclimate Murray. But given Jokic’s unselfish style of play, there’s room for both of them to be satisfied by the volume of shots they’re getting. Unfortunately, the Nuggets have to wait, potentially another season, but Jokic is 26-years-old, Murray 24, Porter 22. When Denver has their Big Three back together, they could be far more potent while still being able to enjoy a lengthy run as legitimate title contenders.

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NBA Daily: D’Angelo Russell Back on Track

D’Angelo Russell lost much of the 2020-21 season to injury. Drew Maresca explains why his return will surprise people around the league.

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D’Angelo Russell was traded to the Minnesota Timberwolves last February, just before the COVID-19 pandemic shut down the entire season. But we’ve yet to see what Russell can really do in Minnesota.

The Timberwolves acquired Russell in late February in exchange for a future first-round pick – which transitions this season if they pick later than third – a 2021 second-round pick and Andrew Wiggins.

Sidenote: For those keeping score at home, the Timberwolves currently have the third-worst record in the league with five games remaining. It would behoove Minnesota to lose as many of their remaining games as possible to keep their 2021 pick. If the pick does not transition this season, it becomes unrestricted in 2020.

Trying to turn an owed pick into an unprotected future first is usually the wrong move; but in this instance, it’s better to keep the high first-rounder this year with an understanding that your 2022 pick will probably fall in or around the middle of the lottery.

The thinking around the deal was that Minnesota could qualify for the playoffs as soon as this season by swapping Wiggins’ contract for a young, talented lead guard in Russell. It has not played out as planned.

COVID resulted in a play stoppage shortly after the deal, robbing Russell of the opportunity to ramp up with his new team. When the NBA returned to finish the 2019-20 season, the Timberwolves failed to qualify for bubble play – and considering the US was still battling a global pandemic, Russell couldn’t easily practice with his new teammates and/or coaches.

The 2020-21 season began weirdly, too. The NBA proceeded with an abbreviated training camp and preseason. And while this impacted all teams, Russell was additionally hindered by the decision.

Ready or not, the season began. In 2020-21, Russell is averaging a near-career low in minutes per game (28.2) across just 36 games. He’s tallying 19.1 points per game on 43.6% shooting and a career-best 38.8% on three-point attempts. He’s also he’s posting a near career-best assist-to-turnover ratio (5.7 to 2.8).

Despite Russell’s contributions, the Timberwolves have failed to meet expectations. Far from the playoff squad they hoped to be, Minnesota is in contention for the top pick in this year’s draft. So what has gone wrong in Minneapolis?

Russell’s setbacks are fairly obvious. In addition to the lack of preparation with his teammates and coaches, Russell was diagnosed with a “loose body” in his knee, requiring arthroscopic knee surgery in February. As a result, he missed 27 consecutive games. Russell returned on April 5, but head coach Chris Finch revealed that he’d been on a minutes restriction until just recently.

Minnesota is clearly being cautious with Russell. Upon closer review, Russell has been restricted to under 30 minutes per game in all of his first 10 games back. Since then, Russell is averaging 31 minutes per game including an encouraging 37 minutes on May 5 in a four-point loss to Memphis.

Since returning from knee surgery, Russell is averaging 27 minutes per game across 16 games. Despite starting 19 of the team’s first 20 games, he hadn’t started in any game since returning – until Wednesday.

On the whole, Russell’s impact is about the same as it was prior to the injury, which should be encouraging to Timberwolves’ fans. He’s scoring slightly less (18.8 points since returning vs. 19.3 prior), shooting better from the field (44.9% since returning vs 42.6%% prior) and has been just slightly worse from three-point range (37.4% since vs. 39.9 prior). He’s dishing out more assists per game (6.5 since vs. 5.1 prior), too, and he posted three double-digit assist games in his last five contents – a feat achieved only once all season prior to his last five games.

Despite playing more and dropping more dimes, there’s still room to improve. Looking back to his career-bests, Russell averaged 23.1 points per game in 2019-20 in 33 games with Golden State (23.6) and 12 games with Minnesota (21.7).

But his most impactful season came in 2018-19 with the Brooklyn Nets. That season, Russell averaged 21.1 points and 7.0 assists per game, leading the Nets to the playoffs and earning his first trip to the All-Star game. He looked incredibly comfortable, playing with supreme confidence and flashing the ability to lead a playoff team.

At his best, Russell is a dynamic playmaker. The beauty of Russell is that he can also play off the ball. He has a quick release on his jumper and impressive range. His game is not predicated on athleticism, meaning he should stay at his peak for longer than guys like De’Aaron Fox and Ja Morant.

And while he’s been in the league for what feels like ever (six seasons), Russell just turned 25 approximately two months ago. Granted, comparing anyone to Steph Curry is unwise, but Curry wasn’t Steph Curry yet at 25. Former MVP Steve Nash hadn’t yet averaged double-digits (points) at 25. Twenty-five is also an inflection point for Damian Lillard and Russell Westbrook. And the list goes on.

To be fair, Russell was drafted at 19 so he’s more acclimated to the league at this age than most, but his game will continue expanding nonetheless. He’ll develop trickier moves, become stronger and grow his shooting range. And a good deal of that growth should be evident as soon as next season since he’ll be fully healed from knee surgery and have a full offseason and training camp to finally work with teammates and coaches.

So while Minnesota’s 2020-21 season was incredibly bleak, their future is quite bright – and much of it has to do with the presence of Russell.

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NBA AM: Is This It for Indiana?

Following their major drop-off, Matt John explains why the Pacers trying to get back to where they were may not be the best decision.

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Remember when, following the maligned trade of Paul George, the sky was the limit for the Indiana Pacers? The 2017-18 Pacers were one of the best stories in the NBA that season because they made their opponents work for their victories, and they put on a spectacle every night.

It’s hard to believe that all transpired three whole years ago. When Cleveland eliminated Indiana in a very tight first-round series, I asked if having the exciting season that they did – when many thought it would turn out the opposite – was going to benefit them in the long run. Three years later, this happens.

We were getting plenty of smoke about the Pacers’ drama behind-the-scenes beforehand, and now, we have seen the fire firsthand. More and more reports indicate that the crap has hit the fan. Indiana has seemingly already had enough of Nate Bjorkgren in only his first year as his coach. When you see the results they’ve had this season compared to the last three, it’s not hard to see why.

The Pacers have routinely found themselves in the 4-5 playoff matchup for the last three years. Sadly, despite their fight – and, to be fair, they had pretty awful injury luck the past two postseasons – they haven’t been able to get over the hump in the first round. They may not have been in the elite tier, but they weren’t slouches either. So, seeing them not only fail to take the next step but look more and more likely for the play-in is as discouraging as it gets. Especially after they started the season 6-2.

If these reports about the tensions between the players and Bjorkgren are real, then this has already become a lost season for the Pacers. It’s too late in the season to make any major personnel changes. At this point, their best route is just to cut their losses and wait until this summer to think over what the next move is.

In that case, let’s take a deep breath. This has been a weird season for everyone. Every aspect minus the playoffs has been shorter than usual since last October. Everything was shortened from the offseason to the regular season. Oh, and COVID-19 has played a role as the season has turned out, although COVID-19 has probably been the least of Indy’s problems. Let’s think about what next season would look like for Indiana.

TJ Warren comes back with a clean bill of health. Caris Levert gets more acquainted with the team and how they run. Who knows? Maybe they finally resolve the Myles Turner-Domantas Sabonis situation once and for all. A new coach can come aboard to steady the ship, and it already looks like they have an idea for who that’s going to be

Should they run it back, there’s a solid chance they can get back to where they were before. But that’s sort of the problem to begin with. Even if this recent Pacers’ season turns out to be just a negative outlier, their ceiling isn’t all too high anyway. A team that consists of Warren, Domantas Sabonis, Malcolm Brogdon, and Caris Levert as their core four is a solid playoff team. Having Turner, Doug McDermott, TJ McConnell, Jeremy Lamb, and the Holiday brothers rounds out a solid playoff team. Anyone who takes a good look at this roster knows that this roster is a good one. It’s not great though.

Just to be clear, Indiana has plenty of ingredients for a championship team. They just don’t have the main one: The franchise player. Once upon a time, it looked like that may have been Oladipo, but a cruel twist of fate took that all away. This isn’t a shot at any of the quality players they have on their roster, but think of it this way.

For the next couple of years, they’re going to go up against Kevin Durant, James Harden, and Kyrie Irving. All of whom are on the same team. For potentially even longer, they’ll be going up against the likes of Giannis Antetoukounmpo, Joel Embiid, and Jayson Tatum. With the roster they have, they could make a series interesting against any one of those teams. However, it’s a rule of thumb in the NBA that the team with the best player usually wins the series. Not to mention, they’d have to beat most of the teams those players play for to go on a substantial playoff run. That’s a pretty tall order.

There’s no joy in talking about the Pacers like this because they have built this overachieving underdog from nothing more than shrewd executive work. They turned a disgruntled and expiring Paul George into Oladipo and Sabonis. Both of whom have since become two-time all-stars (and counting). They then managed to turn an expiring and hobbled Oladipo – who had no plans to return to Indiana – into the electric Levert. They also pretty much stole Brogdon and Warren away while paying very little for either of them.

That is fantastic work. The only hangup is that, as of now, it just doesn’t seem like it will be enough. But, doubt and skepticism are things Indiana’s had thrown their way consistently since 2017. Many thought their approach to trading Paul George would blow up in their face, and since then, they’ve done everything in their power to make everyone eat their words.

Kevin Pritchard’s got his work cut out for him this summer. This season will hopefully turn out to be nothing more than performance ruined by both the wrong coaching hire and an unusual season that produced negatively skewed results. But at this point, Pritchard’s upcoming course of action this summer shouldn’t be about getting his team back to where they were, but deciding whether he can get them a step or two further than that by adding more to what they have or starting over completely.

Indiana’s had a rough go of it in this COVID-shortened season, but their disappointing play may have little to no bearing on where they go from here.

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