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Acute-Phase Blood Pressure Levels Correlate With a High Risk of Recurrent Strokes in Young-Onset Ischemic Stroke.

https://arctichealth.org/en/permalink/ahliterature282505
Source
Stroke. 2016 Jun;47(6):1593-8
Publication Type
Article
Date
Jun-2016
Author
Satu Mustanoja
Jukka Putaala
Daniel Gordin
Lauri Tulkki
Karoliina Aarnio
Jani Pirinen
Ida Surakka
Juha Sinisalo
Mika Lehto
Turgut Tatlisumak
Source
Stroke. 2016 Jun;47(6):1593-8
Date
Jun-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age of Onset
Blood Pressure - physiology
Brain Ischemia - physiopathology - therapy
Female
Finland
Follow-Up Studies
Humans
Hypertension - drug therapy - physiopathology
Male
Middle Aged
Outcome Assessment (Health Care) - statistics & numerical data
Recurrence
Registries - statistics & numerical data
Stroke - physiopathology - therapy
Young Adult
Abstract
High blood pressure (BP) in acute stroke has been associated with a poor outcome; however, this has not been evaluated in young adults.
The relationship between BP and long-term outcome was assessed in 1004 consecutive young, first-ever ischemic stroke patients aged 15 to 49 years enrolled in the Helsinki Young Stroke Registry. BP parameters included systolic (SBP) and diastolic BP, pulse pressure, and mean arterial pressure at admission and 24 hours. The primary outcome measure was recurrent stroke in the long-term follow-up. Adjusted for demographics and preexisting comorbidities, Cox regression models were used to assess independent BP parameters associated with outcome.
Of our patients (63% male), 393 patients (39%) had prestroke hypertension and 358 (36%) used antihypertensive treatment. The median follow-up period was 8.9 years (interquartile range 5.7-13.2). Patients with a recurrent stroke (n=142, 14%) had significantly higher admission SBP, diastolic BP, pulse pressure, and mean arterial pressure (P
PubMed ID
27217509 View in PubMed
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Admission Hyperglycemia and Clinical Outcome in Cerebral Venous Thrombosis.

https://arctichealth.org/en/permalink/ahliterature273503
Source
Stroke. 2016 Feb;47(2):390-6
Publication Type
Article
Date
Feb-2016
Author
Susanna M Zuurbier
Sini Hiltunen
Turgut Tatlisumak
Guusje M Peters
Suzanne M Silvis
Elena Haapaniemi
Nyika D Kruyt
Jukka Putaala
Jonathan M Coutinho
Source
Stroke. 2016 Feb;47(2):390-6
Date
Feb-2016
Language
English
Publication Type
Article
Keywords
Adult
Anticoagulants - therapeutic use
Cerebral Hemorrhage - epidemiology - therapy
Cohort Studies
Coma - epidemiology
Comorbidity
Decompressive Craniectomy
Female
Finland - epidemiology
Humans
Hyperglycemia - drug therapy - epidemiology
Hypoglycemic agents - therapeutic use
Insulin - therapeutic use
Intensive Care Units - utilization
Intracranial Thrombosis - epidemiology - mortality - therapy
Logistic Models
Male
Middle Aged
Netherlands - epidemiology
Odds Ratio
Prognosis
Retrospective Studies
Severity of Illness Index
Sinus Thrombosis, Intracranial - epidemiology - mortality - therapy
Venous Thrombosis - epidemiology - mortality - therapy
Abstract
Admission hyperglycemia is associated with poor clinical outcome in ischemic and hemorrhagic stroke. Admission hyperglycemia has not been investigated in patients with cerebral venous thrombosis.
Consecutive adult patients with cerebral venous thrombosis were included at the Academic Medical Center, The Netherlands (2000-2014) and the Helsinki University Central Hospital, Finland (1998-2014). We excluded patients with known diabetes mellitus and patients without known admission blood glucose. We defined admission hyperglycemia as blood glucose =7.8 mmol/L (141 mg/dL) and severe hyperglycemia as blood glucose =11.1 mmol/L (200 mg/dL). We used logistic regression analysis to determine if admission hyperglycemia was associated with modified Rankin Scale (mRS) score of 3 to 6 or mortality at last follow-up. We adjusted for: age, sex, coma, malignancy, infection, intracerebral hemorrhage, deep cerebral venous thrombosis, and location of recruitment.
Of 380 patients with cerebral venous thrombosis, 308 were eligible. Of these, 66 (21.4%) had admission hyperglycemia with 8 (2.6%) having severe admission hyperglycemia. Coma (31.3% versus 5.0%, P
PubMed ID
26670083 View in PubMed
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Analysis of 1008 consecutive patients aged 15 to 49 with first-ever ischemic stroke: the Helsinki young stroke registry.

https://arctichealth.org/en/permalink/ahliterature152380
Source
Stroke. 2009 Apr;40(4):1195-203
Publication Type
Article
Date
Apr-2009
Author
Jukka Putaala
Antti J Metso
Tiina M Metso
Nina Konkola
Yvonn Kraemer
Elena Haapaniemi
Markku Kaste
Turgut Tatlisumak
Author Affiliation
Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. jukka.putaala@hus.fi
Source
Stroke. 2009 Apr;40(4):1195-203
Date
Apr-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Age of Onset
Brain Ischemia - diagnosis - epidemiology - etiology
Female
Finland - epidemiology
Humans
Male
Middle Aged
Registries - statistics & numerical data
Retrospective Studies
Risk factors
Sex Distribution
Stroke - diagnosis - epidemiology - etiology
Young Adult
Abstract
To analyze trends in occurrence, risk factors, etiology, and neuroimaging features of ischemic stroke in young adults in a large cohort.
We evaluated all 1008 consecutive ischemic stroke patients aged 15 to 49 admitted to Helsinki University Central Hospital, 1994 to 2007. Etiology was classified by Trial of Org 10172 in Acute Stroke Treatment criteria. Comparisons were done between groups stratified by gender and age.
Estimated annual occurrence was 10.8/100,000 (range 8.4 to 13.0), increasing exponentially with aging. Of our 628 male and 380 female (ratio 1.7:1) patients, females were preponderant among those 44 clearly had more risk factors. Cardioembolism (20%) and cervicocerebral artery dissection (15%) were the most frequent etiologic subgroups. Proportions of large-artery atherosclerosis (8%) and small-vessel disease (14%) began to enlarge at age 35, whereas frequency of undetermined etiology (33%) decreased along aging. Posterior circulation infarcts were more common among patients
Notes
Comment In: Stroke. 2009 Jul;40(7):e491; author reply e49219498177
PubMed ID
19246709 View in PubMed
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Association of prestroke statin use and lipid levels with outcome of intracerebral hemorrhage.

https://arctichealth.org/en/permalink/ahliterature113146
Source
Stroke. 2013 Aug;44(8):2330-2
Publication Type
Article
Date
Aug-2013
Author
Satu Mustanoja
Daniel Strbian
Jukka Putaala
Atte Meretoja
Sami Curtze
Elena Haapaniemi
Tiina Sairanen
Ronja Hietikko
Joonas Sirén
Markku Kaste
Turgut Tatlisumak
Author Affiliation
Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland. satu.mustanoja@hus.fi
Source
Stroke. 2013 Aug;44(8):2330-2
Date
Aug-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cerebral Hemorrhage - blood - epidemiology - mortality
Cholesterol, LDL - adverse effects - blood
Female
Finland - epidemiology
Glasgow Coma Scale
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects - therapeutic use
Male
Middle Aged
Outcome Assessment (Health Care)
Registries
Severity of Illness Index
Abstract
It is unclear whether blood lipid profiles and statin use before intracerebral hemorrhage (ICH) are associated with its outcome.
The Helsinki ICH Study, a single-center observational registry of consecutive ICH patients, was used to study the associations between premorbid statin use, baseline lipid levels, and clinical outcome.
The registry includes 964 ICH patients. Statin users (n=187; 19%) were significantly older, had more frequent comorbidities and medication, lower lipid levels, and higher admission Glasgow Coma Scale compared with nonusers. Modified Rankin Scale at discharge or mortality did not differ between statin users and nonusers. Compared with survivors, significantly lower total cholesterol and low-density lipoprotein cholesterol levels were observed in patients who died in hospital (median, 4.1 mmol/L [interquartile range, 3.6-4.4] versus 4.5 [3.8-5.1]; P
PubMed ID
23760210 View in PubMed
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Cardiovascular events after ischemic stroke in young adults: A prospective follow-up study.

https://arctichealth.org/en/permalink/ahliterature282329
Source
Neurology. 2016 May 17;86(20):1872-9
Publication Type
Article
Date
May-17-2016
Author
Karoliina Aarnio
Bob Siegerink
Jani Pirinen
Juha Sinisalo
Mika Lehto
Elena Haapaniemi
Alexander-Heinrich Nave
Markku Kaste
Turgut Tatlisumak
Jukka Putaala
Source
Neurology. 2016 May 17;86(20):1872-9
Date
May-17-2016
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Brain Ischemia - complications - epidemiology
Cardiovascular Diseases - epidemiology - etiology
Female
Finland - epidemiology
Follow-Up Studies
Humans
Incidence
Kaplan-Meier Estimate
Male
Middle Aged
Proportional Hazards Models
Prospective Studies
Recurrence
Registries
Risk
Stroke - complications - epidemiology
Young Adult
Abstract
To study the long-term risk of recurrent cardiac, arterial, and venous events in young stroke patients, and whether these risks differed between etiologic subgroups.
The study population comprised 970 patients aged 15-49 years from the Helsinki Young Stroke Registry (HYSR) who had an ischemic stroke in 1994-2007. We obtained follow-up data until 2012 from the Finnish Care Register and Statistics Finland. Cumulative 15-year risks were analyzed with life tables, whereas relative risks and corresponding confidence intervals (CI) were based on hazard ratios (HR) from Cox regression analyses.
There were 283 (29.2%) patients with a cardiovascular event during the median follow-up of 10.1 years (range 0.1-18.0). Cumulative 15-year risk for venous events was 3.9%. Cumulative 15-year incidence rate for composite vascular events was 34.0 (95% CI 30.1-38.2) per 1,000 person-years. When adjusted for age and sex, patients with an index stroke caused by high-risk sources of cardioembolism had the highest HR for any subsequent cardiovascular events (3.7; 95% CI 2.6-5.4), whereas the large-artery atherosclerosis group had the highest HR (2.7; 95% CI 1.6-4.6) for recurrent stroke compared with patients with stroke of undetermined etiology.
The risk for future cardiovascular events after ischemic stroke in young adults remains high for years after the index stroke, in particular when the index stroke is caused by high-risk sources of cardioembolism or large-artery atherosclerosis.
PubMed ID
27164672 View in PubMed
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Causes of death and predictors of 5-year mortality in young adults after first-ever ischemic stroke: the Helsinki Young Stroke Registry.

https://arctichealth.org/en/permalink/ahliterature149781
Source
Stroke. 2009 Aug;40(8):2698-703
Publication Type
Article
Date
Aug-2009
Author
Jukka Putaala
Sami Curtze
Sini Hiltunen
Heli Tolppanen
Markku Kaste
Turgut Tatlisumak
Author Affiliation
Department of Neurology, Helsinki University Central Hospital, Haartmaninkatu 4, FIN-00290, Helsinki, Finland. jukka.putaala@hus.fi
Source
Stroke. 2009 Aug;40(8):2698-703
Date
Aug-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Brain Ischemia - etiology - mortality
Cause of Death - trends
Female
Finland - epidemiology
Humans
Male
Middle Aged
Registries
Risk factors
Stroke - etiology - mortality
Young Adult
Abstract
Data on mortality and its prognostic factors after an acute ischemic stroke in young adults are scarce and based on relatively small heterogeneous patient series.
We analyzed 5-year mortality data of all consecutive patients aged 15 to 49 with first-ever ischemic stroke treated at the Department of Neurology, Helsinki University Central Hospital, from January 1994 to September 2003. We followed up the patients using data from the mortality registry of Statistics Finland. We used life table analyses for calculating mortality risks. Kaplan-Meier method allowed comparisons of survival between clinical subgroups. We used the Cox proportional hazard model for identifying predictors of mortality. Stroke severity was measured using the National Institutes of Health Stroke Scale and the Glasgow Coma Scale.
Among the 731 patients (mean age, 41.5+/-7.4 years; 62.8% males) followed, 78 died. Cumulative mortality risks were 2.7% (95% CI, 1.5% to 3.9%) at 1 month, 4.7% (3.1% to 6.3%) at 1 year, and 10.7% (9.9% to 11.5%) at 5 years with no gender difference. Those > or =45 years of age had lower probabilities of survival. Among the 30-day survivors (n=711), stroke caused 21%, cardioaortic and other vascular causes 36%, malignancies 12%, and infections 9% of the deaths. Malignancy, heart failure, heavy drinking, preceding infection, type 1 diabetes, increasing age, and large artery atherosclerosis causing the index stroke independently predicted 5-year mortality adjusted for age, gender, relevant risk factors, stroke severity, and etiologic subtype.
Despite the overall low mortality after an ischemic stroke in young adults, several recognizable subgroups had substantially increased risk of death in the long term.
PubMed ID
19590052 View in PubMed
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The CAVE score for predicting late seizures after intracerebral hemorrhage.

https://arctichealth.org/en/permalink/ahliterature103116
Source
Stroke. 2014 Jul;45(7):1971-6
Publication Type
Article
Date
Jul-2014
Author
Elena Haapaniemi
Daniel Strbian
Costanza Rossi
Jukka Putaala
Tuulia Sipi
Satu Mustanoja
Tiina Sairanen
Sami Curtze
Jarno Satopää
Reina Roivainen
Markku Kaste
Charlotte Cordonnier
Turgut Tatlisumak
Atte Meretoja
Author Affiliation
Department of Neurology (E.H., D.S., J.P., T. Sipi, S.M., T. Sairanen, S.C., R.R., M.K., T.T., A.M.) and Department of Neurosurgery (J.S.), Helsinki University Central Hospital, Helsinki, Finland; Neurology Department, EA 1046, Université Lille Nord de France, CHU Lille, Lille, France (C.R., C.C.); and Departments of Medicine and the Florey, University of Melbourne, Melbourne, Australia (A.M.).
Source
Stroke. 2014 Jul;45(7):1971-6
Date
Jul-2014
Language
English
Publication Type
Article
Keywords
Aged
Cerebral Hemorrhage - complications - epidemiology - mortality
Female
Finland - epidemiology
Humans
Male
Middle Aged
Patient Outcome Assessment
Predictive value of tests
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk
Seizures - epidemiology - etiology - mortality
Severity of Illness Index
Time Factors
Abstract
Seizures are a common complication of intracerebral hemorrhage (ICH). We developed a novel tool to quantify this risk in individual patients.
Retrospective analysis of the observational Helsinki ICH Study (n=993; median follow-up, 2.7 years) and the Lille Prognosis of InTra-Cerebral Hemorrhage (n=325; 2.2 years) cohorts of consecutive ICH patients admitted between 2004 and 2010. Helsinki ICH Study patients' province-wide electronic records were evaluated for early seizures occurring within 7 days of ICH and among 7-day survivors (n=764) for late seizures (LSs) occurring >7 days from ICH. A Cox regression model estimating risk of LSs was used to derive a prognostic score, validated in the Prognosis of InTra-Cerebral Hemorrhage cohort.
Of the Helsinki ICH Study patients, 109 (11.0%) had early seizures within 7 days of ICH. Among the 7-day survivors, 70 (9.2%) patients developed LSs. The cumulative risk of LSs was 7.1%, 10.0%, 10.2%, 11.0%, and 11.8% at 1 to 5 years after ICH, respectively. We created the CAVE score (0-4 points) to estimate the risk of LSs, with 1 point for each of cortical involvement, age10 mL, and early seizures within 7 days of ICH. The risk of LSs was 0.6%, 3.6%, 9.8%, 34.8%, and 46.2% for CAVE scores 0 to 4, respectively. The c-statistic was 0.81 (0.76-0.86) and 0.69 (0.59-0.78) in the validation cohort.
One in 10 patients will develop seizures after ICH. The risk of this adverse outcome can be estimated by a simple score based on baseline variables.
PubMed ID
24876089 View in PubMed
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Different risk factor profiles for ischemic and hemorrhagic stroke in type 1 diabetes mellitus.

https://arctichealth.org/en/permalink/ahliterature258791
Source
Stroke. 2014 Sep;45(9):2558-62
Publication Type
Article
Date
Sep-2014
Author
Stefanie Hägg
Lena M Thorn
Carol M Forsblom
Daniel Gordin
Markku Saraheimo
Nina Tolonen
Johan Wadén
Ron Liebkind
Jukka Putaala
Turgut Tatlisumak
Per-Henrik Groop
Source
Stroke. 2014 Sep;45(9):2558-62
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anthropometry
Blood Glucose - analysis
Blood pressure
Brain Ischemia - complications - diagnosis
Diabetes Mellitus, Type 1 - complications - diagnosis
Female
Finland
Follow-Up Studies
Humans
Intracranial Hemorrhages - complications - diagnosis
Male
Middle Aged
Proportional Hazards Models
Risk factors
Stroke - complications - diagnosis
Abstract
Despite the fact that patients with type 1 diabetes mellitus have a markedly increased risk of experiencing a stroke, independent risk factors for stroke and its subtypes in these patients have remained unclear.
A total of 4083 patients with type 1 diabetes mellitus from the Finnish Diabetic Nephropathy (FinnDiane) Study, without a history of stroke at baseline, were included. Strokes were classified based on medical files and brain imaging. At baseline, mean age was 37.4±11.8 years, duration of diabetes mellitus was 20.0 (11.0-30.0) years, and 51% were men. During 9.0±2.7 years (36 680 patient-years) of follow-up, 105 patients experienced an ischemic stroke and 44 a hemorrhagic stroke. Cox proportional hazards analyses were performed to determine independent risk factors.
Independent risk factors for ischemic stroke were duration of diabetes mellitus, presence of diabetic nephropathy, higher hemoglobin A1c, higher systolic blood pressure, insulin resistance, and history of smoking, whereas sex, lipids, high-sensitivity C-reactive protein, and the metabolic syndrome were not associated with an increased risk. Diabetic nephropathy, severe diabetic retinopathy, higher systolic blood pressure, and lower body mass index were independently associated with hemorrhagic stroke.
The risk factor profile for ischemic stroke seems partly different from that of hemorrhagic stroke in patients with type 1 diabetes mellitus.
PubMed ID
25061078 View in PubMed
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Extent of secondary intraventricular hemorrhage is an independent predictor of outcomes in intracerebral hemorrhage: data from the Helsinki ICH Study.

https://arctichealth.org/en/permalink/ahliterature269618
Source
Int J Stroke. 2015 Jun;10(4):576-81
Publication Type
Article
Date
Jun-2015
Author
Satu Mustanoja
Jarno Satopää
Atte Meretoja
Jukka Putaala
Daniel Strbian
Sami Curtze
Elena Haapaniemi
Tiina Sairanen
Mika Niemelä
Markku Kaste
Turgut Tatlisumak
Source
Int J Stroke. 2015 Jun;10(4):576-81
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Aged
Cerebral Hemorrhage - mortality - pathology
Female
Finland
Follow-Up Studies
Glasgow Coma Scale
Humans
Male
Middle Aged
Multivariate Analysis
Prognosis
Registries
Risk factors
Severity of Illness Index
Abstract
Intraventricular hemorrhage is a severe subtype of intracerebral hemorrhage associated with high mortality and poor outcome.
We analyzed various intraventricular hemorrhage scores at baseline to find common parameters associated with increased mortality.
Consecutive intracerebral hemorrhage patients treated in Helsinki University Central Hospital during 2005-2010 were included in the Helsinki Intracerebral Hemorrhage Study registry and analyzed for three-month mortality.
After excluding lost-to-follow-up patients, 967 intracerebral hemorrhage patients were included, out of whom 398 (41%) had intraventricular hemorrhage. Intraventricular hemorrhage patients, compared with nonintraventricular hemorrhage patients, had lower baseline Glasgow Coma Scale [median 12 (IQR 6-15) vs. 15 (13-15); P?
PubMed ID
25580771 View in PubMed
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Incidence of stroke according to presence of diabetic nephropathy and severe diabetic retinopathy in patients with type 1 diabetes.

https://arctichealth.org/en/permalink/ahliterature259150
Source
Diabetes Care. 2013 Dec;36(12):4140-6
Publication Type
Article
Date
Dec-2013
Author
Stefanie Hägg
Lena M Thorn
Jukka Putaala
Ron Liebkind
Valma Harjutsalo
Carol M Forsblom
Daniel Gordin
Turgut Tatlisumak
Per-Henrik Groop
Source
Diabetes Care. 2013 Dec;36(12):4140-6
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Adult
Brain - pathology - radiography
Diabetes Mellitus, Type 1 - blood - complications - diagnosis
Diabetic Nephropathies - complications - diagnosis
Diabetic Retinopathy - complications - diagnosis
Female
Finland
Follow-Up Studies
Humans
Incidence
Magnetic Resonance Imaging
Male
Middle Aged
Prognosis
Retrospective Studies
Risk factors
Severity of Illness Index
Stroke - diagnosis - epidemiology - etiology
Tomography, X-Ray Computed
Abstract
Type 1 diabetes is associated with a markedly increased risk of stroke, but only a few studies on the incidence of stroke in type 1 diabetes exist. Therefore, we assessed the incidence of stroke in patients with type 1 diabetes and studied the impact of diabetic nephropathy (DN) and severe diabetic retinopathy (SDR) on this risk.
We studied 4,083 patients with type 1 diabetes from the Finnish Diabetic Nephropathy Study. Mean age was 37.4 ± 11.8 years, duration of diabetes was 21.6 ± 12.1 years, and 52% were men. Strokes were identified from medical records, death certificates, and the National Hospital Discharge Register and classified based on medical files and brain images.
During 36,680 person-years of follow-up, 149 (4%) patients suffered an incident stroke (105 infarctions and 44 hemorrhages). Of the infarctions, 58 (55%) were lacunar. The incidence of stroke, cerebral infarction, and cerebral hemorrhage was 406 (95% CI 344-477), 286 (234-347), and 120 (87-161) per 100,000 person-years, respectively. In an adjusted analysis, microalbuminuria increased the risk of stroke with a hazard ratio (HR) of 3.2 (1.9-5.6), macroalbuminuria 4.9 (2.9-8.2), and end-stage renal disease 7.5 (4.2-13.3), and SDR increased the risk with an HR of 3.0 (1.9-4.5). The risk of cerebral infarction, cerebral hemorrhage, and lacunar infarction increased in a similar manner. The proportion of lacunar versus nonlacunar infarction did not change across DN groups.
The presence of SDR and DN, independently, increases the risk of stroke, cerebral infarction, and cerebral hemorrhage in patients with type 1 diabetes.
Notes
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PubMed ID
24101700 View in PubMed
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21 records – page 1 of 3.