Database : MEDLINE
Search on : Hallux and Rigidus [Words]
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[PMID]: 29306736
[Au] Autor:Karpe P; Killen MC; Chauhan A; Pollock R; Limaye R
[Ad] Address:University Hospital of North Tees, Hardwick, Stockton on Tees, TS19 8PE, United Kingdom. Electronic address: prasad.karpe1@nhs.net.
[Ti] Title:Early results of Roto-glide joint arthroplasty for treatment of hallux rigidus.
[So] Source:Foot (Edinb);34:58-62, 2017 Nov 14.
[Is] ISSN:1532-2963
[Cp] Country of publication:Scotland
[La] Language:eng
[Ab] Abstract:BACKGROUND: Traditionally severe hallux rigidus is treated with arthrodesis. Recently arthroplasty has been used in order to retain motion at the metatarsophalangeal joint. AIM: To assess the early to mid-term functional and radiological outcomes in patients undergoing first metatarsophalangeal arthroplasty using the Rotoglide implant. MATERIALS AND METHODS: A prospective review was undertaken to assess functional and radiological outcomes of all patients undergoing an un-cemented three-component first metatarsophalangeal arthroplasty for hallux rigidus. Thirty four implants were performed in 28 patients over a 2-year period. Mean age was 60.5 years (range 45-77 years). Mean follow-up was 27.7 months (range 7-44 months). RESULTS: Mean AOFAS score improved from 41.2 pre-operatively to 89.1 at final follow-up (47.9; 95% CI=43.6-54.3; p<0.0001). The mean metatarsophalangeal (MTP) range of motion improved from 29.5° pre-operatively to 68.2° post-operatively (38.7; 95% CI=35.1-42.2; p<0.0001). The mean AOFAS pain scores improved from 8.8 preoperatively to 35.0 postoperatively (26.2; 95% CI=22.4-29.9; p<0.0001). Three patients required revision surgery. No radiological complications were observed in any other patients. CONCLUSIONS: This un-cemented prosthesis provides pain relief, while maintaining range of motion of the joint. The authors have observed clinically and statistically significant improvement in functional outcomes, with a low early complication rate and high patient satisfaction levels.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

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[PMID]: 29277083
[Au] Autor:Ajwani S; Kocialkowski C; Hill R; Kurdy N
[Ad] Address:Foot and Ankle Unit, Department of Trauma and Orthopaedics, University Hospital of South Manchester, United Kingdom.
[Ti] Title:Manipulation under anaesthesia and steroid injection for pain and stiffness after surgery to the first metatarsophalangeal joint.
[So] Source:Foot (Edinb);34:36-39, 2017 Nov 22.
[Is] ISSN:1532-2963
[Cp] Country of publication:Scotland
[La] Language:eng
[Ab] Abstract:AIM: To determine the effectiveness of manipulation under anaesthesia and local steroid injection to treat stiffness of the first metatarsophalangeal joint following surgery for hallux rigidus or hallux valgus. METHODS: Patients were identified who had undergone surgery for hallux rigidus or hallux valgus and subsequently were treated with manipulation and steroid injection for stiffness of their joint. Patient records were reviewed to determine the range of movement of the joint pre-operatively, immediately following the procedure and at subsequent follow up. Manchester-Oxford foot questionnaires (MOXFQ) were sent to patients to evaluate symptoms post-operatively. RESULTS: In total 35 patients were analysed, which included a total of 38 foot operations. Twenty seven had prior surgery for hallux rigidus and 11 for hallux valgus correction. The total range of movement of the joint improved following manipulation by an overall mean of 44.7° (p<0.0001). At subsequent follow up, the total range of movement of the joint was still improved by 22.2° (p<0.0001) overall. The mean post-operative MOXFQ score was 24.8 but no correlation was found between MOXFQ scores and range of movement. CONCLUSIONS: Manipulation under anaesthesia and local steroid injection is an effective way of treating stiffness following first ray surgery. Treatment results in an improved range of movement of the joint and patients report good function post-operatively.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher

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[PMID]: 28449701
[Au] Autor:Kuyucu E; Mutlu H; Mutlu S; Gülenç B; Erdil M
[Ad] Address:Orthopedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey. ersinkuyucu@yahoo.com.tr.
[Ti] Title:Arthroscopic treatment of focal osteochondral lesions of the first metatarsophalangeal joint.
[So] Source:J Orthop Surg Res;12(1):68, 2017 Apr 27.
[Is] ISSN:1749-799X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Although arthroscopic surgical treatment of the first metatarsophalangeal (MTP) joint involves painful sesamoid excision, synovectomy, debridement, and partial cheilectomy, no gold standard treatment technique has been defined in the literature for hallux rigidus and focal osteochondral lesions. This study aimed to assess the arthroscopic treatment for early grade focal osteochondral lesions of the first MTP joint and to determine the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in a group of patients who failed conservative treatment. METHODS: This prospective study included 14 patients with hallux rigidus and focal osteochondral lesions of the first MTP joint who underwent surgery in 2014 and were followed on a regular basis thereafter. RESULTS: The patients had mean preoperative VPS (visual pain score) and AOFAS (American Orthopedic Foot and ankle Society)-Hallux scores of 8.14 ± 0.86 SD and 48.64 ± 4.27, respectively; the corresponding postoperative values of both scores were 1.86 ± 0.66 SD and 87.00 ± 3.70. Both VPS and AOFAS-Hallux scores changed significantly. DISCUSSION: In this prospective study, we explored the impact of arthroscopic microhole drill surgery on foot function and activities of daily living in patients with focal osteochondral lesions of the first MTP joint. Our results showed significant improvements in VPS and AOFAS scores with this treatment. CONCLUSIONS: An arthroscopic microhole drill technique can be used with impressive functional scores and without any complications in patients who failed conservative therapy for hallux rigidus with focal chondral injury.
[Mh] MeSH terms primary: Arthroscopy/methods
Hallux Rigidus/diagnostic imaging
Hallux Rigidus/surgery
Metatarsophalangeal Joint/diagnostic imaging
Metatarsophalangeal Joint/surgery
[Mh] MeSH terms secundary: Adult
Cohort Studies
Female
Humans
Male
Middle Aged
Prospective Studies
Treatment Outcome
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[Js] Journal subset:IM
[Da] Date of entry for processing:170429
[St] Status:MEDLINE
[do] DOI:10.1186/s13018-017-0562-7

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[PMID]: 29506394
[Au] Autor:Thomas D; Thordarson D
[Ad] Address:1 Department of Orthopedic Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA.
[Ti] Title:Rolled Tendon Allograft Interposition Arthroplasty for Salvage Surgery of the Hallux Metatarsophalangeal Joint.
[So] Source:Foot Ankle Int;:1071100717746609, 2018 Mar 01.
[Is] ISSN:1944-7876
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Hallux rigidus is a common osteoarthritic disease of the first metatarsophalangeal joint (MTPJ). Few salvage treatment options exist that preserve motion for patients who have failed an initial procedure and who are not amenable to fusion, typically patients who are active or who would like to wear high heels. Allograft tendon interpositional arthroplasty is an unconventional salvage treatment option that may preserve motion and prevent bone loss. METHODS: A retrospective chart review is reported of 19 patients who failed previous procedures and refused fusion who underwent allograft tendon interpositional arthroplasty of the hallux MTPJ by a single surgeon between 2012 and 2015. Outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale assessment as well as measurement of apparent joint space on anterior to posterior and lateral views. RESULTS: The cumulative average AOFAS score for all patients was 68.5 preoperatively and 74.1 postoperatively. The average AOFAS pain subscore was 24.7 preoperatively and 26.8 postoperatively (SD = 7.7 and 13.8, respectively). Radiographically, patients had an increase in apparent joint space from pre- to postoperatively, most notable on the lateral view (0.6 to 4.7 mm; SD = 0.7 and 3.2 mm). Five patients required a second operative procedure, for an overall 26% reoperation rate. One patient underwent hallux MTPJ fusion after the interpositional arthroplasty. An additional 4 patients (21%) had symptoms requiring a steroid injection, and another 3 patients (16%) were recommended to undergo a revision procedure based on their symptoms. CONCLUSION: Rolled allograft tendon interposition arthroplasty performed poorly as a salvage strategy for failed previous hallux MTPJ surgery for hallux rigidus because of a high rate of complication and minimal benefits. The senior author has abandoned the technique. LEVEL OF EVIDENCE: Level IV, retrospective case series.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180306
[Lr] Last revision date:180306
[St] Status:Publisher
[do] DOI:10.1177/1071100717746609

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[PMID]: 29503133
[Au] Autor:Asif M; Qasim SN; Kannan S; Bhatia M
[Ad] Address:Surgeon, Musculoskeletal Department, University Hospitals of Leicester, Leicester, UK. Electronic address: drmasif@yahoo.com.
[Ti] Title:A Consecutive Case Series of 166 First Metatarsophalangeal Joint Fusions Using a Combination of Cup and Cone Reamers and Crossed Cannulated Screws.
[So] Source:J Foot Ankle Surg;, 2018 Mar 02.
[Is] ISSN:1542-2224
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Fusion of the first metatarsophalangeal joint (MTPJ) is the reference standard surgery for significant hallux rigidus. A number of different techniques for first MTPJ fusion have been reported. We describe our technique of first MTPJ fusion using cup and cone reamers for joint surface preparation and 2 crossed cannulated screws for fixation. To the best of our knowledge, this is the single largest series using this technique. The present study reports on a single-surgeon, consecutive series of 166 consecutive cases in 147 patients who had undergone first MTPJ fusion. The demographic data and comorbidities of the patients were collected from the digital medical records, and the radiographs were evaluated by 2 of us (S.Q., M.A.) independently to document fusion status. Radiologic nonunion was seen in 11 of 166 cases (6.6%). The mean duration of follow up was 60 ± 29.5 (minimum 26, maximum 183) days. However, only 4 of the 11 cases (36%) of nonunion were clinically symptomatic and underwent revision using a bone graft and locking plate. A statistically significant difference was found in union rates among males and females (p = .01). Other factors, such as diabetes (p = .2), inflammatory arthritis (p = .5), steroids (p = .6), smoking (p = .5), hallux valgus deformity (p = .5), and concomitant forefoot surgery, did not have a statistically significant (p = .3) effect on union in our study. The union rate of first MTPJ fusion with our technique was comparable to that of others, with the advantage of being simple and less expensive compared with the use of a plate.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:Publisher

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[PMID]: 28449699
[Au] Autor:Munteanu SE; Landorf KB; McClelland JA; Roddy E; Cicuttini FM; Shiell A; Auhl M; Allan JJ; Buldt AK; Menz HB
[Ad] Address:Discipline of Podiatry, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, 3086, Australia. s.munteanu@latrobe.edu.au.
[Ti] Title:Shoe-stiffening inserts for first metatarsophalangeal joint osteoarthritis (the SIMPLE trial): study protocol for a randomised controlled trial.
[So] Source:Trials;18(1):198, 2017 Apr 27.
[Is] ISSN:1745-6215
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: This article describes the design of a parallel-group, participant- and assessor-blinded randomised controlled trial comparing the effectiveness of shoe-stiffening inserts versus sham shoe insert(s) for reducing pain associated with first metatarsophalangeal joint (MTPJ) osteoarthritis (OA). METHODS: Ninety participants with first MTPJ OA will be randomised to receive full-length shoe-stiffening insert(s) (Carbon Fibre Spring Plate, Paris Orthotics, Vancouver, BC, Canada) plus rehabilitation therapy or sham shoe insert(s) plus rehabilitation therapy. Outcome measures will be obtained at baseline, 4, 12, 24 and 52 weeks; the primary endpoint for assessing effectiveness being 12 weeks. The primary outcome measure will be the foot pain domain of the Foot Health Status Questionnaire (FHSQ). Secondary outcome measures will include the function domain of the FHSQ, severity of first MTPJ pain (using a 100-mm Visual Analogue Scale), global change in symptoms (using a 15-point Likert scale), health status (using the Short-Form-12® Version 2.0 and EuroQol (EQ-5D-5L™) questionnaires), use of rescue medication and co-interventions, self-reported adverse events and physical activity levels (using the Incidental and Planned Activity Questionnaire). Data will be analysed using the intention-to-treat principle. Economic analysis (cost-effectiveness and cost-utility) will also be performed. In addition, the kinematic effects of the interventions will be examined at 1 week using a three-dimensional motion analysis system and multisegment foot model. DISCUSSION: This study will determine whether shoe-stiffening inserts are a cost-effective intervention for relieving pain associated with first MTPJ OA. The biomechanical analysis will provide useful insights into the mechanism of action of the shoe-stiffening inserts. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, identifier: ACTRN12616000552482 . Registered on 28 April 2016.
[Mh] MeSH terms primary: Clinical Protocols
Foot Orthoses
Metatarsophalangeal Joint/physiopathology
Osteoarthritis/therapy
[Mh] MeSH terms secundary: Biomechanical Phenomena
Cost-Benefit Analysis
Humans
Osteoarthritis/rehabilitation
Outcome Assessment (Health Care)
Patient Compliance
Shoes
[Pt] Publication type:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Entry month:1803
[Cu] Class update date: 180302
[Lr] Last revision date:180302
[Js] Journal subset:IM
[Da] Date of entry for processing:170429
[St] Status:MEDLINE
[do] DOI:10.1186/s13063-017-1936-1

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[PMID]: 29478481
[Au] Autor:Nakajima K
[Ad] Address:Orthopedic Surgeon, Department of Orthopaedic Surgery, Yashio Central General Hospital, Saitama, Japan. Electronic address: nakajimakenichiro@hotmail.co.jp.
[Ti] Title:Arthroscopy of the First Metatarsophalangeal Joint.
[So] Source:J Foot Ankle Surg;57(2):357-363, 2018 Mar - Apr.
[Is] ISSN:1542-2224
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Arthroscopic treatments for the first metatarsophalangeal joint have not spread fully owing to a number of factors. First, in the common arthroscopic view, the joint is observed from above, which makes the structures difficult to grasp and the dorsal aspect of the joint difficult to visualize and treat. Second, techniques for widening the view have not yet been reported. Third, the portals necessary for observation and treatment with hallux sesamoids have not yet been established. Finally, techniques for detecting the sesamoids have not been previously reported. We have developed a method for first metatarsophalangeal joint arthroscopy by treating 14 patients with hallux rigidus and 9 patients with hallux sesamoid disorders. We report a new method that combines a variety of arthroscopic techniques. Our study has 4 novel points. First, in our arthroscopic technique, the joint can be examined from the medial side because traction is directly and horizontally applied to the great toe using an adjustable traction device with the surgeon standing on the unoperated side. The technique enables observation of the dorsal aspect of the metatarsal head and proximal phalanx and makes the structures easier to grasp. Second, the coagulator technique as an arthroscopic aid is demonstrated. Third, all aspects of the joint, including the sesamoids, can be observed through our 4 portals. Finally, techniques for detecting the sesamoids are identified. We believe our novel method will ensure that arthroscopy of the first metatarsophalangeal joint is easier than previously described methods.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180226
[Lr] Last revision date:180226
[St] Status:In-Process

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[PMID]: 29331290
[Au] Autor:Zdilla MJ; Miller KD; Swearingen JV; Lambert HW
[Ad] Address:Associate Professor of Biology & Physician Assistant Sciences, Department of Natural Sciences and Mathematics, West Liberty University, West Liberty, WV; Associate Professor of Biology & Physician Assistant Sciences, Department of Graduate Health Sciences, West Liberty University, West Liber
[Ti] Title:The Use of Ultrasonography to Identify the Intersection of the Dorsomedial Cutaneous Nerve of the Hallux and the Extensor Hallucis Longus Tendon: A Cadaveric Study.
[So] Source:J Foot Ankle Surg;57(2):296-300, 2018 Mar - Apr.
[Is] ISSN:1542-2224
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Terminal branches of the superficial fibular nerve are at risk of iatrogenic damage during foot surgery, including hallux valgus rigidus correction, bunionectomy, cheilectomy, and extensor hallucis longus tendon transfer. One terminal branch, the dorsomedial cutaneous nerve of the hallux, is particularly at risk of injury at its intersection with the extensor hallucis longus tendon. Iatrogenic injuries of the dorsomedial cutaneous nerve of the hallux can result in sensory loss, neuroma formation, and/or debilitating causalgia. Therefore, preoperative identification of the nerve is of great clinical importance. The present study used ultrasonography to identify the intersection between the dorsomedial cutaneous nerve of the hallux and the extensor hallucis longus tendon in cadavers. On ultrasound identification of the intersection, dissection was performed to assess the accuracy of the ultrasound screening. The method successfully pinpointed the nerve in 21 of 28 feet (75%). The sensitivity, positive likelihood ratio, and positive and negative predictive values of ultrasound identification of the junction of the dorsomedial cutaneous nerve and the extensor hallucis longus tendon were 75%, 75%, 100%, and 0%, respectively. We have described an ultrasound protocol that allows for the preoperative identification of the dorsomedial cutaneous nerve of the hallux as it crosses the extensor hallucis longus tendon. The technique could potentially be used to prevent the debilitating iatrogenic injuries known to occur in association with many common foot surgeries.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180226
[Lr] Last revision date:180226
[St] Status:In-Process

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[PMID]: 29269025
[Au] Autor:Cone B; Staggers JR; Naranje S; Hudson P; Ingram J; Shah A
[Ad] Address:Research Fellow, Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL.
[Ti] Title:First Metatarsophalangeal Joint Arthrodesis: Does the Addition of a Lag Screw to a Dorsal Locking Plate Influence Union Rate and/or Final Alignment after Fusion.
[So] Source:J Foot Ankle Surg;57(2):259-263, 2018 Mar - Apr.
[Is] ISSN:1542-2224
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:First metatarsophalangeal (MTP-1) joint fusion is a reliable method for the correction of various deformities, including hallux valgus and hallux rigidus. Ideal constructs provide high rates of fusion in the desired alignment. The present study examined the union rates and the change in dorsiflexion angle during the follow-up period in patients who had undergone MTP-1 fusion with a dorsal locking plate and a lag screw compared with patients who had undergone fusion with a dorsal locking plate alone. We performed a retrospective review of 99 feet undergoing MTP-1 fusion. The joints were fused using either a dorsal locking plate alone or a lag screw plus a dorsal locking plate. Union was determined radiographically during the follow-up period. Suspected nonunions were confirmed by computed tomography. The dorsiflexion angles were radiographically measured at the first postoperative visit and at the final follow-up visit. Of the 99 feet, 36 (36.4%) were in the lag screw plus dorsal plate group and 63 (63.6%) in the dorsal plate group. The mean follow-up period was 12.9 (range 12 to 33.5) months. The dorsal plate plus lag screw group had a significantly lower change in the mean dorsiflexion angle (0.57° ± 5.01°) during the postoperative period compared with the dorsal plate group (6.73° ± 7.07°). The addition of a lag screw to a dorsal locking plate for MTP-1 arthrodesis might offer improved stability of the joint in the sagittal plane over time compared with a dorsal plate alone.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180226
[Lr] Last revision date:180226
[St] Status:In-Process

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[PMID]: 29448824
[Au] Autor:Cody EA; Do HT; Koltsov JCB; Mancuso CA; Ellis SJ
[Ad] Address:1 Duke University Medical Center, Durham, NC, USA.
[Ti] Title:Influence of Diagnosis and Other Factors on Patients' Expectations of Foot and Ankle Surgery.
[So] Source:Foot Ankle Int;:1071100718755473, 2018 Feb 01.
[Is] ISSN:1944-7876
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Many patient factors have been associated with higher or lower expectations of orthopaedic surgery. In foot and ankle surgery, the diverse diagnoses seen may also influence expectations. The aim of this study was to investigate the relationship between diagnosis and patients' preoperative expectations of elective foot and ankle surgery. METHODS: Two hundred seventy-eight patients undergoing elective foot or ankle surgery for 1 of 7 common diagnoses were enrolled in a prospective cohort study. Preoperative expectations were assessed with the Hospital for Special Surgery Foot & Ankle Surgery Expectations Survey. Patients also completed the Foot & Ankle Outcome Score, Short Form 12, pain visual analog scale, and questionnaires for depressive and anxiety symptoms. Demographic and clinical data were collected. Patient factors and diagnosis were analyzed using multivariate regression analysis to identify independent predictors of higher expectations and determine the effect of diagnosis relative to other patient factors on expectations. RESULTS: The multivariate regression analysis adjusting for demographics and other clinical characteristics showed that diagnosis contributed the most to the model, accounting for 10.5% of the variation in expectations survey scores. Patients with mid- or hindfoot arthritis ( P < .001), hallux valgus ( P = .001), or hallux rigidus ( P = .005) had lower scores (lower expectations) than those with ankle instability or osteochondral lesion. In the model, female sex ( P = .001), non-Caucasian race ( P = .031), and lower scores on the Foot & Ankle Outcome Score daily activities subscale ( P = .024) were associated with higher scores. CONCLUSIONS: Diagnosis of ankle instability or osteochondral lesion, female sex, non-Caucasian race, and lower Foot & Ankle Outcome Score daily activities subscale score were all associated with higher expectations. These findings may help inform and guide surgeons as they counsel patients preoperatively. LEVEL OF EVIDENCE: Level II, cross-sectional study.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180216
[Lr] Last revision date:180216
[St] Status:Publisher
[do] DOI:10.1177/1071100718755473


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