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Singh D, Sarkar B, Yadav S, Sarkar K. Silent epidemic of silicotuberculosis in India and emergence of multidrug-resistant tuberculosis? J Glob Antimicrob Resist 2024:S2213-7165(24)00100-0. [PMID: 38825150 DOI: 10.1016/j.jgar.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/01/2024] [Accepted: 05/14/2024] [Indexed: 06/04/2024] Open
Abstract
India's projected silica-dust-exposed workers will be 52 million at the end of 2025. Elimination of tuberculosis is also targeted in India by 2025. Scientists in India have already pointed out that unless silicosis is controlled, the said elimination is difficult to achieve. This study evidences an increasing incidence of tuberculosis and multidrug resistant tuberculosis (MDR-TB) with five deaths due to treatment failure among the silica dust-exposed workers compared to their unexposed counterparts. It was also observed that both tuberculosis as well as MDR-TB were directly proportional to the dose and/or duration of silica dust exposure. This means the incidence of MDR-TB is lowest in the unexposed group, moderate in the radiologically negative but silica dust exposed group (subradiological silicosis due to moderate exposure), and highest in the radiologically confirmed silicotic workers (maximally exposed group. Since India has a huge burden of silicosis, they are vulnerable to tuberculosis including multidrug-resistant tuberculosis resulting in the emergence of MDR-TB among the silica dust-exposed workers. This will also lead to a silent epidemic of silicotuberculosis in India shortly. Therefore, it would be important to have tools to quickly detect silicosis cases at an early stage to identify a vulnerable population and adopt an effective intervention measure.
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Affiliation(s)
- Dharmendra Singh
- Scientist E, Department of Biochemistry, ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases. Tajganj, Agra, Uttar Pradesh, India.
| | - Bidisa Sarkar
- Senior Resident, Department of Community Medicine, Gouri Devi Institute of Medical Sciences & Hospital, Durgapur, West Bengal, India.
| | - Saurabh Yadav
- Assistant Professor, Department of Tuberculosis and Chest, Autonomous State Medical College and Hospital, Firozabad, Uttar Pradesh, India.
| | - Kamalesh Sarkar
- Professor, Department of Public Health, NSHM Knowledge Campus, Kolkata, West Bengal, India.
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Otelea MR, Oancea C, Reisz D, Vaida MA, Maftei A, Popescu FG. Club Cells-A Guardian against Occupational Hazards. Biomedicines 2023; 12:78. [PMID: 38255185 PMCID: PMC10813369 DOI: 10.3390/biomedicines12010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/11/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Club cells have a distinct role in the epithelial repair and defense mechanisms of the lung. After exposure to environmental pollutants, during chronic exposure, the secretion of club cells secretory protein (CCSP) decreases. Exposure to occupational hazards certainly has a role in a large number of interstitial lung diseases. According to the American Thoracic Society and the European Respiratory Society, around 40% of the all interstitial lung disease is attributed to occupational hazards. Some of them are very well characterized (pneumoconiosis, hypersensitivity pneumonitis), whereas others are consequences of acute exposure (e.g., paraquat) or persistent exposure (e.g., isocyanate). The category of vapors, gases, dusts, and fumes (VGDF) has been proven to produce subclinical modifications. The inflammation and altered repair process resulting from the exposure to occupational respiratory hazards create vicious loops of cooperation between epithelial cells, mesenchymal cells, innate defense mechanisms, and immune cells. The secretions of club cells modulate the communication between macrophages, epithelial cells, and fibroblasts mitigating the inflammation and/or reducing the fibrotic process. In this review, we describe the mechanisms by which club cells contribute to the development of interstitial lung diseases and the potential role for club cells as biomarkers for occupational-related fibrosis.
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Affiliation(s)
- Marina Ruxandra Otelea
- Clinical Department 5, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Corina Oancea
- Department of Physical Medicine and Rehabilitation, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daniela Reisz
- Department of Neurology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Monica Adriana Vaida
- Department of Anatomy and Embryology, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| | - Andreea Maftei
- Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Florina Georgeta Popescu
- Department of Occupational Health, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timișoara, Romania;
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Ahn C, Lee T, Shin JH, Lee JS, Upaassana VT, Ghosh S, Ku BK. Lab on a chip for detecting Clara cell protein 16 (CC16) for potential screening of the workers exposed to respirable silica aerosol. MICROFLUIDICS AND NANOFLUIDICS 2023; 27:1-10. [PMID: 38196842 PMCID: PMC10772934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Early detection of pulmonary responses to silica aerosol exposure, such as lung inflammation as well as early identification of silicosis initiation, is of great importance in disease prevention of workers. In this study, to early screen the health condition of the workers who are exposed to respirable silica dusts, an immunoassay lab on a chip (LOC) was designed, developed and fully characterized for analyzing Clara cell protein 16 (CC16) in serum which has been considered as one of the potential biomarkers of lung inflammation or lung damage due to the respirable silica dusts. Sandwich immunoassay of CC16 was performed on the LOC developed with a custom-designed portable analyzer using artificial serums spiked with CC16 protein first and then human serums obtained from the coal mine workers exposed to the respirable silica-containing dusts. The dynamic range of CC16 assay performed on the LOC was in a range of 0.625-20 ng/mL, and the achieved limit of detection (LOD) was around 0.35 ng/mL. The assay results of CC16 achieved from both the developed LOC and the conventional 96 well plate showed a reasonable corelation. The correlation between the conventional reader and the developed portable analyzer was found to be reasonable, resulting in R2 ~ 0.93. This study shows that the LOC developed for the early detection of CC16 can be potentially applied for the development of a field-deployable point-of-care testing (POCT) for the early monitoring of the field workers who are exposed to silica aerosol.
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Affiliation(s)
- Chong Ahn
- Department of Electrical and Computer Engineering, Miscrosystems and BioMEMS Laboratory, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Taekhee Lee
- PMRD, Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Pittsburgh, PA 15236, USA
| | - Jae Hoon Shin
- Korea Workers’ Compensation & Welfare Service (COMWEL), Institute of Occupation and Environment (IOE), Incheon 21417, South Korea
| | - Jong Seong Lee
- Korea Workers’ Compensation & Welfare Service (COMWEL), Institute of Occupation and Environment (IOE), Incheon 21417, South Korea
| | - V. Thiyagarajan Upaassana
- Department of Electrical and Computer Engineering, Miscrosystems and BioMEMS Laboratory, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Sthitodhi Ghosh
- Department of Electrical and Computer Engineering, Miscrosystems and BioMEMS Laboratory, University of Cincinnati, Cincinnati, OH 45221, USA
| | - Bon Ki Ku
- Health Effects Laboratory Division (HELD), Centers for Disease Control and Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH 45226, USA
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Li JF, Zou Q, Li X, Liu Y, He QY, Fu L, Zhao H. Associations of Serum Clara Cell Protein 16 with Severity and Prognosis in Adults with Community-Acquired Pneumonia. Int J Gen Med 2023; 16:4907-4917. [PMID: 37928954 PMCID: PMC10625334 DOI: 10.2147/ijgm.s429665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023] Open
Abstract
Background Clara cell protein 16 (CC16) has multiple functions, including antioxidant, anti-inflammatory, and immune regulation properties. Nevertheless, the concrete function of CC16 in adult patients with community-acquired pneumonia (CAP) remained blurred. Methods A total of 541 adult patients with CAP were recruited on admission. Peripheral blood specimens, clinical parameters, and demographic characteristics were collected. The concentration of serum CC16 was evaluated through ELISA. The relationships between serum CC16 and clinical parameters were appraised by Spearman or Pearson correlative analyses. The correlations of serum CC16 with severity and prognosis were assessed using linear or logistic regression models. Results The level of CC16 was gradually decreased across with the elevated severity scores system of CAP. After treatment, the level of serum CC16 was upregulated. Correlative analyses found that serum CC16 was negatively related to inflammatory cytokines. Additionally, multivariate linear and logistic regression models revealed that serum CC16 was inversely associated with severity scores system. In addition, reduced serum CC16 on admission elevated the risks of vasoactive agent usage, ICU admission, and death during hospitalization. We observed an almost discriminatory ability for severity and death between serum CC16 and severity scores system, and were all obviously elevated compared to routine inflammatory and infectious markers. Conclusion There are substantially inverse correlations between serum CC16 level on admission with severity scores and poorly prognostic outcomes, indicating that CC16 is involved in the pathophysiological process of CAP. This study is helpful for establishing the potential application of serum CC16 in risk evaluation and targeted treatment.
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Affiliation(s)
- Jia-Fei Li
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, People’s Republic of China
- Department of Respiratory and Critical Care Medicine, First People’s Hospital of Chuzhou, Chuzhou, Anhui, 239001, People’s Republic of China
- Institute of Respiratory Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, People’s Republic of China
| | - Qian Zou
- Department of Respiratory and Critical Care Medicine, First People’s Hospital of Chuzhou, Chuzhou, Anhui, 239001, People’s Republic of China
| | - Xun Li
- Department of Respiratory and Critical Care Medicine, First People’s Hospital of Chuzhou, Chuzhou, Anhui, 239001, People’s Republic of China
| | - Ying Liu
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, People’s Republic of China
- Institute of Respiratory Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, People’s Republic of China
| | - Qi-Yuan He
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, People’s Republic of China
- Institute of Respiratory Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, People’s Republic of China
| | - Lin Fu
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, People’s Republic of China
- Institute of Respiratory Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, People’s Republic of China
| | - Hui Zhao
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, People’s Republic of China
- Institute of Respiratory Diseases, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230601, People’s Republic of China
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Singh D, Carr SK, Sarkar B, Ali SI, Sarkar K. A cluster onset of acute and accelerated silicosis cases in workers of ramming mass industries in Jharkhand, Eastern India. J Family Med Prim Care 2023; 12:1654-1658. [PMID: 37767429 PMCID: PMC10521824 DOI: 10.4103/jfmpc.jfmpc_2518_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 09/29/2023] Open
Abstract
Introduction and Methodology A cross-sectional study was conducted among workers of ramming mass industries in the East Singhbhum district of Jharkhand, eastern India. Workers had occupational exposure to respirable crystalline silica dust of varied duration between 1 and 6 years. A total of 122 subjects participated in it. Relevant epidemiological information was collected from them. All were x-rayed using 300 mA radiation for the detection of the presence of silicotic opacities if any as described by the International Labour Organisation (ILO) for the detection of silicosis. Results The study revealed that 61.4% (n = 75) of subjects had silicosis. Of them, 19 had acute silicosis (having a duration of silica dust exposure of 2 years or lesser) and 56 had accelerated silicosis (a duration of occupational exposure of > 2 to 6 years). The offending agent was clouds of respirable crystalline silica dust from the ramming mass industries. Epidemiological Interpretation To the best of our knowledge, this is the first report of an outbreak of acute and accelerated silicosis cases because of occupational inhalational exposure to ramming mass in India with a sizable portion of female workers with silicosis. Regional as well as national authorities need to take appropriate interventional measures in a programmatic mode as soon as possible. Conclusion An in-depth investigation on the existence and magnitude of the problem of silico-tuberculosis is needed to be performed in them as silicosis increases the vulnerability of pulmonary tuberculosis among the affected workers.
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Affiliation(s)
- Dharmendra Singh
- Department of Biochemistry, ICMR-National JALMA Institute for Leprosy and Other Mycobacterial Diseases, Agra, Uttar Pradesh, India
| | - Samit Kumar Carr
- Occupational Safety and Health Association of Jharkhand (OSHAJ), Jamshedpur, Jharkhand, India
| | - Bidisa Sarkar
- Department of Community Medicine, Gouri Devi Institute of Medical Sciences and Hospital, Durgapur, West Bengal, India
| | - Syed Irfan Ali
- Department of Community Medicine, Manipal Tata Medical College, Manipal Academy of Higher Education, Jamshedpur, Jharkhand, India
| | - Kamalesh Sarkar
- ICMR-National Institute of Occupational Health, Ahmedabad, Gujarat, India
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Singh D, Sarkar B, Sarkar K. Elimination of tuberculosis requires prior control of silicosis including sub-radiological silicosis. Indian J Tuberc 2023; 70:273-275. [PMID: 37562900 DOI: 10.1016/j.ijtb.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 05/03/2023] [Indexed: 08/12/2023]
Abstract
India is committed to the elimination of tuberculosis by 2025. But its achievement appears to be difficult as India has a huge burden of silicosis as well as sub-radiological silicosis, which was never given its required attention. Silicotic subjects are highly vulnerable to pulmonary tuberculosis due to the progressive decline of lung immunity. A study among vulnerable glass factory workers in Firozabad, Uttar Pradesh, revealed that silicotic workers were 7.5 times more at risk of pulmonary tuberculosis compared to non-silicotic subjects. Since India has a huge burden of silicosis and sub-radiological silicosis, the elimination of tuberculosis needs prior attention on silicosis. This article may be viewed as an eye-opener for understanding the necessity of dual control of both silicosis as well as tuberculosis by integrating both together.
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Affiliation(s)
- Dharmendra Singh
- Department of Biochemistry, ICMR-National JALMA Institute for Leprosy & Other Mycobacterial Diseases, Agra, Uttar Pradesh, India.
| | - Bidisa Sarkar
- Department of Community Medicine, Gouri Devi Institute of Medical Sciences & Hospital, Durgapur, West Bengal, India.
| | - Kamalesh Sarkar
- ICMR-National Institute of Occupational Health, Ahmedabad, Gujarat, India.
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Silica-associated lung disease in developing countries. Curr Opin Pulm Med 2023; 29:65-75. [PMID: 36695765 DOI: 10.1097/mcp.0000000000000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE OF REVIEW There is a considerable burden of silica-associated lung diseases in the developing world. This review summarizes the epidemiology of these diseases, especially silicosis and silico-tuberculosis, mitigative efforts and treatment, especially in the context of developing countries. RECENT FINDINGS In 2017, the highest incidence of silicosis was in China, India and Brazil among the developing countries. The prevalence of silicosis amongst exposed workers may vary from 4 to 55%; there is a risk of underestimation because of the 'healthy worker effect'. The permissible exposure limit for respirable silica adopted by governments in developing countries remains higher than the proposed 0.025 mg/m3. Silica exposure in informal or unorganized industries is challenging, as it falls outside statutory controls. Recent efforts on regulation and compensation by various governments in developing countries are encouraging but need proper implementation on the ground. Biomarkers such as club cell protein 16 and imaging methods such as computed tomography may offer earlier and easier detection of silicosis. Advanced silicosis remains incurable; novel treatments such as antifibrotics agents may be potentially effective. SUMMARY Silica-associated lung diseases are prevalent in developing countries. Efforts directed at preventing or minimizing exposure to respirable crystalline silica are required for mitigation.
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Căluțu IM, Smărăndescu RA, Rașcu A. Biomonitoring Exposure and Early Diagnosis in Silicosis: A Comprehensive Review of the Current Literature. Biomedicines 2022; 11:biomedicines11010100. [PMID: 36672608 PMCID: PMC9855648 DOI: 10.3390/biomedicines11010100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/23/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
Silicosis is a particular form of lung fibrosis attributable to occupational exposure to crystalline silica. The occupational exposure to crystalline silica also increases the risk of chronic obstructive pulmonary disease (COPD), cancer and lung infections, especially pulmonary tuberculosis. Silicosis is currently diagnosed in previously exposed workers by standard chest X-ray, when lesions are visible and irreversible. Therefore, it would be necessary to find specific and non-invasive markers that could detect silicosis in earlier stages, before the occurrence of X-ray opacities. In this narrative review, we present several diagnostic, monitoring and predictive biomarkers with high potential in the management of silicosis, such as: pro- and anti-inflammatory cytokines (TNF (Tumour necrosis factor-α), IL-1 (Interleukin-1), IL-6, IL-10), CC16 (Clara cell 16, an indirect marker of epithelial cell destruction), KL-6 (Krebs von den Lungen 6, an indirect marker of alveolar epithelial damage), neopterin (indicator of cellular immunity) and MUC5B gene (Mucin 5B, a gel-forming mucin in mucus). Studies have shown that all the aforementioned markers have a high potential for early diagnosis or evaluation of progression in silicosis and represent promising alternatives to radiology. We consider that a multicentric study is needed to evaluate these biomarkers in correlation with occupational history, histopathological examination, imaging signs and pulmonary functions tests on large groups of subjects to better evaluate the accuracy of the presented biomarkers.
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Affiliation(s)
- Iulia-Maria Căluțu
- Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Raluca-Andreea Smărăndescu
- Doctoral School, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Correspondence:
| | - Agripina Rașcu
- Clinical Department 5, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Occupational Medicine, Colentina Clinical Hospital, 020125 Bucharest, Romania
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A rapid point of care CC16 kit for screening of occupational silica dust exposed workers for early detection of silicosis/silico-tuberculosis. Sci Rep 2021; 11:23485. [PMID: 34873200 PMCID: PMC8648725 DOI: 10.1038/s41598-021-02392-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/29/2021] [Indexed: 11/09/2022] Open
Abstract
Silicosis is an irreversible, incurable and progressive occupational disease caused by prolonged exposure to crystalline-silica dust while working in the relevant industries. Conventionally diagnosis is done by chest radiology, often in an advanced stage as early symptoms often go unnoticed. Early detection and necessary intervention (secondary prevention) could be a realistic possible control strategy for controlling silicosis as no effective treatment is available to stop and/or reverse the pathological process. Additionally, these patients are also vulnerable to pulmonary tuberculosis, which often becomes difficult to treat and with uncertain treatment outcome. Considering India has a huge burden of silicosis and silico-tuberculosis, a rapid and inexpensive screening method was realized to be an urgent need for early detection of silicosis among silica dust exposed workers. Serum club cell protein 16 (CC16) is evidenced to be a useful proxy screening marker for early detection of silicosis as evidenced from the recent research work of ICMR-National Institute of Occupational Health (ICMR-NIOH), India. In this study a lateral-flow assay for semi-quantitative estimation of serum CC16 level was developed. The detection was performed using gold nanoparticles conjugated anti-CC16 monoclonal antibodies. A sum of 106 serum samples was tested to do the performance evaluation of the assay. A concentration of 6 ng/ml or less produced one band, 6.1–9 ng/ml produced two bands, while more than 9 ng/ml produced all the three bands at the test zone. The sensitivity of the assay was 100% while the specificity was 95%. This assay may be used as a sensitive tool for periodic screening of silica dust exposed vulnerable workers for early detection of silicosis in them.
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