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Numakura K, Kobayashi M, Muto Y, Sato H, Sekine Y, Sobu R, Aoyama Y, Takahashi Y, Okada S, Sasagawa H, Narita S, Kumagai S, Wada Y, Mori N, Habuchi T. The Current Trend of Radiation Therapy for Patients with Localized Prostate Cancer. Curr Oncol 2023; 30:8092-8110. [PMID: 37754502 PMCID: PMC10529045 DOI: 10.3390/curroncol30090587] [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: 06/23/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/28/2023] Open
Abstract
A recent approach to radiotherapy for prostate cancer is the administration of high doses of radiation to the prostate while minimizing the risk of side effects. Thus, image-guided radiotherapy utilizes advanced imaging techniques and is a feasible strategy for increasing the radiation dose. New radioactive particles are another approach to achieving high doses and safe procedures. Prostate brachytherapy is currently considered as a combination therapy. Spacers are useful to protect adjacent organs, specifically the rectum, from excessive radiation exposure.
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Affiliation(s)
- Kazuyuki Numakura
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Mizuki Kobayashi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Yumina Muto
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Hiromi Sato
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Yuya Sekine
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Ryuta Sobu
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Yu Aoyama
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Yoshiko Takahashi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Syuhei Okada
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Hajime Sasagawa
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
| | - Satoshi Kumagai
- Department of Radiology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (S.K.); (Y.W.); (N.M.)
| | - Yuki Wada
- Department of Radiology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (S.K.); (Y.W.); (N.M.)
| | - Naoko Mori
- Department of Radiology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (S.K.); (Y.W.); (N.M.)
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita 010-8543, Japan; (M.K.); (Y.M.); (H.S.); (Y.S.); (R.S.); (Y.A.); (Y.T.); (S.O.); (H.S.); (S.N.); (T.H.)
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Mehr JP, Blum KA, Green T, Howell S, Palasi S, Sullivan AT, Kim B, Kannady C, Wang R. Comparison of satisfaction with penile prosthesis implantation in patients with prostate cancer radiation therapy versus radical prostatectomy. Transl Androl Urol 2023; 12:690-699. [PMID: 37305636 PMCID: PMC10251085 DOI: 10.21037/tau-22-600] [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: 09/08/2022] [Accepted: 02/12/2023] [Indexed: 06/13/2023] Open
Abstract
Background Penile prosthesis surgery (PPS) is a commonly used treatment for erectile dysfunction (ED), either as first-line therapy or in cases refractory to other treatment options. In patients with a urologic malignancy such as prostate cancer, surgical interventions like radical prostatectomy (RP) as well as non-surgical treatments such as radiation therapy can all induce ED. PPS as a treatment for ED has high satisfaction rates in the general population. Our aim was to compare sexual satisfaction in patients with prosthesis implantation for ED following RP versus ED following radiation therapy for prostate cancer. Methods A retrospective chart review from our institutional database was conducted to identify patients who underwent PPS at our institution from 2011 to 2021. Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS) questionnaire data at least 6 months from implant operative date available was required for inclusion. Eligible patients were placed in one of two groups depending on etiology of ED-following RP or prostate cancer radiation therapy. To prevent crossover confounding; patients with history of pelvic radiation were excluded from the RP group and patients with history of RP were excluded from the radiation group. Data were obtained from 51 patients in the RP group and 32 patients in the radiation therapy group. Mean EDITS scores and additional survey questions were compared between the radiation and RP groups. Results There was a significant difference in mean survey responses for 8 of the 11 questions in the EDITS questionnaire between the RP group and the radiation group. Additional survey questions administered also found RP patients reported significantly higher rate of satisfaction with size of penis post-operatively versus the radiation group. Conclusions These preliminary findings, while requiring large-scale follow-up, suggest that there is greater sexual satisfaction and penile prosthesis device satisfaction in patients undergoing IPP placement following RP versus radiation therapy for prostate cancer. Use of validated questionnaires should continue to be utilized in quantifying device and sexual satisfaction following PPS.
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Affiliation(s)
- Justin P. Mehr
- Department of Surgery, Division of Urology, McGovern Medical School at UTHealth - Houston, Houston, TX, USA
| | - Kyle A. Blum
- Department of Surgery, Division of Urology, McGovern Medical School at UTHealth - Houston, Houston, TX, USA
| | - Travis Green
- Department of Surgery, Division of Urology, McGovern Medical School at UTHealth - Houston, Houston, TX, USA
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Skyler Howell
- Department of Surgery, Division of Urology, McGovern Medical School at UTHealth - Houston, Houston, TX, USA
| | - Stephen Palasi
- Department of Surgery, Division of Urology, McGovern Medical School at UTHealth - Houston, Houston, TX, USA
| | - Andrew T. Sullivan
- Department of Surgery, Division of Urology, McGovern Medical School at UTHealth - Houston, Houston, TX, USA
| | - Benjamin Kim
- Department of Surgery, Division of Urology, McGovern Medical School at UTHealth - Houston, Houston, TX, USA
| | - Christopher Kannady
- Department of Surgery, Division of Urology, McGovern Medical School at UTHealth - Houston, Houston, TX, USA
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Run Wang
- Department of Surgery, Division of Urology, McGovern Medical School at UTHealth - Houston, Houston, TX, USA
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
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Labate C, Panunzio A, De Carlo F, Zacheo F, De Matteis S, Barba MC, Carbonara U, Rizzo FL, Leo S, Forte S, Ditonno P, Tafuri A, Pagliarulo V. Current Knowledge on Radiation-Therapy-Induced Erectile Dysfunction in Prostate-Cancer Patients: A Narrative Review. URO 2023. [DOI: 10.3390/uro3020013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Prostate cancer is the most frequently diagnosed cancer in men in the United States. Among the different available treatment options, radiation therapy is recommended for localized or even advanced disease. Erectile dysfunction (ED) often occurs after radiation therapy due to neurological, vascular, and endocrine mechanisms resulting in arterial tone alteration, pudendal-nerve neuropraxia, and lastly fibrosis. Considering the influence of quality of life on patients’ treatment choice, radiation-therapy-induced ED prevention and treatment are major issues. In this narrative review, we briefly summarize and discuss the current state of the art on radiation-therapy-induced ED in PCa patients in terms of pathophysiology and available treatment options.
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Affiliation(s)
- Connie Labate
- Department of Urology, “Vito Fazzi” Hospital, 73100 Lecce, Italy
- Department of Emergency and Organ Transplantation, Urology and Andrology Section, University of Bari, 70124 Bari, Italy
| | - Andrea Panunzio
- Department of Urology, “Vito Fazzi” Hospital, 73100 Lecce, Italy
| | | | - Federico Zacheo
- Department of Urology, “Vito Fazzi” Hospital, 73100 Lecce, Italy
| | - Sara De Matteis
- Department of Radiation Therapy, “Vito Fazzi” Hospital, 73100 Lecce, Italy
| | | | - Umberto Carbonara
- Department of Emergency and Organ Transplantation, Urology and Andrology Section, University of Bari, 70124 Bari, Italy
- Department of Urology, Royal Surrey NHS Trust, London NW3 2PS, UK
| | | | - Silvana Leo
- Department of Oncology, “Vito Fazzi” Hospital, 73100 Lecce, Italy
| | - Saverio Forte
- Department of Emergency and Organ Transplantation, Urology and Andrology Section, University of Bari, 70124 Bari, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation, Urology and Andrology Section, University of Bari, 70124 Bari, Italy
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Adequacy of sexual care information given to prostate cancer patients receiving radical external beam radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background:
Despite the acknowledged value of providing prostate radiotherapy patients with sexual dysfunction (SD) information, there is little evidence related to patient perceptions of this or the extent to which information is provided to them. This study aimed to critically evaluate the quality and format of SD information given to patients before, during and after radical EBRT to treat prostate cancer.
Method:
Members of UK prostate cancer support groups were asked to complete an anonymous online survey tool seeking opinions of the SD information they were given before, during and after external beam radiotherapy (EBRT).
Results:
There were 56 responses to the survey with over 42% of respondents reporting that they had not received any SD information. Of those who did, 78·1% (25/32) received information before the start of EBRT. Physicians were the most involved in the provision of SD information, with nurses and therapeutic radiographers being underutilised. Responses were mostly negative, or neutral regarding the quality of SD information and the information received about impact on relationships, psychological and emotional health. Many participants wanted more information and support.
Conclusion:
This study demonstrates that prostate cancer patients who have undergone radical EBRT have not received adequate information relating to potential sexual function side effects and the psychological and emotional effects of SD. This information should be included in verbal and written information provided at all stages of the radiotherapy pathway.
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Shen C, Jain K, Shah T, Schaefer E, Zhou S, Fried D, Helmer DA, Sadeghi-Nejad H. Relationships between erectile dysfunction, prostate cancer treatment type and inflatable penile prosthesis implantation. Investig Clin Urol 2022; 63:316-324. [PMID: 35534219 PMCID: PMC9091830 DOI: 10.4111/icu.20210445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/15/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The prevalence of erectile dysfunction (ED) and the utilization of inflatable penile prosthesis (IPP) among prostate cancer patients are understudied. The aim of the study was to examine the relationships between ED, prostate cancer treatment type and IPP implantation in a national cohort. MATERIALS AND METHODS We identified a retrospective cohort of Surveillance, Epidemiology, and End Results (SEER)-Medicare patients diagnosed with locoregional prostate cancer between 2006 and 2011 and treated with surgery or radiation. Chi-square tests were used to detect significant differences in ED rates as well as use of IPP among the subset with ED. Multivariable logistic regression was used to examine factors associated with the use of IPP. RESULTS Among 31,233 patients in our cohort, 10,334 (33.1%) received prostatectomy and 20,899 (66.9%) received radiation. ED within 5 years was significantly more common in the prostatectomy group relative to those the radiation group (65.3% vs. 33.8%, p<0.001). In the subset of 13,812 patients with ED, the radiation group had greater median time to ED diagnosis compared to the prostatectomy group (346 vs. 133 days, p<0.001). IPP implantation was more frequent for prostatectomy patients than for radiation patients (3.6% vs. 1.4%, p<0.001). Cancer treatment type, race, and marital status were significantly associated with IPP utilization. CONCLUSIONS ED is highly prevalent among prostate cancer patients, and IPP implantation is be underutilized. ED rates, time to ED diagnosis and utilization of IPP differed significantly by prostate cancer treatment type.
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Affiliation(s)
- Chan Shen
- Department of Surgery, Division of Outcomes Research and Quality, Penn State College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Division of Health Services and Behavioral Research, Penn State College of Medicine, Hershey, PA, USA.
| | - Kunj Jain
- Division of Urology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Tejash Shah
- Division of Urology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Eric Schaefer
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, Penn State College of Medicine, Hershey, PA, USA
| | - Shouhao Zhou
- Department of Public Health Sciences, Division of Biostatistics and Bioinformatics, Penn State College of Medicine, Hershey, PA, USA
| | - Dennis Fried
- War-Related Injury & Illness Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
| | - Drew A Helmer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Hossein Sadeghi-Nejad
- War-Related Injury & Illness Study Center, VA New Jersey Health Care System, East Orange, NJ, USA
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Chung E, Mulhall J. Practical Considerations in Inflatable Penile Implant Surgery. J Sex Med 2021; 18:1320-1327. [PMID: 34247953 DOI: 10.1016/j.jsxm.2021.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/20/2021] [Accepted: 05/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Penile prosthesis implantation remains an effective solution for men with medical-refractory erectile dysfunction (ED) following radical pelvic surgery. Despite the distortion of pelvic anatomy, a penile implant can be performed with excellent clinical outcomes provided strict patient selection, proper preoperative workup and safe surgical principles are adhered to. AIM To provide practical recommendations on inflatable penile prosthesis (IPP) implantation in patients with medical-refractory ED, with an emphasis on patient selection and counselling, preoperative workup as well as surgical considerations to minimize intraoperative complications. METHODS A Medline search on relevant English-only articles on penile prostheses and pelvic surgery was undertaken and the following terms were included in the search for articles of interest: "bladder cancer", "prostate cancer", "rectal cancer", "pelvic surgery" and "inflatable penile implant". OUTCOMES Clinical key recommendations on patient selection, preoperative workup and surgical principles. RESULTS Patients should be made aware of the mechanics of IPP and the informed consent process should outline the benefits and disadvantages of IPP surgery, alternative treatment options, cost, potential prosthetic complications and patient's expectations on clinical outcomes. Specialised diagnostic test for workup for ED is often not necessary although preoperative workup should include screening for active infection and optimising pre-existing medical comorbidities. Precautionary measures should be carried out to minimise infective complication. Corporal dilation and reservoir placement can be challenging in this group, and surgeons may require knowledge of advanced reconstructive surgical techniques when dealing with specific cases such as coexisting Peyronie's disease and continence issue. CLINICAL TRANSLATION Strict patient selection and counselling process coupled with safe surgical principles are important to achieve excellent linical outcomes and patient satisfaction rates. STRENGTHS AND LIMITATIONS This masterclass paper provides an overview of the practical considerations for men who are undergoing IPP surgery following radical pelvic surgery. Limitations include the lack of highquality data and detailed surgical description on each surgical troubleshooting steps for various prosthetic-related complications. CONCLUSION The IPP implantation can be performed efficiently and safely in patients following radical pelvic surgery. Chung E, Mulhall J. Practical Considerations in Inflatable Penile Implant Surgery. J Sex Med 2021;18:1320-1327.
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Affiliation(s)
- Eric Chung
- AndroUrology Centre, Brisbane QLD, Australia; Princess Alexandra Hospital, University of Queensland, Brisbane QLD, Australia; Macquarie University Hospital, Sydney, NSW, Australia.
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Cuccia F, Corradini S, Mazzola R, Spiazzi L, Rigo M, Bonù ML, Ruggieri R, Buglione di Monale e Bastia M, Magrini SM, Alongi F. MR-Guided Hypofractionated Radiotherapy: Current Emerging Data and Promising Perspectives for Localized Prostate Cancer. Cancers (Basel) 2021; 13:1791. [PMID: 33918650 PMCID: PMC8070332 DOI: 10.3390/cancers13081791] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 12/13/2022] Open
Abstract
In this review we summarize the currently available evidence about the role of hybrid machines for MR-guided radiotherapy for prostate stereotactic body radiotherapy. Given the novelty of this technology, to date few data are accessible, but they all report very promising results in terms of tolerability and preliminary clinical outcomes. Most of the studies highlight the favorable impact of on-board magnetic resonance imaging as a means to improve target and organs at risk identification with a consequent advantage in terms of dosimetric results, which is expected to relate to a more favorable toxicity pattern. Still, the longer treatment time per session may potentially affect the patient's compliance to the treatment, although first quality of life assessment studies have reported substantial tolerability and no major impact on quality of life. Finally, in this review we hypothesize some future scenarios of further investigation, based on the possibility to explore the superior anatomy visualization and the role of daily adapted treatments provided by hybrid MR-Linacs.
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Affiliation(s)
- Francesco Cuccia
- Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, Italy; (F.C.); (R.M.); (M.R.); (R.R.); (F.A.)
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital Munich Campus Grosshadern, 81377 Munchen, Germany;
| | - Rosario Mazzola
- Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, Italy; (F.C.); (R.M.); (M.R.); (R.R.); (F.A.)
| | - Luigi Spiazzi
- Medical Physics Department, ASST Spedali Civili Hospital, 25123 Brescia, Italy
| | - Michele Rigo
- Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, Italy; (F.C.); (R.M.); (M.R.); (R.R.); (F.A.)
| | - Marco Lorenzo Bonù
- Department of Radiation Oncology, ASST Spedali Civili of Brescia, 25123 Brescia, Italy; (M.L.B.); (M.B.d.M.eB.); (S.M.M.)
- Radiation Oncology Department, University of Brescia, 25121 Brescia, Italy
| | - Ruggero Ruggieri
- Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, Italy; (F.C.); (R.M.); (M.R.); (R.R.); (F.A.)
| | - Michela Buglione di Monale e Bastia
- Department of Radiation Oncology, ASST Spedali Civili of Brescia, 25123 Brescia, Italy; (M.L.B.); (M.B.d.M.eB.); (S.M.M.)
- Radiation Oncology Department, University of Brescia, 25121 Brescia, Italy
| | - Stefano Maria Magrini
- Department of Radiation Oncology, ASST Spedali Civili of Brescia, 25123 Brescia, Italy; (M.L.B.); (M.B.d.M.eB.); (S.M.M.)
- Radiation Oncology Department, University of Brescia, 25121 Brescia, Italy
| | - Filippo Alongi
- Advanced Radiation Oncology Department, Sacro Cuore Don Calabria Hospital, 37024 Negrar di Valpolicella, Italy; (F.C.); (R.M.); (M.R.); (R.R.); (F.A.)
- Radiation Oncology Department, University of Brescia, 25121 Brescia, Italy
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