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Taminato M, Morais RBD, Fram DS, Pereira RRF, Esmanhoto CG, Pignatari AC, Barbosa DA. Risk factors for colonization and infection by resistant microorganisms in kidney transplant recipients. Rev Bras Enferm 2021; 74Suppl 6:e20210219. [PMID: 34406267 DOI: 10.1590/0034-7167-2021-0219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/13/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to assess the prevalence of colonization and infection by multidrug-resistant bacteria in patients undergoing kidney transplantation and identify the rate of infection, morbidity and mortality and associated risk factors. METHODS a prospective cohort of 200 randomly included kidney transplant recipients. Epidemiological surveillance of the studied microorganisms was carried out in the first 24 hours and 7 days after transplantation. RESULTS ninety (45%) patients were considered colonized. Female sex, hypertension and diabetes (p<0.005), dialysis time (p<0.004), length of stay after transplantation, delayed renal function, and length of stay were identified as risk factors. The microorganisms were isolated from surgical site, bloodstream and urinary tract infections. CONCLUSIONS colonization by resistant microorganisms in kidney transplant patients was frequent and risk factors associated with infection were identified. The results should guide the care team in order to minimize morbidity and mortality related to infectious causes in this population.
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Affiliation(s)
- Monica Taminato
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
| | - Richarlisson Borges de Morais
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil.,Universidade Federal de Uberlândia. Uberlândia, Minas Gerais, Brazil
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García-Ríos E, Nuévalos M, Mancebo FJ, Pérez-Romero P. Is It Feasible to Use CMV-Specific T-Cell Adoptive Transfer as Treatment Against Infection in SOT Recipients? Front Immunol 2021; 12:657144. [PMID: 33968058 PMCID: PMC8104120 DOI: 10.3389/fimmu.2021.657144] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/06/2021] [Indexed: 12/19/2022] Open
Abstract
During the last decade, many studies have demonstrated the role of CMV specific T-cell immune response on controlling CMV replication and dissemination. In fact, it is well established that transplanted patients lacking CMV-specific T-cell immunity have an increased occurrence of CMV replication episodes and CMV-related complications. In this context, the use of adoptive transfer of CMV-specific T-cells has been widely investigated and applied to Hematopoietic Stem Cell Transplant patients and may be useful as a therapeutic alternative, to reconstitute the CMV specific T-cell response and to control CMV viremia in patients receiving a transplantation. However, only few authors have explored the use of T-cell adoptive transfer in SOT recipients. We propose a novel review in which we provide an overview of the impact of using CMV-specific T-cell adoptive transfer on the control of CMV infection in SOT recipients, the different approaches to stimulate, isolate and expand CMV-specific T-cells developed over the years and a discussion of the possible use of CMV adoptive cellular therapy in this SOT population. Given the timeliness and importance of this topic, we believe that such an analysis will provide important insights into CMV infection and its treatment/prevention.
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Affiliation(s)
- Estéfani García-Ríos
- National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Marcos Nuévalos
- National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Francisco J Mancebo
- National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain
| | - Pilar Pérez-Romero
- National Center for Microbiology, Instituto de Salud Carlos III, Majadahonda, Spain
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Immunosuppressive Medication and Non-Rejection-Related Complications Following Heart Transplantation. JOURNAL OF INTERDISCIPLINARY MEDICINE 2020. [DOI: 10.2478/jim-2020-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Although the clinical evolution of a patient with heart failure is initially improved by transplantation, a number of potential complications may occur in the post-transplant period, which may be directly related to the effects of chronic immunosuppression. The purpose of this study was to analyze the occurrence and frequency of post-transplant complications related to immunosuppressive treatment in the Institute of Cardiovascular Diseases and Transplantation of Târgu Mureș, Romania.
Material and methods: This is a descriptive study including 53 patients out of a total of 71 patients who underwent cardiac transplantation between 2000 and 2017 in the Institute of Cardiovascular Disease and Cardiac Transplantation in Târgu Mureș, Romania. Data were collected from the patient files and included demographic, clinical and laboratory data, as well as information about post-transplant complications related to immunosuppressive treatment.
Results: The mean age of patients undergoing heart transplantation was 40.72 ± 14.07 years, the majority of patients being male (84.91%) and living in an urban environment (56.60%). The average length of hospital stay was 33.6 days. From the total number of patients, 7 (13.2%) presented post-transplantation bacterial infections, while antibodies indicating the presence or history of B hepatitis, toxoplasma, and cytomegalovirus infection were identified with a relatively high incidence in the study population.
Conclusions: Infections following surgery are probably the most common post-transplant pathology, the primary reason being the administration of immunosuppressive medication.
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Marcoval J, Bonfill-Ortí M, Martínez-Molina L, Valentí-Medina F, Penín RM, Servitje O. Evolution of Kaposi sarcoma in the past 30 years in a tertiary hospital of the European Mediterranean basin. Clin Exp Dermatol 2018; 44:32-39. [PMID: 29934954 DOI: 10.1111/ced.13605] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The incidence of Kaposi sarcoma (KS) has reduced as a result of the introduction of antiretroviral therapy. It is currently considered a rare disease in developed countries, and there has been a paucity of clinical papers on the subject in recent years in Europe. AIM To analyse the clinical features and evolution of the different clinical forms of KS in the past 30 years. METHODS Patients with cutaneous lesions of KS diagnosed during the period 1987-2016 at Bellvitge Hospital (an 800-bed university referral centre in Barcelona, Spain) were enrolled. Data recorded included age, sex, ethnicity, involved site, number of lesions, extracutaneous involvement, leg oedema, treatment, blood haemoglobin level, and blood cell (leucocyte, lymphocyte and CD4) counts. RESULTS Cutaneous lesions of KS were diagnosed in 191 patients (167 men, 24 women, mean ± SD age 51.95 ± 20.16 years). Clinical forms identified were classic KS (n = 53), acquired immunodeficiency syndrome (AIDS)-associated KS (n = 118), immunosuppression-associated KS (n = 18), and African endemic KS (n = 2). The number of patients diagnosed annually reached a maximum in the 1990s because of the AIDS epidemic, and has decreased since 2000. However, both classic KS and immunosuppression-associated KS doubled from the first to the second half of the analysed period. Cutaneous lesions involved the legs in 137 cases, and extracutaneous lesions were detected in 32 patients. In 46 of 118 patients with AIDS, the diagnosis of KS was simultaneous to the detection of human immunodeficiency virus infection. CONCLUSION After a decrease in incidence since the middle of the 1990s, AIDS-associated KS continues to occur in Europe, and the number of annual cases of classic KS and immunosuppression-associated KS is increasing.
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Affiliation(s)
- J Marcoval
- Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain
| | - M Bonfill-Ortí
- Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain
| | - L Martínez-Molina
- Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain
| | - F Valentí-Medina
- Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain
| | - R M Penín
- Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain
| | - O Servitje
- Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain
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de Santana Sarmento DJ, Tozetto-Mendoza TR, Masami Sumita L, Pierroti LC, Pallos D, Caliento R, Palmieri M, de Oliveira Martins VA, Gallottini M, Pannuti CS, Braz-Silva PH. Oral shedding of human herpesviruses in renal transplant recipients. Clin Oral Investig 2017; 22:885-891. [PMID: 28669106 DOI: 10.1007/s00784-017-2166-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe the shedding profile of human herpesviruses in the saliva of renal transplant recipients. METHODS This is a prospective case-control study of 50 renal transplant recipients and control group of 50 individuals (non-transplanted and immunocompetent). Mouthwash samples were collected via oral rinse and then submitted to screening for the presence of eight types of herpesviruses by using multiplex PCR. Fisher's exact, chi-square, and Student t tests were used for statistical analysis, and the significance level was set at 5%. RESULTS The mean age of the study group was 49.42 ± 12.94 years, 28/50 (56%) were female, and the time elapsed after transplantation was 68.20 ± 67.19 months. Herpes simplex virus 1 (HSV-1) (P = 0.025) and Epstein-Barr virus (EBV) (P = 0.024) were, statistically, more excreted in the saliva of renal transplant recipients compared to control group. Gender (P = 1.00) and age (P = 0.563) did not influence the salivary shedding of herpesviruses in renal transplant recipients. Individuals who excreted varicella-zoster virus in saliva had a shorter mean time of transplantation (22:00 + 2.82 months) (P < 0.001). CONCLUSION Renal transplant recipients excreted herpesviruses more often than controls, especially HSV-1 and EBV, with salivary shedding of herpesviruses being more frequent in patients with recent kidney transplantation. CLINICAL RELEVANCE The present findings support other longitudinal studies evaluating the relationship between oral shedding of human herpesviruses and clinical presence of active infection and renal transplant failure.
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Affiliation(s)
- Dmitry José de Santana Sarmento
- Division of Pathology, Department of Stomatology, University of São Paulo School of Dentistry, Av. Prof. Lineu Prestes, 2227 - Cidade Universitária, São Paulo, SP, Brazil
| | - Tânia Regina Tozetto-Mendoza
- Laboratory of Virology, Institute of Tropical Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 470 - Jd. América, São Paulo, SP, Brazil
| | - Laura Masami Sumita
- Laboratory of Virology, Institute of Tropical Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 470 - Jd. América, São Paulo, SP, Brazil
| | - Ligia Camara Pierroti
- Department of Infectious Diseases, University of São Paulo School of Medicine, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, SP, Brazil
| | - Débora Pallos
- Department of Dentistry, University of Santo Amaro, Rua Professor Enéas de Siqueira Neto, 340 - Santo Amaro, São Paulo, SP, Brazil
| | - Rubens Caliento
- Division of Pathology, Department of Stomatology, University of São Paulo School of Dentistry, Av. Prof. Lineu Prestes, 2227 - Cidade Universitária, São Paulo, SP, Brazil
| | - Michelle Palmieri
- Division of Pathology, Department of Stomatology, University of São Paulo School of Dentistry, Av. Prof. Lineu Prestes, 2227 - Cidade Universitária, São Paulo, SP, Brazil
| | - Victor Adriano de Oliveira Martins
- Division of Pathology, Department of Stomatology, University of São Paulo School of Dentistry, Av. Prof. Lineu Prestes, 2227 - Cidade Universitária, São Paulo, SP, Brazil
| | - Marina Gallottini
- Division of Pathology, Department of Stomatology, University of São Paulo School of Dentistry, Av. Prof. Lineu Prestes, 2227 - Cidade Universitária, São Paulo, SP, Brazil
| | - Claudio Sergio Pannuti
- Laboratory of Virology, Institute of Tropical Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 470 - Jd. América, São Paulo, SP, Brazil
| | - Paulo Henrique Braz-Silva
- Division of Pathology, Department of Stomatology, University of São Paulo School of Dentistry, Av. Prof. Lineu Prestes, 2227 - Cidade Universitária, São Paulo, SP, Brazil. .,Laboratory of Virology, Institute of Tropical Medicine, University of São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 470 - Jd. América, São Paulo, SP, Brazil.
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Lewandowska DW, Schreiber PW, Schuurmans MM, Ruehe B, Zagordi O, Bayard C, Greiner M, Geissberger FD, Capaul R, Zbinden A, Böni J, Benden C, Mueller NJ, Trkola A, Huber M. Metagenomic sequencing complements routine diagnostics in identifying viral pathogens in lung transplant recipients with unknown etiology of respiratory infection. PLoS One 2017; 12:e0177340. [PMID: 28542207 PMCID: PMC5441588 DOI: 10.1371/journal.pone.0177340] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 04/26/2017] [Indexed: 12/19/2022] Open
Abstract
Background Lung transplant patients are a vulnerable group of immunosuppressed patients that are prone to frequent respiratory infections. We studied 60 episodes of respiratory symptoms in 71 lung transplant patients. Almost half of these episodes were of unknown infectious etiology despite extensive routine diagnostic testing. Methods We re-analyzed respiratory samples of all episodes with undetermined etiology in order to detect potential viral pathogens missed/not accounted for in routine diagnostics. Respiratory samples were enriched for viruses by filtration and nuclease digestion, whole nucleic acids extracted and randomly amplified before high throughput metagenomic virus sequencing. Viruses were identified by a bioinformatic pipeline and confirmed and quantified using specific real-time PCR. Results In completion of routine diagnostics, we identified and confirmed a viral etiology of infection by our metagenomic approach in four patients (three Rhinovirus A, one Rhinovirus B infection) despite initial negative results in specific multiplex PCR. Notably, the majority of samples were also positive for Torque teno virus (TTV) and Human Herpesvirus 7 (HHV-7). While TTV viral loads increased with immunosuppression in both throat swabs and blood samples, HHV-7 remained at low levels throughout the observation period and was restricted to the respiratory tract. Conclusion This study highlights the potential of metagenomic sequencing for virus diagnostics in cases with previously unknown etiology of infection and in complex diagnostic situations such as in immunocompromised hosts.
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Affiliation(s)
| | - Peter W. Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Macé M. Schuurmans
- Division of Pulmonary Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Bettina Ruehe
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Osvaldo Zagordi
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Cornelia Bayard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Greiner
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | | | - Riccarda Capaul
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Andrea Zbinden
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Jürg Böni
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Christian Benden
- Division of Pulmonary Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Nicolas J. Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Alexandra Trkola
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Michael Huber
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
- * E-mail:
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Prophylaxis for Infections Following Allogeneic Hematopoietic Stem Cell Transplantation. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marques HHDS, Shikanai-Yasuda MA, Azevedo LSFD, Caiaffa-Filho HH, Pierrotti LC, Aquino MZD, Lopes MH, Maluf NZ, Campos SV, Costa SF. Management of post-transplant Epstein-Barr virus-related lymphoproliferative disease in solid organ and hematopoietic stem cell recipients. Rev Soc Bras Med Trop 2014; 47:543-6. [DOI: 10.1590/0037-8682-0036-2014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 07/30/2014] [Indexed: 12/18/2022] Open
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Sanclemente G, Moreno A, Navasa M, Lozano F, Cervera C. Genetic variants of innate immune receptors and infections after liver transplantation. World J Gastroenterol 2014; 20:11116-11130. [PMID: 25170199 PMCID: PMC4145753 DOI: 10.3748/wjg.v20.i32.11116] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 05/14/2014] [Accepted: 06/13/2014] [Indexed: 02/06/2023] Open
Abstract
Infection is the leading cause of complication after liver transplantation, causing morbidity and mortality in the first months after surgery. Allograft rejection is mediated through adaptive immunological responses, and thus immunosuppressive therapy is necessary after transplantation. In this setting, the presence of genetic variants of innate immunity receptors may increase the risk of post-transplant infection, in comparison with patients carrying wild-type alleles. Numerous studies have investigated the role of genetic variants of innate immune receptors and the risk of complication after liver transplantation, but their results are discordant. Toll-like receptors and mannose-binding lectin are arguably the most important studied molecules; however, many other receptors could increase the risk of infection after transplantation. In this article, we review the published studies analyzing the impact of genetic variants in the innate immune system on the development of infectious complications after liver transplantation.
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Florescu DF, Langnas AN, Sandkovsky U. Opportunistic viral infections in intestinal transplantation. Expert Rev Anti Infect Ther 2014; 11:367-81. [DOI: 10.1586/eri.13.25] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Baez CF, Guimarães MAAM, Martins RAG, Zalona ACJ, Cossatis JJ, Zalis MG, Cavalcanti SMB, Varella RB. Detection of merkel cell polyomavirus in oral samples of renal transplant recipients without Merkel cell carcinoma. J Med Virol 2013; 85:2016-9. [DOI: 10.1002/jmv.23687] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2013] [Indexed: 01/16/2023]
Affiliation(s)
- Camila Freze Baez
- Department of Microbiology and Parasitology; Fluminense Federal University; RJ Brazil
| | | | - Rosângela A. G. Martins
- Division of Research, University Hospital Clementino Fraga Filho; Federal University of Rio de Janeiro; RJ Brazil
| | | | - João José Cossatis
- Department of Microbiology and Parasitology; Fluminense Federal University; RJ Brazil
| | - Mariano Gustavo Zalis
- Department of Preventive Medicine; Faculty of Medicine, Federal University of Rio de Janeiro; RJ Brazil
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Pérez JL, Ayats J, de Oña M, Pumarola T. The role of the clinical microbiology laboratory in solid organ transplantation programs. Enferm Infecc Microbiol Clin 2012; 30 Suppl 2:2-9. [PMID: 22542029 DOI: 10.1016/s0213-005x(12)70076-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Infections remain a major complication of solid organ transplantation. For this reason, the clinical microbiology laboratory plays a key role in the success of transplant programs, which must have the support of a qualified laboratory, both technically and professionally. Transplant programs strongly condition the structure and functionality of microbiology laboratories, but at the same time, benefit greatly from the knowledge generated from these programs. The laboratory must make a special effort to implement rapid methods that can respond to the broad spectrum of potential pathogens in solid organ transplant patients. The integration of microbiologists in multidisciplinary teams is highly recommended, as only then can they obtain the highest quality and efficiency in the diagnostic process. This article provides an updated review of the techniques to be used once transplantation has occurred. The role of the microbiologist is also crucial in the pretransplant period, as good microbiological candidate evaluation at this time strongly conditions the success of the transplantation program.
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Affiliation(s)
- José L Pérez
- Service of Microbiology, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
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