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Amaral-Sobrinho LFD, Lima FSD, Santos DBDN, Cavalcante IL, de Arruda JAA, Netto JDNS, Andrade NS, de Andrade BAB, Tenório JR. Oral Lesions of Immune-Mediated and Autoimmune Diseases: A 12-year Experience at a Single Brazilian Referral Center. Head Neck Pathol 2024; 18:49. [PMID: 38884863 PMCID: PMC11183038 DOI: 10.1007/s12105-024-01654-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 05/14/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Oral lesions of immune-mediated and autoimmune diseases have been well-documented, but studies from Brazil are limited. The varied spectrum of oral lesions within this demographic group poses challenges to clinicians, particularly when they occur in isolation. This study aimed to evaluate the occurrence, clinical characteristics, and management of patients with oral lesions of immune-mediated and autoimmune diseases at a single center in Brazil. METHODS A retrospective cross-sectional study was conducted from 2010 to 2022. Clinicodemographic data, histopathological features, and treatment modalities were analyzed descriptively and analytically. RESULTS Of the 3,790 oral and maxillofacial lesions diagnosed, 160 (4.2%) were confirmed as immune-mediated or autoimmune diseases. The population surveyed predominantly consisted of women (73.7%), with a mean age of 60.2 years. Oral lichen planus (51.3%), mucous membrane pemphigoid (MMP) (23.7%), and pemphigus vulgaris (PV) (19.4%) were the most prevalent lesions. The buccal mucosa (59.4%) was predominantly affected, with pain reported in 46.2% of cases, notably in individuals with PV and MMP. The average time to disease stabilization post-local and/or systemic corticosteroid therapy was 15.8 months for systemic lupus erythematosus, 8.7 months for MMP, and 6.5 months for PV. CONCLUSION Although oral lesions related to immune-mediated and autoimmune diseases are uncommon, their diverse clinicopathological aspects require multidisciplinary management.
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Affiliation(s)
- Lucas Fellipe do Amaral-Sobrinho
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Cidade Universitária, R. Rodolpho Paulo Rocco, n. 325, 1st floor, Rio de Janeiro, RJ, Brazil
| | - Fernanda Silva de Lima
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Cidade Universitária, R. Rodolpho Paulo Rocco, n. 325, 1st floor, Rio de Janeiro, RJ, Brazil
| | - Diego Belmiro do Nascimento Santos
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Cidade Universitária, R. Rodolpho Paulo Rocco, n. 325, 1st floor, Rio de Janeiro, RJ, Brazil
| | - Israel Leal Cavalcante
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Cidade Universitária, R. Rodolpho Paulo Rocco, n. 325, 1st floor, Rio de Janeiro, RJ, Brazil
- Department of Dentistry, Universidade de Fortaleza, Fortaleza, Brazil
| | - José Alcides Almeida de Arruda
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Cidade Universitária, R. Rodolpho Paulo Rocco, n. 325, 1st floor, Rio de Janeiro, RJ, Brazil.
| | - Juliana de Noronha Santos Netto
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Cidade Universitária, R. Rodolpho Paulo Rocco, n. 325, 1st floor, Rio de Janeiro, RJ, Brazil
| | | | - Bruno Augusto Benevenuto de Andrade
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Cidade Universitária, R. Rodolpho Paulo Rocco, n. 325, 1st floor, Rio de Janeiro, RJ, Brazil
| | - Jefferson R Tenório
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Cidade Universitária, R. Rodolpho Paulo Rocco, n. 325, 1st floor, Rio de Janeiro, RJ, Brazil
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Anitua E, Alkhraisat MH, Eguia A, Piñas L. Oral Pemphigoid Recalcitrant Lesion Treated with PRGF Infiltration. Case Report. Dent J (Basel) 2021; 9:dj9110137. [PMID: 34821601 PMCID: PMC8620069 DOI: 10.3390/dj9110137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/12/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Mucous membrane pemphigoid (MMP) is a heterogeneous group of chronic autoimmune subepithelial blistering diseases. Oral involvement is present in almost all patients, may represent the onset of the disease, and causes different degrees of pain, dysphagia, soreness, and bleeding. Treatment is based on systemic and/or oral corticoids, or other immunosuppressants. Occasionally, oral lesions can show a poor response to standard treatments. We present the case of a 61-year-old female patient with a painful extensive MMP oral ulcerative lesion recalcitrant to previous systemic azathioprine and local triamcinolone treatment, which was successfully treated in a novel way using PRGF infiltrations as adjuvant. After four weekly infiltrations, pain was reduced from 10 to 0 in a VAS and the lesion was completely healed. The patient continued with a low dose maintenance immunosuppressive treatment (prednisone 5 mg/day PO), and after 13 months of follow-up, there was no relapse of the lesion and no side effects. Although future research is necessary to confirm these observations, PRGF could be a useful adjuvant for the management of extensive mucous membrane pemphigoid oral lesions.
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Affiliation(s)
- Eduardo Anitua
- Clínica Eduardo Anitua, 01007 Vitoria, Spain; (A.E.); (L.P.)
- BTI Biotechnology Institute, 01007 Vitoria, Spain;
- Correspondence:
| | | | - Asier Eguia
- Clínica Eduardo Anitua, 01007 Vitoria, Spain; (A.E.); (L.P.)
- Department of Estomatology III, Faculty of Medicine and Nursing, University of the Basque Country, 48940 Leioa, Spain
| | - Laura Piñas
- Clínica Eduardo Anitua, 01007 Vitoria, Spain; (A.E.); (L.P.)
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Rashid H, Lamberts A, Borradori L, Alberti‐Violetti S, Barry R, Caproni M, Carey B, Carrozzo M, Caux F, Cianchini G, Corrà A, Diercks G, Dikkers F, Di Zenzo G, Feliciani C, Geerling G, Genovese G, Hertl M, Joly P, Marzano A, Meijer J, Mercadante V, Murrell D, Ormond M, Pas H, Patsatsi A, Prost C, Rauz S, van Rhijn B, Roth M, Schmidt E, Setterfield J, Zambruno G, Zillikens D, Horváth B. European guidelines (S3) on diagnosis and management of mucous membrane pemphigoid, initiated by the European Academy of Dermatology and Venereology - Part I. J Eur Acad Dermatol Venereol 2021; 35:1750-1764. [PMID: 34245180 PMCID: PMC8457055 DOI: 10.1111/jdv.17397] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/17/2021] [Indexed: 12/15/2022]
Abstract
This guideline on mucous membrane pemphigoid (MMP) has been elaborated by the Task Force for Autoimmune Blistering Diseases of the European Academy of Dermatology and Venereology (EADV) with a contribution of physicians from all relevant disciplines and patient organizations. It is a S3 consensus-based guideline encompassing a systematic review of the literature until June 2019 in the MEDLINE and EMBASE databases. This first part covers methodology, the clinical definition of MMP, epidemiology, MMP subtypes, immunopathological characteristics, disease assessment and outcome scores. MMP describes a group of autoimmune skin and mucous membrane blistering diseases, characterized by a chronic course and by predominant involvement of the mucous membranes, such as the oral, ocular, nasal, nasopharyngeal, anogenital, laryngeal and oesophageal mucosa. MMP patients may present with mono- or multisite involvement. Patients' autoantibodies have been shown to be predominantly directed against BP180 (also called BPAG2, type XVII collagen), BP230, laminin 332 and type VII collagen, components of junctional adhesion complexes promoting epithelial stromal attachment in stratified epithelia. Various disease assessment scores are available, including the Mucous Membrane Pemphigoid Disease Area Index (MMPDAI), the Autoimmune Bullous Skin disorder Intensity Score (ABSIS), the 'Cicatrising Conjunctivitis Assessment Tool' and the Oral Disease Severity Score (ODSS). Patient-reported outcome measurements (PROMs), including DLQI, ABQOL and TABQOL, can be used for assessment of quality of life to evaluate the effectiveness of therapeutic interventions and monitor disease course.
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4
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Duan S, Zhang X, Wang F, Shi Y, Wang J, Zeng X. Coexistence of oral mucous membrane pemphigoid and lichenoid drug reaction: a case of toripalimab-triggered and pembrolizumab-aggravated oral adverse events. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:e86-e91. [PMID: 34238713 DOI: 10.1016/j.oooo.2021.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/22/2021] [Accepted: 05/26/2021] [Indexed: 02/05/2023]
Abstract
Toripalimab and pembrolizumab belong to anti-programmed death receptor-1 monoclonal antibodies for the treatment of various cancers. Anti-programmed death receptor-1 therapy can cause mucocutaneous adverse events. Here, we report the first case, to our knowledge, of oral mucous membrane pemphigoid and lichenoid reaction triggered by toripalimab and aggravated by switching to pembrolizumab. Mucous membrane pemphigoid was a definite diagnosis, whereas lichenoid reaction was a clinical diagnosis without pathologic evidence. Although discontinuation of the culprit drugs achieved clinical resolution in most reported cases, multiple studies demonstrated statistically significant associations between the development of dermatologic adverse events and superior clinical outcomes. Thus, more studies are needed to find satisfactory measures in terms of both cancer control and avoidance of severe adverse events.
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Affiliation(s)
- Shumin Duan
- State Key Laboratory of Oral Diseases, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xuefeng Zhang
- State Key Laboratory of Oral Diseases, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Fei Wang
- State Key Laboratory of Oral Diseases, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Yujie Shi
- State Key Laboratory of Oral Diseases, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jiongke Wang
- State Key Laboratory of Oral Diseases, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
| | - Xin Zeng
- State Key Laboratory of Oral Diseases, National Center of Stomatology, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
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Lucchese A, Petruzzi M, Lauritano D. Crossreactivity: The possible role of oral microbiota in oral mucous membrane pemphigoid. Autoimmun Rev 2021; 20:102799. [PMID: 33722751 DOI: 10.1016/j.autrev.2021.102799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 12/31/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Alberta Lucchese
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania 'Luigi Vanvitelli', Naples, Italy.
| | - Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Dorina Lauritano
- Department of Medicine and Surgery, Centre of Neuroscience of Milan, University of Milano-Bicocca, 20126 Milan, Italy
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Benign Mucosal Membrane Pemphigoid as a Differential Diagnosis of Necrotizing Periodontal Disease. Case Rep Dent 2020; 2020:8885158. [PMID: 33425400 PMCID: PMC7772047 DOI: 10.1155/2020/8885158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/16/2020] [Accepted: 10/28/2020] [Indexed: 11/22/2022] Open
Abstract
Desquamative gingivitis is an oral sign of systemic changes that may be symptomatic or asymptomatic. It is generally related to immunological changes. This report is aimed at describing the case of a 51-year-old female patient, who presented with clinical desquamative gingivitis and was initially diagnosed and treated as necrotizing periodontal disease, but no improvement. The cause was hypothesized to be an autoimmune disease. Drug therapy was initiated as a combination of prednisone and topical clobetasol propionate 0.5% cream twice a day. After this treatment, there was an improvement in pain and the blistering of the gingiva. However, the gingiva remained erythematous. A biopsy led to the diagnosis of benign mucous membrane pemphigoid (BMMP). The BMMP case reported in this article has been successfully treated with systemic and topical immunosuppressive therapy. The efficacy of systemic corticosteroids with dapsone and multidisciplinary follow-up has been highlighted and can lead to the stabilization and adequate control of the disease.
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Rashid H, Lamberts A, Diercks GFH, Pas HH, Meijer JM, Bolling MC, Horváth B. Oral Lesions in Autoimmune Bullous Diseases: An Overview of Clinical Characteristics and Diagnostic Algorithm. Am J Clin Dermatol 2019; 20:847-861. [PMID: 31313078 PMCID: PMC6872602 DOI: 10.1007/s40257-019-00461-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Autoimmune bullous diseases are a group of chronic inflammatory disorders caused by autoantibodies targeted against structural proteins of the desmosomal and hemidesmosomal plaques in the skin and mucosa, leading to intra-epithelial or subepithelial blistering. The oral mucosa is frequently affected in these diseases, in particular, in mucous membrane pemphigoid, pemphigus vulgaris, and paraneoplastic pemphigus. The clinical symptoms are heterogeneous and may present with erythema, blisters, erosions, and ulcers localized anywhere on the oral mucosa, and lead to severe complaints for the patients including pain, dysphagia, and foetor. Therefore, a quick and proper diagnosis with adequate treatment is needed. Clinical presentations of autoimmune bullous diseases often overlap and diagnosis cannot be made based on clinical features alone. Immunodiagnostic tests are of great importance in differentiating between the different diseases. Direct immunofluorescence microscopy shows depositions of autoantibodies along the epithelial basement membrane zone in mucous membrane pemphigoid subtypes, or depositions on the epithelial cell surface in pemphigus variants. Additional immunoserological tests are useful to discriminate between the different subtypes of pemphigoid, and are essential to differentiate between pemphigus and paraneoplastic pemphigus. This review gives an overview of the clinical characteristics of oral lesions and the diagnostic procedures in autoimmune blistering diseases, and provides a diagnostic algorithm for daily practice.
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Affiliation(s)
- Hanan Rashid
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Aniek Lamberts
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Gilles F H Diercks
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
- Department of Pathology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hendri H Pas
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Joost M Meijer
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Maria C Bolling
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | - Barbara Horváth
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
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8
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Abstract
Mucocutaneous diseases affecting the oral cavity are predominantly immune mediated or inflammatory. Three of the most common and clinically significant conditions are reviewed in this article: lichen planus, pemphigus vulgaris, and mucous membrane pemphigoid. Because oral manifestations may be the first or only manifestation of mucocutaneous diseases, oral health professionals play a critical role in the early diagnosis and multidisciplinary management of these conditions.
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Faraji F, Crawford K, Stramiello CJ, Jafari A, Weissbrod PA, Brumund KT. Bullous Pemphigoid Presenting as Oropharyngeal Hemorrhage. JAMA Otolaryngol Head Neck Surg 2019; 145:288-290. [PMID: 30676623 DOI: 10.1001/jamaoto.2018.4051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Farhoud Faraji
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California, San Diego
| | - Kayva Crawford
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California, San Diego
| | - Captain Joshua Stramiello
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California, San Diego
| | - Aria Jafari
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California, San Diego
| | - Philip A Weissbrod
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California, San Diego
| | - Kevin T Brumund
- Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California, San Diego.,Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, VA San Diego Healthcare, La Jolla, California
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Fitzpatrick SG, Cohen DM, Clark AN. Ulcerated Lesions of the Oral Mucosa: Clinical and Histologic Review. Head Neck Pathol 2019; 13:91-102. [PMID: 30701449 PMCID: PMC6405793 DOI: 10.1007/s12105-018-0981-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 10/26/2018] [Indexed: 12/24/2022]
Abstract
Ulcerated lesions of the oral cavity have many underlying etiologic factors, most commonly infection, immune related, traumatic, or neoplastic. A detailed patient history is critical in assessing ulcerative oral lesions and should include a complete medical and medication history; whether an inciting or triggering trauma, condition, or medication can be identified; the length of time the lesion has been present; the frequency of episodes in recurrent cases; the presence or absence of pain; and the growth of the lesion over time. For multiple or recurrent lesions the presence or history of ulcers on the skin, genital areas, or eyes should be evaluated along with any accompanying systemic symptoms such as fever, arthritis, or other signs of underlying systemic disease. Biopsy may be indicated in many ulcerative lesions of the oral cavity although some are more suitable for clinical diagnosis. Neoplastic ulcerated lesions are notorious in the oral cavity for their ability to mimic benign ulcerative lesions, highlighting the essential nature of biopsy to establish a diagnosis in cases that are not clinically identifiable or do not respond as expected to treatment. Adjunctive tests may be required for final diagnosis of some ulcerated lesions especially autoimmune lesions. Laboratory tests or evaluation to rule out systemic disease may be also required for recurrent or severe ulcerations especially when accompanied by other symptoms. This discussion will describe the clinical and histopathologic characteristics of a variety of ulcerated lesions found in the oral cavity.
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Affiliation(s)
- Sarah G Fitzpatrick
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA.
| | - Donald M Cohen
- Department of Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Ashley N Clark
- Department of Diagnostic and Biomedical Sciences, University of Texas at Houston Health Science Center School of Dentistry, Houston, TX, USA
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