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Tanaka S, Geneve C, Tebano G, Grall N, Piednoir P, Bronchard R, Godement M, Atchade E, Augustin P, Mal H, Castier Y, Montravers P, Desmard M. Morbidity and mortality related to pneumonia and TRACHEOBRONCHITIS in ICU after lung transplantation. BMC Pulm Med 2018; 18:43. [PMID: 29506501 PMCID: PMC5836426 DOI: 10.1186/s12890-018-0605-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 02/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background Bacterial respiratory infections (BRI) are major complications contributing to increased morbidity and mortality after lung transplantation (LT). This study analyzed epidemiology and outcome of 175 consecutive patients developing BRI in ICU after LT between 2006 and 2012. Methods Three situations were described: colonization determined in donors and recipients, pneumonia and tracheobronchitis during the first 28 postoperative days. Severity score, demographic, bacteriologic and outcome data were collected. Results 26% of donors and 31% of recipients were colonized. 92% of recipients developed BRI, including at least one episode of pneumonia in 19% of recipients. Only 21% of recipients developed BRI with an organism cultured from the donor’s samples, while 40% of recipients developed BRI with their own bacteria cultured before LT. Purulent sputum appears to be an important factor to discriminate tracheobronchitis from pneumonia. When compared to patients with tracheobronchitis, those with pneumonia had longer durations of mechanical ventilation (13 [3–27] vs 3 [29], p = 0.0005) and ICU stay (24 [16–34] vs 14 [9-22], p = 0.002). Pneumonia was associated with higher 28-day (11 (32%) vs 9 (7%), p = 0.0004) and one-year mortality rates (21 (61%) vs 24 (19%), p ≤ 0.0001). Conclusions These data confirm the high frequency of BRI right from the early postoperative period and the poor prognosis of pneumonia after LT.
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Affiliation(s)
- Sebastien Tanaka
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France.
| | - Claire Geneve
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France
| | - Gianpiero Tebano
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France
| | - Nathalie Grall
- Université Denis Diderot, PRESS Sorbonne Cité, Paris, France.,INSERM, UMR 1137, Infection, Antimicrobiens, Modélisation, Evolution, Paris, France.,AP-HP, CHU Bichat-Claude Bernard Laboratoire de Microbiologie, Paris, France
| | - Pascal Piednoir
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France
| | - Régis Bronchard
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France
| | - Mathieu Godement
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France
| | - Enora Atchade
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France
| | - Pascal Augustin
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France
| | - Herve Mal
- Université Denis Diderot, PRESS Sorbonne Cité, Paris, France.,APHP, CHU Bichat-Claude Bernard, Service de Pneumologie B et Transplantation Pulmonaire, Paris, France.,INSERM, UMR1152. Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France
| | - Yves Castier
- Université Denis Diderot, PRESS Sorbonne Cité, Paris, France.,INSERM, UMR1152. Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France.,APHP, CHU Bichat-Claude Bernard, Service de Chirurgie Thoracique et Vasculaire, Paris, France
| | - Philippe Montravers
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France.,Université Denis Diderot, PRESS Sorbonne Cité, Paris, France.,INSERM, UMR1152. Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France
| | - Mathieu Desmard
- APHP, CHU Bichat-Claude Bernard, Département d'Anesthésie Réanimation, 46 rue Henri Huchard, 75018, Paris, France.,Service de Réanimation, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
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Bhadade R, Harde M, deSouza R, More A, Bharmal R. Emerging trends of nosocomial pneumonia in intensive care unit of a tertiary care public teaching hospital in Western India. Ann Afr Med 2017; 16:107-113. [PMID: 28671150 PMCID: PMC5579893 DOI: 10.4103/aam.aam_7_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Nosocomial pneumonia poses great challenge to an intensivist. Detailed information about hospital-acquired pneumonia (HAP) and ventilator-acquired pneumonia (VAP) is crucial for prevention and optimal management, thus improving quality Intensive Care Unit (ICU) care. Hence, we aimed to study the current trend of nosocomial pneumonia in ICU. MATERIALS AND METHODS It was a prospective observational cohort study, conducted in the ICU of a tertiary care teaching public hospital over a period of 18 months. We studied clinical profile and outcome of 120 adult patients who developed VAP/HAP during the study period. We also analyzed the causative organisms, antibiotic sensitivity, and resistance pattern in these patients. RESULTS Out of 120 patients, 29 patients were HAP and 91 patients were VAP. Mortality was 60% (72), and development of VAP and requirement of mechanical ventilation showed significant association with mortality (P < 0.00001). Most common organism causing HAP was Staphylococcus aureus (43.4%) and VAP was Klebsiella pneumoniae (49%). Maximum antibiotic sensitivity was found to piperacillin + tazobactam (58.8%), followed by imipenem (49.5%) and meropenem (41.8%), whereas maximum antibiotic resistance was found to cefepime (95.1%), followed by ceftazidime and amoxicillin (91.2%). CONCLUSION Nosocomial pneumonia showed high incidence (17.44%) and mortality (60%). Common organisms identified were S. aureus and K. pneumoniae. Resistance was high for commonly used antibiotics and high antibiotic sensitivity for piperacillin + tazobactam and carbapenem. Contexte: La pneumonie nosocomiale pose un grand défi à un intensiviste. Des informations détaillées sur la pneumonie acquise dans les hôpitaux (HAP) et la pneumonie acquise par le ventilateur (VAP) sont essentielles pour la prévention et la gestion optimale, améliorant ainsi les soins de soins intensifs de qualité (UTI). Par conséquent, nous avons cherché à étudier la tendance actuelle de la pneumonie nosocomiale en UTI. Matériaux et méthodes: il s'agissait d'une étude de cohorte observationnelle prospective menée dans l'UCI d'un hôpital public d'enseignement tertiaire sur une période de 18 mois. Nous avons étudié le profil clinique et le résultat de 120 patients adultes qui ont développé le VAP / HAP pendant la période d'étude. Nous avons également analysé les organismes responsables, la sensibilité aux antibiotiques et le modèle de résistance chez ces patients. Résultats: Sur 120 patients, 29 patients étaient HAP et 91 patients étaient VAP. La mortalité était de 60% (72), et le développement du VAP et l'exigence de ventilation mécanique ont montré une association significative avec la mortalité (P < 0,00001). L'organisme le plus fréquent causant HAP était Staphylococcus aureus (43,4%) et VAP était Klebsiella pneumoniae (49%). Une sensibilité antibiotique maximale a été observée chez la pipéracilline + tazobactam (58,8%), suivie de l'imipénème (49,5%) et du méropénem (41,8%), alors que la résistance antibiotique maximale a été observée à cefépime (95,1%), suivie de ceftazidime et de l'amoxicilline (91,2%) . CONCLUSION la pneumonie nosocomiale a montré une incidence élevée (17,44%) et la mortalité (60%). Les organismes communs identifiés étaient S. aureus et K. pneumoniae. La résistance était élevée pour les antibiotiques couramment utilisés et une forte sensibilité aux antibiotiques pour la pipéracilline + le tazobactam et le carbapénème.
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Affiliation(s)
- Rakesh Bhadade
- Department of Medicine, Topiwala National Medical College, B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Minal Harde
- Department of Anesthesiology, Topiwala National Medical College, B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Rosemarie deSouza
- Department of Medicine, Topiwala National Medical College, B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Ashwini More
- Department of Medicine, Topiwala National Medical College, B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Ramesh Bharmal
- Department of Microbiology, Topiwala National Medical College, B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
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Mahmoodpoor A, Hamishehkar H, Hamidi M, Shadvar K, Sanaie S, Golzari SEJ, Khan ZH, Nader ND. A prospective randomized trial of tapered-cuff endotracheal tubes with intermittent subglottic suctioning in preventing ventilator-associated pneumonia in critically ill patients. J Crit Care 2017; 38:152-156. [DOI: 10.1016/j.jcrc.2016.11.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 09/22/2016] [Accepted: 11/08/2016] [Indexed: 11/25/2022]
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Sondes d’intubation et prévention des pneumonies acquises sous ventilation mécanique. MEDECINE INTENSIVE REANIMATION 2011. [DOI: 10.1007/s13546-010-0004-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Humphreys L, Orme RML, Moore P, Charaklias N, Sahgal N, Pont NP, Magan N, Stone N, Kendall CA. Electronic nose analysis of bronchoalveolar lavage fluid. Eur J Clin Invest 2011; 41:52-8. [PMID: 20840375 DOI: 10.1111/j.1365-2362.2010.02376.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Electronic nose (E-nose) technology has been successfully used to diagnose a number of microbial infections. We have investigated the potential use of an E-nose for the diagnosis of ventilator-associated pneumonia (VAP) by detecting micro-organisms in bronchoalveolar lavage (BAL) fluid in a prospective comparative study of E-nose analysis and microbiology. MATERIALS AND METHODS BAL samples were collected using a blind technique from 44 patients following a minimum of 72 h mechanical ventilation. Control samples were collected from six patients mechanically ventilated on the intensive care unit (ICU) immediately following elective surgery. Quantitative microbiological culture and E-nose headspace analysis of the BAL samples were undertaken. Multivariate analysis was applied to correlate E-nose response with microbiological growth. RESULTS E-nose fingerprints correctly classified 77% of the BAL samples, with and without microbiological growth from patients not on antibiotics. Inclusion of patients on antibiotics resulted in 68% correct classification. Seventy per cent of isolates, cultured in the laboratory from the clinical samples, were accurately discriminated into four clinically significant groups. CONCLUSIONS E-nose technology can accurately discriminate between different microbial species in BAL samples from ventilated patients on ICU at risk of developing VAP with accuracy comparable with accepted microbiological techniques.
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Affiliation(s)
- Lee Humphreys
- Biophotonics Research Unit, Gloucestershire Royal Hospital, Gloucester, UK
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Dragoumanis CK, Vretzakis GI, Papaioannou VE, Didilis VN, Vogiatzaki TD, Pneumatikos IA. Investigating the failure to aspirate subglottic secretions with the Evac endotracheal tube. Anesth Analg 2007; 105:1083-5, table of contents. [PMID: 17898392 DOI: 10.1213/01.ane.0000278155.19911.67] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Aspiration of subglottic secretions is a widely used intervention for prevention of ventilator-associated pneumonia. However, using the Hi-Lo Evac endotracheal tube (Hi-Lo Evac; Mallinckrodt; Athlone, Ireland) (Evac ETT), dysfunction of the suction lumen and subsequent failure to aspirate the subglottic secretions are common. Our objective in this study was to determine the causes of suction lumen dysfunction experienced with the Evac ETT. METHODS We studied 40 adult patients intubated with the Evac ETT. In all cases for which dysfunction of the suction lumen was observed, the subglottic suction port was examined visually using a flexible bronchoscope. RESULTS Dysfunction of the suction lumen occurred in 19 of 40 patients (48%). In 17 of these (43%), it was attributed to blockage of the subglottic suction port by suctioned tracheal mucosa. CONCLUSION Evacuation of subglottic secretions using the Evac ETT is often ineffective due to prolapse of tracheal mucosa into the subglottic suction port.
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Affiliation(s)
- Christos K Dragoumanis
- Department of Intensive Care, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
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Sutyak JP, Wohltmann CD, Larson J. Pulmonary contusions and critical care management in thoracic trauma. Thorac Surg Clin 2007; 17:11-23, v. [PMID: 17650693 DOI: 10.1016/j.thorsurg.2007.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Many victims of thoracic trauma require ICU care and mechanical ventilatory support. Pressure and volume-limited modes assist in the prevention of ventilator-associated lung injury. Ventilator-associated pneumonia is a significant cause of posttraumatic morbidity and mortality. Minimizing ventilator days, secretion control, early nutritional support, and patient positioning are methods to reduce the risk of pneumonia.
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Affiliation(s)
- John P Sutyak
- Southern Illinois Trauma Center, Southern Illinois University, P.O. Box 19663, Springfield, IL 62794, USA.
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9
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Garcia R. A review of the possible role of oral and dental colonization on the occurrence of health care-associated pneumonia: underappreciated risk and a call for interventions. Am J Infect Control 2005; 33:527-41. [PMID: 16260328 DOI: 10.1016/j.ajic.2005.02.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Accepted: 02/21/2005] [Indexed: 01/15/2023]
Affiliation(s)
- Robert Garcia
- The Brookdale Hospital Medical Center, Brooklyn, NY 11212, USA.
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10
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Salahuddin N, Zafar A, Sukhyani L, Rahim S, Noor MF, Hussain K, Siddiqui S, Islam M, Husain SJ. Reducing ventilator-associated pneumonia rates through a staff education programme. J Hosp Infect 2004; 57:223-7. [PMID: 15236851 DOI: 10.1016/j.jhin.2004.03.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2003] [Accepted: 03/01/2004] [Indexed: 10/26/2022]
Abstract
Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients on mechanical ventilation and results in increases in mortality, prolonged hospitalization and costs. Preventive measures for VAP are well-documented and evidence-based, yet remain poorly implemented in most intensive care units. We undertook an observational pre and post-intervention study to assess whether an educational programme focusing on preventive practices for VAP could reduce the incidence. Six hundred and seventy-seven adult patients, mechanically ventilated for >48 h were included in the study population. An evidence-based guideline for preventive practices at the bedside was developed and disseminated to the intensive care unit staff. VAP incidence rates before and after implementation of the educational programme were compared. VAP infection rates reduced by 51%, from a mean of 13.2+/-1.2 in the pre-intervention period to 6.5+/-1.5/1000 device days in the post-intervention period (mean difference 6.7; 95% CI: 2.9-10.4, P =0.02). A multidisciplinary educational programme geared towards intensive care unit staff can successfully reduce the incidence rates of VAP. Further studies will be needed to assess the impact on broader outcome measures such as costs or mortality.
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Affiliation(s)
- N Salahuddin
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan.
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Michalopoulos AS, Geroulanos S, Mentzelopoulos SD. Determinants of Candidemia and Candidemia-Related Death in Cardiothoracic ICU Patients. Chest 2003; 124:2244-55. [PMID: 14665507 DOI: 10.1378/chest.124.6.2244] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To develop and prospectively validate models of independent predictors of candidemia and candidemia-related death in cardiothoracic ICU (CICU) patients. DESIGN (1) An initial, prospective, one-center, case-control, independent predictor-model determining study; and (2) a prospective, two-center, model-validation study. SETTING The initial study was performed at the 14-bed CICU of the Onassis Cardiac Surgery Center, Athens, Greece; the model-validation study was performed at the Onassis Cardiac Surgery Center CICU and the 12-bed CICU of Henry Dunant General Hospital, Athens, Greece. PATIENTS In the initial study, 4,312 patients admitted to the Onassis Center CICU between March 1997 and October 1999 were considered for enrollment; 30 candidemic and 120 control patients (case/control ratio, 1/4) matched according to potential confounders were ultimately enrolled. In the model-validation study, 2,087 patients admitted to the Onassis and Henry Dunant CICUs between November 1999 and May 2002 were prospectively enrolled. MEASUREMENTS AND RESULTS Models of predictors of candidemia and associated death were constructed with stepwise logistic regression and subsequently validated. Independent candidemia predictors were ongoing invasive mechanical ventilation (IMV) > OR =10 days, hospital-acquired bacterial infection and/or bacteremia, cardiopulmonary bypass duration > 120 min, and diabetes mellitus. Model performance was as follows: sensitivity, 53.3%/57.9%; specificity, 100%/100%; positive predictive value (PPV), 100%/100%; negative predictive value (NPV), 88.9%/99.6%; and accuracy, 90.1%/99.6% (initial/model-validation study values, respectively). IMV > or =10 days and hospital-acquired bacterial infection/bacteremia were the two strongest candidemia predictors. APACHE (acute physiology and chronic health evaluation) II score > or =30 at candidemia onset independently predicted candidemia-related death with 80.0%/85.7% sensitivity, 80%/75% specificity, 66.7%/66.7% PPV, 88.9%/88.9% NPV, and 80.0%/78.9% accuracy (initial/model-validation study values, respectively). CONCLUSIONS We provided a set of easily determinable independent predictors of the occurrence of candidemia in CICU patients. Our results provide a rationale for implementing preventive measures in the form of independent predictor control, and initiating antifungal prophylaxis in high-risk CICU patients.
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Abstract
A variety of different endotracheal tubes are available for distinct purposes, though the majority of patients will be well served with the standard single-lumen endotracheal tube. Specialized endotracheal tubes have been developed to aid in specific situations and novel tubes continue to be evaluated as clinicians strive for improved outcomes in various clinical conditions. Ultimately, the choice of an endotracheal tube depends on the purpose it is intended to serve.
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Affiliation(s)
- Anthony W Gray
- Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111, USA.
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Lorente C, Del Castillo Y, Rello J. Prevention of infection in the intensive care unit: current advances and opportunities for the future. Curr Opin Crit Care 2002; 8:461-4. [PMID: 12357116 DOI: 10.1097/00075198-200210000-00015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent studies have contributed to our understanding of the risk factors and the impact of nosocomial infections in the ICU, allowing a more rational approach to the prevention of such infections. Ventilator-associated pneumonia, bloodstream infections, and outbreaks all occur in the presence of artificial devices. High antibiotic pressure, prolonged hospitalization, and the presence of comorbidities facilitate the selection of multiresistant strains in the ICU setting. In clinical practice, prevention is the more effective investment to reduce costs. Potential measures of control should focus on the patient, the microorganisms, and the device. A number of recent studies addressing these issues have been published and will be reviewed in this article.
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Affiliation(s)
- Carmen Lorente
- Critical Care Department, University Hospital Joan XXIII, University Rovira & Virgili, Tarragona, Spain
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