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Bacharaki D, Karagiannis M, Giannakopoulos P, Papachristou E, Divanis D, Sardeli A, Petrou D, Nikolopoulos P, Bratsiakou A, Zoi V, Piliouras N, Damoraki G, Liakopoulos V, Goumenos D, Giamarellos-Bourboulis EJ. Immune responses of patients on maintenance hemodialysis after infection by SARS-CoV-2: a prospective observational cohort study. BMC Infect Dis 2023; 23:581. [PMID: 37674148 PMCID: PMC10481459 DOI: 10.1186/s12879-023-08569-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Immune dysregulation in patients with acute COVID-19 under chronic hemodialysis (CHD) is fully not elucidated. The changes of mononuclear counts and mediators before and after HD and associations with final outcome were studied. METHOD In this prospective study, hospitalized patients with moderate-to-severe COVID-19 under CHD and matched comparators under HD were analyzed for their absolute counts of lymphoid cells and circulating inflammatory mediators. Blood samples were collected before start and at the end of the first HD session; dialysate samples were also collected. RESULT Fifty-nine patients with acute COVID-19 under CHD and 20 uninfected comparators under CHD were enrolled. Circulating concentrations of tumor necrosis factor-alpha (TNFα), interleukin (IL)-10, interferon-γ and platelet-derived growth factor-A were increased in patients. Concentrations of mediators did not differ before and after HD. Significant decreases of CD4-lymphocytes and CD19-lymphocytes were found in patients. The decrease of the expression of HLA-DR on CD14-monocytes was associated with unfavorable outcome (defined as WHO-CPS 6 or more by day 28); increased counts of CD19-lymphocytes were associated with better outcomes. CONCLUSION Patients under CHD develop an inflammatory reaction to SARS-CoV-2 characterized by increase of inflammatory mediators, decrease of circulating T-lymphocytes and decrease of the expression of HLA-DR on CD14-monocytes.
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Affiliation(s)
- Dimitra Bacharaki
- Department of Nephrology, University General Hospital Attikon, Athens, Greece.
| | - Minas Karagiannis
- Department of Nephrology, University General Hospital Attikon, Athens, Greece
| | | | - Evangelos Papachristou
- Department of Nephrology, Rion University Hospital, University of Patras, Patras, Greece
| | - Dimitrios Divanis
- 2nd Department of Nephrology, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aggeliki Sardeli
- Department of Nephrology, University General Hospital Attikon, Athens, Greece
| | - Dimitra Petrou
- Department of Nephrology, University General Hospital Attikon, Athens, Greece
| | - Petros Nikolopoulos
- Department of Nephrology, University General Hospital Attikon, Athens, Greece
| | - Adamantia Bratsiakou
- Department of Nephrology, Rion University Hospital, University of Patras, Patras, Greece
| | - Vassiliki Zoi
- Department of Nephrology, University General Hospital Attikon, Athens, Greece
| | - Nikitas Piliouras
- Department of Nephrology, University General Hospital Attikon, Athens, Greece
| | - Georgia Damoraki
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Vassilios Liakopoulos
- 2nd Department of Nephrology, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Goumenos
- Department of Nephrology, Rion University Hospital, University of Patras, Patras, Greece
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Roumeliotis S, Roumeliotis A, Stamou A, Divanis D, Theodoridis M, Panagoutsos S, Liakopoulos V. MO627ASSOCIATION OF OXIDIZED LDL CHOLESTEROL WITH MORTALITY AND PROGRESSION OF PROTEINURIC DIABETIC KIDNEY DISEASE. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab093.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Oxidative modification of low-density lipoprotein (oxLDL) contributes to the pathogenesis and progression of oxidative stress (OS) and atherosclerosis in both Type 2 Diabetes Mellitus (T2DM) and Chronic Kidney Disease (CKD). Compared to normo-and micro-albuminuric, T2DM patients with macroalbuminuria have significantly higher plasma oxLDL levels. In this study we aimed to assess the possible predictive role of oxLDL for mortality and deterioration of renal function in a cohort of patients with proteinuric diabetic CKD.
Method
91 patients with diabetic retinopathy, persistent proteinuria and eGFR below 90ml/min were recruited. At baseline, oxLDL, proteinuria and eGFR were assessed and patients were categorized according to median oxLDL (above or below 66.22 U/L). All patients were prospectively followed for a period of 10 years or the occurrence of a combined outcome of mortality or at least 30% decline in eGFR and/or progression to end stage renal disease (ESRD), requiring renal replacement therapy. At the end of the follow-up period, renal function was re-assessed with a new estimation of eGFR, using the CKD-EPI formula. We performed a statistical analysis with receiver operation curves (ROC) to further examine the possible effect of oxLDL on the percentage change in eGFR and proteinuria over time (calculated as ΔeGFR/baseline eGFR and Δproteinuria/baseline proteinuria respectively) and divided by the follow-up time.
Results
The mean age of the patients was 67.02±8.2 years, and the mean duration of T2DM was 14.5±8.0 years. At baseline, compared to the low, patients with high circulating oxLDL levels had significantly higher levels of triglycerides, higher diastolic blood pressure and lower eGFR (P=0.001, P=0.04 and P-0.013, respectively, Mann-Whitney test). After a 10-year follow up, 10/46 patients in the low and 20/45 patients in the high ox-LDL group presented the composite outcome. Kaplan-Meier curves (Figure 1) showed that patients with oxLDL levels above median (>66.22 U/L) presented a significantly higher risk for the outcome compared to the low oxLDL group (P=0.001, log-rank test). Univariate Cox proportional hazard analysis revealed that high circulating oxLDL levels were independent predictors of the composite endpoint (HR=3.42, 95%CI: 1.55-7.56, P=0.002). After adjustment for all factors that were associated with the outcome in univariate models (baseline proteinuria, serum albumin, duration of T2DM and triglycerides), multivariate Cox analysis showed that the association between high oxLDL levels and the study endpoint remained significant (HR=3.76, 95%CI: 1.52-9.27, P=0.004). At ROC analysis the area under the curve (AUC) for oxLDL to identifying progressor patients was 0.68 (95% CI: 0.56-0.80, P=0.005). Of note, this AUC was virtually identical to that of baseline proteinuria. OxLDL failed to show any association with the change of proteinuria over time.
Conclusion
Circulating ox-LDL might play an important role in the progression of proteinuric DKD.
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Affiliation(s)
- Stefanos Roumeliotis
- AHEPA Hospital, School of Medicine, Aristotle Univeristy of Thessaloniki, Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Thessaloniki, Greece
| | - Athanasios Roumeliotis
- AHEPA Hospital, School of Medicine, Aristotle Univeristy of Thessaloniki, Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Thessaloniki, Greece
| | - Aikaterini Stamou
- AHEPA Hospital, School of Medicine, Aristotle Univeristy of Thessaloniki, Department of Microbiology, Thessaloniki, Greece
| | - Dimitrios Divanis
- AHEPA Hospital, School of Medicine, Aristotle Univeristy of Thessaloniki, Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Thessaloniki, Greece
| | - Marios Theodoridis
- University Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Department of Nephrology, Alexandroupolis, Greece
| | - Stylianos Panagoutsos
- University Hospital of Alexandroupolis, School of Medicine, Democritus University of Thrace, Department of Nephrology, Alexandroupolis, Greece
| | - Vassilios Liakopoulos
- AHEPA Hospital, School of Medicine, Aristotle Univeristy of Thessaloniki, Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Thessaloniki, Greece
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Vaios V, Georgianos PI, Vareta G, Divanis D, Dounousi E, Eleftheriadis T, Papagianni A, Zebekakis PE, Liakopoulos V. Age dependence of brachial cuff-based ambulatory PWV in end-stage kidney disease patients undergoing long-term peritoneal dialysis. Perit Dial Int 2021; 42:65-74. [PMID: 33655788 DOI: 10.1177/0896860821996927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The newly introduced device Mobil-O-Graph (IEM, Stolberg, Germany) combines brachial cuff oscillometry and pulse wave analysis, enabling the determination of pulse wave velocity (PWV) via complex mathematic algorithms during 24-h ambulatory blood pressure monitoring (ABPM). However, the determinants of oscillometric PWV in the end-stage kidney disease (ESKD) population remain poorly understood. METHODS In this study, 81 ESKD patients undergoing long-term peritoneal dialysis underwent 24-h ABPM with the Mobil-O-Graph device. The association of 24-h oscillometric PWV with several demographic, clinical and haemodynamic parameters was explored using linear regression analysis. RESULTS In univariate analysis, among 21 risk factors, 24-h PWV exhibited a positive relationship with age, body mass index, overhydration assessed via bioimpedance spectroscopy, diabetic status, history of dyslipidaemia and coronary heart disease, and it had a negative relationship with female sex and 24-h heart rate. In stepwise multivariate analysis, age (β: 0.883), 24-h systolic blood pressure (BP) (β: 0.217) and 24-h heart rate (β: -0.083) were the only three factors that remained as independent determinants of 24-h PWV (adjusted R 2 = 0.929). These associations were not modified when all 21 risk factors were analysed conjointly or when the model included only variables shown to be significant in univariate comparisons. CONCLUSION The present study shows that age together with simultaneously assessed oscillometric BP and heart rate are the major determinants of Mobil-O-Graph-derived PWV, explaining >90% of the total variation of this marker. This age dependence of oscillometric PWV limits the validity of this marker to detect the premature vascular ageing, a unique characteristic of vascular remodelling in ESKD.
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Affiliation(s)
- Vasilios Vaios
- Peritoneal Dialysis Unit, 1st Department of Medicine, 37788AHEPA Hospital, Aristotle University of Thessaloniki, Greece
| | - Panagiotis I Georgianos
- Peritoneal Dialysis Unit, 1st Department of Medicine, 37788AHEPA Hospital, Aristotle University of Thessaloniki, Greece
| | - Georgia Vareta
- Peritoneal Dialysis Unit, 1st Department of Medicine, 37788AHEPA Hospital, Aristotle University of Thessaloniki, Greece
| | - Dimitrios Divanis
- Peritoneal Dialysis Unit, 1st Department of Medicine, 37788AHEPA Hospital, Aristotle University of Thessaloniki, Greece
| | - Evangelia Dounousi
- Department of Nephrology, School of Medicine, 69157University of Ioannina, Greece
| | | | - Aikaterini Papagianni
- Department of Nephrology, Hippokration Hospital, 37782Aristotle University of Thessaloniki, Greece
| | - Pantelis E Zebekakis
- Peritoneal Dialysis Unit, 1st Department of Medicine, 37788AHEPA Hospital, Aristotle University of Thessaloniki, Greece
| | - Vassilios Liakopoulos
- Peritoneal Dialysis Unit, 1st Department of Medicine, 37788AHEPA Hospital, Aristotle University of Thessaloniki, Greece
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Oikonomaki T, Ntounousi E, DUNI ANILA, Roumeliotis S, Divanis D, Liakopoulos V. P1014INCRETIN BASED THERAPIES IN DIABETIC KIDNEY TRANSPLANT RECIPIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p1014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
Diabetes mellitus (DM) is the major cause of ESRD. New-onset DM after transplantation (NODAT) frequently occurs and increases the risk of infection and mortality. Kidney transplant recipients (KTR) with pre-existing risk factors for DMt2 are more prone to develop NODAT. An intriguing novel concept is the use of the incretin-based therapies including dipeptidyl peptidase-4 inhibitors (DPP-4i), glucagon-like peptide-1 receptor agonists (GLP-1-RAs) and Sodium-glucose co-transporter-2 inhibitors (SGLT2i) in solid organ transplantation. This class of antidiabetic therapy is not yet established in KTR. Our aim was to examine the efficacy and safety of incretin-based therapies in DM or NODAT in KTR.
Method
We searched without language restrictions for all publications on Kidney/Renal Transplantation and DPP-4i, GLP-1-RAs and SGLT-2i using electronic databases including Medline, Embase, Cochrane, PubMed. We hand-search the reference lists of every relevant study for additional publications. Further searches were done by reviewing abstract and review articles. We included every study (retrospective/prospective) that used these classes of antidiabetics as treatment of NODAT or DMt2 in KTR. All the primary and secondary outcomes were calculated as mean ± sd. Heterogeneity was assessed with Cochrane’s Q statistics and quantified using the I stat, which indicated the proportion of variability across studies that was due to heterogeneity. We used the DerSimonian-Laird estimator for tau^2. Meta-regression was used to assess the effect of different antidiabetics on the primary and secondary outcomes. We assumed a priori the presence of heterogeneity and we used the model of random effects in all analyses. We assessed publication bias using the Begg-Mazumdar test and to nullify the estimated bias the trim-and-fill method, where it was necessary. A p-value < 0.05 was considered statistical significant.
Results
On the 1512 references screened, 16 studies were included in the final analysis. In total, 310 individuals were analyzed with a mean age of 55.98 ± 8.81 years, similar between studies. In 10 of them, participants were diagnosed with NODAT, whereas in all other trials were DMt2 or NODAT. In 8 studies participants received DPP-4i, in 6 SGLT-2i i and in rest 2 GLP-1-RAs. All included KTR were stable and transplanted over 6 months. The mean follow-up of all trials included was 22,03±14.95 weeks. Glycemic control reduces HbA1c (10 studies, MD=-0.38 %, I=45%). The MD of HbA1c for the DPP-4i group was -0.3741 and for the SGLT-2i group was -0.4596 mg/dl. Within every group of each different category of drugs, there was homogeneity (QM, p-value>0.05) and it was explained the most of the variance of the previous meta-analysis (QE= 15.76). The Begg-Mazumdar test showed that publication bias was not present (p> 0.05). Nine trials reported the difference of FPG and 5 of PPG before and after the administration of antidiabetics. The common MD estimator with a random effect model was – 25.76 for FPG and – 6.61 for PPG with a high grade of heterogeneity for both. Seven trials reported the change of body mass index (BMI) and body weight (BW) before and after the administration of this class of antidiabetics. The BW reduction, where reported, was significant in KTR on SGLT1i or DPP-4i whereas BMI wasn’t significantly reduced in this group, possible due to statistical artifact. The majority of the studies showed that GFR and hepatic biochemical parameters, didn’t change during therapy (DPP-4i, GLP-1-RAs, SGLT-2i).
Conclusion
Evidence concerning the efficacy of incretins in diabetes on KTR is limited. SGLT2i and DPP-4i are efficacious for glucose-lowering. The safety profile based on renal and hepatic function is indicative for the use of this class of antidiabetics in this population. More high-quality studies are required to help guide therapeutic choice for antidiabetics in KTR.
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Affiliation(s)
| | - Evangelia Ntounousi
- Medical School, University of Ioannina, Ioannina, Greece, Nephrology Department, Ioannina, Greece
| | - ANILA DUNI
- Medical School, University of Ioannina, Ioannina, Greece, Nephrology Department, Ioannina, Greece
| | - Stefanos Roumeliotis
- AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Thessaloniki, Greece
| | - Dimitrios Divanis
- AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Thessaloniki, Greece
| | - Vassilios Liakopoulos
- AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, Division of Nephrology and Hypertension, 1st Department of Internal Medicine, Thessaloniki, Greece
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Humalda JK, Assa S, Navis GJ, Franssen CFM, De Borst MH, Ogawa H, Ota Y, Watanabe T, Watanabe Y, Nishii H, Sato A, Waniewski J, Debowska M, Wojcik-Zaluska A, Ksiazek A, Zaluska W, Guastoni CM, Turri C, Toma L, Rombola G, Frattini G, Romei Longhena G, Teatini U, Siriopol DC, Stuard S, Ciolan A, Mircescu G, Raluca D, Nistor I, Covic A, De Roij Van Zuijdewijn CL, Chapdelaine I, Nube MJ, Blankestijn PJ, Bots ML, Konings SJ, Van Den Dorpel MA, Van Der Weerd NC, Ter Wee PM, Grooteman MP, Djuric PS, Jankovic A, Tosic J, Bajcetic S, Damjanovic T, Popovic J, Dimkovic N, Dimkovic N, Marinkovic J, Djuric Z, Knezevic V, Lazarevic T, Ljubenovic S, Markovic R, Rabrenovic V, Djukanovic L, Djuric PS, Popovic J, Jankovic A, Tosic J, Radovic Maslarevic V, Dimkovic N, Mathrani V, Drew P, Chess JI, Williams AI, Robertson S, Jibani M, Aithal VI, Kumwenda M, Roberts G, Mikhail AI, Grzegorzewska AE, Ostromecki G, Mostowska A, Sowi ska A, Jagodzi ski PP, Wu HY, Chen HY, Hsu SP, Pai MF, Yang JY, Peng YS, Hirose M, Hasegawa T, Kaneshima N, Sasai F, Komukai D, Takahashi K, Koiwa F, Shishido K, Yoshimura A, Selim G, Stojceva-Taneva O, Tozija L, Dzekova-Vidimliski P, Trajceska L, Petronievic Z, Gelev S, Amitov V, Sikole A, Moon SJ, Yoon SY, Shin DH, Lee JE, Kim HJ, Park HC, Hadjiyannakos D, Filiopoulos V, Loukas G, Pagonis S, Andriopoulos C, Drakou A, Vlassopoulos D, Catarino C, Cunha P, Ribeiro S, Rocha-Pereira P, Reis F, Sameiro-Faria M, Miranda V, Bronze-Rocha E, Belo L, Costa E, Santos-Silva A, De Mauri A, Brambilla M, Chiarinotti D, Lizio D, Matheoud R, Conti N, Conte MM, Carriero A, De Leo M, Karpetas AV, Sarafidis PA, Georgianos PI, Koutroumpas G, Divanis D, Vakianis P, Tzanis G, Raptopoulou K, Protogerou A, Stamatiadis D, Syrganis C, Liakopoulos V, Efstratiadis G, Lasaridis AN, Georgianos PI, Sarafidis PA, Karpetas AV, Koutroumpas G, Divanis D, Tersi M, Tzanis G, Raptopoulou K, Protogerou A, Syrganis C, Stamatiadis DN, Liakopoulos V, Efstratiadis G, Lasaridis AN, Kuczera P, Adamczak M, Wiecek A, Bove S, Giacon B, Corradini R, Prati E, Brognoli M, Tommasi A, Sereni L, Palladino G, Moriya H, Mochida Y, Ishioka K, Oka M, Maesato K, Hidaka S, Ohtake T, Kobayashi S, Moura A, Madureira J, Alija P, Fernandes JC, Oliveira JG, Lopez M, Filgueiras M, Amado L, Miranda V, Sameiro-Faria M, Vieira M, Santos-Silva A, Costa E, Lee JE, Seok JH, Choi HY, Ha SK, Park HC, Bossola M, Laudisio A, Antocicco M, Tazza L, Colloca G, Tosato M, Zuccala G, Ettema EM, Kuipers J, Assa S, Groen H, Gansevoort RT, Stade K, Bakker SJL, Gaillard CAJM, Westerhuis R, Franssen CFM, Bacchetta J, Couchoud K, Semlali S, Sellier-Leclerc AL, Bertholet-Thomas A, Cartier R, Cochat P, Ranchin B, Kim JC, Park K, Van Ende C, Wilmes D, Lecouvet FE, Labriola L, Cuvelier R, Van Ingelgem G, Jadoul M, De Mauri A, Doriana C, Brambilla M, Matheoud R, David P, Capurro F, Brustia M, Ruva CE, De Leo M, Bossola M, Giungi S, Di Stasio E, Tazza L, Lemesch S, Leber B, Horvath A, Ribitsch W, Schilcher G, Zettel G, Tawdrous M, Rosenkranz AR, Stadlbauer-Kollner V, Matsushima H, Oyama A, Bosch Benitez-Parodi E, Baamonde Laborda E, Batista Garcia F, Perez Suarez G, Anton Perez G, Garcia Canton C, Toledo Gonzalez A, Lago Alonso MM, Checa Andres MD, Cobo G, Di Gioia C, Camacho R, Garcia Lacalle C, Ortega O, Rodriguez I, Herrero J, Oliet A, Ortiz M, Mon C, Vigil A, Gallar P, Bossola M, Pellu V, Di Stasio E, Giungi S, Nebiolo PE, Sasaki K, Yamguchi S, Hesaka A, Iwahashi E, Sakai S, Fujimoto T, Minami S, Fujita Y, Yokoyama K, Shutov E, Ryabinskya G, Lashutin S, Gorelova E, Volodicheva E, Podesta MA, Cancarini G, Cucchiari D, Montanelli A, Badalamenti S, Graziani G, Bossola M, Distasio E, Tazza L, Pchelin I, Shishkin A, Fedorova Y, Kao CC, Chu TS, Tsai TJ, Wu KD, Wu MS, Kim JC, Park K, Raikou V, Kaisidis P, Tsamparlis E, Kanellopoulos P, Boletis J, Ueda A, Hirayama A, Owada S, Nagai K, Saito C, Yamagata K. DIALYSIS. PATHOPHYSIOLOGY AND CLINICAL STUDIES. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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