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Arifin J, Biakto KT, Johan MP, Anwar SFZ. Clinical outcomes and surgical strategy for spine tuberculosis: a systematic review and meta-analysis. Spine Deform 2024; 12:271-291. [PMID: 37975989 PMCID: PMC10867033 DOI: 10.1007/s43390-023-00785-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Spinal tuberculosis (TB) is a slow-developing disease that often causes cord compression, spinal instability, and deformity. Surgery is generally required in cases of refractory disease, severe kyphosis, neurological deficits, or lack of improvement. However, there is a lack of comprehensive evidence in comparing the efficacy of various surgical approaches. The study aims to provide a clearer understanding of the relative effectiveness of the available surgical modalities in the management of spinal TB. METHODS This review adhered to the PRISMA statement with searching conducted until 11th April 2023. Inclusion criteria included studies involving surgical procedures for spinal tuberculosis, with relevant clinical outcomes reported. Data extraction involved the collection of information on study and population characteristics, interventions used, relevant clinical outcomes, and reported complications. The risk of bias was evaluated using Cochrane's Risk of Bias in Non-randomized Studies tool. RESULTS Searching resulted in 20 cohort studies that analyzed surgical methods for spinal tuberculosis. Eleven studies had low bias and nine studies had moderate bias. The anterior approach was associated with faster perioperative duration [- 2.02 (- 30.71, 26.67), p < 0.00001], less blood loss [- 4242 (- 176.02, 91.18), p < 0.00001], shorter hospitalization [- 0.19 (- 2.39, 2.01), p < 0.00001], better angle correction [1.01 (- 1.82, 3.85), p < 0.00001], and better correction rates [11.36 (- 7.32, 30.04), p < 0.00001] compared to the posterior approach. Regarding neurological function recovery, the anterior and posterior approaches were equally effective, while the posterior approach was associated with a higher incidence of complications. The review also reported on the complications associated with the surgical approaches, and 9 out of 20 studies reported complications. The anterior approach was found to have fewer complications overall. CONCLUSION The anterior approach is thought to have fewer complications than both combined and posterior-only approaches, but the variability of the findings indicates that the decision-making process for selecting a surgical approach must consider individual patient and disease characteristics, as well as surgeon training.
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Affiliation(s)
- Jainal Arifin
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia
| | - Karya Triko Biakto
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia
| | - Muhammad Phetrus Johan
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia
| | - St Fatimah Zahrah Anwar
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia.
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Arifin J, Sakti M, Massi N, Bukhari A, Hamid F, Winangun PA. Vertebral destruction in tuberculous spondylitis correlates with Toll-like Receptor 4 (TLR-4) levels: a cross-sectional study. Ann Med Surg (Lond) 2024; 86:800-804. [PMID: 38333260 PMCID: PMC10849308 DOI: 10.1097/ms9.0000000000001707] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/29/2023] [Indexed: 02/10/2024] Open
Abstract
Background Tuberculous (TB) spondylitis is a hazardous infectious disease causing significant spinal deformity. Increased toll-like receptor-4 (TLR-4) activity promotes more extensive infections in patients with TB spondylitis, so it has the potential to be used as a biomarker to predict the severity. This study aims to determine the relationship between TLR-4 levels and the degree of vertebral destruction in TB spondylitis patients. Materials and methods A cross-sectional study was conducted from May to October 2023. A total of 27 TB spondylitis samples were then measured for TLR-4 serum levels. Vertebral destruction is assessed based on the Spine At Risk Signs (SARS) criteria on X-ray and MRI examinations. Moreover, the degree of sensory and motor impairment was also assessed in this study. The Spearman correlation test assessed the correlation between TLR-4 levels and vertebral destruction. Results Most of the samples in this study were less than 30 years old (10 people, 37%), female (14 people, 51.9%), had spinal destruction at 1 level (11 people, 40.7%), had paraplegia (8 people, 29.6%), and had hypoesthesia (11 people, 40.7%). TLR-4 levels had a mean value of 8254.1±1076.1 ng/ml. TLR-4 levels were positively correlated with the degree of vertebral destruction (r=0.599, P=0.001), motor disorders (r=0.632.x, P=0.000), and sensory disorders (r=0.574, P=0.002). Conclusion TLR-4 levels are associated with the severity of vertebral destruction in TB spondylitis, so it has the potential to be used as a prognostic biomarker.
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Affiliation(s)
- Jainal Arifin
- Department of Orthopedic and Traumatology, Spine Divison
| | - Muhammad Sakti
- Department of Orthopedic and Traumatology, Sports and Injury Division
| | | | | | | | - Putu A.N. Winangun
- Orthopaedic and Traumatology Study Program, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Arifin J, Massi MN, Biakto KT, Bukhari A, Noor Z, Johan MP. Randomized controlled trial of vitamin d supplementation on toll-like receptor-2 (tlr-2) and toll-like receptor-4 (tlr-4) in tuberculosis spondylitis patients. J Orthop Surg Res 2023; 18:983. [PMID: 38129893 PMCID: PMC10740285 DOI: 10.1186/s13018-023-04445-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Tuberculosis spondylitis accounts for approximately 50% of all cases of skeletal tuberculosis. Vitamin D plays a role in the immune system. Vitamin D helps in the activation of TLR-2 and TLR-4, which play a role in the process of tuberculosis infection. The objective of this study was to investigate the effect of oral supplementation with vitamin D on TLR-2 and TLR-4 levels in tuberculosis spondylitis patients. METHODS The true Experiment Design Pretest-Posttest with Control Group (Pretest-Posttest with Control Group) was used for this research. TLR-2 and TLR-4 were measured by ELISA. Repeated ANOVA, ANOVA tests, and Kolmogorov-Smirnov normality tests on the SPSS program were used to statistically analyze the results. RESULT In the dose groups of 10,000 IU and 5000 IU, significant increases in the levels of vitamin D, TLR-2, and TLR-4 were observed at weeks 4 and 8 (p < 0.05). In the control group, there was no significant increase. CONCLUSIONS Vitamin D supplements can significantly increase TLR-2 and TLR-4 levels. Supplementation with vitamin D 10,000 IU/day for 8 weeks can increase vitamin D levels > 50 ng/dl to optimally act as an immunomodulator.
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Affiliation(s)
- Jainal Arifin
- Orthopaedic and Traumatology Department, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Muhammad Nasrum Massi
- Clinical Microbiology Department, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - Karya Triko Biakto
- Orthopaedic and Traumatology Department, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Agussalim Bukhari
- Clinical Nutrition Department, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Zairin Noor
- Orthopaedic and Traumatology Department, Faculty of Medicine, Lambung Mangkurat University, Banjarmasin, Indonesia
| | - Muhammad Phetrus Johan
- Orthopaedic and Traumatology Department, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
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Arifin J, Saleh MR, Argo RS, Kennedy D, Usman MA, Singjie LC. Relationship between TLR-2 level and clinical or radiological severity on patients with tuberculosis spondylitis in Dr. Wahidin Sudirohusodo hospital Makassar. Medicine (Baltimore) 2023; 102:e35815. [PMID: 37933050 PMCID: PMC10627633 DOI: 10.1097/md.0000000000035815] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/05/2023] [Indexed: 11/08/2023] Open
Abstract
Spinal tuberculosis or TB spondylitis is one of the most common types of extra pulmonary tuberculosis, which is about 15% of all cases. It causes severe morbidity, neurological deficits, and severe deformities in the patients. The growth of Mycobacterium tuberculosis in culture specimens obtained from infected tissue is the single gold standard diagnostic test for spinal TB. Toll-like receptor (TLR) is one of the important receptors in the first-line defence system against microbes. TLR-2 and TLR-4 are known to be associated with tuberculosis infection. Based on this background, the researchers were interested in examining the relationship between TLR-2 levels and the clinical and radiological severity of TB spondylitis patients. A cross-sectional study was conducted with patients diagnosed with tuberculosis spondylitis at Dr Wahidin Sudirohusodo Makassar. Patients diagnosed with TB spondylitis confirmed by blood tests, GeneExpert, and magnetic resonance imaging without prior treatment were included. Data analysis were conducted by using descriptive analysis and one-way ANOVA for bivariate analysis. The mean value of TLR2 levels in TB spondylitis patients was 9.1 g/dL. TLR2 levels in paraesthesia were significantly higher than normal (P < .05). Similar trend were analyzed on the motor neurologic status with TLR2 levels in paraparesis were significantly higher than those in normal (P < .05). There is a significant relationship between the TLR2 levels in TB spondylitis and their impaired motor and sensory function. Spinal destruction has been shown to provide significant relationship with TLR2 value in spondylitis TB.
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Affiliation(s)
- Jainal Arifin
- Department of Orthopaedic and Traumatology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - M. Ruksal Saleh
- Department of Orthopaedic and Traumatology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Risang Setyo Argo
- Department of Orthopaedic and Traumatology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Dave Kennedy
- Department of Orthopaedic and Traumatology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - M. Andry Usman
- Department of Orthopaedic and Traumatology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Leonard Christianto Singjie
- Department of Orthopaedic and Traumatology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
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Johan MP, Sukendar AE, Yurianto H, Singjie LC, Abidin MA, Arifin J, Usman MA, Sakuda T, Saleh MR. Functional outcome of campanacci grade 3 giant cell tumours of distal radius after resection and reconstruction with ulnar translocation technique: a case series. Ann Med Surg (Lond) 2023; 85:3179-3186. [PMID: 37363498 PMCID: PMC10289634 DOI: 10.1097/ms9.0000000000000849] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/10/2023] [Indexed: 06/28/2023] Open
Abstract
Reconstruction after en-bloc resection can be challenging in cases of Campanacci grade 3 giant cell tumour of the bone (GCTB) of the distal radius. Here, the authors examined the outcomes of patients with Campanacci grade 3 GCTBs of the distal radius who underwent wrist arthrodesis and reconstruction with ulnar translocation. Material and methods This case series was a retrospective single-centre study. Clinical assessments regarding the functional status and complications were follow-up. The functional results were evaluated using the Musculoskeletal Tumor Society (MSTS) and Disability of Arm, Shoulder, and Hand (DASH) Score. Paired t-tests were used to compare the MSTS and DASH scores separately before and after the operation. Statistical differences were considered significant at P less than 0.05. Results Seven patients were included in this study. The mean follow-up period was 14.43±8.08 months. The average length of tumour resection was 9.78±2.88 cm. The average range of motion of the involved forearm was 82.66° of supination and 81.54° of pronation. The average MSTS score was 11.71±2.21 before and 25.14±2.41 after the operation (P<0.05). The average DASH score on admission was 40.14±14.66, which decreased to 9.02±4.23 after the operation (P<0.05). Of the seven cases, one case had a recurrence, and one patient had radioulnar synostosis. Conclusion Wrist arthrodesis combined with ulnar translocation can be considered a simple and effective reconstruction method with preservation of function after en-bloc resection of Campanacci grade 3 GCTB of the distal radius. It provides good functional outcomes with low complication rates.
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Affiliation(s)
- Muhammad Phetrus Johan
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo General Hospital
| | - Anthony Evans Sukendar
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo General Hospital
| | - Henry Yurianto
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo General Hospital
| | - Leonard Christianto Singjie
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo General Hospital
| | | | - Jainal Arifin
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo General Hospital
| | - Muhammad Andry Usman
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo General Hospital
| | - Tomohiko Sakuda
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - M. Ruksal Saleh
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo General Hospital
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Johan MP, Paturusi IA, Yurianto H, Usman MA, Arifin J, Abidin MA, Kawilarang MA, Kennedy D. The role of neutrophil to lymphocyte ratio in predicting lung metastasis in giant cell tumor of the extremities. Eur Rev Med Pharmacol Sci 2022; 26:8914-8923. [PMID: 36524511 DOI: 10.26355/eurrev_202212_30565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Inflammation has a vital role in tumor development and metastasis. Changes in blood count parameters have been associated with tumor prognosis. We aimed to evaluate the prognostic significance of neutrophil to lymphocyte ratio (NLR) in predicting lung metastasis of giant cell tumors of the bone (GCTB) of the extremities. PATIENTS AND METHODS 34 GCTB patients (22 males and 12 females) were included in the study. Patients were divided into two groups. The metastasis group (n = 7) included GCTB patients with lung metastasis, while the non-metastasis group (n = 27) included those without lung metastasis. Descriptive statistics and frequency distribution were calculated [age, white blood cell (WBC), neutrophil, lymphocyte, platelets, neutrophil to lymphocyte ratio (NLR), and platelets to lymphocytes ratio (PLR)]. Continuous normal variables were expressed as mean ± standard deviation and compared using Student's t-tests. The receiver operating characteristic (ROC) curve analysis was used to evaluate the ability of NLR and PLR to predict lung metastasis. The factors were considered to be statistically significant at p < 0.05. RESULTS There were no significant differences between the lymphocyte count (1.81 vs. 2.23 103/mm3), platelet count (436 vs. 364 103/mm3), and PLR values (247 vs. 190) of the two groups (p > 0.05). The WBC count (11.8 vs. 8.95 103/mm3), neutrophil count (8.78 vs. 5.69 103/mm3), and NLR levels (5.45 vs. 2.81) (p < 0.05) were significantly higher in the metastasis group. The presence of an NLR cut-off value of 3.7 significantly predicted the existence of lung metastasis (AUC = 0.857 [95%CI = 0.714-1], p = 0.004) with a sensitivity of 85% and specificity of 82%. CONCLUSIONS NLR may serve as a promising prognostic marker for predicting lung metastasis in GCTB patients.
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Affiliation(s)
- M P Johan
- Department of Orthopedics and Traumatology, Faculty of Medicine, Hasanuddin University, Dr. Wahidin Sudirohusodo General Hospital, Makassar, Indonesia.
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Sakti M, Arifin J, Wonggokusuma G, Arden F, Faidzin M. A comparison of functional knee outcomes post-arthroscopic anterior cruciate ligament (ACL) reconstruction using hamstring and peroneus longus (PL) autograft. Bali Med J 2022. [DOI: 10.15562/bmj.v11i2.3233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: Hamstring autograft (HA) is the most common graft used in ACL reconstruction procedures. However, harvesting HA could weaken the secondary stabilizer of the knee joint. Peroneus longus grafts (PL) is a novel option secondary to hamstring graft with less morbidity at the knee joint. We intended to determine whether peroneus longus autograft (PL) is a comparable alternative to hamstring autograft for ACL Reconstruction.
Methods: 84 patients were grouped into "hamstring" (n = 51) and "peroneus longus" (n = 33) groups, with a mean age of 26.2 ± 5.9 in the Hamstring group and a mean age of 26.4 ± 6.6 in peroneus group. We obtain secondary data from the medical records of several hospitals in Makassar.
Results: There was a significant difference in Lysholm score (p<0.05) in the hamstring group with peroneus at 6 months and 12 months postoperatively for IKDC score, anterior translation, Power Grading Flexi-Extension, ROM on flexion, and extension. In addition, in muscle atrophy, the Hamstring group compared to the peroneus group also showed a significant difference (p=0.001).
Conclusion: The study's results did not show significant differences between the hamstring and peroneus groups other than atrophy of thigh muscles in the hamstring group. Based on the results of this study, we conclude peroneus longus graft is one of the graft options in ACL reconstruction surgery.
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Arifin J, Biakto KT, Winangun PAN. Cervical myelopathy due to an endodermal intraspinal cyst in a two-year-old child: a case report. Bali Med J 2021. [DOI: 10.15562/bmj.v10i3.2785] [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: 11/05/2022] Open
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Thehumury A, Saleh R, Arifin J. Compatibility of clinical presentation and imaging for patient with multiple lumbar canal stenosis at Wahidin Hospital. Journal of Health Sciences and Medicine 2019. [DOI: 10.32322/jhsm.517616] [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: 11/05/2022] Open
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Biakto KT, Arifin J, Lee J, Benjamin M. Occipitocervical Fusion and Posterior Fossa Decompression in Neglected Jefferson Fracture-Dislocation of Atlas Associated With Odontoid Peg Fracture: A Case Report. Int J Spine Surg 2019; 13:11-16. [PMID: 30805280 DOI: 10.14444/6001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/19/2022] Open
Abstract
Background Only a few cases of traumatic atlantoaxial fracture-dislocation have been reported, and neglected cases are seldom found because of the fatal nature of this condition. Methods We reported a neglected case of Jefferson fracture-dislocation associated with type II displaced odontoid peg fracture which was nonambulatory and myelopathic. A surgical plan involving posterior fossa decompression and laminectomy of the posterior arch of atlas following posterior spinal instrumentation was then conducted. Results Patient experienced marked neurologic recovery and was able to stand and walk with assistance during the early postoperative period. Conclusions This procedure may be an effective alternative treatment in neglected cases.
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Affiliation(s)
- Karya T Biakto
- Department of Orthopaedic and Traumatology, Wahidin Sudirohusodo General Hospital, University of Hasanuddin, Makassar, Indonesia
| | - Jainal Arifin
- Department of Orthopaedic and Traumatology, Wahidin Sudirohusodo General Hospital, University of Hasanuddin, Makassar, Indonesia
| | - Jansen Lee
- Department of Orthopaedic and Traumatology, Wahidin Sudirohusodo General Hospital, University of Hasanuddin, Makassar, Indonesia
| | - Michael Benjamin
- Department of Orthopaedic and Traumatology, Wahidin Sudirohusodo General Hospital, University of Hasanuddin, Makassar, Indonesia
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