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1.
Urology ; 157: 120-127, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34425151

RESUMEN

OBJECTIVE: To evaluate the clinical profile and the organisms producing adjustable transobturator male system (ATOMS) infection in a contemporary series. METHODS: Multicenter retrospective study evaluating patients undergoing ATOMS explant for clinical signs of infection from a series of 902 patients treated in 9 academic institutions. Clinical and microbiological data were evaluated. RESULTS: Infection presented in 24 patients (2.7%). The median age was 73 ± 7yrs and the median interval from ATOMS implantation to explant 11 ± 26.5mo. Infection was diagnosed within 3-months after surgery in 7(29.2%). Scrotal port erosion was present in 6 cases (25%) and systemic symptoms of parenchymatous testicular infection in 2(8.3%). The culture of the periprosthetic fluid was positive in 20(83.3%): 12(50%) Gram-negative bacteria, 9(37.5%) Gram-positive cocci and 1(4.2%) yeast. The most frequent isolates were Enterococcus and Proteus sp. (16.7% each), followed by Pseudomona sp. and S. epidermidis (12.5% each). Methicillin resistant S. aureus was detected only in 1 case (4.2%). Despite the infection 17 patients (70.8%) were satisfied with the implant and 18(75%) received a second device (11 repeated ATOMS and 7 AUS) at a median 9.7 ± 12.6mo after explant. Limitations include retrospective design and lack of microbiological cultures in ATOMS explanted for non-infective cause. CONCLUSION: Infection of a prosthetic device is a disturbing complication. A proportion of patients with ATOMS infection is associated to scrotal port erosion and/or parenchymatous urinary tract infection. Enterococcus and Proteus sp. are the most common organisms producing ATOMS infection and this could have implications for the selection of the most appropriate surgical prophylaxis.


Asunto(s)
Infecciones Bacterianas/microbiología , Infecciones Relacionadas con Prótesis/microbiología , Cabestrillo Suburetral/efectos adversos , Enfermedades Testiculares/microbiología , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/cirugía , Remoción de Dispositivos , Enterococcus , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina , Micosis/complicaciones , Micosis/microbiología , Infecciones Relacionadas con Prótesis/complicaciones , Infecciones Relacionadas con Prótesis/cirugía , Infecciones por Proteus/complicaciones , Infecciones por Proteus/microbiología , Infecciones por Pseudomonas/complicaciones , Infecciones por Pseudomonas/microbiología , Reoperación , Estudios Retrospectivos , Escroto , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/microbiología , Staphylococcus epidermidis , Enfermedades Testiculares/cirugía , Incontinencia Urinaria de Esfuerzo/cirugía
2.
BMJ Case Rep ; 14(8)2021 Aug 23.
Artículo en Inglés | MEDLINE | ID: mdl-34426427

RESUMEN

Proteus mirabilis is a gram-negative bacterium frequently considered a pathogen of the urinary tract. Septic discitis and septic pulmonary emboli resulting from P. mirabilis urosepsis is a rare phenomenon. We report a 39-year-old woman who was admitted to our hospital with a complicated urinary tract infection resulting in bacteraemia, septic discitis, paraspinal abscesses and septic emboli. She was treated with a prolonged course of intravenous antibiotics resulting in the clinical resolution of her symptoms. Based on our PubMed search of the English literature, this is only the second reported case of septic discitis caused by P. mirabilis This paper illustrates that physicians should include septic discitis caused by P. mirabilis as a possible aetiology of low back pain in patients with active or recently treated urinary tract infection. Additionally, this article discusses the pathogenesis and other complications resulting from P. mirabilis bacteraemia.


Asunto(s)
Discitis , Mirabilis , Infecciones por Proteus , Infecciones Urinarias , Adulto , Discitis/diagnóstico , Discitis/tratamiento farmacológico , Femenino , Humanos , Infecciones por Proteus/complicaciones , Infecciones por Proteus/diagnóstico , Infecciones por Proteus/tratamiento farmacológico , Proteus mirabilis , Infecciones Urinarias/complicaciones , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/tratamiento farmacológico
3.
Am J Physiol Renal Physiol ; 317(5): F1342-F1349, 2019 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-31509008

RESUMEN

Bacterial infection has long been recognized to contribute to struvite urinary stone deposition; however, its contribution to the development of chronic kidney stones has not been extensively investigated. In the present study, we hypothesized another possible method of bacteria contributing to the formation of calcium oxalate (CaOx) that accounts for the biggest part of the kidney stone. Bacteria may play important roles by influencing renal Ca2+-related ion channel activities, resulting in chronic inflammation of the kidney along with rapid aggregation of stones. We examined the correlation among infection-promoted CaOx kidney stones and alterations in Ca2+-related ion channels in an animal model with experimentally induced Proteus mirabilis and foreign body infection. After the bladder was infected for 7 days, the data demonstrated that stones were presented and induced severe renal tubular breakage as well as altered levels of monocyte chemoattractant protein-1, cyclooxygenase-2, osteopontin, and transient receptor potential vanilloid member 5 expression, reflecting responses of kidney ion channels. Monocyte chemoattractant protein-1, osteopontin, and transient receptor potential vanilloid member 5 expression was significantly downregulated over time, indicating the chronic inflammation phase of the kidney and accelerated aggregation of CaOx crystals, respectively, whereas cyclooxygenase-2 exhibited no differences. These results indicated that bacterial infection is considerably correlated with an alteration in renal Ca2+-related ion channels and might support specific and targeted Ca2+-related ion channel-based therapeutics for urolithiasis and related inflammatory renal damage.


Asunto(s)
Canales de Calcio/metabolismo , Cálculos Renales/metabolismo , Urolitiasis/metabolismo , Animales , Regulación de la Expresión Génica , Inmunidad Innata , Riñón/patología , Infecciones por Proteus/complicaciones , Proteus mirabilis , ARN Mensajero/genética , ARN Mensajero/metabolismo , Ratas , Estruvita , Vejiga Urinaria/patología , Urolitiasis/etiología
4.
Medicine (Baltimore) ; 98(34): e16664, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31441842

RESUMEN

INTRODUCTION: The Waterhouse-Friderichsen syndrome (WFS), also known as purpura fulminans, is a potentially lethal condition described as acute hemorrhagic necrosis of the adrenal glands. It is often caused by infection. Classically, Neisseriae meningitidis represents the main microorganism related to WFS, although, infrequently, also other infectious agents are reported as a possible etiologic agent. The authors report the first case of death due to Proteus mirabilis infection, with postmortem evidence of WFS. PATIENT CONCERNS: After a facial trauma that provoked a wound on the nose, the subject, a healthy 40-years old man, was conducted to the local hospital (in Sicily, Italy) after the primary care he was discharged. Subsequently, after 2 days of general malaise, he returned to the hospital due to the worsening of the clinical condition. During the hospitalization, hypotension, and neurological impairment appeared; the laboratory analysis showed leukocytosis and the alteration of renal, hepatic and coagulative parameters. Microbiological blood analysis resulted positive for a P mirabilis infection. DIAGNOSIS: Multiorgan failure (MOF) with disseminated intravascular coagulation (DIC) due to sepsis was diagnosed. INTERVENTIONS: The practitioners administered intensive support, antibiotic therapy, antithrombin III, vitamin K, and plasma. OUTCOMES: After 3 days the subject died. The autopsy and the microscopic investigation were performed revealing, also, the adrenal diffuse micronodular hyperplasia associated with a cortico-medullary hemorrhagic apoplexy. CONCLUSION: To our knowledge, this is the first case of MOF with WFS due to P mirabilis infection. This case report suggests that P mirabilis should be added to the list of unusual bacteria causing WFS. Furthermore, it supports the theory that any bacterium which causes DIC may cause adrenal hemorrhage and should suggest to clinicians the importance to consider a potential adrenal involvement in every patient with sepsis and DIC.


Asunto(s)
Huésped Inmunocomprometido , Infecciones por Proteus/complicaciones , Proteus mirabilis , Síndrome de Waterhouse-Friderichsen/etiología , Adulto , Humanos , Masculino
5.
Ortop Traumatol Rehabil ; 19(3): 297-300, 2017 May 10.
Artículo en Polaco | MEDLINE | ID: mdl-29086755

RESUMEN

Subacute acetabular osteomyelitis is a rare disease of bone. Deep location of the infection site sometimes may delay diagnosis. The most common cause is Staphylococcus aureus, whereas Proteus organisms are very rare etiologic agents. The aim of this case report is to present an unusual case of subacute acetabular osteomyelitis caused by Proteus mirabilis in a 12-year-old boy. Subacute acetabular osteomyelitis can be induced by Proteus mirabilis in the absence of previous trauma, predisposing conditions or disease. The patient was successfully treated with antibiotics. Local biopsy was essential in diagnosing this infection. Antibiotics should be given only after clinical sampling and susceptibility tests.


Asunto(s)
Antibacterianos/uso terapéutico , Osteomielitis/tratamiento farmacológico , Osteomielitis/etiología , Infecciones por Proteus/complicaciones , Infecciones por Proteus/tratamiento farmacológico , Proteus mirabilis/aislamiento & purificación , Niño , Humanos , Masculino , Resultado del Tratamiento
7.
Orthopedics ; 40(1): e176-e178, 2017 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-27684079

RESUMEN

Compartment syndrome is an orthopedic emergency with a multitude of etiologies. Although it is most commonly associated with trauma to the extremity, hematoma and infection are 2 rare etiologies of insidious compartment syndrome. Proteus mirabilis is an opportunistic gram-negative species that can infect the respiratory tract, urinary tract, and open wounds. The authors present the case of a 69-year-old woman who developed tissue necrosis and compartment syndrome secondary to an untreated hematoma infected by P mirabilis. This case involves an atypical presentation caused by an untreated infected hematoma, emphasizing the need for a high index of suspicion. Current literature supports immediate surgical intervention in the clinical scenario of fulminant compartment syndrome, regardless of compartment pressure findings. The probability of compartment syndrome in the patient presenting with pain, paresthesias, paresis, and pain with passive stretch, all of which were positive findings in this patient, has been reported to be 98%. Thus, Doppler evaluation and intercompartmental pressures were considered but forgone to expedite operative treatment. Emergent 4-compartment fasciotomies, with excision and debridement of nonviable tissue, are potentially limb-saving procedures, intended to limit loss of function and obviate the need for lower extremity amputation. The decision was made to perform a dual-incision fasciotomy to avoid contamination of the uninvolved compartments with a standard single-incision approach. To date, this represents the first report in the English literature of the insidious onset of tissue necrosis secondary to a Proteus-infected hematoma, highlighting a unique etiology of atypical compartment syndrome. [Orthopedics. 2017; 40(1):e176-e178.].


Asunto(s)
Síndromes Compartimentales/cirugía , Fasciotomía/métodos , Infecciones por Proteus/cirugía , Proteus mirabilis , Anciano , Síndromes Compartimentales/microbiología , Femenino , Humanos , Infecciones por Proteus/complicaciones , Resultado del Tratamiento
10.
PLoS Pathog ; 11(1): e1004601, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25568946

RESUMEN

The human genitourinary tract is a common anatomical niche for polymicrobial infection and a leading site for the development of bacteremia and sepsis. Most uncomplicated, community-acquired urinary tract infections (UTI) are caused by Escherichia coli, while another bacterium, Proteus mirabilis, is more often associated with complicated UTI. Here, we report that uropathogenic E. coli and P. mirabilis have divergent requirements for specific central pathways in vivo despite colonizing and occupying the same host environment. Using mutants of specific central metabolism enzymes, we determined glycolysis mutants lacking pgi, tpiA, pfkA, or pykA all have fitness defects in vivo for P. mirabilis but do not affect colonization of E. coli during UTI. Similarly, the oxidative pentose phosphate pathway is required only for P. mirabilis in vivo. In contrast, gluconeogenesis is required only for E. coli fitness in vivo. The remarkable difference in central pathway utilization between E. coli and P. mirabilis during experimental UTI was also observed for TCA cycle mutants in sdhB, fumC, and frdA. The distinct in vivo requirements between these pathogens suggest E. coli and P. mirabilis are not direct competitors within host urinary tract nutritional niche. In support of this, we found that co-infection with E. coli and P. mirabilis wild-type strains enhanced bacterial colonization and persistence of both pathogens during UTI. Our results reveal that complementary utilization of central carbon metabolism facilitates polymicrobial disease and suggests microbial activity in vivo alters the host urinary tract nutritional niche.


Asunto(s)
Coinfección/metabolismo , Glucólisis/fisiología , Fenómenos Fisiológicos de la Nutrición , Infecciones Urinarias/metabolismo , Animales , Coinfección/genética , Coinfección/microbiología , Escherichia coli/enzimología , Escherichia coli/genética , Escherichia coli/patogenicidad , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/metabolismo , Infecciones por Escherichia coli/microbiología , Femenino , Glucólisis/genética , Humanos , Ratones , Ratones Endogámicos CBA , Infecciones por Proteus/complicaciones , Infecciones por Proteus/metabolismo , Infecciones por Proteus/microbiología , Proteus mirabilis/enzimología , Proteus mirabilis/genética , Proteus mirabilis/patogenicidad , Transaldolasa/genética , Infecciones Urinarias/microbiología
14.
BMJ Case Rep ; 20142014 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-24792028

RESUMEN

Necrotising fasciitis is a rapidly progressive soft tissue infection that leads to diffuse tissue necrosis. It is associated with systemic toxicity and rapid deterioration resulting in high mortality. Rapid diagnosis and prompt treatment are essential to improve the outcome. We report the case of a 26-year-old woman who presented with severe thigh pain and swelling associated with irritability of a few hours' duration following 2 days history of right abdominal pain. Urgent MRI and CT scan showed features of necrotising fasciitis in the thigh spreading from an inflamed appendix. Emergency surgery was performed which revealed perforated appendix with disseminated infection in the intraperitoneal and retroperitoneal spaces as well as the right thigh. The patient rapidly deteriorated with evidence of sepsis, shock and renal impairment. In spite of surgery and all supportive measures, she succumbed shortly postoperatively. Blood culture revealed Staphylococcus aureus and Streptococci, while tissue culture showed growth of Escherichia coli and proteus.


Asunto(s)
Apendicitis/diagnóstico , Infecciones por Escherichia coli/diagnóstico , Fascitis Necrotizante/diagnóstico , Infecciones por Proteus/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Adulto , Antibacterianos/uso terapéutico , Apendicectomía , Apendicitis/complicaciones , Apendicitis/terapia , Desbridamiento , Diagnóstico Tardío , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/terapia , Fascitis Necrotizante/complicaciones , Fascitis Necrotizante/terapia , Resultado Fatal , Femenino , Humanos , Imagen por Resonancia Magnética , Infecciones por Proteus/complicaciones , Infecciones por Proteus/terapia , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/terapia , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/terapia , Muslo/cirugía
15.
APMIS ; 122(6): 505-11, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24164670

RESUMEN

Proteus mirabilis cause urinary tract infections which are recurrent and can lead to formation of urinary calculi. Both bacterial and the host factors are involved in the development of urolithiasis. To determine the impact of glycosaminoglycans (GAGs) in the formation of P. mirabilis-induced urinary stones, we investigated the in vitro crystallization, aggregation and adhesion of crystals in the presence of GAGs naturally appearing in urine. Crystallization experiments were performed in synthetic urine infected with P. mirabilis in the presence of: hyaluronic acid (HA), heparan sulfate (HS), chondroitin sulfate A, B and C (ChSA, ChSB, ChSC). The intensity of crystallization and aggregation were established by counting particles and phase-contrast microscopy. To analyze the adhesion of crystals, we used normal urothelium and (45)Ca isotope-labeled crystals. In the presence of ChSC, both the size of the crystals formed and their number were higher compared with the control. GAGs increased crystals adhesion to the cells, but only for ChSA this effect was significant. Chondroitin sulfates, which accelerate the first stages of infection-induced stones formation, may play an important role in the pathogenesis of infectious urolithiasis.


Asunto(s)
Glicosaminoglicanos/orina , Infecciones por Proteus/orina , Proteus mirabilis , Cálculos Urinarios/química , Infecciones Urinarias/orina , Adhesividad , Apatitas/química , Apatitas/orina , Línea Celular , Sulfatos de Condroitina/orina , Cristalización , Dermatán Sulfato/orina , Glicosaminoglicanos/química , Heparitina Sulfato/orina , Interacciones Huésped-Patógeno , Humanos , Ácido Hialurónico/orina , Compuestos de Magnesio/química , Compuestos de Magnesio/orina , Microscopía de Contraste de Fase , Modelos Biológicos , Fosfatos/química , Fosfatos/orina , Infecciones por Proteus/complicaciones , Proteus mirabilis/patogenicidad , Estruvita , Cálculos Urinarios/etiología , Cálculos Urinarios/orina , Infecciones Urinarias/complicaciones , Urotelio/química , Virulencia
16.
J Infect Dis ; 209(10): 1524-32, 2014 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-24280366

RESUMEN

BACKGROUND: Catheter-associated urinary tract infections (CaUTIs) are the most common hospital-acquired infections worldwide and are frequently polymicrobial. The urease-positive species Proteus mirabilis and Providencia stuartii are two of the leading causes of CaUTIs and commonly co-colonize catheters. These species can also cause urolithiasis and bacteremia. However, the impact of coinfection on these complications has never been addressed experimentally. METHODS: A mouse model of ascending UTI was utilized to determine the impact of coinfection on colonization, urolithiasis, and bacteremia. Mice were infected with P. mirabilis or a urease mutant, P. stuartii, or a combination of these organisms. In vitro experiments were conducted to assess growth dynamics and impact of co-culture on urease activity. RESULTS: Coinfection resulted in a bacterial load similar to monospecies infection but with increased incidence of urolithiasis and bacteremia. These complications were urease-dependent as they were not observed during coinfection with a P. mirabilis urease mutant. Furthermore, total urease activity was increased during co-culture. CONCLUSIONS: We conclude that P. mirabilis and P. stuartii coinfection promotes urolithiasis and bacteremia in a urease-dependent manner, at least in part through synergistic induction of urease activity. These data provide a possible explanation for the high incidence of bacteremia resulting from polymicrobial CaUTI.


Asunto(s)
Bacteriemia/microbiología , Coinfección , Infecciones por Enterobacteriaceae/complicaciones , Proteus mirabilis , Providencia , Urolitiasis/microbiología , Animales , Infecciones por Enterobacteriaceae/microbiología , Inducción Enzimática , Regulación Bacteriana de la Expresión Génica/fisiología , Ratones , Ratones Endogámicos CBA , Infecciones por Proteus/complicaciones , Infecciones por Proteus/microbiología , Ureasa/metabolismo
17.
APMIS ; 122(5): 363-8, 2014 May.
Artículo en Inglés | MEDLINE | ID: mdl-23992372

RESUMEN

Genetic, molecular and biological studies indicate that rheumatoid arthritis (RA), a severe arthritic disorder affecting approximately 1% of the population in developed countries, is caused by an upper urinary tract infection by the microbe, Proteus mirabilis. Elevated levels of specific antibodies against Proteus bacteria have been reported from 16 different countries. The pathogenetic mechanism involves six stages triggered by cross-reactive autoantibodies evoked by Proteus infection. The causative amino acid sequences of Proteus namely, ESRRAL and IRRET, contain arginine doublets which can be acted upon by peptidyl arginine deiminase thereby explaining the early appearance of anti-citrullinated protein antibodies in patients with RA. Consequently, RA patients should be treated early with anti-Proteus antibiotics as well as biological agents to avoid irreversible joint damages.


Asunto(s)
Artritis Reumatoide/microbiología , Infecciones por Proteus/microbiología , Infecciones Urinarias/microbiología , Anticuerpos Antibacterianos/sangre , Artritis Reumatoide/etiología , Artritis Reumatoide/genética , Autoanticuerpos/sangre , Condrocitos/inmunología , Reacciones Cruzadas , Antígeno HLA-DR1/genética , Antígeno HLA-DR1/metabolismo , Humanos , Ganglios Linfáticos/inmunología , Infecciones por Proteus/complicaciones , Proteus mirabilis/patogenicidad , Infecciones Urinarias/complicaciones
18.
Jpn J Infect Dis ; 66(3): 241-4, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23698488

RESUMEN

An uncomplicated cystitis caused by CO2-dependent Proteus mirabilis was observed in a 64-year-old Japanese female patient with Sjögren's syndrome in the Aomori Kyoritsu Hospital, Aomori, Japan. The initial P. mirabilis isolate came from a midstream urine specimen containing large numbers of Gram-negative, rod-shaped organisms that failed to grow on both Drigalski agar and sheep blood agar incubated in ambient air. The organism did grow when the urine was cultured overnight on blood agar under anaerobic conditions. Hence, we believed that the organism was an anaerobe. Further investigation revealed that the isolate grew on sheep blood agar along with swarming when the atmospheric CO2 concentrations were increased to 5%. Initially, we failed to characterize or identify the P. mirabilis isolate or determine its antimicrobial susceptibilities using the MicroScan WalkAway-40 System because the isolate did not grow in the system. However, the isolate was subsequently identified as P. mirabilis based on its morphological, cultural, and biochemical properties by using the commercially available kit systems, Quick ID-GN and ID-Test EB-20. This identification of the isolate was confirmed by sequencing the 16S rRNA gene of the organism. To our knowledge, this is the first clinical isolation of capnophilic P. mirabilis.


Asunto(s)
Dióxido de Carbono/metabolismo , Cistitis/complicaciones , Cistitis/microbiología , Infecciones por Proteus/complicaciones , Infecciones por Proteus/microbiología , Proteus mirabilis/aislamiento & purificación , Síndrome de Sjögren/complicaciones , Técnicas Bacteriológicas/métodos , ADN Bacteriano/química , ADN Bacteriano/genética , ADN Ribosómico/química , ADN Ribosómico/genética , Femenino , Humanos , Japón , Persona de Mediana Edad , Proteus mirabilis/clasificación , Proteus mirabilis/genética , Proteus mirabilis/metabolismo , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADN , Orina/microbiología
19.
Ear Nose Throat J ; 92(1): E10-2, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23354894

RESUMEN

We report an unusual case in which a 28-year-old woman presented with a long-standing history of ear discharge, hearing loss, facial weakness with ipsilateral facial swelling and cellulitis, a postauricular fistula, and an abscess of the temporozygomatic, infratemporal, and parotid areas. The pus stained positive for bacteria and acid-fast bacilli, and culture was positive for Proteus vulgaris and mycobacteria. Based on these findings, a diagnosis of tuberculous otitis media with complications was made. Computed tomography showed extensive destruction of the tympanic and mastoid part of the temporal bone, as well as lytic lesions in the skull. The patient was placed on antituberculosis drug therapy. Although her facial nerve palsy and hearing loss persisted, she otherwise responded well and did not require surgery.


Asunto(s)
Absceso/microbiología , Coinfección/microbiología , Mastoiditis/microbiología , Otitis Media Supurativa/microbiología , Infecciones por Proteus/complicaciones , Proteus vulgaris/aislamiento & purificación , Tuberculosis/complicaciones , Absceso/complicaciones , Adulto , Enfermedad Crónica , Femenino , Humanos , Mastoiditis/complicaciones , Otitis Media Supurativa/complicaciones , Hueso Temporal
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