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1.
Eur J Clin Microbiol Infect Dis ; 38(4): 743-746, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30680575

RESUMO

The incidence of sepsis is disproportionately higher in elderly adults, and age is an independent predictor of mortality. Retrospective analysis was conducted among patients admitted to the emergency department in a tertiary teaching hospital from January 2016 to June 2017. To study the prognosis determinants of sepsis among elderly patients attended in the emergency room of a tertiary care hospital. As secondary objectives, we aimed to describe the causes of sepsis, the general outcome, and the general characteristics of these patients. Two hundred thirty-five episodes data of patients admitted throughout the 15-month study period who were diagnosed with sepsis, severe sepsis or septic shock, were included. Throughout the study cohort, 51 patients (21.7%) fulfilled the criteria of severe sepsis or septic shock. All-cause mortality was 11 patients (4.7%) on day 14 and 27 (11.5%) on day 30. Prognosis factors associated with 30-day mortality were the following: albumin level < 2.6 g/dl (first quartile of the overall population), odds ratio (OR 3.26, 95% CI 12-9.41; p = 0.029), Charlson comorbidity index (OR 1.23, 95% CI 1.04-1.45; p = 0.012), C-reactive protein on admission (OR 1.04, 95% CI 0.99-1.08; p = 0.062), and non-adequacy of the initial antimicrobial therapy (OR 3.3, 95% CI 1.06-10.4; p = 0.039). Among elderly patients with sepsis, strong predictors of mortality such as albumin could be considered as part of prognosis and future potential interventions. Adequacy of antimicrobial therapy at admission must be one of the objectives in the treatment of sepsis, also in the elderly, since it is an independent predictor of mortality.


Assuntos
Mortalidade Hospitalar , Sepse/patologia , Albumina Sérica Humana/análise , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização , Hospitais de Ensino , Humanos , Masculino , Razão de Chances , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Sepse/mortalidade
2.
AIDS ; 32(7): 913-920, 2018 Apr 24.
Artigo em Inglês | MEDLINE | ID: mdl-29424785

RESUMO

OBJECIVE: Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is used to assess bone health in HIV patients. DXA measures the amount of mineral, but not other key aspects of bone strength such as bone microarchitecture or bone quality. Trabecular bone score (TBS) and in-vivo microindentation directly measure trabecular microarchitecture and bone tissue quality, respectively. The aim of this study is to measure bone strength properties using these techniques. RESULTS: Forty naive HIV patients who were going to start antiretroviral therapy (ART), a single pill treatment with elvitegravir/cobicistat, tenofovir disoproxil fumarate (TDF), emtricitavine (FTC) were included. A significant reduction in BMD at spine (-3.25%, P < 0.001) and in femoral neck (-3.82%, P = 0.016) between baseline and 48 weeks of treatment were found. Bone microarchitecture score at the spine, as measured by TBS, also significantly decreased from 1.357 (0.09) to 1.322 (0.09) (-2.5%, P = 0.011) between baseline to 48 weeks of treatment. Microindentation (BMSi) values were significantly higher than at baseline [89.04 (4.2) versus 86.07 (6.1); 3.49%, P < 0.001] after 48 weeks of TDF-based ART treatment, indicating improved bone material properties CONCLUSION:: A significant decrease in BMD and TBS were observed after 1 year of TDF therapy. However, tissue quality significantly improved after 1 year of treatment, suggesting a recovery of bone material properties following the control of the infection despite the significant reduction of BMD. These techniques provide additional and necessary information to DXA about bone health in treated HIV patients, and because of its convenience and feasibility they could be routinely apply to assess bone in clinical practice.

4.
PLoS One ; 12(4): e0173802, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28388647

RESUMO

Dysbalance in gut microbiota has been linked to increased microbial translocation, leading to chronic inflammation in HIV-patients, even under effective HAART. Moreover, microbial translocation is associated with insufficient reconstitution of CD4+T cells, and contributes to the pathogenesis of immunologic non-response. In a double-blind, randomised, placebo-controlled trial, we recently showed that, compared to placebo, 12 weeks treatment with probiotic Saccharomyces boulardii significantly reduced plasma levels of bacterial translocation (Lipopolysaccharide-binding protein or LBP) and systemic inflammation (IL-6) in 44 HIV virologically suppressed patients, half of whom (n = 22) had immunologic non-response to antiretroviral therapy (<270 CD4+Tcells/µL despite long-term suppressed viral load). The aim of the present study was to investigate if this beneficial effect of the probiotic Saccharomyces boulardii is due to modified gut microbiome composition, with a decrease of some species associated with higher systemic levels of microbial translocation and inflammation. In this study, we used 16S rDNA gene amplification and parallel sequencing to analyze the probiotic impact on the composition of the gut microbiome (faecal samples) in these 44 patients randomized to receive oral supplementation with probiotic or placebo for 12 weeks. Compared to the placebo group, in individuals treated with probiotic we observed lower concentrations of some gut species, such as those of the Clostridiaceae family, which were correlated with systemic levels of bacterial translocation and inflammation markers. In a sub-study of these patients, we observed significantly higher parameters of microbial translocation (LBP, soluble CD14) and systemic inflammation in immunologic non-responders than in immunologic responders, which was correlated with a relative abundance of specific gut bacterial groups (Lachnospiraceae genus and Proteobacteria). Thus, in this work, we propose a new therapeutic strategy using the probiotic yeast S. boulardii to modify gut microbiome composition. Identifying pro-inflammatory species in the gut microbiome could also be a useful new marker of poor immune response and a new therapeutic target.


Assuntos
Infecções por HIV/microbiologia , Intestinos/microbiologia , Microbiota , Probióticos , Saccharomyces boulardii , Adulto , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placebos
5.
J Acquir Immune Defic Syndr ; 75(3): 322-327, 2017 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-28418990

RESUMO

OBJECTIVES: HIV infection has been associated with reduced bone mineral density (BMD). Antiretroviral therapy (ART) has a deleterious effect on BMD, but its effect on bone fragility is not clear. The objective of this study is to analyze the BMD, microarchitecture, and tissue quality of bone in patients receiving long-term tenofovir- or abacavir-based ART. DESIGN: We conducted a cross-sectional study in patients with HIV undergoing tenofovir or abacavir ART for more than 5 years. METHODS: We measured BMD using dual X-ray absorptiometry ,bone michroarchitecture using trabecular bone score (TBS), and bone tissue quality using microindentation. TBS is a dual X-ray absorptiometry-based software that is more highly correlated with bone fragility than BMD. Microindentation (BMSi) directly assesses bone quality at the tissue level. RESULTS: A total of 63 patients were included in this study, with 36 belonging to the TDF-FTC group and 27 to the ABC-3TC group. Patients receiving TDF-FTC treatment showed lower BMD values than those in the ABC-3TC group. We found no differences in TBS or microindentation between the 2 groups. However, after adjusting for sex, age, body mass index, and 25[OH]vitD we found lower BMSi and thus poorer bone properties in the TDF-FTC group than in the ABC-3TC group [beta coefficient -3.594 (confidence interval: 95% -0.12 to -7.61); P = 0.043]. CONCLUSIONS: Long-term treatment with TDF-FTC leads to impaired bone health, not only in terms of BMD but also in terms of bone quality, another determinant of overall bone strength. To complement BMD-based predictions, these other techniques may also be used to identify patients with excess fracture risk.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Densidade Óssea/efeitos dos fármacos , Didesoxinucleosídeos/efeitos adversos , Emtricitabina/efeitos adversos , Infecções por HIV/fisiopatologia , Lamivudina/efeitos adversos , Tenofovir/efeitos adversos , Absorciometria de Fóton , Fármacos Anti-HIV/administração & dosagem , Remodelação Óssea , Estudos Transversais , Didesoxinucleosídeos/administração & dosagem , Combinação de Medicamentos , Emtricitabina/administração & dosagem , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lamivudina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Espanha , Tenofovir/administração & dosagem
6.
Rev. esp. quimioter ; 29(3): 119-121, jun. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-153085

RESUMO

We report a quasi-experimental study of the implementation of an antimicrobial stewardship program in two surgical wards, with a pre-intervention period with just assessment of prescription and an intervention period with a prospective audit on antibiotic prescription model. There was a significant reduction of length of stay and the total days of antimicrobial administration. There were no differences in mortality between groups. The antimicrobial stewardship program led to the early detection of inappropriate empirical antibiotic treatment and was associated with a significant reduction in length of stay and the total duration of antimicrobial therapy (AU)


Presentamos un estudio cuasi-experimental de la aplicación de un programa de uso de terapia antimicrobiana en dos salas quirúrgicas, con un período de pre-intervención en que se realizó evaluación de la prescripción y un período de intervención con una auditoría prospectiva sobre la prescripción antibiótica siguiendo un modelo de recomendación. Hubo una reducción significativa de la estancia media y del total de días de tratamiento antibiótico. No hubo diferencias en la mortalidad entre los grupos. El programa de uso de terapia antimicrobiana condujo a la detección precoz de tratamiento antibiótico empírico inadecuado y se asoció con una reducción significativa de la estancia media y la duración total de la terapia antimicrobiana (AU)


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Tempo de Internação/estatística & dados numéricos , Tempo de Internação/tendências , Salas Cirúrgicas , Antibacterianos/uso terapêutico , Estudos Prospectivos , Diagnóstico Precoce , Tempo de Internação/economia , Tempo de Internação/legislação & jurisprudência , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Cefotaxima/uso terapêutico , Ciprofloxacino/uso terapêutico , Piperacilina/uso terapêutico
7.
J Acquir Immune Defic Syndr ; 72(3): 314-8, 2016 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-26910501

RESUMO

Low bone mineral density (BMD) in HIV-infected individuals has been documented in an increasing number of studies. However, it is not clear whether it is the infection itself or the treatment that causes bone impairment. Microindentation measures bone material strength (Bone Material Strength index) directly. We recruited 85 patients, 50 infected with HIV and 35 controls. Median Bone Material Strength index was 84.5 (interquartile range 83-87) in HIV-infected patients and 90 (88.5-93) in controls (P < 0.001). No significant differences in BMD between cases and controls at any of the sites examined (total hip, femoral neck, and lumbar spine). HIV infection is associated with bone damage, independently of BMD.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Colo do Fêmur/patologia , Infecções por HIV/complicações , Vértebras Lombares/patologia , Osteoporose/patologia , Absorciometria de Fóton , Adulto , Fármacos Anti-HIV/efeitos adversos , Densidade Óssea , Estudos Transversais , Feminino , Colo do Fêmur/virologia , Infecções por HIV/patologia , Infecções por HIV/virologia , Humanos , Vértebras Lombares/virologia , Masculino , Pessoa de Meia-Idade , Osteoporose/virologia , Medição de Risco , Espanha
8.
BMC Med Genomics ; 8: 75, 2015 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-26555194

RESUMO

BACKGROUND: MicroRNAs (miRNAs) are important regulators of gene expression, with documented roles in bone metabolism and osteoporosis, suggesting potential therapeutic targets. Our aim was to identify miRNAs differentially expressed in fractured vs nonfractured bones. Additionally, we performed a miRNA profiling of primary osteoblasts to assess the origin of these differentially expressed miRNAs. METHODS: Total RNA was extracted from (a) fresh femoral neck trabecular bone from women undergoing hip replacement due to either osteoporotic fracture (OP group, n = 6) or osteoarthritis in the absence of osteoporosis (Control group, n = 6), matching the two groups by age and body mass index, and (b) primary osteoblasts obtained from knee replacement due to osteoarthritis (n = 4). Samples were hybridized to a microRNA array containing more than 1900 miRNAs. Principal component analysis (PCA) plots and heat map hierarchical clustering were performed. For comparison of expression levels, the threshold was set at log fold change > 1.5 and a p-value < 0.05 (corrected for multiple testing). RESULTS: Both PCA and heat map analyses showed that the samples clustered according to the presence or absence of fracture. Overall, 790 and 315 different miRNAs were detected in fresh bone samples and in primary osteoblasts, respectively, 293 of which were common to both groups. A subset of 82 miRNAs was differentially expressed (p < 0.05) between osteoporotic and control osteoarthritic samples. The eight miRNAs with the lowest p-values (and for which a validated miRNA qPCR assay was available) were assayed, and two were confirmed: miR-320a and miR-483-5p. Both were over-expressed in the osteoporotic samples and expressed in primary osteoblasts. miR-320a is known to target CTNNB1 and predicted to regulate RUNX2 and LEPR, while miR-483-5p down-regulates IGF2. We observed a reduction trend for this target gene in the osteoporotic bone. CONCLUSIONS: We identified two osteoblast miRNAs over-expressed in osteoporotic fractures, which opens novel prospects for research and therapy.


Assuntos
Perfilação da Expressão Gênica , MicroRNAs/genética , Osteoporose/genética , Ossos Pélvicos/metabolismo , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Fator de Crescimento Insulin-Like II/genética , Análise de Sequência com Séries de Oligonucleotídeos , Osteoblastos/metabolismo , Osteoporose/patologia , Ossos Pélvicos/patologia
9.
J Acquir Immune Defic Syndr ; 68(3): 256-63, 2015 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-25469528

RESUMO

BACKGROUND: Microbial translocation has been associated with an increase in immune activation and inflammation in HIV infection despite effective highly active antiretroviral therapy. It has been shown that some probiotics have a beneficial effect by reducing intestinal permeability and, consequently, microbial translocation. OBJECTIVES: To assess changes in microbial translocation and inflammation after treatment with probiotics (Saccharomyces boulardii) in HIV-1-infected patients with virologic suppression. METHODS: A double-blind, randomized, placebo-controlled trial was conducted in 44 nonconsecutive HIV-1-infected patients with viral load of <20 copies per milliliter for at least 2 years. Patients were randomized to oral supplementation with probiotics or placebo during 12 weeks. Markers of microbial translocation (lipopolysaccharide-binding protein [LBP] and soluble CD14), inflammation (interleukin 6 [IL-6], tumor necrosis factor alpha, interferon gamma, high-sensitivity C-reactive protein), and immunological and clinical data were determined before and after the intervention and 3 months after treatment discontinuation. Quantitative variables were compared using the Mann-Whitney U test, and categorical variables were compared using the Fisher exact test. RESULTS: After 12 weeks of treatment, differences between the probiotic arm and the placebo arm were observed in LBP values (-0.30 vs +0.70 pg/mL) and IL-6 (-0.60 vs +0.78 pg/mL). These differences were also noted at 3 months after treatment withdrawal. Qualitative analysis was performed, defining a variable as "decreased" or "increased" from baseline LBP. A significant decrease of LBP at 12 weeks of treatment was observed (57.9% patients in the probiotic group vs 6.2% in the placebo group, P = 0.002). CONCLUSIONS: Treatment with S. boulardii decreases microbial translocation (LBP) and inflammation parameters (IL-6) in HIV-1-infected patients with long-term virologic suppression.


Assuntos
Translocação Bacteriana , Infecções por HIV/complicações , Inflamação/prevenção & controle , Probióticos/uso terapêutico , Saccharomyces/fisiologia , Proteínas da Fase Aguda , Administração Oral , Proteína C-Reativa/análise , Proteínas de Transporte/sangue , Citocinas/sangue , Método Duplo-Cego , Feminino , Infecções por HIV/terapia , Humanos , Receptores de Lipopolissacarídeos/sangue , Masculino , Glicoproteínas de Membrana/sangue , Placebos/administração & dosagem , Saccharomyces/crescimento & desenvolvimento , Resultado do Tratamento
10.
Arq Bras Endocrinol Metabol ; 58(5): 478-83, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25166038

RESUMO

With the advent of high active antiretroviral therapy there was a significant improvement on HIV subjects survival. Thus, bone changes related to HIV became an important aspect of these individuals. HIV affects bone remodeling causing bone fragility. In addition, antiretroviral therapy may also negatively affect bone metabolism. Several studies describe an increased incidence of fractures in these patients when compared with controls without the disease. The European Society of AIDS (EACS), and other societies, have included guidance on management of osteoporosis in HIV-infected patients emphasizing the identification of patients with low bone mass. Supplementation of calcium and vitamin D and the use of alendronate in these individuals should be recommended on a case base.


Assuntos
Envelhecimento/metabolismo , Osso e Ossos/metabolismo , Osso e Ossos/virologia , Fraturas Ósseas , Infecções por HIV , Osteoporose/complicações , Antirretrovirais/efeitos adversos , Densidade Óssea , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/virologia , Infecções por HIV/complicações , Infecções por HIV/metabolismo , Humanos , Masculino , Fraturas por Osteoporose/prevenção & controle , Fatores de Risco
11.
Arq. bras. endocrinol. metab ; 58(5): 478-483, 07/2014. graf
Artigo em Inglês | LILACS | ID: lil-719193

RESUMO

With the advent of high active antiretroviral therapy there was a significant improvement on HIV subjects survival. Thus, bone changes related to HIV became an important aspect of these individuals. HIV affects bone remodeling causing bone fragility. In addition, antiretroviral therapy may also negatively affect bone metabolism. Several studies describe an increased incidence of fractures in these patients when compared with controls without the disease. The European Society of AIDS (EACS), and other societies, have included guidance on management of osteoporosis in HIV-infected patients emphasizing the identification of patients with low bone mass. Supplementation of calcium and vitamin D and the use of alendronate in these individuals should be recommended on a case base.


Com o advento da terapia antirretroviral, houve uma melhora considerável na sobrevida dos indivíduos portadores do vírus HIV. Dessa forma, as alterações ósseas referentes ao HIV se tornaram um fator importante no cuidado desses indivíduos. O HIV altera o remodelamento ósseo causando fragilidade óssea. As alterações causadas por esse vírus nos linfócitos T afetam a produção de RANKL e de citocinas pró-inflamatórias levando à osteoclastogênese. Ademais, a terapia antirretroviral também pode afetar negativamente o metabolismo ósseo. Vários estudos descrevem aumento da incidência de fraturas nesses indivíduos quando comparados a controles sem a doença. Diretrizes da Sociedade Europeia de SIDA (EACS) têm orientado o manejo da osteoporose nesses sujeitos, enfatizando a identificação de pacientes com baixa massa óssea. A suplementação de cálcio e vitamina D e o uso de alendronato nesses indivíduos devem ser recomendados caso a caso.


Assuntos
Feminino , Humanos , Masculino , Envelhecimento/metabolismo , Osso e Ossos/metabolismo , Osso e Ossos/virologia , Fraturas Ósseas , Infecções por HIV , Osteoporose/complicações , Antirretrovirais/efeitos adversos , Densidade Óssea , Fraturas Ósseas/etiologia , Fraturas Ósseas/virologia , Infecções por HIV/complicações , Infecções por HIV/metabolismo , Fraturas por Osteoporose/prevenção & controle , Fatores de Risco
13.
J Acquir Immune Defic Syndr ; 66(1): 90-5, 2014 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-24457634

RESUMO

BACKGROUND: Different studies have reported an association between HIV infection, antiretroviral therapies, and impaired bone metabolism, but data on their impact on fracture risk are scarce. We studied the association between a clinical diagnosis of HIV infection and fracture risk. METHODS: We conducted a case-control study using data from the Danish National Health Service registries, including 124,655 fracture cases and 373,962 age- and gender-matched controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression. RESULTS: A total of 50 (0.40/1000) patients in the fracture group and 52 (0.14/1000) controls had an HIV diagnosis. The risk of any fracture was thus significantly increased among HIV-infected patients (age- and gender-matched OR = 2.89, 95% CI: 1.99 to 4.18). Similarly, significant increases in the risk of hip (OR = 8.99, 95% CI: 1.39 to 58.0), forearm (OR = 3.50, 95% CI: 1.26 to 9.72), and spine fractures (OR = 9.00, 95% CI: 1.39 to 58.1) were observed. CONCLUSIONS: HIV infection is associated with an almost 3-fold increase in fracture risk compared with that of age- and gender-matched uninfected patients. HIV patients are also at an almost 9-fold higher risk of hip fracture.


Assuntos
Fraturas Ósseas/epidemiologia , Infecções por HIV/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Pré-Escolar , Dinamarca/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Medição de Risco , Adulto Jovem
15.
J Bone Miner Res ; 28(6): 1259-63, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23362011

RESUMO

HIV infection and antiretroviral therapies have detrimental effects on bone metabolism, but data on their impact on fracture risk are controversial. We conducted a population-based cohort study to explore the association between clinical diagnosis of HIV infection and hip and major osteoporotic fracture risk. Data were obtained from the SIDIAP(Q) database, which contains clinical information for >2 million patients in Catalonia, Spain (30% of the population). We screened the database to identify participants with a clinical diagnosis of HIV infection, and ascertained incident hip and osteoporotic major fractures in the population aged 40 years or older in 2007 to 2009. In addition, data on incident fractures involving hospital admission were obtained from the Hospital Admissions database. Cox regression models were used to estimate hazard ratios (HRs) for the HIV-infected versus uninfected participants. Models were adjusted for age, sex, body mass index, smoking status, alcohol drinking, oral glucocorticoid use, and comorbid conditions (Charlson index). Among 1,118,156 eligible participants, we identified 2489 (0.22%) subjects with a diagnosis of HIV/AIDS. Age- and sex-adjusted HR for HIV/AIDS were 6.2 (95% confidence interval [CI] 3.5-10.9; p < 0.001) and 2.7 (2.01-3.5; p < 0.001) for hip and major fractures, respectively; this remained significant after adjustment for all mentioned potential confounders: HR 4.7 (2.4-9.5; p < 0.001) and 1.8 (1.2-2.5; p = 0.002). After stratifying by age, the association between HIV infection and major fractures was attenuated for those aged <59 years (adjusted HR 1.35 [0.88-2.07], p = 0.17) but appeared stronger in older patients (adjusted HR 2.11 [1.05-4.22], p = 0.035). We report a strong association between HIV infection and hip fracture incidence, with an almost fivefold increased risk in the HIV infected, independent of sex, age, smoking, alcohol drinking, and comorbidities. Similarly, we demonstrate a 75% higher risk of all clinical fractures and a 60% increase in risk of non-hip clinical fractures among patients with a diagnosis of HIV infection.


Assuntos
Bases de Dados Factuais , Infecções por HIV , Fraturas do Quadril , Modelos Biológicos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Infecções por HIV/complicações , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia
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