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Co-prescribing of Warfarin with Statins and Proton Pump Inhibitors in Elderly Australians 澳大利亚老年人华法林与他汀类药物和质子泵抑制剂的联合处方
Pub Date : 2014-09-27 DOI: 10.4172/2167-1052.1000161
Svetla Gadzhanova, E. Roughead
Background: Comorbidity is common in individuals with atrial fibrillation (AF). The predominant treatment for AF is warfarin and medicine interactions with warfarin represent a challenge for optimising treatment of AF in older people with comorbidities. Statins and Proton Pump Inhibitors are commonly prescribed therapies and in both classes, there are medicines with greater or lesser potential to interact with warfarin. Objective: The aim of this study was to examine use of antithrombotic treatment in elderly Australians, and the extent of concurrent use of interacting statins and proton pump inhibitors (PPIs) with warfarin. Methods: A retrospective cohort study was conducted using data from the Australian Government Department of Veterans’ Affairs. The cohort included all patients who had at least one hospitalisation with a primary diagnosis for AF between 2007 and 2011. Individuals contributed person-months from the date of first AF hospitalisation to death or end of study (December 2011). Monthly utilisation of antithrombotics was assessed. A sub-cohort of warfarin users was defined as those with AF who received warfarin as monotherapy and the proportions of those co-dispensed statins or PPIs were established. Results: Around 70% of patients with AF were receiving antithrombotic treatment, with 35% dispensed warfarin, 17% aspirin, and 7% clopidogrel as monotherapy. In December 2011, 54% of patients with AF on warfarin monotherapy were co-dispensed a statin, with the statins with potential for interaction dispensed at highest rates; atorvastatin followed by simvastatin and rosuvastatin. At study end, 43% of the warfarin cohort were also dispensed PPIs, with one-third using esomeprazole, followed by pantoprazole, both of which have the potential to interact with warfarin. Conclusion: 30% of patients with AF were not receiving antithrombotic treatment. In those receiving an antithrombotic agent, warfarin was the most commonly dispensed (35%). The most common statin and PPI coprescribed with warfarin were agents with the potential to interact with warfarin, despite alternative agents being available. Raising awareness of the safer alternative for people with comorbidities may improve warfarin management.
背景:合并症在房颤(AF)患者中很常见。心房颤动的主要治疗方法是华法林,与华法林的药物相互作用对有合并症的老年人心房颤动的优化治疗提出了挑战。他汀类药物和质子泵抑制剂是常用的处方疗法,在这两类药物中,都有或多或少与华法林相互作用的可能性。目的:本研究的目的是检查澳大利亚老年人抗血栓治疗的使用情况,以及他汀类药物和质子泵抑制剂(PPIs)与华法林同时使用的程度。方法:采用澳大利亚政府退伍军人事务部的数据进行回顾性队列研究。该队列包括所有在2007年至2011年间至少有一次初步诊断为房颤住院治疗的患者。从首次房颤住院之日起至死亡或研究结束(2011年12月),个人贡献的人月数。评估每月抗血栓药物的使用情况。华法林使用者的亚队列定义为接受华法林单药治疗的房颤患者,并确定联合配用他汀类药物或PPIs的比例。结果:大约70%的房颤患者正在接受抗血栓治疗,其中35%的患者使用华法林,17%的患者使用阿司匹林,7%的患者使用氯吡格雷进行单药治疗。2011年12月,54%接受华法林单药治疗的房颤患者同时配用了他汀类药物,其中配用可能发生相互作用的他汀类药物的比例最高;阿托伐他汀,其次是辛伐他汀和瑞舒伐他汀。在研究结束时,43%的华法林队列患者也使用PPIs,其中三分之一使用埃索美拉唑,其次是泮托拉唑,这两种药物都有可能与华法林相互作用。结论:30%的房颤患者未接受抗栓治疗。在接受抗血栓药物治疗的患者中,华法林是最常用的(35%)。与华法林共同使用的最常见的他汀类药物和PPI是有可能与华法林相互作用的药物,尽管有替代药物可用。提高对合并症患者的安全替代方案的认识可能会改善华法林的管理。
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引用次数: 5
Urinary Tract Infections in Children: A Changing Paradigm 儿童尿路感染:一个不断变化的范式
Pub Date : 2014-09-26 DOI: 10.4172/2167-1052.1000163
B. Rajendra
Purpose: To review the changing paradigms in the diagnosis, investigation and management of Urinary Tract Infections (UTIs) in children beyond the neonatal period. Methods: A literature search was done using PUBMED, EBSCO host database and GOOGLE SCHOLAR of all articles including reviews and guidelines on UTIs in children for the last ten years. A total of 2725 articles including review articles and guidelines published over the last 10 years were searched and reviewed. Results: UTIs are the second most common cause of serious bacterial infections in early childhood, thus placing a huge financial burden on the health budget. Despite increasing resistance to several first-line antibiotics, appropriate antibiotic treatment has almost eliminated mortality. Early guidelines advocated aggressive treatment and extensive imaging studies, particularly for the detection of serious ureteric reflex and kidney scarring. Treatment in the acute episode is aimed at eradication of bacteriuria and alleviation of symptoms. Long-term goals include prevention of recurrent attacks of UTIs, kidney scarring and correction of urological lesions that may predispose to recurrent infections. Although there is increasing evidence to show that long-term antimicrobial prophylaxis may be associated with a reduced risk of recurrent infection in selected groups of patients, but not renal scarring, more studies are needed to confirm this. Surgical intervention is now restricted to cases with severe vesicoureteric reflux and failed medical management with endoscopic surgery being increasingly used in most centres compared to open surgery. Conclusion: Following extensive research, a more tangible approach to UTIs is advocated providing for more judicious use of resources with reduced harm from procedures, without affecting outcome. This review addresses the diagnosis, management and treatment of UTIs in children beyond the neonatal period.
目的:综述新生儿期以后儿童尿路感染(uti)的诊断、调查和治疗模式的变化。方法:使用PUBMED、EBSCO主机数据库和GOOGLE SCHOLAR检索近十年来关于儿童尿路感染的所有文章,包括综述和指南。共检索和审查了近10年来发表的2725篇文章,包括综述文章和指南。结果:尿路感染是儿童早期严重细菌感染的第二大常见原因,因此给卫生预算带来了巨大的经济负担。尽管对几种一线抗生素的耐药性不断增加,但适当的抗生素治疗几乎消除了死亡率。早期的指南提倡积极的治疗和广泛的影像学检查,特别是对严重输尿管反射和肾瘢痕的检测。治疗急性发作的目的是根除菌尿和减轻症状。长期目标包括预防尿路感染的复发,肾脏瘢痕形成和纠正可能导致复发性感染的泌尿系统病变。尽管有越来越多的证据表明,长期抗菌素预防可能与某些患者复发感染风险降低有关,但与肾瘢痕形成无关,但需要更多的研究来证实这一点。手术干预现在仅限于严重膀胱输尿管反流和医疗管理失败的病例,与开放手术相比,大多数中心越来越多地使用内窥镜手术。结论:经过广泛的研究,提倡一种更切实的方法来治疗尿路感染,提供更明智的资源使用,减少手术的伤害,而不影响结果。本文综述了新生儿期以后儿童尿路感染的诊断、管理和治疗。
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引用次数: 1
Factors Affecting Long-Term Safety of Trastuzumab in Patients with Early HER2-Positive Breast Cancer 影响早期her2阳性乳腺癌患者曲妥珠单抗长期安全性的因素
Pub Date : 2014-09-26 DOI: 10.4172/2167-1052.1000160
A. Boekhout, Werkhoven Ed, R. Liebergen, C. Korse, A. Burylo, Trip Ak, J. Beijnen, J. Schellens
Background: Trastuzumab treatment is associated with cardiac dysfunction. We evaluated the incidence of cardiotoxicity during and long-term after trastuzumab treatment in an unselected early breast cancer population. Methods: This study included a retrospective part, the chemotherapy- and trastuzumab treatment period and a prospective part, the period of data collection long-term after trastuzumab treatment. Cardiac evaluation included left ventricular ejection fraction (LVEF) changes and an evaluation of symptomatic cardiotoxicity. Cardiac events were defined as a decrease of 10 percentage points in LVEF compared with baseline and to an absolute LVEF of below 50%. Secondary outcomes included the evaluation of cardiac markers (B-type natriuretic peptide and troponins) and single nucleotide polymorphisms (SNPs) in the HER2 gene as parameters to detect or predict trastuzumab-related cardiotoxicity. Results: Overall, 105 patients were evaluable for the primary endpoint. The 3-year cumulative incidence of cardiac events was 12% (95 CI, 4%-19%). All 8 patients with a cardiac event were pre-treated with anthracyclines and cyclophosphamide and 7 of them recovered partially or completely. Four patients experienced symptomatic cardiotoxicity, of who 2 recovered completely and the other 2 recovered partially. No statistically significant association was observed between cardiac events and cardiac markers or SNPs. Conclusion: Trastuzumab treatment in combination with anthracy cline-based chemotherapy is associated with significant and only partly reversible cardiac dysfunction. Baseline LVEF value is a prominent predictor for long-term LVEF especially, in patients who are not treated with anthracycline-based chemotherapy. These findings can be used to establish optimal monitoring strategies in trastuzumab treatment.
背景:曲妥珠单抗治疗与心功能障碍相关。我们在未选择的早期乳腺癌人群中评估了曲妥珠单抗治疗期间和长期后的心脏毒性发生率。方法:本研究包括回顾性部分,即化疗和曲妥珠单抗治疗期,以及前瞻性部分,即曲妥珠单抗治疗后长期的数据收集期。心脏评估包括左心室射血分数(LVEF)变化和症状性心脏毒性评估。心脏事件定义为LVEF较基线下降10个百分点,且绝对LVEF低于50%。次要结果包括评估心脏标志物(b型利钠肽和肌钙蛋白)和HER2基因的单核苷酸多态性(snp)作为检测或预测曲妥珠单抗相关心脏毒性的参数。结果:总体而言,105例患者可评估主要终点。3年累积心脏事件发生率为12% (95 CI, 4%-19%)。8例心脏事件患者均经蒽环类药物和环磷酰胺预处理,其中7例部分或完全康复。4例出现症状性心脏毒性,2例完全恢复,2例部分恢复。心脏事件与心脏标记物或snp之间无统计学意义的关联。结论:曲妥珠单抗联合炭疽临床化疗与明显且仅部分可逆的心功能障碍相关。基线LVEF值是长期LVEF的重要预测指标,特别是在未接受蒽环类化疗的患者中。这些发现可用于建立曲妥珠单抗治疗的最佳监测策略。
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引用次数: 1
Preventive Prescribing of Laxatives for Opioid-induced Constipation Using Electronic Clinical Rule Implementation by Cinical Pharmacists 临床药师应用电子临床规则预防处方阿片类药物引起的便秘
Pub Date : 2014-08-22 DOI: 10.4172/2167-1052.1000159
A. J. Scheepers-Hoeks, R. Grouls, C. Neef, Anne-Marie J Doppen, Erik H M Korsten
Objective: The objective of this study was: (1) to develop and validate an electronic clinical rule for ‘Opioid-Laxative Use’ and to implement this rule in clinical pharmacy practice; (2) to improve guideline compliance by using this refined clinical rule; and (3) to investigate if opioid-induced constipation (OIC) can be reduced in hospitalised patients by the application of this clinical rule. Methods: Interventions using clinical rule alerts were performed between June and September 2009. We compared guideline compliance before and after the intervention to determine the difference. Interventions consisted of telephone consultations by a clinical pharmacist advising physicians to add a laxative to opioid therapy. Patient files were matched to a historical control group using an opioid without a laxative to examine the difference between intervention- and control patients in the presence of OIC. Results: Prospective validation of the rule resulted in several refinements. In the intervention period, 140 alerts were generated, 60 of which (43%) led to co-prescription of a laxative. Therefore, guideline compliance increased from 70% to 83%. A significant difference in OIC was found between the intervention group (12%) and the control group (56%). Conclusions: This study showed that pharmacy intervention based on an electronic clinical rule for ´Opioid-Laxative Use´ led to more adequate co-prescription of opioids and laxatives. This led to a better compliance with the guideline as well as a better outcome, as measured by the significant decrease in the prevalence of OIC.
目的:本研究的目的是:(1)制定和验证“阿片类泻药使用”的电子临床规则,并在临床药学实践中实施该规则;(2)通过使用该改进的临床规则提高指南的依从性;(3)研究阿片类药物引起的便秘(OIC)是否可以通过应用这一临床规则来减少住院患者。方法:2009年6 - 9月采用临床规则提示进行干预。我们比较干预前后的指南依从性来确定差异。干预措施包括由临床药师电话咨询,建议医生在阿片类药物治疗中添加泻药。患者档案与使用阿片类药物而不使用泻药的历史对照组相匹配,以检查存在OIC的干预组和对照组患者之间的差异。结果:该规则的前瞻性验证导致了一些改进。在干预期间,产生了140个警报,其中60个(43%)导致共同处方泻药。因此,指南依从性从70%增加到83%。OIC在干预组(12%)和对照组(56%)之间有显著差异。结论:本研究表明,基于“阿片类泻药使用电子临床规则”的药学干预导致阿片类药物和泻药的联合处方更充分。通过OIC患病率的显著下降,这使得指南得到了更好的遵守,结果也更好。
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引用次数: 7
Effects of Drugs 药物的作用
Pub Date : 2014-08-07 DOI: 10.4172/2167-1052.1000004-R
Jhansi Konduru
Abstract Drugs are more poisons. These are very harmful to the body, when people take the drug make you feel relaxed and happy, but sometimes make people it leads to allergic, anxious finally leads to death. So that people will change the lifestyle when they have to maintain good health to control it.
药物是更多的毒药。这些都是对身体非常有害的,当人们服用药物时让你感到放松和快乐,但有时会使人导致过敏,焦虑最终导致死亡。所以人们会改变生活方式,当他们必须保持良好的健康来控制它。
{"title":"Effects of Drugs","authors":"Jhansi Konduru","doi":"10.4172/2167-1052.1000004-R","DOIUrl":"https://doi.org/10.4172/2167-1052.1000004-R","url":null,"abstract":"Abstract \u0000 \u0000Drugs are more poisons. These are very harmful to the body, when people take the drug make you feel relaxed and happy, but sometimes make people it leads to allergic, anxious finally leads to death. So that people will change the lifestyle when they have to maintain good health to control it.","PeriodicalId":7385,"journal":{"name":"Advances in Pharmacoepidemiology and Drug Safety","volume":"36 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2014-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79978711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Modelling population-level drug use with demographic and geographic approaches and techniques 用人口统计学和地理学方法和技术模拟人口层面的药物使用情况
Pub Date : 2014-06-30 DOI: 10.4172/2167-1052.1000158
F. Janssen, E. Hak
Within the field of pharmacoepidemiology and drug safety as in the wider field of epidemiology focus has been on individual-level studies. However, the impact of drug use for the society as a whole cannot directly be inferred from such studies and population-level causal designs are required. For example, for health policy it is crucial to know the role of drugs in affecting regional, national or international morbidity and mortality trends. Similarly, predicting (future) levels of local health care and drug use is essential for prevention purposes, targeted allocation of care and meeting health demands. Moreover, actual end users of drugs in society may largely differ from clinical trial populations [1,2] used to study the efficacy of drugs for registration purposes [3].
在药物流行病学和药物安全领域,正如在更广泛的流行病学领域一样,重点一直放在个人水平的研究上。然而,药物使用对整个社会的影响不能直接从这些研究中推断出来,需要进行人口一级的因果设计。例如,就卫生政策而言,至关重要的是要了解药物在影响区域、国家或国际发病率和死亡率趋势方面的作用。同样,预测(未来)当地保健和药物使用水平对于预防目的、有针对性地分配保健和满足保健需求至关重要。此外,社会中药物的实际最终用户可能与用于研究药物注册疗效的临床试验人群[1,2]存在很大差异[3]。
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引用次数: 0
Pharmacologic Management of Non-Alcoholic Fatty Liver Disease 非酒精性脂肪肝的药物治疗
Pub Date : 2014-06-30 DOI: 10.4172/2167-1052.1000157
G. Goh, S. Dasarathy, A. McCullough
Background: Non-alcoholic fatty liver disease (NAFLD) is a common complex chronic liver disease that encompasses a spectrum of disease from simple steatosis to non-alcoholic steatohepatitis (NASH). NASH has the potential to progress to advanced fibrosis and cirrhosis and is associated with increased morbidity and mortality. Currently, there are no definitive universally accepted treatment options available for NASH. Most pharmacological agents that have been investigated are limited by inconsistent efficacy or side effects. We reviewed the current literature on the principle drugs that have been tested for NAFLD in the adult population, with special emphasis on clinical data and safety profiles. Methods: A comprehensive PUBMED/MEDLINE search was conducted to identify principal therapeutic intervention studies for NAFLD, from which a summary of the studies were formulated in this review. Results: A variety of studies, including retrospective, open-label and randomised controlled trials were reviewed in terms of clinical efficacy and side effect profiles. In addition to the most commonly studied therapeutic agents (insulin sensitizers, vitamin E, pentoxifylline, UDCA, PUFA, statins and ezetimibe), emerging pharmacologic agents showing potential efficacy in NAFLD were also explored. Conclusion: Based on risk-benefit profiles, pentoxifylline seems to have the best treatment outcomes currently, with significant improvement in histology while having minimal tolerable side effects. Further clinical research is warranted to understand and improve our repertoire of treatment options, including potential combination therapy, towards this complex disease.
背景:非酒精性脂肪性肝病(NAFLD)是一种常见的复杂慢性肝病,包括从单纯性脂肪变性到非酒精性脂肪性肝炎(NASH)的一系列疾病。NASH有可能发展为晚期纤维化和肝硬化,并与发病率和死亡率增加相关。目前,NASH还没有被普遍接受的治疗方案。大多数已被研究的药理学制剂都受到不一致的疗效或副作用的限制。我们回顾了目前在成人NAFLD中测试的主要药物的文献,特别强调了临床数据和安全性。方法:对PUBMED/MEDLINE进行全面检索,以确定NAFLD的主要治疗干预研究,并在本综述中对这些研究进行总结。结果:在临床疗效和副作用方面回顾了各种研究,包括回顾性、开放标签和随机对照试验。除了最常用的治疗药物(胰岛素增敏剂、维生素E、己酮茶碱、UDCA、PUFA、他汀类药物和依折替米布)外,研究人员还探索了对NAFLD具有潜在疗效的新兴药物。结论:基于风险-收益分析,己酮茶碱目前似乎具有最好的治疗效果,组织学有显著改善,副作用最小。进一步的临床研究是必要的,以了解和改进我们的治疗方案,包括潜在的联合治疗,针对这种复杂的疾病。
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引用次数: 4
Periodic Safety Update Reporting of Newly Launched Drugs through Hospitals–Need of the Hour: A Drug Controller General of India Initiative 通过医院定期发布新上市药物的安全更新报告——时效性需要:印度药品管制总干事倡议
Pub Date : 2014-05-30 DOI: 10.4172/2167-1052.1000155
Alkesh K Lokh, M. Prabhu, M. Unnikrishnan, G. Thunga, M. S. Rajan
A Periodic Safety Update Report (PSUR) is comprise of most complete safety experience of drug submitted to the competent drug regulatory authorities at defined period of time. In India, PSURs for all newer drugs must be submitted every six month for first two years followed by annually for next two years to the Drug Controller General of India [DCG(I)], New Delhi. So far, it’s been mandatory only to Marketing Authorization Holders (MAHs) to submit PSURs periodically to DCG(I), New Delhi. But, since 28 August 2012 DCG(I) has made it mandatory for hospitals in India to implement PSUR system for newly introduced drugs. In country like India where, lots of irregularity seen in safety surveillance of patients. We have very less active Adverse Drug Reaction (ADR) monitoring centers in function and a lot of determination is needed in order to collect drug safety data which may be carried out through active safety surveillance of therapeutic agents. Thus it has become important to comply with the requirement of DCG(I) and address the safety concern of our hospitalized patients. PSUR is the need of the hour to in our hospitals. We have to take steps for monitoring patients who are on newly introduced drugs and generate data for the reporting of PSURs to the DCG(I). This pioneering hospital based PSUR setup will create an environment for healthy safety reporting and helps the regulatory authorities for drug safety related decisions.
定期安全更新报告(PSUR)包括在规定的时间内提交给主管药品监管机构的最完整的药物安全经验。在印度,所有新药的psur必须在头两年每六个月提交一次,然后在接下来的两年每年提交一次,提交给位于新德里的印度药品监督总局[DCG(I)]。到目前为止,只有营销授权持有人(mah)必须定期向新德里DCG(I)提交psur。但是,自2012年8月28日以来,DCG(I)已强制要求印度的医院对新引入的药物实施PSUR系统。在印度这样的国家,在对病人的安全监测中发现了很多不正常的现象。活跃的药物不良反应(ADR)监测中心很少,需要进行大量的测定,以收集药物安全数据,这些数据可以通过对治疗药物的主动安全监测来进行。因此,遵守DCG(I)的要求,解决住院患者的安全问题变得非常重要。PSUR是我们医院最需要的。我们必须采取措施,监测使用新引进药物的患者,并生成数据,向DCG(I)报告PSURs。这种开创性的基于医院的PSUR设置将为健康安全报告创造一个环境,并帮助监管机构做出与药物安全相关的决策。
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引用次数: 1
Review on Birth Control Drugs 节育药物综述
Pub Date : 2014-05-29 DOI: 10.4172/2167-1052.1000R002
Jhansi Konduru, P. Vanita
Birth control drugs are those which can prevent the pregnancy. In some times people do not want to get pregnancy, in these cases they want to use by doctors prescription. Birth control drugs have many medical uses for women. Sometimes these are harmful. So we can use by drugs within limit, proper suggestion from doctors only.
避孕药是那些可以防止怀孕的药物。有时人们不想怀孕,在这些情况下,他们想使用医生的处方。避孕药对妇女有许多医疗用途。有时这些是有害的。所以我们可以在限度内使用药物,只有医生的适当建议。
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引用次数: 1
The Missing Voice of Non-Serious Adverse Drug Reactions from Marketing Authorisation Holders 上市许可持有人的非严重药物不良反应缺失的声音
Pub Date : 2014-05-18 DOI: 10.4172/2167-1052.1000154
Jindřich Srba
New pharmacovigilance legislation (Regulation (EU) No. 1235/2010 and Directive 2010/84/EU) was adopted by the European Parliament in December 2010. The European Medicines Agency (EMA) is responsible for implementing much of the new legislation, which has been effective since July 2012. One of the impacts concerned to marketing authorisation holders (MAH) is to submit adverse drug reaction (ADR) reports only into EudraVigilance, a safety database superintended by EMA.
欧洲议会于2010年12月通过了新的药物警戒立法(法规(EU) No 1235/2010和指令2010/84/EU)。欧洲药品管理局(EMA)负责实施大部分新法规,该法规自2012年7月起生效。上市许可持有人(MAH)关注的影响之一是仅向EMA监管的安全数据库EudraVigilance提交药物不良反应(ADR)报告。
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引用次数: 2
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Advances in Pharmacoepidemiology and Drug Safety
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