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1.
OBJECTIVE: The purpose of this study was to evaluate the efficacy of contrast-enhanced gray scale transrectal ultrasonography (TRUS) for detection of prostate cancer in peripheral zone hypoechoic lesions of the prostate. METHODS: The study involved 66 patients with peripheral zone hypoechoic lesions detected by TRUS. The lesions were evaluated with contrast-enhanced TRUS to differentiate prostate cancer from benign lesions, and the results were compared with color Doppler ultrasonographic findings. RESULTS: Transrectal ultrasonographically guided biopsy of the hypoechoic lesions revealed prostate cancer in 30 patients and benign prostatic diseases in 36. Flow signals within the lesions were classified as no, increased, equal, and decreased flow compared with surrounding peripheral zone tissue as follows: 1, 16, 12, and 1, respectively, in the prostate cancer group and 10, 12, 10, and 4 in the benign disease group. If we considered an increased flow signal within a peripheral hypoechoic lesion as a sign of prostate cancer, color Doppler ultrasonography had low sensitivity and specificity (55.2% and 53.8%, respectively). The enhancement intensity within the lesions was classified as no, increased, equal, and decreased enhancement compared with surrounding peripheral zone tissue as follows: 2, 20, 3, and 5 in the prostate cancer group and 14, 8, 4, and 10 in the benign disease group. The difference was statistically significant (P<.05). Thus, the peak enhancement intensity would be the optimal parameter for discriminatory performance (area under the receiver operating characteristic curve, 0.74; 95% confidence interval, 0.60-0.88). CONCLUSIONS: Contrast-enhanced TRUS could reveal the presence of vasculature within peripheral zone hypoechoic lesions more objectively than color Doppler ultrasonography and could be promising in guidance of prostate biopsy.  相似文献   

2.
目的回顾性总结无症状性炎性前列腺炎(asymptomatic inflammatory prostatitis,AIP)的临床和声像图特征。 方法1468例次患者因为怀疑前列腺癌而行经直肠超声引导前列腺穿刺活检,其中84例确诊为AIP。 结果59例血清前列腺特异性抗原增高(〉4ng/ml),占70.2%(59/84),范围为4.3~45.3ng/ml,平均17.3ng/ml;32例声像图显示前列腺外腺有局限性低回声病灶,4例为外腺弥漫性低回声病变,另外48例声像图未发现前列腺外腺病灶。 结论AIP患者可以出现前列腺外腺低回声病变,但大部分患者前列腺外腺无声像图异常,AIP的最终确诊仍然需要前列腺液检查或穿刺活检。  相似文献   

3.
经直肠超声检查对前列腺癌穿刺点选择的价值   总被引:11,自引:0,他引:11  
目的:探讨经直肠超声(transrectal ultrasonography,TRUS)对前列腺穿刺活检选点的价值。方法:135例前列腺穿刺活检患者术前行TRUS检查,对324个穿刺部位的声像图与病理结果对照分析。结果:324个穿刺部位病理证实为前列腺癌的120个,前列腺增生症175个,前列腺炎29个。在120个前列腺癌部位TRUS发现异常回声结节、局部血流增多等异常目标的有86个,无异常目标的为34个。TRUS检查对前列腺癌穿刺选点的敏感性71.7%(86/120),特异性76.5%(156/204)。结论:TRUS有助于前列腺癌穿刺活检的选点。  相似文献   

4.
OBJECTIVE: The purpose of this study was to compare cancer detection rates of sonographically suspicious lesion-directed biopsies and random biopsies through transverse examination of prostate halves in 518 patients over 5 years. METHODS: From 1998 to 2002, 518 patients were referred for prostate biopsies because of either elevated prostate-specific antigen (PSA) levels or abnormal digital rectal examination findings. On the basis of transverse examination of prostate halves by transrectal ultrasound, we performed lesion-directed biopsy of 3 to 5 cores if morphologically suspicious lesions existed on sonography or random biopsy of 3 cores if no obvious suspicious lesions existed. Biopsy specimens were put into 2 labeled containers. Pathologic results were correlated with random and lesion-directed guided locations. RESULTS: Nine-hundred fifty-nine results were obtained from 439 random and 520 lesion-directed biopsies in 518 patients. Cancer was detected in 207 patients (40.7%). Patients with cancer who had PSA levels of 10.0 ng/mL or greater had higher proportions of bilateral cancer lesions than those with PSA levels of less than 10 ng/mL (P = 0.03). One hundred ten (25.1%) of 439 normal-appearing halves taken by random biopsy were tumor-positive compared with 200 (38.5 %) of 520 biopsies from halves with sonographically suspicious lesions. Regardless of having random or lesion-directed biopsies, patients with PSA levels of 10 ng/mL or greater had higher positive malignancy rates than those with PSA levels of less than 10.0 ng/mL (P < .001). In about 40 patients, a diagnosis was made by random biopsy from halves that were morphologically normal on sonography, not by lesion-directed biopsy from tumor-suspicious contralateral halves. CONCLUSIONS: Cancer detection rates of lesion-directed biopsies are superior to those of random biopsies regardless of PSA level.  相似文献   

5.
目的 探讨经直肠超声引导自动活检在前列腺占位性病变诊断中的应用。方法 利用自动活检枪 ,在超声引导下 ,经直肠对前列腺进行自动活检。结果 阳性率 85 .5 % ,其中前列腺恶性肿瘤 15例 (2 4.2 % ) ,恶性淋巴瘤 2例 (3 .2 % ) ,前列腺平滑肌肉瘤 1例 (1.6% ) ,良性前列腺增生 2 1例 (3 3 .9% ) ,前列腺上皮内瘤 2例 (3 .2 % ) ,急性脓肿 1例 (1.6% ) ,结核 1例 (1.6% ) ,慢性前列腺炎 10例 (16.1% )。结论 经直肠超声引导自动活检操作简便 ,病人几乎无痛苦 ,取材准确可靠  相似文献   

6.
目的探讨经直肠超声引导下前列腺穿刺活检对前列腺特异抗原(PSA)<4ng/ml前列腺癌诊断的临床价值。方法59例PSA<4ng/ml疑为前列腺癌的患者行经直肠超声引导下前列腺多点穿刺活检,观察前列腺内结节声像图特点,并病理分级,对照分析活检术式的检出情况。结果59例患者中经病理证实前列腺癌16例,检出率为27%,其中12例声像图显示前列腺结节性病变,均分布于外腺,且血流增加较良性病变及癌前病变高。结节区域定点穿刺的检出率较六点系统穿刺活检术高(P<0.05);活检阳性点数占所有活检点数比率为51.2%,病理分级中分化程度占56.25%,低分化程度占31.25%。结论结合经直肠超声声像图和前列腺多点穿刺活检可提高PSA<4ng/ml的前列腺癌检出率,对前列腺癌的早期诊断非常必要。  相似文献   

7.
经直肠超声引导下穿刺活检诊断前列腺肉瘤   总被引:2,自引:0,他引:2  
目的探讨经直肠超声(TRUS)引导下穿刺活检在前列腺肉瘤中的诊断价值.方法回顾分析996例疑患前列腺癌者经直肠超声引导下穿刺活检后病理证实的6例前列腺肉瘤的临床资料.结果 4例表现为前列腺内低回声病灶,2例为弥漫性病灶,经直肠超声引导下穿刺活检3例诊断为前列腺横纹肌肉瘤,1例为平滑肌肉瘤,1例为神经源性肉瘤,1例为梭形细胞肉瘤.结论经直肠超声引导下前列腺穿刺活检安全性好、准确性高,是诊断前列腺肉瘤的有效方法之一.  相似文献   

8.
的探讨经直肠超声引导下前列腺系统穿刺与磁共振可疑病灶靶向穿刺在前列腺癌活检中的价值。方法回顾性分析2011年9月至2013年9月浙江大学医学院附属第二医院行经直肠超声引导下前列腺穿刺的患者共181例。所有181例患者均行经直肠超声引导下前列腺系统穿刺,其中116例患者磁共振检查时发现可疑病灶而行靶向穿刺。穿刺活检病理检查诊断为前列腺癌97例,前列腺增生84例。采用χ2检验比较经直肠超声引导下前列腺系统穿刺与磁共振可疑病灶靶向穿刺的前列腺癌检出率差异;以穿刺活检病理诊断结果作为金标准,计算经直肠超声引导下前列腺系统穿刺、磁共振可疑病灶靶向穿刺诊断前列腺癌的敏感度、特异度、准确性、阳性预测值及阴性预测值并采用χ2检验进行比较。结果 181例患者穿刺共检出前列腺癌97例,检出率为53.6%(97/181)。其中,经直肠超声引导下前列腺系统穿刺检出前列腺癌63例,检出率为34.8%(63/181);磁共振可疑病灶靶向穿刺检出前列腺癌81例,检出率为44.8%(81/181);磁共振可疑病灶靶向穿刺的前列腺癌检出率高于经直肠超声引导下前列腺系统穿刺,且差异具有统计学意义(χ2=34.830,P=0.015)。其中,经直肠超声引导下前列腺系统穿刺漏诊34例前列腺癌,磁共振可疑病灶靶向穿刺漏诊16例前列腺癌,分别占检出前列腺癌的35.1%(34/97)及16.5%(16/97)。181例患者共穿刺1 896针,其中经直肠超声引导下前列腺系统穿刺1 448针,磁共振可疑病灶靶向穿刺448针。经直肠超声引导下前列腺系统穿刺诊断前列腺癌的敏感度为71.8%(224/312),特异度为22.7%(360/1 584),准确性为30.80%(584/1 896),阳性预测值为15.5%(224/1 448),阴性预测值为80.4%(360/448);磁共振可疑病灶靶向穿刺诊断前列腺癌的敏感度为89.8%(280/312),特异度为87.4%(1 384/1 584),准确性为87.8%(1 664/1  相似文献   

9.
During the past 10 years, it has been suggested, and accepted by some, that transrectal ultrasound (TRUS) of the prostate should be used to identify a hypoechoic lesion or, if needed, guide biopsy into nonspecific areas. Retrospectively, the authors attempted to evaluate the need to identify areas that were on pathologic analysis, prostate cancer, but were not hypoechoic, but would require random/systematic biopsy to exclude prostate cancer. Six-hundred fifteen consecutive men were referred to the authors because of a concern found on digital rectal examination or because of increase in prostate-specific antigen. All patients underwent TRUS-guided biopsy of the prostate using either the four-quadrant or sextant biopsy technique. Each area undergoing biopsy was characterized as: 1) normal-appearing; 2) hypoechoic; 3) mixed echogenic (containing both hypoechoic and hyperechoic elements); 4) subtly hyperechoic (containing no calculi); or 5) isoechoic (lesion was seen because of distortion of the normal architecture). A diagnosis of carcinoma was made in 197 patients (32%). Of these, 99 (50.2%) patients had a hypoechoic lesion as the primary site, corresponding to their highest Gleason grade. Twenty-five (12.7%) had mixed echogenicity, nine (4.6%) had hyperechoic foci, and 23 (11.7%) had isoechoic biopsy-proven foci of prostate cancer. Forty-one (20.8%) patients with adenocarcinoma had normal ultrasound findings. The median Gleason grade for cancer in visible mixed echogenic and hyperechoic areas were generally higher than that for cancer in hypoechoic sites. Hypoechoic cancer sites had a Gleason grade range of 2 to 10 (median 5); mixed echogenic foci had a Gleason range of 2 to 10 (median 6); hyperechogenic cancers had a Gleason range of 2 to 8 (median 6); isoechoic cancers had a Gleason range of 2 to 7 (median 5); normal foci had a Gleason range of 2 to 8 (median 5). Results of this study suggest that 50% of clinically significant prostate cancers are not purely hypoechoic, and 37% of all diagnosed cancers contain no hypoechoic elements.  相似文献   

10.
经直肠超声引导经会阴前列腺穿刺活检术安全性评估   总被引:2,自引:2,他引:2  
目的评价经直肠超声引导下经会阴前列腺穿刺活检术的安全性.方法对60例临床疑前列腺癌患者行经直肠超声引导经会阴前列腺穿刺活检术并随访分析术后并发症情况.随访内容包括术中疼痛和术后感染、血尿、血精、血便、排尿困难等.结果 60例患者术后出现并发症的36例(60%).其中单纯血尿28例(77.7%);血尿伴血精3例(8.3%);血尿伴排尿困难3例(8.3%);血尿伴会阴穿刺处出血2例(5.6%).60例患者术中出现明显疼痛的7例(11.7%).结论经直肠超声引导经会阴前列腺穿刺活检术是一种安全可靠的前列腺活检方法,与经直肠穿刺方法相比,该法降低了术后感染和直肠出血等严重并发症的发生率.  相似文献   

11.
The purpose of this study was to assess the effectiveness of transrectal ultrasonographically guided needle aspiration in the treatment of prostatic abscess. Fourteen patients with prostatic abscess were evaluated with this technique and treated with sonographically guided needle aspiration. Using this technique, all cases (100%) had one or more hypoechoic areas within the prostate that contained inhomogeneous materials; in 10 patients (71.0%), the lesion showed internal septa or solid portion. The margins of the hypoechoic area were well defined and thick in 11 patients (79.0%) and poorly defined in 3 patients (21.0%). The estimated volume of the prostatic abscess ranged between 2 and 28 ml (mean, 12.0 ml). The presence of a pus collection within the prostate was confirmed by transrectal ultrasonographically guided aspiration in all patients. However, successful treatment of prostatic abscess with transrectal needle aspiration was done in 12 (86.0%) of 14 patients; the treatment failed in 2 (14.0%) of 14 patients. One patient was treated with perineal incision and drainage and the other with transurethral resection. The amount of pus drained ranged between 1 and 39 ml (mean, 12.0 ml). On follow-up transrectal ultrasonographic examination, no remaining abscess pocket was found within the prostate in any of the cases. One year later, the prostatic abscess recurred in one case. In conclusion, transrectal ultrasonographic guidance is useful in the diagnosis of prostatic abscess as well as in the guidance for aspiration and the drainage of such abscesses. Transrectal ultrasonographically guided needle aspiration could be an effective method for treating prostatic abscess.  相似文献   

12.
We report a rare case of infective granulomatous prostatitis caused by Mycobacterium tuberculosis that may be mistaken for prostatic carcinoma, both on clinical examination and transrectal sonography (TRUS). A large hypoechoic mass was detected in the prostate of a 46-year-old man during TRUS and histopathologic examination after TRUS-guided biopsies reported the diagnosis of tuberculous prostatitis. We herein describe the clinical and TRUS findings of this case.  相似文献   

13.
目的 探讨经直肠彩色多普勒超声对前列腺周缘区低回声结节良恶性诊断的价值。方法 对77例前列腺周缘区低回声结节行经直肠彩色多普勒超声探测,利用彩色直方图软件计算结节内彩色血流面积与选定结节面积比值(black and white color ratio,BCR)和整个前列腺血流BCR并比较二者的BCR,如结节内BCR高于整个前列腺内5%则为血流增多。结果 77例前列腺周缘区低回声结节穿刺活检证实前列腺癌51例,前列腺增生症26例。周缘区低回声内血流增多共50例,其中前列腺癌41例。经直肠彩色多普勒超声检查结节内血流增加对诊断前列腺癌的敏感性、特异性、阳性预测值分别为80.4%,65.4%,82.0%。结论 经直肠彩色多普勒超声检查前列腺周缘区低回声结节内血流并用BCR解释其丰富程度对结节良恶性的鉴别诊断有一定帮助。  相似文献   

14.
目的探讨经直肠超声造影在鉴别诊断前列腺良恶性病灶中的应用价值。 方法回顾性分析2014年1月至2016年12月在第三军医大学西南医院行经直肠超声造影检查的72例前列腺疾病患者共88个病灶。所有患者均经超声引导下经直肠前列腺穿刺活检确诊。采用独立样本t检验比较前列腺癌与前列腺良性疾病患者前列腺体积、前列腺内腺体积。以超声引导下经直肠前列腺穿刺活检病理结果作为诊断"金标准",计算经直肠超声造影诊断前列腺病灶良恶性的敏感度、特异度、准确性。 结果本组72例前列腺疾病患者中,52例为前列腺良性疾病患者共67个病灶,20例为前列腺癌患者共21个病灶。前列腺癌患者与前列腺良性疾病患者前列腺体积、前列腺内腺体积差异均无统计学意义[(58.33±34.99)cm3 vs (57.14±24.42)cm3,t=0.185,P=0.854;(34.98±19.96)cm3 vs (33.89±17.65)cm3,t=0.213,P=0.832]。前列腺癌病灶多位于前列腺外腺区(15/21),其超声造影特征多为动脉期呈高增强,且造影剂消退较周围正常组织迅速(16/21);前列腺良性病灶多位于前列腺内腺区(47/67),其超声造影特征多为动脉期等增强,且静脉期与周围正常组织同时消退(47/67)。以超声引导下经直肠前列腺穿刺活检病理结果作为诊断"金标准",经直肠超声造影诊断前列腺病灶良恶性的敏感度为85.71%,特异度为91.04%,准确性为89.77%。漏诊的3个前列腺癌病灶中,2个位于前列腺内外腺交界区,且Gleason评分均为中高分化。误诊的6个前列腺良性病灶,超声引导下经直肠前列腺穿刺活检病理证实5个为前列腺增生伴慢性炎症,1个为肉芽肿性炎伴凝固性坏死。 结论经直肠超声造影能有效鉴别前列腺良恶性病灶,可为前列腺癌的准确诊断提供可靠信息。  相似文献   

15.
OBJECTIVE: The purpose of this investigation was to study the correlation between hypoechoic nodules detected on ultrasonography and benign hyperplasia in the prostatic outer gland (POG) diagnosed by transrectal ultrasonography (TRUS)-guided biopsies. METHODS: The TRUS-guided biopsies were performed on 472 patients suspected of having prostate cancer. Specimens obtained by biopsies were independently assessed by pathologists at 3 hospitals. RESULTS: The histologic results of 310 patients (65.68%) were benign. Focal hypoechoic nodules located in the POG were found in 240 patients (50.8%) on TRUS scans. Among them, in 22 patients (9.17% of the 240 patients with hypoechoic nodules), benign hyperplasia was found in focal hypoechoic nodules located in the POG. Focal nodules were seen as well circumscribed with an ovoid shape and smooth surface in 18 patients. CONCLUSIONS: Benign hyperplasia may sometimes originate in the POG and may appear as a hypoechoic nodule, similar to the appearance of prostate cancer.  相似文献   

16.
Transrectal ultrasound appearance of granulomatous prostatitis   总被引:1,自引:0,他引:1  
Granulomatous prostatitis is an uncommon condition that can masquerade as prostatic carcinoma on both digital rectal exam and prostate ultrasound. It occurs most often after acute urinary tract infection, transurethral prostate resection, or needle biopsy. It can be seen in systemic granulomatous diseases and after intravesical bacillus Calmette-Guerin (BCG) therapy for bladder carcinoma. In some cases it is idiopathic. Six patients who underwent transrectal ultrasound of the prostate and subsequent transrectal ultrasound-guided biopsy had histologic diagnosis of granulomatous prostatitis. One patient was undergoing BCG therapy for bladder cancer. Two patients had recent urinary tract infections. The other three patients had no known predisposing conditions. Sonographically, the glands were enlarged in five patients, with multiple large and small hypoechoic zones throughout the peripheral, transition, and central zones. The appearance was similar to that seen in diffuse prostatic carcinoma. In one patient, a solitary hypoechoic lesion in the peripheral zone, indistinguishable from carcinoma, was present. Granulomatous prostatitis should be considered in the differential diagnosis of focal and diffuse abnormality with prostatic ultrasound.  相似文献   

17.
The purpose of this study was to assess the role of color Doppler ultrasonography and power Doppler ultrasonography in the identification of diffuse prostatic lesions. Forty male patients underwent gray scale transrectal ultrasonography, color and power Doppler sonography, and transrectal ultrasonographically guided biopsy. Transrectal ultrasonographically guided biopsy revealed cancer in 23 patients and benign lesions in 17 patients. Among the prostatic cancers 82.6% (19 of 23) showed increased flow signals, whereas 23.5% (four of 17) of benign lesions showed increased flow signals on color or power Doppler ultrasonography. If we consider increased flow signal on color or power Doppler sonography as a sign of a prostate cancer in diffuse prostatic lesions, these modalities have a sensitivity of 82.6%, specificity of 76.5%, and positive predictive value of 82.6%. On the basis of our study, we may conclude that color and power Doppler ultrasonography are useful in the identification of diffuse prostatic lesions.  相似文献   

18.
Objective. Mapping of transrectal ultrasonographic (TRUS) prostate biopsies is of fundamental importance for either diagnostic purposes or the management and treatment of prostate cancer, but the localization of the cores seems inaccurate. Our objective was to evaluate the capacities of an operator to plan transrectal prostate biopsies under 2‐dimensional TRUS guidance using a registration algorithm to represent the localization of biopsies in a reference 3‐dimensional ultrasonographic volume. Methods. Thirty‐two patients underwent a series of 12 prostate biopsies under local anesthesia performed by 1 operator using a TRUS probe combined with specific third‐party software to verify that the biopsies were indeed conducted within the planned targets. Results. The operator reached 71% of the planned targets with substantial variability that depended on their localization (100% success rate for targets in the middle and right parasagittal parts versus 53% for targets in the left lateral base). Feedback from this system after each series of biopsies enabled the operator to significantly improve his dexterity over the course of time (first 16 patients: median score, 7 of 10 and cumulated median biopsy length in targets of 90 mm; last 16 patients, median score, 9 of 10 and a cumulated median length of 121 mm; P = .046). Conclusions. In addition to being a useful tool to improve the distribution of prostate biopsies, the potential of this system is above all the preparation of a detailed “map” of each patient showing biopsy zones without substantial changes in routine clinical practices.  相似文献   

19.
OBJECTIVE: Large-core needle biopsy of the breast can be performed with stereotactic or ultrasonographic guidance. However, ultrasonographically guided large-core needle biopsy has notable advantages, including the absence of ionizing radiation, increased patient comfort, and greater cost-effectiveness. The purpose of this study was to evaluate the accuracy of ultrasonographically guided large-core needle biopsy for the diagnosis of breast cancer in palpable and nonpalpable breast masses. METHODS: The study was a retrospective review of consecutive ultrasonographically guided large-core needle biopsies for indeterminate breast masses. A total 424 ultrasonographically guided core biopsies were performed in 367 patients with 1 or more breast masses. Ultrasonographically guided core biopsy was performed with a 14-gauge spring-loaded needle and a freehand technique. Correlation of ultrasonographically guided core biopsy pathologic findings with subsequent surgical pathologic findings or long-term imaging follow-up was performed. RESULTS: Of 424 indeterminate breast lesions for which histopathologic findings were obtained by ultrasonographically guided core biopsy, 234 cancers were diagnosed. Twenty-eight additional lesions had either questionable but not definitively malignant pathologic features (n = 11) or radiologic-pathologic discordance (n = 17) and were surgically excised. Of these, 8 additional cancers were diagnosed. Patients or surgeons chose excision of 41 additional lesions that were benign on ultrasonographically guided core biopsy No cancer was found in these surgical specimens. One additional cancer was diagnosed at a 6-month imaging follow-up because of interval growth. On the basis of surgical and long-term imaging follow-up, the sensitivity of ultrasonographically guided core biopsy for the diagnosis of breast carcinoma was 99.2% (95% confidence interval, 95.6%-99.9%) in 173 palpable breast masses and 93.2% (95% confidence interval, 87.1%-97%) in 251 nonpalpable masses. In cancers diagnosed on the basis of immediate surgical excision as a result of ultrasonographically guided core biopsy that showed either questionable pathologic features or radiologic-pathologic discordance, the sensitivity of ultrasonographically guided core biopsy for the diagnosis of breast cancer was 99.2%. CONCLUSIONS: Ultrasonographically guided large-core needle biopsy is a sensitive percutaneous biopsy method for the diagnosis of breast cancer in palpable and nonpalpable breast masses.  相似文献   

20.
前列腺癌的超声表现与组织结构   总被引:8,自引:0,他引:8  
目的:探讨前列腺癌的超声表现与组织结构改变的关系。提高前列腺癌的超声诊断水平。方法:对71例经病理证实为前列腺腺癌的病例做前列腺超声的研究。采用前列腺超声表现与前列腺穿刺活检病理学检查的对照研究方法。结果:71例前列腺腺癌其中47例(66.20%)表现为或多个低回声结节,12例(16.90%)为均质回声无结节,9例(12.68%)为混合回声,3例(4.22%)为强回声改变。作者发现前列腺癌回声不同,但在组织构直没有明显差异,只是强回声癌改变有明显的间质纤维化。结论:前列腺腺癌的回声表现多样化,但组织结构没有明显差别。  相似文献   

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