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1.
Objective To analyze the clinical outcome of PD related peritonitis in our center. Methods All patients who developed PD related peritonitis between January 2004 and December 2010 in Renji Hospital of Shanghai Jiao Tong University School of Medicine were included. Outcomes of PD related peritonitis were analyzed. Results A total of 220 patients developed 371 episodes of PD related peritonitis during the study period in our center, and the average peritonitis rate was one episode per every 54.4 patient-months. Among the 371 episodes of peritonitis, 285 (76.8%) episodes had been cured, 17 (4.6%) episodes had needed temporary hemodialysis (HD), 46 (12.4%) episodes had led to switch to permanent HD and 21 (5.7%) episodes had caused death. After refractory peritonitis, there was a significant reduction of 4 h ultrafiltration (330 vs 270 ml, P=0.036) and an increase tendency of 4h D/Pcr (0.55±0.08 vs 0.58±0.10, P=0.086). Conclusions Peritoneal dialysis related peritonitis is an important contributor to technique failure and death in Chinese PD patients. Refractory peritonitis might injure peritoneal membrane function.  相似文献   

2.
目的探讨腹膜透析相关性腹膜炎的致病菌和耐药性,及其与转归之间的关系。方法回顾性分析169例次腹膜透析相关性腹膜炎的临床资料、致病菌与耐药性,探讨其与转归的联系。结果116例次培养阳性,培养总阳性率达68.6%,近5年高达87.7%。致病菌中G^+球菌占58例次(50%),G^-杆菌45例次(38.8%),真菌6例次(5.2%),G^+杆菌、G^-球菌及混合感染7例(6%)。G^+球菌中最常见为葡萄球菌(56.8%);G^-杆菌中大肠杆菌阳性率最高(62.2%)。从耐药性看,G^-杆菌对氨苄西林的耐药率最高(76.7%),对阿米卡星和哌拉西林/他唑巴坦的耐药率较低(2.9%、3.4%)。G^+球菌对万古霉素均敏感,对利福平和哌拉西林/他唑巴坦的耐药率较低(2.1%、7.9%)。腹膜炎致持续非卧床腹膜透析(CAPD)退出率为10.1%(17/169),以真菌腹膜炎为主。结论近5年本中心培养阳性率较高,及时采用血培养瓶留取标本很关键。G^-杆菌对阿米卡星和哌拉西林/他唑巴坦较敏感,而万古霉素、利福平和哌拉西林/他唑巴坦宜作为抗G^+球菌的经验用药。真菌性腹膜炎是导致腹膜透析退出的主要原因。  相似文献   

3.
腹膜透析相关性腹膜炎经验用药分析   总被引:1,自引:0,他引:1  
目的 研究华山医院及宝山分院腹膜透析(腹透)相关性腹膜炎的致病菌、耐药性及患者转归,为临床经验用药提供依据。 方法 回顾性分析2007年1月至2010年1月上述两医院腹透中心收治的93例腹透相关性腹膜炎的临床表现、致病菌、耐药性及转归。 结果 75例腹透液培养阳性,阳性率为80.2%,其中革兰阳性球菌45例,革兰阴性杆菌21例,真菌2例,革兰阳性杆菌1例,革兰阴性球菌1例,多种菌混合感染5例。革兰阳性球菌主要以凝固酶阴性的葡萄球菌为主,所有革兰阳性球菌对万古霉素均敏感,但对头孢唑林耐药率高达60.0%,而且耐药率有明显的逐年增加趋势。革兰阴性菌对头孢他啶的耐药率达到46.1%,所有革兰阴性杆菌对亚胺培南均敏感。因腹膜炎而退出腹膜透析有16例,退出率为17.2%(16/93)。腹腔使用万古霉素对残肾功能无显著影响。 结论 两院腹透中心腹透相关腹膜炎致病菌以革兰阳性球菌为多数。头孢唑啉耐药性逐年增高,目前不再适合作为初始治疗的经验用药。腹腔使用万古霉素可推荐作为革兰阳性菌致腹膜炎的初始经验用药。  相似文献   

4.
腹膜透析相关性腹膜炎抗生素初始治疗方案探讨   总被引:1,自引:0,他引:1  
目的 探讨头孢唑啉联合头孢他啶与万古霉素联合头孢他啶作为腹膜透析相关性腹膜炎初始治疗的效果。 方法 回顾性分析2006年1月至2009年5月在北京大学第三医院收治的合并腹膜透析相关性腹膜炎的患者90例。其中37例次采用头孢唑啉+头孢他啶治疗,97例次采用万古霉素+头孢他啶治疗。比较其初始治疗的有效率、最终转归、细菌培养和药物敏感试验情况。 结果 头孢唑啉+头孢他啶组患者腹膜炎的初始治疗有效率为81.1%,万古霉素+头孢他啶组为86.2%,两组间差异无统计学意义(P > 0.05);两组患者的G+细菌感染分别为56.8%和50.5%,差异无统计学意义(P > 0.05);两组患者在发病3周后治愈率分别为91.9%和97.9%,差异无统计学意义(P > 0.05)。 结论 头孢唑啉联合头孢他啶与万古霉素联合头孢他啶均可以作为腹膜透析相关性腹膜炎的初始治疗方案,且疗效相当。  相似文献   

5.
Objective To compare the efficacy of different antibiotics strategy, introperitoneal (IP) cefazolin plus third-generation cephalosporin versus IP Vancomycin plus third-generation cephalosporin on peritoneal dialysis (PD)-related peritonitis. Methods All episodes of PD-associated peritonitis happened in prevalent PD patients between January 2008 and December 2012 were recruited from the PD Center of Peking University First Hospital. According to their empiric antibiotics scheme, episodes were divided into group A (where IP cefazolin plus third-generation cephalosporins were administrated) and group B (where IP Vancomycin plus third-generation cephalosporins were administrated). Multivariable logistic regression model was used to explore the influence of different empiric antibiotics scheme on peritonitis outcome. Results Patients in Group B had significantly lower level of serum albumin (33.5±6.0 vs 35.3±5.2 g/L) and cholesterol (4.6±1.3 vs 4.9±1.1 mmol/L) than those in group A. In group A, the percentage of gram-positive bacteria was similar to group B (43.2% vs 43.3%, P=0.96), but gram-negative bacteria was numerically lower (16.9% vs 24.7%, P=0.08). Different empiric antibiotics strategy was not independent predictor of peritonitis outcome [OR=1.07, 95%CI(0.45, 2.56), P=0.87]. Conclusion Both cefazolin and vancomycin can be selected as first-line empiric antibiotic covering gram-positive organisms in the treatment of PD related peritonitis.  相似文献   

6.
目的探讨频发腹膜透析相关性腹膜炎的临床特征及危险因素。方法回顾性分析2007年1月至2014年12月安徽医科大学附属省立医院腹膜透析置管后行持续性非卧床腹膜透析的尿毒症患者,选择1年内发生腹膜炎≥2次者定义为频发组,1年内仅发生1次腹膜炎者定义为单发组,比较2组临床及实验数据差异,并分析频发腹膜透析相关性腹膜炎的危险因素。结果频发组13例,发生感染性腹膜炎30例次,单发组57例,发生感染性腹膜炎57例次。频发组与单发组相比,患者血压和体质量指数明显升高(P0.05),未及时治疗者[7例(53.85%)比13例(22.81%)]及抗感染疗程不足者[5例(38.46%)比8例(14.04%)]增多(P0.05),无效拔管率[5例(38.46%)比7例(12.28%)]增加(P0.05),血红蛋白、血白蛋白显著降低(P0.05),全段甲状旁腺素水平升高(P0.05)。病原学检查分析频发组革兰阴性菌感染率(33.33%)及真菌感染率(10.00%)均较高,但以革兰阴性菌增加的趋势最明显(P=0.035)。2组间置管时年龄、性别、透析时间、文化程度、腹膜炎诱因、病死率、残余肾功能、外周血白细胞、血钙、血磷、C反应蛋白、血总胆固醇、三酰甘油、首次腹透液白细胞数比较差异均无统计学意义。Logistic回归分析显示高体质量指数、严重高血压、低血红蛋白、低血白蛋白为频发腹膜透析相关性腹膜炎的危险因素。结论营养不良、体质量指数过高、严重高血压为腹膜透析者频发腹膜炎的危险因素,积极纠正低蛋白血症、控制血压、保持标准体质量指数,积极按时规范治疗腹腔内源性感染有助于该病的预防和控制。  相似文献   

7.
目的 探讨持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)相关性腹膜炎的致病菌及其耐药性.方法 回顾性分析2008年1月至2013年5月在我中心就诊的180例327例次CAPD相关性腹膜炎的致病菌及其耐药性.结果 202例次培养阳性,培养阳性率为61.77%.革兰阳性球菌154例次,其中金黄色葡萄球菌及凝固酶阴性葡萄球菌123例次,占病原微生物培养阳性的60.89%;革兰阴性杆菌38例次,其中大肠埃希菌11例次,占病原微生物培养阳性的5.45%;真菌10例次,其中假丝酵母菌7例次,占病原微生物培养阳性的3.47%.革兰阳性球菌对万古霉素耐药率最低,为3.25%,其次为莫西沙星,为5.19%,对利福平、庆大霉素、左氧氟沙星耐药率分别为12.99%、35.71%、45.45%,对青霉素的耐药率最高,达84.42%.革兰阴性菌对哌拉西林/他唑巴坦耐药率最低,为10.53%,其次为头孢他啶,为23.68%,对左氧氟沙星、头孢匹美、庆大霉素耐药率分别为26.32%、28.21%、36.84%,对氨苄西林/舒巴坦的耐药率最高,达50.00%.重复感染54例,共114例次,72例次培养阳性,阳性率为63.16%,其中革兰阳性球菌63例次,占87.50%,革兰阴性杆菌9例次,占12.50%,革兰阳性球菌以金黄色葡萄球菌为主,革兰阴性杆菌以大肠埃希菌为主.结论 本中心CAPD相关性腹膜炎致病菌以革兰阳性球菌为多,接触污染是导致腹膜炎的主要原因.革兰阳性球菌对青霉素耐药率最高,革兰阴性杆菌对氨苄西林/舒巴坦耐药率最高.  相似文献   

8.
目的 探讨维持性腹膜透析患者腹膜透析相关性葡萄球菌腹膜炎的发生率及相关危险因素.方法 以中山大学附属东华医院腹膜透析中心192例患者为研究对象.根据腹膜透析液培养结果分成腹膜炎组与正常组.采用多因素logistic回归分析腹膜透析相关性葡萄球菌腹膜炎的危险因素.结果 共16例(8.3%)患者发生腹膜透析相关性葡萄球菌腹膜炎.致病菌以表皮葡萄球菌为主,占50.0%(8/16).治愈12例(75.0%),死亡1例.高龄(OR=1.35,95% CI 1.16~7.68,P=0.026)、糖尿病(OR =3.34,95% CI 1.90~6.54,P<0.001)、低血红蛋白(OR=1.68,95% CI 1.21~6.48,P=0.022)及低白蛋白血症(OR=1.04,95% CI1.02~1.07,P=0.036)是腹膜透析相关性葡萄球菌腹膜炎的相关危险因素.结论 腹膜透析相关性葡萄球菌腹膜炎发生率较高;高龄、低血红蛋白、糖尿病及低白蛋白血症是其相关危险因素.  相似文献   

9.
目的 回顾性分析中山大学附属第一医院腹膜透析中心2006年1月至2010年12月腹膜透析相关性葡萄球菌腹膜炎的临床特征,为临床诊治提供依据.方法 选取近5年我院葡萄球菌腹膜炎的持续性不卧床腹膜透析(CAPD)患者,作为研究对象,归为腹膜炎组;同时,选取相应的未发生腹膜炎的CAPD患者,作为一对一配对观察目标,归为对照组.探讨葡萄球菌腹膜炎的易感因素、菌群分布、耐药性和预后.结果 腹膜炎组和对照组各纳入74例患者,两组患者基线资料差异无统计学意义.腹膜炎组患者Kt/V低于对照组(1.74±0.03比2.61±0.48,P<0.01),腹膜炎组营养学指标、血红蛋白[(91.70±25.43) g/L比(111.50±19.59) g/L,P<0.01]、钾[(3.43±0.70)mmol/L比(3.78±0.73) mmol/L,P=0.002]、钠[(137.09±5.06)mmol/L比(140.57±3.55)mmol/L,P<0.01]、氯[(98.31±6.14) mmol/L比(101.52±4.58) mmol/L,P=0.001]、钙[(2.23±0.24) mmol/L比(2.31±0.22) mmol/L,P=0.04]水平均明显低于对照组.葡萄球菌腹膜炎5年总体发病率为0.030例/腹透年,表皮葡萄球菌为主要菌种,其次是金黄色葡萄球菌.各类葡萄球菌对万古霉素、替考拉宁、利奈唑胺均敏感.葡萄球菌腹膜炎近5年总体治愈率为89.19%,病死率为4.05%;表皮葡萄球菌复发率高于其他菌种,为40%.结论 营养差、透析不充分、随诊周期长、贫血、电解质失衡是葡萄球菌腹膜炎的易感因素.我院葡萄球菌腹膜炎在近5年总体发病率、病死率较前下降低,表皮葡萄球菌复发率高,需加强防治.  相似文献   

10.
目的 对腹膜透析相关腹膜炎因素进行分析并提出其相应的护理措施.方法 对83例101例次腹膜透析相关腹膜炎患者的病历资料问卷调查进行分析.结果 操作不规范、透析环境污染及出口处感染是引起腹膜炎的重要因素.结论 医护人员对患者及家属的健康教育、进行规范操作的再培训、加强出口处的护理可以提病腹膜透析的疗效.  相似文献   

11.
目的探讨改进腹膜透析相关感染性腹膜炎透出液致病菌的培养方法,提高病原菌的培养阳性率。方法收集27例患者45例次腹膜炎透出液标本。腹膜炎患者透出液同时按以下6组方法分别进行致病菌培养:传统平板法、离心平板法、BacT/Alert培养瓶法(PF瓶法、SA瓶法、SN瓶法)和冻融法。结果离心平板组阳性率高于传统平板组,差异具统计学意义(60.0%比44.4%,P<0.05);与离心平板组相比,PF瓶组(84.4%)、SA瓶组(82.2%)和SN瓶组(82.2%)阳性率均提高(P均<0.01)。在检测致病菌生长所需时间(TDG)方面,与离心平板组[(24.31±9.80)h]相比,PF瓶组[(14.25±9.13)h]、SA瓶组[(12.75±7.47) h]和SN瓶组[(9.79±4.14)h]的TDG均缩短(P均<0.01);SN瓶组的TDG比PF瓶组和SA瓶组更显著缩短(P均<0.01)。结论离心法能显著提高培养阳性率。BacT/Alert培养系统与普通平板技术相比,能显著提高培养阳性率并缩短检测致病菌生长所需时间。SN培养瓶法检测致病菌生长所需时间最短。  相似文献   

12.
目的 探讨亚胺培南-西司他丁钠作为腹膜透析相关性腹膜炎后续治疗的疗效.方法 以2007年1月至2010年12月在北京大学第三医院收治的并发腹膜透析相关性腹膜炎患者44例为对象.这些患者经过3d的初始治疗透析液仍未清亮,细菌培养结果是革兰阴性杆菌或阴性,其中13例次采用头孢他啶治疗;36例次采用亚胺培南-西司他丁钠治疗....  相似文献   

13.
腹膜透析(PD)相关性腹膜炎是腹膜透析患者的严重并发症,降低腹膜透析相关感染的风险应该是每个PD中心的重要工作目标。对于出现感染者,应在早期进行经验性治疗,并高质量留取标本,进行有效的微生物学诊断和药敏试验,以保证抗感染治疗的准确性和有效性。腹膜透析中心应积极开展团队质量改进,包括持续进行感染监测、分析感染发生的根本原因。建立全面的腹膜炎风险评估机制,尤其要重点加强主动预防理念,在开始腹膜透析治疗的同时,对高龄、糖尿病患者等高危人群进行重点预防,有意识地加强操作正规培训和再培训、积极防止腹泻和(或)便秘以及加强隧道和出口处护理等主动预防措施,尽可能降低腹膜透析相关性腹膜炎的发生概率。  相似文献   

14.
Expeditious diagnosis of peritonitis remains a significant goal in the management of patients maintained on peritoneal dialysis. Several attempts to use leukocyte esterase reagent strips to diagnose peritonitis have been described. In this study we examined the usefulness of a new reagent strip, the PeriScreen Test Strip, in the diagnosis of peritonitis. A series of 72 peritoneal effluent samples obtained from 22 maintenance peritoneal dialysis patients is reported. In this study, the test strips had a sensitivity of 100% and a specificity of 98.3% as compared to an abnormal leukocyte count. Thus, in the diagnosis of peritonitis we believe that the PeriScreen Test Strip can be used as a simple bedside screening test to exclude peritonitis in peritoneal dialysis patients.  相似文献   

15.
目的通过万古霉素联合美罗培南作为腹膜透析相关性腹膜炎(peritoneal dialysis-related peritonitis,PDRP)经验用药的疗效分析,为临床经验性用药提供一定的依据。方法回顾性分析2011年6月至2014年6月在安徽医科大学第一附属医院住院的106例PDRP病例,按治疗方案分为治疗组44例和对照组62例。治疗组给予万古霉素十美罗培南治疗,对照组给予万古霉素+其他(三代头孢或氨基糖苷类)治疗。抽取PDRP患者首袋浑浊的腹膜透析液,送检细胞计数分类,并进行培养及药敏试验。收集患者临床资料,包括出现症状至入院时间,腹膜透析液白细胞计数、血红蛋白、白蛋白、血白细胞、中性比、C反应蛋白等指标,腹膜透析液培养及药敏结果等情况。结果 106例患者中以革兰阳性球菌为主,革兰阳性菌中耐药率最低的是利奈唑胺,万古霉素,莫西沙星;革兰阴性菌中耐药率最低的是美罗培南、妥布霉素、哌拉西林他唑巴坦。万古霉素联合美罗培南治疗后腹膜透析液白细胞计数显著下降,与对照组相比有统计学意义(P0.05),且退出率、病死率、霉菌检出率低于对照组,预后较好。结论腹腔经验性应用万古霉素联合碳青霉烯类能迅速控制腹膜透析液白细胞计数,预后较好,且符合我中心的药敏结果,推荐作为部分腹膜透析相关性腹膜炎初始经验用药,以供临床医生参考。  相似文献   

16.
BackgroundPeritoneal dialysis has become commonly used for renal replacement therapy; however, some patients withdraw from peritoneal dialysis due to complications, including peritoneal dialysis-related peritonitis, resulting in the low number of patients on peritoneal dialysis. Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis are less certain. This retrospective study aimed to investigate these risk factors.MethodsWe retrospectively analyzed clinical characteristics, laboratory data, and causative microorganisms of 204 episodes of peritoneal dialysis-related peritonitis between 2007 and 2018 at our institution.ResultsOf the 204 episodes, 38 resulted in withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis. The number of peritonitis episodes per patient-year and the incidence of cardiovascular disease were significantly higher in the withdrawal group. Similarly, this group had low levels of serum creatinine, urea nitrogen, serum albumin, alanine aminotransferase, cholinesterase and high C-reactive protein, and second dialysate cell counts after antibiotic administration. Multivariate logistic regression analysis revealed that serum albumin (odds ratio: 0.465; 95% confidence interval: 0.249–0.868; P = 0.016) and cardiovascular disease (odds ratio: 2.508; 95% confidence interval: 1.184–5.315; P = 0.016) exhibited significant differences.ConclusionsThe results of this study suggest that hypoalbuminemia and the presence of cardiovascular disease were independent risk factors for withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis.  相似文献   

17.
Objective To investigate the incidence of gastrointestinal symptoms and diseases in peritoneal dialysis (PD) patients, and explore their associations with PD-associated peritonitis. Methods PD patients who were followed up in PD center of the First Affiliated Hospital of Sun Yat-sen University from March 1, 2016 to December 31, 2017 were prospectively enrolled and followed up until withdrew from PD or until December 31, 2019. Gastrointestinal symptoms, gastrointestinal diseases and peritonitis episodes were collected during the study period. The severity of gastrointestinal symptoms was assessed by the Gastrointestinal Symptoms Rating Scale. The demographic and clinical data were compared between patients with and without gastrointestinal diseases. The influencing factors of peritonitis were analyzed by Poisson regression model. Results A total of 471 PD patients were included. Among them, 387(82.2%) patients had at least one gastrointestinal symptom, and 142(30.2%) patients had gastrointestinal diseases. The incidence of peritonitis was 0.094 episodes per patient year, 0.034 episodes per patient year for gram-positive bacteria peritonitis and 0.027 episodes per patient year for gram-negative bacteria peritonitis. The multi-factor Poisson regression model showed that gastrointestinal disease was an independent influencing factor for the occurrence of total peritonitis and gram-negative bacteria peritonitis (OR=1.852, 95%CI 1.252-6.369, P=0.002; OR=3.324, 95%CI 1.616-6.836, P=0.001, respectively), and higher score of diarrheal symptoms was an independent influencing factor for the occurrence of gram-negative bacterial peritonitis (OR=2.832, 95%CI 1.616-4.963, P<0.001). Conclusions The incidence of gastrointestinal diseases in PD patients is 30.2%. Gastrointestinal disease is an independent influencing factor for the occurrence of total peritonitis and gram-negative bacteria peritonitis, and diarrhea symptom is an independent influencing factor for the occurrence of gram-negative bacteria peritonitis.  相似文献   

18.
目的 探讨实施腹透患者照护性参与自我管理,对降低其腹透相关性腹膜炎的效果.方法 选取2017年1月—2017年12月腹透门诊建档行规律随访的125例居家腹透患者作为对照组,采用常规门诊随访和健康教育指导.2018年1月—2018年12月腹透门诊建档行规律随访的130例居家腹透患者作为干预组,在常规门诊随访和健康宣教指导...  相似文献   

19.
腹膜透析中腹膜炎发病率统计方法的评估   总被引:9,自引:0,他引:9  
目的 评估腹膜透析(腹透)中腹膜炎发病率的统计方法。方法 回顾性的分析仁济医院腹透中心1999年8月1日至2004年6月30日之间使用双联系统的腹透患者腹膜炎发病率,分别采用队列特异性腹膜炎发病率、负二项分布模型、腹膜炎发病率的中位数和无腹膜炎的生存率等方法进行统计。结果队列特异性腹膜炎发病率为1/56.14患者月,负二项分布模型统计的腹膜炎发病率为1/49.58患者月,腹膜炎发病率的中位数为0,平均无腹膜炎的生存时间为39.71月。无腹膜炎生存时间与个体特异性腹膜炎发病率负相关(P<0.05)。结论 队列特异性腹膜炎发病率能描述一个腹透中心的腹膜炎发病率,便于各中心之间进行比较。负二项分布模型能反映患者腹膜炎发病频数的分布趋势,有助于发现高危人群和高危因素,并加强预防。腹膜炎发病率的中位数可用于腹膜炎发生人数超过50%的腹透中心,无腹膜炎生存率能预示腹膜炎的易感性,适用于规模较大的腹透中心评估腹膜炎发病率。综合使用这些方法能更真实的描述腹膜炎发病情况,为针对性的预防腹膜炎提供科学依据。  相似文献   

20.
目的探讨腹膜透析相关性腹膜炎(PDAP)致病菌的耐药性。方法回顾性分析2008年7月-2012年7月我院腹膜透析中心PDAP患者的临床资料及药敏结果。结果(1)203例次PDAP培养阳性率为59.1%,共培养出致病菌124株。124株致病菌中革兰阳性球菌68株,占54.8%;革兰阴性杆菌28株,占22.6%;革兰阳性杆菌12株,占9.7%;奈瑟茵属5株,占4.0%;真菌11株,占8.9%。其中耐药菌株54株,包括多药耐药菌50株,泛耐药菌4株,本中心PDAP患者尚未培养出全耐药菌。(2)药敏结果:对革兰阳性球菌敏感性较高的前3种药物为:利奈唑胺100%,莫西沙星95.8%,万古霉素95.2%。对革兰阴性杆菌敏感性较高的前3种药物为:阿米卡星85.7%,亚胺培南82.1%,左氧氟沙星75.0%。(3)转归:PDAP患者总治愈率为77.3%。结论PDAP致病菌耐药性的产生导致临床上可供选择的药物减少,临床医牛府采取多种措施延缓致病菌耐药件。  相似文献   

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