NURSING- PICO outline

profilesmatal
LiteratureReviewTable.xlsx

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Literature <5 years old (excluding seminal articles) Contains at least one meta-analysis or meta-synthesis Contains at least 16 primary sources Well-rounded to represent each section of PICO question Title Author/Year Sample Purpose(s) Study type/Data Collection Techniques Intervention/Variables Findings Comments
Yes Meta analyis N/A Allograft Cadaver skin allograft may improve mortality rate for burns involving over 30% of total body surface area: a propensity score analysis of data from four burn centers. Choi, Y. H., Cho, Y. S., Lee, J. H., Choi, Y., Noh, S. Y., Park, S., Sung, C., Lim, J. K., Kim, J., Shin, J. J., Yang, B., Jeong, J., Chun, H., & Kim, K. J. (2018). 1,282 analyze the effect of cadaveric skin allograft on mortality rates in patients with burns involving > 30% of total body surface area (TBSA) Meta analysis retrospectively analyzed the electronic medical records of patients admitted to four hospitals in Korea between June 1, 2008 and December 31, 2016. This tudy included patients with burns affecting over 30% of TBSA. 698 patients underwent cadaver skin allograft (cadaver group), and 584 were treated with conventional treatment (noncadaver group) Patients with major burns who underwent cadaver skin allografting had a lower mortality rate than those who did not. Cadaver skin allograft may improve the survival of patients with major burns, especially in the early phase of injury. compairison between cadaver and traditional allograft treatments
No Literature review N/A Xenograft & Allograft Porcine xenografts vs. (cryopreserved) allografts in the management of partial thickness burns: Is there a clinical difference? Michel H.E. Hermans, M.D. 17 Aug 2013 N/A Determine is there is a statistically significant difference between porcine xenografts and allografts Literature review Allografts are more effective but supply may be severely restricted. Porcine skin may be more available. A literature analysis was performed in an attempt to investigate whether true (statistically significant) differences exist on clinical performance and on other determinants for use. allografts and porcine xenograft seem to perform equally well clinically with regard to healing related outcomes. In addition, the risk of disease transfer, in real life, was shown to be minimal. Consequently, clinical aspects being equal, other aspects such as price and availability should be used to decide which material to use for the management of partial thickness burns. no statistically significant difference between porcine xenografts and allografts
No Literature review N/A Complications The use of human deceased donor skin allograft in burn care Jorge Leon-Villapalos, Mohamed Eldardiri, Peter Dziewulski, 26 June 2009 N/A Review of current use of cadaver allografts Literature review identified value of a project that aims to provide a less antigenic, more readily available and completely free from the already remote risks of disease transmission allograft will increase the value of this already extremely useful tool in burns surgery. identified need for more comparative studies in regards to burn treatment good explanation of procedure and limitations of cadaver allografts
Yes Patient study 1/16 Allograft Live Skin Allograft in the Management of Severe Burns Shaban Saidi, July 2016 5 Live skin allografting is a useful skin substitute for severely burnt patients in resource limited areas Patient study Between August 2010 and August 2014, five patients underwent live skin allografting without medical immunosuppresion. All patients had deep severe burns of more than 40% burn surface area. 3 skin donors were patients’ mothers while 2 were brothers Three patients had complete healing not requiring skin autografting. One patient had hyper acute rejection and another had normal rejection and underwent secondary auto grafting.
No Patient study 2/16 Allograft Burn wound dressing with human amniotic membrane B Bose 1979 (seminal) 15 Determine usefulness of amniotic membrane tissue for treatment of burns Patient study Physiological dressing with human amniotic membrane was used on I5 burn patients over a period of 30 months. In the earlier part of this series gross infection in a case of leg burn precluded the use of the membrane after 3 days and instead treatment was continued with mafenide (Sulfamylon) cream. The results in the other I4 cases were uniformly satisfactory. The pain relief after application of the membrane was impressive and in 2 cases dramatic. small study supporting use of amniotic membrane allografts
Yes Patient study 3/16 Xenograft Innovative treatment using tilapia skin as a xenograft for partial thickness burns after a gunpowder explosion Edmar Maciel Lima-Junior, Manoel Odorico de Moraes Filho, Bruno Almeida Costa, Francisco Vagnaldo Fechine, Maria Elisabete Amaral de Moraes, Francisco Raimundo Silva-Junior, Maria Flaviane Araújo do Nascimento Soares, Marina Becker Sales Rocha, Cybele Maria Philopimin Leontsinis 2019 1 Determine usefulness of talapia xenograft for burn treatment Patient study Tilapia skin has non-infectious microbiota, high amounts of type I collagen, and similar morphological structure to human skin, so it has been suggested as a potential xenograft for the management of burn wounds. A 23-year-old male patient, with no comorbidities, arrived at our burn treatment center after a thermal injury caused by contact with flames from a gunpowder explosion. Superficial partial thickness burns were present in his right upper limb and deep partial thickness burns were present in his left upper limb. Tilapia skin was applied to the lesions, leading to complete reepithelialization within 12 and 17 days of treatment, respectively. No dressing changes were needed and no side effects were observed. xenograft with tilapia skin showed success in one patient
Yes Meta Analysis Xenograft & Allograft Is allograft skin, the gold-standard for burn skin substitute? A systematic literature review and meta-analysis André O. Paggiaroa, Renata Bastianellia, Viviane F. Carvalhoa, Cesar Isaacb, Rolf Gemperlib 6 April 2019 N/A The objective of this systematic review is to compare AS with other skin substitutes, which have been used in the treatment of burns. Meta analysis Randomized clinical trial (RCT) and nonrandomized clinical trial (NRCT) studies comparing AS to any other skin substitute in the treatment of burns were extracted from PubMed/Medline, Scopus, EMBASE, and Web of Science. For the risk of bias analysis, the Cochrane bias risk handbook was used for RCT studies and ROBINS-1 was used for NRCT studies.Outcomes such as healing, self-grafting, scar appearance, and mortality were evaluated. Twelve RCT and six NRCT were selected, with most of the methodologies presenting a high risk of bias. Based on the outcomes of the studies, it was not possible to detect any advantages for using AS, as opposed to other skin substitutes. In the meta-analysis, only two outcomes could be evaluated: healing and graft take percentage; however, no significant differences were observed between the groups. Another study that identified lack of quality research into compairsons between burn treatments
No Exploratory study 4/16 Allograft Human amniotic membrane: a versatile wound dressing JOSEPH S. Gruss,* MB, B CH; DENNIS W. JIRSCH, MD, M SC, PH D, FRCS[C], CMA Journal May 20, 1978 120 Determine benefits of wound treatment with amniotic membrane allografts Exploratory study included in the study were 120 patients in need of temporary biologic dressings. Their wounds were mainly full-thickness defects of diverse origin and certain partial-thickness defects. Accurate clinical and photographic records were kept. Human amniotic membrane was used successfully as a temporary biologic dressing for various wounds in 120 patients. The membrane is easily obtained, at little or no cost. It provides excellent wound coverage and has distinct advantages compared with other biologic dressings. Tied together cadaver skin allograft, pigskin xenograft and human amniotic membrane
No Comparative study 5/16 Complications Allogeneic Versus Xenogeneic Immune Reaction to Bioengineered Skin Grafts Gulsun Erdag* and Jeffrey R. Morgan, Cell Transplantation, 14 April, 2004 N/A Explore immune reactions to allogeneic and xenogeneic responses to CSS of human keratinocytes and genetically engineered CSS expressing keratinocyte growth factor Comparative study investigated the allogeneic and xenogeneic responses to CSS of human keratinocytes and genetically engineered CSS expressing keratinocyte growth factor (KGF) that forms a hyperproliferative epidermis. CSS (control and KGF modified) and neonatal human foreskins were evaluated by immunohistochemistry study demonstrates that human the human skin substitutes. In their model, rejection of CSS, even when genetically engineered to make them neonatal skin required 21 days, whereas our data and the hyperproliferative, are less immunogenic than neonatal studies of others have demonstrated that reconstituted skin and that this results in prolonged survival in the SCID will reject neonatal human skin by 9 days. Thus, allograft model and delayed rejection in the xenograft our data demonstrate that even in SCID mice that have model. R Cellular study going into depth with immune response
no Comparative study 6/16 Xenografts Application of acellular dermal xenografts in full-thickness skin burns Xiaodong Chen Xiangsheng Feng Julin Xie Shubin Ruan Yan Lin Zepeng Lin Rui Shen Fenggang Zhang, 2013 30 explore the clinical value of the porcine acellular dermal xenograft (ADX) in combination with autologous split-thickness skin and pure autologous split-thickness skin grafting applied in deep full-thickness burns and scar wounds Comparative study A total of 30 patients with deep burns were randomly divided into experimental and control groups following escharectomy. The patients were separately treated with porcine acellular dermal xenograft (ADX) in combination with autologous split-thickness skin and pure autologous split-thickness skin graft. The wound healing was observed routinely and the scores were evaluated using Vancouver scar scale at different times following transplant surgery. The combination of the meshed ADX and the split-thickness skin autograft applied in deep full-thickness burns and scar wounds may induce tissue regeneration via dermis aiming. This method also has superior shape and functional recovery, and has an extensive clinical application value. cografting of ADX and split-thickness skin autograft is an ideal treatment method for the repair of deep full-thickness burns
yes Experimental study 7/16 Xenograft Skin grafts from genetically modified α-1,3-galactosyltransferase knockout miniature swine: A functional equivalent to allografts D.A. Leonard,a,b,c,*,1 C. Mallard,a,1 A. Albritton,a R. Torabi,a,b M. Mastroianni,a,b D.H. Sachs,a J.M. Kurtz,a,d and C.L. Cetrulo, Jra,b, 2017 N/A Collect data to support stage 1 clinical trials of GaIT-KO Experimental study GalT-KO porcine skin grafts warrant further investigation in a phase 1 clinical trial to confirm safety, as this technology has the potential to offer an attractive alternative or addition to allogeneic skin in the management of severe burns. No statistically significant difference was identified between GalT-KO and allogeneic skin grafts in any of the assessed parameters, and graft take and function was not adversely effected by the freeze–thaw process. These data demonstrate that GalT-KO porcine grafts are functionally comparable to allogeneic skin grafts for temporary closure of full thickness wounds, and support their consideration as an alternative to cadaver allogeneic skin in the emergency management of large burns. Possible future type of xenograft--maybe we can use this in a conclusion to tie in future research
No Survey 8/16 Preferences for treatment Results of a survey on the use of different treatment options for partial and full thickness burns M.H.E. Hermans, 29 April 1998 (seminal) N/A Survey to analyse different burn treatments International survey Questions were asked on the treatment preferred for partial thickness burns, mixed (partial and full thickness) burns. and full thickness burns. The preferential treatment for partial and mixed burns was to be chosen from a list with treatment options survey showed that burn care is not always driven by scientific prool and dated practices, even when scientifically unsound, are still used. There is clearly no real consistency in the way similar burns are treated in different centers and countries Another study showing lack of cohesive studies supporting best practices for burn treatments
yes Experimental study 9/16 primary source burn injuries, wound dressing, xenografts, wound healing Hemocompatibility of different burn wound dressings. Denzinger, M., Held, M., Scheffler, H., Haag, H., Nussler, A. K., Wendel, H. P., Schlensak, C., Daigeler, A., & Krajewski, S. (2019). Wound Repair & Regeneration, 27(5), 470–476. 5 to compare the hemocompatibility and immunogenicity of burn wound dressings/ skin substitutes becasue blood reaction toward wound dressings may cause a reaction that will either cause an immune reaction or exacerbate a pre-existing reponse already taking place which would effect wound healing process and the immune system's reaction Experimental study Independent variable: wound dressing/ skin substitutes Depedent varibale: human whole blood "there was no difference in hemoglobin concentrations after incibation," porcine collogen fibers may inititate a coagulation cascade, sample C (contains porcine dermis), showed high increases in TAT-III concentrations this showing that coagulation was activated while being incubated for 30 min. thus supporting the lower INR values of sample when compared to the control, and higher beta-thromboglobulin concentrations compared to control and baseline(a marker for platelet acitivation), none of the dressings presented with high or low Hb (hemolysis) compared to control, SC5b-9 complement activation indicator had close readings to level with control but higher than baseline values, cytolkine (IL-1B & IFN-y) immune response marker did not of extremely high or low lelvels compared to control experiment conclusion- xenografts (sample C &D) had a hemostyptic effect, sample D caused the compliment system acitvation, none of the wound dressings/ skin replacemnts caused hemolysis of the blood nor cytokine release (IL-1B or IFN-y).
yes Randomized control study 10/16 primary source partial-thickness scald burn injuries, porcine xenograft, wound healing time Superiority of silver-foam over procine xenograft dressings for treatment of scalds in children: A prospective randomised controlled trial Karlsson, M., Elmasry, M., Steinvall, I., Sjöberg, F., Olofsson, P., & Thorfinn, J. (2019). Burns (03054179), 45(6), 1401–1409. 58 to evaulate wound healing time with secondary evaulation of pain, need for operation, wound infection, duration of hospital stay, amount of dressing chnages and length of time to change dressings Randomized control study interventions: procine xenografts vs. silver-foam dressings for the treatment of partila thickness scald burns Independent variables: porcine zenografts, silver-foam dressing dependent variables: burn wound median time for 97% helaing: porcine 15 (9-29) days, Silver-foam 9 (7-23) days; median time for complete healing: porcine xenograft 20.5 (11-42) days, silver-foam 15 (9-29) days; pain, infection risk, duration of stay, and number of operations were similar; dressing change number and length of time to complete was lower with silver-foam requested full text of study through interlibrary loan
yes Case Study 11/16 pediatric burn wond, allograft, wound healing time Human Skin Allograft: Is it a Viable Option in Management of Burn Patients? Gupta, S., Mohapatra, D. P., Chittoria, R. K., Subbarayan, E., Reddy, S. K., Chavan, V., Aggarwal, A., & Reddy, L. C. (2019).Journal of Cutaneous & Aesthetic Surgery, 12(2), 132–135. 1 determines if cadaver allografts have a significant place in the treatment of burn wounds Case study on 2nd day of post injury, exicision and biological (fresh skin allograft) coverage of the deep second-degree wound (10% TBA) with the donor being the patient's father. allograft was removed (peeled off) on the 14th post-op day signs of graft rejection began to occur on the 10th post-op day. upon removal on the 14th post-op day the wound underneath was completley healed. besides the graft rejection no other complications (hypovolemia, dyselectolytemia, or infections) occured
yes Retrospective study 12/16 third degree brun wounds peds & adult patients, allografts, zenografts, healing time Comparison of Outcomes between Allograft vs Xenograft use in Burn Injuries Megan E. Pencek, BS, Franca S. Kraenzlin, MHS, Derek E. Bell, MD. (2016) University of Rochester Medical Center, Rochester, NY, USA. North American Society of Plastic Surgeons. 77 determine the statistical outcome differences exist between allografts and xenografts Restrospective study 52 patients had allograft wound coverage, 25 patients had xenograft wound converage= 122 allografted and 65 xenografted sites variables: patient demographics, burn etiology and location, graft measurements, procedure time, percent graft take, time to complete re-epithelialization, complications following grafting, and cost. average total operating time/cm2 area- xenograft (10.1 seconds/cm2 grafted) vs allograft (13.0 seconds/cm2 grafted), total procedure time- xenograft (4.6 seconds/cm2 grafted) vs allograft (65.5 seconds/cm2 grafted), average time to complete re-epithelialization- xenograft (45.2 +/- 17.9 days) vs allografts (44.1+/-14.0 days) compliation findings: hyptertrophi scarring- xenograft (20.0%) vs allograft (27.9%), hypersensitivity- xenograft (12.3%) vs allograft (7.4%), decreased range of motion- xenograft (12.3%) vs allograft (10.7%), dyschromia (altered skin prigmentation)- xenograft (7.79%) vs allograft (23.8%) provides statistical data
yes Textbook N/A N/A Reading,understanding, and applying nursing research Fain, J. A. (2021). (6th ed.). N/A research methodology Textbook N/A N/A sources explains the research methodology we utilized to find, collect, and appraise our sources pp. 75-76
yes (2019) Case Series 13/16 Xenograft - fish skin Acellular Fish Skin Grafts for Management of Split Thickness Donor Sites and Partial Thickness Burns: A Case Series. Alam, Khurshid; Jeffery, Steven L A, 2019 10 to show the effectiveness of using fish skin in acute burns Case series Ten patients all over the age of 18 having split-thickness skin grafting for burn injury were treated with the fish skin xenografts. All donor sites were harvested at a depth of 8/1,000th of an inch. variables: age range from 18-80 Time to 90% epithelialization was reached with an average of 8.5 days (range 7–13). Time to 100% epithelialization had an average of 11.5 days (range 10–16) study that shows healing time with fish skin grafts
no (2015) Case Study 14/16 Allograft Three Pediatric Cases Study with Over 80% TBSA Burn Injury - Surgical Treatment by Using Skin Allografts: A Viable Option for Alternative Cover. Cristina A. Avram, Dan M. Enescu, Dan Ionita, 2015 3 using skin allografts as a viable option for burn coverage Case study three patient cases with 85- 95% TBSA third-degree flame burn, who received complex surgical treatment with both allografts and autografts Temporary alternative cover in massive burn injury, use as biological dressing, promotes healing of partial burn study that shows how allografts prevent infection and further tissues loss
no (2016) Comparative study 15/16 Skin graft Effects of early versus delayed excision and grafting on the return of the burned hand function. Salehi, Seyed Hamid; Sedghi, Maryam; Fatemi, Mohammad Javad; Niazi, Mitra, 2016 60 to determine the the impacts of early excision and grafting on hosptial stay time Comparative study sixty patients were placed into early excision (No. =30) and delayed excision group (No. =30) early excision and grafting with proper physical therapy and rehabilitation management provides a higher functional outcome study that shows if early excision and grafting can decrease hospital stay time and lead to a faster, higher functional outcome
yes (2017) Comparative study 16/16 Xenograft (fish skin) Allograft (human amnion/chorion membrane) Regenerative and Antibacterial Properties of Acellular Fish Skin Grafts and Human Amnion/Chorion Membrane: Implications for Tissue Preservation in Combat Casualty Care. Magnusson, Skuli; Baldursson, Baldur Tumi; Kjartansson, Hilmar; Rolfsson, Ottar; Sigurjonsson, Gudmundur Fertram, 2017 N/A to assess properties of acellular fish skin and human amnion/chorion membranes relevant for severe injuries Comparative study grafts: acellular fish skin compared to dehydrated human amnion/chorion membrane The unique biomechanical properties of the acellular fish skin graft make it ideal to be used as a conformal cover for severe trauma and burn wounds study that shows fish skin is more effective as it is a bacterial barrier and supports cell growth
yes (2020) Double blind randomized study 17/16 Xenograft (fish skin) Allograft (human amnion/chorion membrane) Fish skin grafts compared to human amnion/chorion membrane allografts: A double‐blind, prospective, randomized clinical trial of acute wound healing. Kirsner, Robert S.; Margolis, David J.; Baldursson, Baldur T.; Petursdottir, Kristin; Davidsson, Olafur B.; Weir, Dot; Lantis, John C., 2020 170 To compare fish skin xenografts to human amnion/chorion membrane allografts Randomized control study grafts: acellular fish skin compared to human amnion/chorion membrane wounds treated with fish skin grafts heal faster than wounds treated with human amnion/chorion membrane study that shows fish skin grafts decrease wound healing time compared to human amnion/chorion membrane allografts
yes (2021) Comparative study 18/16 Xenograft (fish skin) Allograft (fetal bovine dermis) Accelerated Wound Closure of Deep Partial Thickness Burns with Acellular Fish Skin Graft Stone, Randolph, 2021 6 To show that fish skin graft integrated faster without increased contraction, resulting in quicker wound closure without skin graft application which suggests fish skin graft improved burn wound healing over fetal bovine dermis. Comparative study grafts: acellular fish skin compared to fetal bovine dermis findings support the use of fish skin graft for achieving enhanced wound closure as evidenced by quicker integration and reepithelization without increased contraction. studys show that the use of fish skin emhanced wound closure vs. allograft
yes Meta analysis 19/16 Allograft Skin substitutes for extensive burn coverage in Togo: A retrospective study. Edem, K. K. T., Séna, A. K., Batarabadja, B., Dzidzo, A. K. J., Yanick, D. Y., & Joseph, D. E. D. (2021). 4 4 children with severe 25-78 TBSA . two children went through skin substitution by dermal templates and te other two went through skin allograts Retrospective study The availability of dermal templates compelled the choice between the two skin substitutes. campaign for the use of skin substitutes especially for children, who are more involved and more brittle to burn injury, would be beneficial. campaign or the use of skin substitutes especially for children, who are more involved and more brittle to burn injury, would be beneficial
Yes Meta analysis 20/16 Allograft vs autograft Comparison of autograft and allograft tendons in posterior cruciate ligament reconstruction: A meta-analysis. Tian, P., Hu, W. Q., Li, Z. J., Sun, X. L., & Ma, X. L. (2017). N/A Comparison of autograft and allograft tendons in posterior cruciate ligament reconstruction Meta analysis A total of 167 studies were identified where 153 reports were excluded because of duplication and irrelevancy and the remaining 14 studies underwent a comprehensive full-text evaluation. The autograft gave better results than the allograft in the posterior stability of the knee the present meta-analysis shows that the clinical outcomes were similar between arthroscopic allograft and autograft tendons for PCL reconstruction.
Yes Meta analysis 21/16 Allograft The impact of skin allograft on inpatient outcomes in the treatment of major burns 20–50% total body surface area—A propensity score matched analysis using the nationwide inpatient sample. Sheckter, C. C., Li, A., Pridgen, B., Trickey, A. W., Karanas, Y., & Curtin, C. (2019). 3,557 Assessing the efficacy of allograft in the treatment of major burns between 20-50 Meta analysis Discharge data from the Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality assessed 3557 major burn patients (>second degree depth and 20-50% TBSA) undergoing operative treatment. Outcomes were evaluated with propensity score matching. After matching, 771 allografted patients were paired with 1774 controls. Allograft use in major burns 20–50% TBSA was associated with a significant increase in inpatient mortality.
Yes Pilot study 22/16 Allograft Can skin allograft occasionally act as a permanent coverage in deep burns? A pilot study. World journal of plastic surgery Rezaei, E., Beiraghi-Toosi, A., Ahmadabadi, A., Tavousi, S. H., Tabrizi, A. A., Fotuhi, K., ... & Moghadam, S. A. (2017). 38 skin allograft was assesd in 38 patients in this case case study between mrch 2009 to march 2014. patients with long skin allograft survival in whom the gender of donor and recipient of allograft was the same were excluded. Seven cases with skin allograft longevity and opposite gender in donor and recipient were finally enrolled. Pilot study skin allograft was assessed in 38 patients between 2009 and 2014. Seven cases with skin allograft longevity and opposite gender in donor and recipient were finally enrolled. In eight months of follow up, no clinical evidence of graft rejection was noted. Long term persistence of skin allograft in patients is worthy of more attention
Yes Meta analysis 23/16 Xenografts vs Allograft Porcine xenografts vs. (cryopreserved) allografts in the management of partial thickness burns: Is there a clinical difference? Michel H.E. Hermans, M.D (2017). N/A The study aims to investigate whether true (statistically significant) differences exist on clinical performance and on other determinants for use. Meta analysis Databases of PubMed, Medline, Google, and the search engine of the Endnote X5 programme (Thompson Reuters, Carlsbad, CA, USA) were searched, focusing primarily on partial thickness burns, porcine skin, porcine derived matrix, preservation methods. No evidence was found showing that xenograft, their derivatives, or allografts perform better clinically in the management of partial thickness burns. All these materials provide rapid reepithelialisation, pain relief, protection of the wound and, generally, good long-term results.
yes Experimental study 24/16 fish skin graft “Improved Skin Regeneration with Acellular Fish Skin Grafts.” Engineered Regeneration Fiakos, Gabriella, 2020 51 The journal shows the studies of skin regeneration used on diabetic foot ulcers. Experimental study Data given was purely fish skin graft results as the focus of the collection Three patients were found to have 100% wound area reduction in six weeks. In patients with chronic wounds (>3 months), slower healing rates were observed at 41.1% and 41.2%. An overall trend of earlier and faster healing times was observed for all subjects. Complete healing was observed in 46% of patients at 5 months for transmetatarsal amputations and 72% for digital amputations. In addition to a general reduction of wound area, no pain, irritation, or odor was perceived as intolerable by the patients It's important to note the general healing and skin regeneration that fish skin grafts promote and how they are the better alternative to the allograft we compare to in our PICO question
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