Assessment of urinary NGAL for differential diagnosis and progression of diabetic kidney disease
Chronic kidney disease (CKD) related to diabetes has become more common than glomerulonephritis in recent years. Given the inefficient and difficult identification of diabetic kidney disease (DKD) from non-diabetic kidney disease (NDKD) as well as a result of emerging evidence supporting a role for...
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| creator | Duan, Suyan Chen, Jiajia Wu, Lin Nie, Guangyan Sun, Lianqin Zhang, Chengning Huang, Zhimin Xing, Changying Zhang, Bo Yuan, Yanggang |
| description | Chronic kidney disease (CKD) related to diabetes has become more common than glomerulonephritis in recent years. Given the inefficient and difficult identification of diabetic kidney disease (DKD) from non-diabetic kidney disease (NDKD) as well as a result of emerging evidence supporting a role for tubular involvement in DKD, we aimed to investigate the utility of urinary neutrophil gelatinase-associated lipocalin (uNGAL) in the differential diagnosis and predictive value of DKD from NDKD.
Data for 100 type 2 diabetic patients with CKD at our center from June 2016 to August 2019 were reviewed. All the patients were categorized into 2 groups by the renal biopsy results: DKD and NDKD. Urinary NGAL levels were normalized by urinary creatinine and calculated as uNGAL/creatinine ratios (uNCR). The independent factors of the occurrence of DKD and the diagnostic implications of uNCR were explored by logistic regression and receiver-operating characteristic (ROC) curve analysis. In addition, we analyzed the relationship between uNCR and proteinuria in patients with DKD by Pearson test and linear regression. Kaplan-Meier survival analysis was performed to assess the prospective association of uNCR with the renal outcome.
Significantly higher levels of uNCR were observed in patients with DKD when compared to those with NDKD (28.65 ng/mg vs 27.47 ng/mg, p< .001). uNCR was identified as an independent risk factor for the occurrence of DKD in diabetic patients with CKD (odds ratio [OR] = 1.020; 95%CI = [1.001–1.399], p = .042). The optimal cutoff value of uNCR for predicting DKD was 60.685 ng/mg with high specificity (90.5%) but relatively low sensitivity (55.7%). In Pearson test, uNCR was positively correlated with proteinuria, serum creatine, blood urea nitrogen, duration of diabetes, interstitial inflammation score and global sclerosis, whereas it was inversely correlated with eGFR, hemoglobin, serum albumin and 25-hydroxy vitamin D. Furthermore, in a fully adjusted model including eGFR, serum albumin and total cholesterol, the group with uNCR>60.685 ng/mg was associated with 7.595 times higher likelihood of nephrotic-range proteinuria compared to the group with uNCR≤60.685 ng/mg. In the Kaplan-Meier survival analysis, the event-free survival probability in patients with uNCR>60.685 ng/mg was significantly lower than those with uNCR≤60.685 ng/mg (p = .048).
uNCR might serve as a potential tool for identifying cases in which there was a high clinical suspicion of DKD |
| doi_str_mv | 10.1016/j.jdiacomp.2020.107665 |
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Data for 100 type 2 diabetic patients with CKD at our center from June 2016 to August 2019 were reviewed. All the patients were categorized into 2 groups by the renal biopsy results: DKD and NDKD. Urinary NGAL levels were normalized by urinary creatinine and calculated as uNGAL/creatinine ratios (uNCR). The independent factors of the occurrence of DKD and the diagnostic implications of uNCR were explored by logistic regression and receiver-operating characteristic (ROC) curve analysis. In addition, we analyzed the relationship between uNCR and proteinuria in patients with DKD by Pearson test and linear regression. Kaplan-Meier survival analysis was performed to assess the prospective association of uNCR with the renal outcome.
Significantly higher levels of uNCR were observed in patients with DKD when compared to those with NDKD (28.65 ng/mg vs 27.47 ng/mg, p< .001). uNCR was identified as an independent risk factor for the occurrence of DKD in diabetic patients with CKD (odds ratio [OR] = 1.020; 95%CI = [1.001–1.399], p = .042). The optimal cutoff value of uNCR for predicting DKD was 60.685 ng/mg with high specificity (90.5%) but relatively low sensitivity (55.7%). In Pearson test, uNCR was positively correlated with proteinuria, serum creatine, blood urea nitrogen, duration of diabetes, interstitial inflammation score and global sclerosis, whereas it was inversely correlated with eGFR, hemoglobin, serum albumin and 25-hydroxy vitamin D. Furthermore, in a fully adjusted model including eGFR, serum albumin and total cholesterol, the group with uNCR>60.685 ng/mg was associated with 7.595 times higher likelihood of nephrotic-range proteinuria compared to the group with uNCR≤60.685 ng/mg. In the Kaplan-Meier survival analysis, the event-free survival probability in patients with uNCR>60.685 ng/mg was significantly lower than those with uNCR≤60.685 ng/mg (p = .048).
uNCR might serve as a potential tool for identifying cases in which there was a high clinical suspicion of DKD and that in whom confirmatory biopsy could be considered, and the best predictive cutoff value of normalized uNCR for DKD diagnosis was 60.685 ng/mg. Type 2 diabetic patients with increased level of uNCR had higher risk to nephrotic-range proteinuria and worse renal outcome.
•uNGAL/creatinine ratios might serve as a biomarker for differential diagnosis of DKD and NDKD.•Diabetic patients with increased uNGAL/creatinine ratios had higher risk to nephrotic-range proteinuria and worse renal outcome.</description><identifier>ISSN: 1056-8727</identifier><identifier>EISSN: 1873-460X</identifier><identifier>DOI: 10.1016/j.jdiacomp.2020.107665</identifier><identifier>PMID: 32653382</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Age ; Biomarkers ; Biopsy ; Blood pressure ; Clinical medicine ; Creatinine ; Diabetes ; Diabetic kidney disease (DKD) ; Diabetic nephropathy ; Diabetic retinopathy ; Hemoglobin ; Hospitals ; Immunoglobulins ; Inflammation ; Kidney diseases ; Laboratories ; Medical diagnosis ; Microscopy ; Neutrophils ; Non-diabetic kidney disease (NDKD) ; Proteins ; Proteinuria ; Regression analysis ; Statistical analysis ; Survival analysis ; Urinary neutrophil gelatinase-associated lipocalin (uNGAL)</subject><ispartof>Journal of diabetes and its complications, 2020-10, Vol.34 (10), p.107665-107665, Article 107665</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><rights>2020. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c462t-3fdf38b1ac8ba89a2534c8d27086780bae64cd07d415538df9333492e91caace3</citedby><cites>FETCH-LOGICAL-c462t-3fdf38b1ac8ba89a2534c8d27086780bae64cd07d415538df9333492e91caace3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2442592201?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32653382$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Duan, Suyan</creatorcontrib><creatorcontrib>Chen, Jiajia</creatorcontrib><creatorcontrib>Wu, Lin</creatorcontrib><creatorcontrib>Nie, Guangyan</creatorcontrib><creatorcontrib>Sun, Lianqin</creatorcontrib><creatorcontrib>Zhang, Chengning</creatorcontrib><creatorcontrib>Huang, Zhimin</creatorcontrib><creatorcontrib>Xing, Changying</creatorcontrib><creatorcontrib>Zhang, Bo</creatorcontrib><creatorcontrib>Yuan, Yanggang</creatorcontrib><title>Assessment of urinary NGAL for differential diagnosis and progression of diabetic kidney disease</title><title>Journal of diabetes and its complications</title><addtitle>J Diabetes Complications</addtitle><description>Chronic kidney disease (CKD) related to diabetes has become more common than glomerulonephritis in recent years. Given the inefficient and difficult identification of diabetic kidney disease (DKD) from non-diabetic kidney disease (NDKD) as well as a result of emerging evidence supporting a role for tubular involvement in DKD, we aimed to investigate the utility of urinary neutrophil gelatinase-associated lipocalin (uNGAL) in the differential diagnosis and predictive value of DKD from NDKD.
Data for 100 type 2 diabetic patients with CKD at our center from June 2016 to August 2019 were reviewed. All the patients were categorized into 2 groups by the renal biopsy results: DKD and NDKD. Urinary NGAL levels were normalized by urinary creatinine and calculated as uNGAL/creatinine ratios (uNCR). The independent factors of the occurrence of DKD and the diagnostic implications of uNCR were explored by logistic regression and receiver-operating characteristic (ROC) curve analysis. In addition, we analyzed the relationship between uNCR and proteinuria in patients with DKD by Pearson test and linear regression. Kaplan-Meier survival analysis was performed to assess the prospective association of uNCR with the renal outcome.
Significantly higher levels of uNCR were observed in patients with DKD when compared to those with NDKD (28.65 ng/mg vs 27.47 ng/mg, p< .001). uNCR was identified as an independent risk factor for the occurrence of DKD in diabetic patients with CKD (odds ratio [OR] = 1.020; 95%CI = [1.001–1.399], p = .042). The optimal cutoff value of uNCR for predicting DKD was 60.685 ng/mg with high specificity (90.5%) but relatively low sensitivity (55.7%). In Pearson test, uNCR was positively correlated with proteinuria, serum creatine, blood urea nitrogen, duration of diabetes, interstitial inflammation score and global sclerosis, whereas it was inversely correlated with eGFR, hemoglobin, serum albumin and 25-hydroxy vitamin D. Furthermore, in a fully adjusted model including eGFR, serum albumin and total cholesterol, the group with uNCR>60.685 ng/mg was associated with 7.595 times higher likelihood of nephrotic-range proteinuria compared to the group with uNCR≤60.685 ng/mg. In the Kaplan-Meier survival analysis, the event-free survival probability in patients with uNCR>60.685 ng/mg was significantly lower than those with uNCR≤60.685 ng/mg (p = .048).
uNCR might serve as a potential tool for identifying cases in which there was a high clinical suspicion of DKD and that in whom confirmatory biopsy could be considered, and the best predictive cutoff value of normalized uNCR for DKD diagnosis was 60.685 ng/mg. Type 2 diabetic patients with increased level of uNCR had higher risk to nephrotic-range proteinuria and worse renal outcome.
•uNGAL/creatinine ratios might serve as a biomarker for differential diagnosis of DKD and NDKD.•Diabetic patients with increased uNGAL/creatinine ratios had higher risk to nephrotic-range proteinuria and worse renal outcome.</description><subject>Age</subject><subject>Biomarkers</subject><subject>Biopsy</subject><subject>Blood pressure</subject><subject>Clinical medicine</subject><subject>Creatinine</subject><subject>Diabetes</subject><subject>Diabetic kidney disease (DKD)</subject><subject>Diabetic nephropathy</subject><subject>Diabetic retinopathy</subject><subject>Hemoglobin</subject><subject>Hospitals</subject><subject>Immunoglobulins</subject><subject>Inflammation</subject><subject>Kidney diseases</subject><subject>Laboratories</subject><subject>Medical diagnosis</subject><subject>Microscopy</subject><subject>Neutrophils</subject><subject>Non-diabetic kidney disease (NDKD)</subject><subject>Proteins</subject><subject>Proteinuria</subject><subject>Regression analysis</subject><subject>Statistical analysis</subject><subject>Survival analysis</subject><subject>Urinary neutrophil gelatinase-associated lipocalin (uNGAL)</subject><issn>1056-8727</issn><issn>1873-460X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU9v1DAQxS1ERUvhK1SRuHDJ4j-x49xYVbRFWtELSNyMY48rh429eBKkfnu82pYDF072eH5vPHqPkCtGN4wy9WHaTD5al-fDhlN-fOyVki_IBdO9aDtFv7-sdypVq3ven5PXiBOlVEnJXpFzwZUUQvML8mOLCIgzpKXJoVlLTLY8Nl9ut7sm5NL4GAKU2o12Xwv7kDJGbGzyzaHkh1K1MaejtDZHWKJrfkaf4LHWCBbhDTkLdo_w9um8JN9uPn29vmt397efr7e71nWKL60IPgg9Muv0aPVguRSd0573VKte09GC6pynve-YlEL7MAghuoHDwJy1DsQleX-aW9f6tQIuZo7oYL-3CfKKhndcSNZTISv67h90ymtJdbtKdVwOnFNWKXWiXMmIBYI5lDhXcwyj5piBmcxzBuaYgTllUIVXT-PXcQb_V_ZsegU-ngCofvyOUAy6CMmBjwXcYnyO__vjD5cEm1I</recordid><startdate>202010</startdate><enddate>202010</enddate><creator>Duan, Suyan</creator><creator>Chen, Jiajia</creator><creator>Wu, Lin</creator><creator>Nie, Guangyan</creator><creator>Sun, Lianqin</creator><creator>Zhang, Chengning</creator><creator>Huang, Zhimin</creator><creator>Xing, Changying</creator><creator>Zhang, Bo</creator><creator>Yuan, Yanggang</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K6X</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202010</creationdate><title>Assessment of urinary NGAL for differential diagnosis and progression of diabetic kidney disease</title><author>Duan, Suyan ; Chen, Jiajia ; Wu, Lin ; Nie, Guangyan ; Sun, Lianqin ; Zhang, Chengning ; Huang, Zhimin ; Xing, Changying ; Zhang, Bo ; Yuan, Yanggang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c462t-3fdf38b1ac8ba89a2534c8d27086780bae64cd07d415538df9333492e91caace3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Age</topic><topic>Biomarkers</topic><topic>Biopsy</topic><topic>Blood pressure</topic><topic>Clinical medicine</topic><topic>Creatinine</topic><topic>Diabetes</topic><topic>Diabetic kidney disease (DKD)</topic><topic>Diabetic nephropathy</topic><topic>Diabetic retinopathy</topic><topic>Hemoglobin</topic><topic>Hospitals</topic><topic>Immunoglobulins</topic><topic>Inflammation</topic><topic>Kidney diseases</topic><topic>Laboratories</topic><topic>Medical diagnosis</topic><topic>Microscopy</topic><topic>Neutrophils</topic><topic>Non-diabetic kidney disease (NDKD)</topic><topic>Proteins</topic><topic>Proteinuria</topic><topic>Regression analysis</topic><topic>Statistical analysis</topic><topic>Survival analysis</topic><topic>Urinary neutrophil gelatinase-associated lipocalin (uNGAL)</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Duan, Suyan</creatorcontrib><creatorcontrib>Chen, Jiajia</creatorcontrib><creatorcontrib>Wu, Lin</creatorcontrib><creatorcontrib>Nie, Guangyan</creatorcontrib><creatorcontrib>Sun, Lianqin</creatorcontrib><creatorcontrib>Zhang, Chengning</creatorcontrib><creatorcontrib>Huang, Zhimin</creatorcontrib><creatorcontrib>Xing, Changying</creatorcontrib><creatorcontrib>Zhang, Bo</creatorcontrib><creatorcontrib>Yuan, Yanggang</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>British Nursing Index</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of diabetes and its complications</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Duan, Suyan</au><au>Chen, Jiajia</au><au>Wu, Lin</au><au>Nie, Guangyan</au><au>Sun, Lianqin</au><au>Zhang, Chengning</au><au>Huang, Zhimin</au><au>Xing, Changying</au><au>Zhang, Bo</au><au>Yuan, Yanggang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of urinary NGAL for differential diagnosis and progression of diabetic kidney disease</atitle><jtitle>Journal of diabetes and its complications</jtitle><addtitle>J Diabetes Complications</addtitle><date>2020-10</date><risdate>2020</risdate><volume>34</volume><issue>10</issue><spage>107665</spage><epage>107665</epage><pages>107665-107665</pages><artnum>107665</artnum><issn>1056-8727</issn><eissn>1873-460X</eissn><abstract>Chronic kidney disease (CKD) related to diabetes has become more common than glomerulonephritis in recent years. Given the inefficient and difficult identification of diabetic kidney disease (DKD) from non-diabetic kidney disease (NDKD) as well as a result of emerging evidence supporting a role for tubular involvement in DKD, we aimed to investigate the utility of urinary neutrophil gelatinase-associated lipocalin (uNGAL) in the differential diagnosis and predictive value of DKD from NDKD.
Data for 100 type 2 diabetic patients with CKD at our center from June 2016 to August 2019 were reviewed. All the patients were categorized into 2 groups by the renal biopsy results: DKD and NDKD. Urinary NGAL levels were normalized by urinary creatinine and calculated as uNGAL/creatinine ratios (uNCR). The independent factors of the occurrence of DKD and the diagnostic implications of uNCR were explored by logistic regression and receiver-operating characteristic (ROC) curve analysis. In addition, we analyzed the relationship between uNCR and proteinuria in patients with DKD by Pearson test and linear regression. Kaplan-Meier survival analysis was performed to assess the prospective association of uNCR with the renal outcome.
Significantly higher levels of uNCR were observed in patients with DKD when compared to those with NDKD (28.65 ng/mg vs 27.47 ng/mg, p< .001). uNCR was identified as an independent risk factor for the occurrence of DKD in diabetic patients with CKD (odds ratio [OR] = 1.020; 95%CI = [1.001–1.399], p = .042). The optimal cutoff value of uNCR for predicting DKD was 60.685 ng/mg with high specificity (90.5%) but relatively low sensitivity (55.7%). In Pearson test, uNCR was positively correlated with proteinuria, serum creatine, blood urea nitrogen, duration of diabetes, interstitial inflammation score and global sclerosis, whereas it was inversely correlated with eGFR, hemoglobin, serum albumin and 25-hydroxy vitamin D. Furthermore, in a fully adjusted model including eGFR, serum albumin and total cholesterol, the group with uNCR>60.685 ng/mg was associated with 7.595 times higher likelihood of nephrotic-range proteinuria compared to the group with uNCR≤60.685 ng/mg. In the Kaplan-Meier survival analysis, the event-free survival probability in patients with uNCR>60.685 ng/mg was significantly lower than those with uNCR≤60.685 ng/mg (p = .048).
uNCR might serve as a potential tool for identifying cases in which there was a high clinical suspicion of DKD and that in whom confirmatory biopsy could be considered, and the best predictive cutoff value of normalized uNCR for DKD diagnosis was 60.685 ng/mg. Type 2 diabetic patients with increased level of uNCR had higher risk to nephrotic-range proteinuria and worse renal outcome.
•uNGAL/creatinine ratios might serve as a biomarker for differential diagnosis of DKD and NDKD.•Diabetic patients with increased uNGAL/creatinine ratios had higher risk to nephrotic-range proteinuria and worse renal outcome.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32653382</pmid><doi>10.1016/j.jdiacomp.2020.107665</doi><tpages>1</tpages></addata></record> |
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| ispartof | Journal of diabetes and its complications, 2020-10, Vol.34 (10), p.107665-107665, Article 107665 |
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| subjects | Age Biomarkers Biopsy Blood pressure Clinical medicine Creatinine Diabetes Diabetic kidney disease (DKD) Diabetic nephropathy Diabetic retinopathy Hemoglobin Hospitals Immunoglobulins Inflammation Kidney diseases Laboratories Medical diagnosis Microscopy Neutrophils Non-diabetic kidney disease (NDKD) Proteins Proteinuria Regression analysis Statistical analysis Survival analysis Urinary neutrophil gelatinase-associated lipocalin (uNGAL) |
| title | Assessment of urinary NGAL for differential diagnosis and progression of diabetic kidney disease |
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