Difference between revisions of "Short bowel syndrome natural history, complications and prognosis"

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==Overview==
 
==Overview==
The symptoms of short bowel syndrome usually develop immediately following [[bowel resection]]. Symptoms
+
The symptoms of short bowel syndrome usually develop immediately following [[bowel resection]]. [[Diarrhea]] may cause massive [[fluid]] and [[Electrolyte disturbance|electrolyte loss]]. Immediately after surgery, [[Intestine|intestinal]] [[adaptation]] develops in three phases, including [[Acute (medicine)|acute]], adaptive and maintenance phase. During the [[adaptation]], structural, motility and functional changes happen. Patients need [[hydration]] and [[Nutrition|nutritional]] support via [[Route of administration|parenteral]], [[Feeding tube|enteral]] and [[Mouth|oral]] routes. Length of remaining small bowel is the most important prognostic factor. patients with more than 200 cm length of small bowel, usually does not need parenteral nutrition. Patients with shorter small bowel may not weaned off from parenteral nutrition support. Complications might happen due to [[malnutrition]], [[surgery]] and [[Total parenteral nutrition|parenteral nutrition]]. Malnutrition presents with [[vitamin]], [[mineral]] and [[Essential fatty acid|essential fatty acids]] deficiencies. Complications related to [[surgery]] including [[thrombosis]], [[infection]], [[Bleeding|hemorrhage]], [[atelectasis]] and [[anastomosis]] disruption might occur. [[Small intestinal bacterial overgrowth]] due to [[Stasis (medicine)|stasis]] and obstruction might happen. [[Chronic liver disease]] following [[Total parenteral nutrition|parenteral nutrition]] is a common complication in short bowel syndrome. There is no definite cure for short bowel syndrome. However, [[Medication|medications]] and [[Nutrition|nutritional]] therapy significantly improve the quality of life and survival of the patients. Prognosis of short bowel syndrome depends on the location and size of the [[bowel resection]], underlying [[pathology]], [[nutrition]] support, [[pharmacotherapy]], and extent of [[Intestine|intestinal]] [[adaptation]]. The 2 and 5-year [[survival rate]] of patients with short bowel syndrome are approximately 80% and 70%, respectively.     
  
 
==Natural History, Complications, and Prognosis==
 
==Natural History, Complications, and Prognosis==
  
 
===Natural History===
 
===Natural History===
*The symptoms of short bowel syndrome usually develop immediately following [[bowel resection]].  
+
*The symptoms of short bowel syndrome usually develop immediately following [[bowel resection]].<ref name="WilmoreRobinson2014">{{cite journal|last1=Wilmore|first1=Douglas W.|last2=Robinson|first2=Malcolm K.|title=Short Bowel Syndrome|journal=World Journal of Surgery|volume=24|issue=12|year=2014|pages=1486–1492|issn=0364-2313|doi=10.1007/s002680010266}}</ref>
*Short bowel syndrome presents with massive [[fluid]] and [[Electrolyte disturbance|electrolyte]] loss.
+
*Short bowel syndrome may cause [[diarrhea]] which presents with massive [[fluid]] and [[Electrolyte disturbance|electrolyte]] loss.<ref name="Wall2013">{{cite journal|last1=Wall|first1=Elizabeth A.|title=An Overview of Short Bowel Syndrome Management: Adherence, Adaptation, and Practical Recommendations|journal=Journal of the Academy of Nutrition and Dietetics|volume=113|issue=9|year=2013|pages=1200–1208|issn=22122672|doi=10.1016/j.jand.2013.05.001}}</ref>
*It is important to manage the patient following [[surgery]], to [[hydrate]] and receive enough [[Nutrient|nutrients]] through [[Route of administration|parenteral]] or [[Feeding tube|enteral]] routes.  
+
*It is important to manage the patient following [[surgery]], to [[hydrate]] and receive enough [[Nutrient|nutrients]] through [[Route of administration|parenteral]] or [[Feeding tube|enteral]] routes.<ref name="RodriguesSeetharam2011">{{cite journal|last1=Rodrigues|first1=Gabriel|last2=Seetharam|first2=Prasad|title=Short bowel syndrome: A review of management options|journal=Saudi Journal of Gastroenterology|volume=17|issue=4|year=2011|pages=229|issn=1319-3767|doi=10.4103/1319-3767.82573}}</ref>
* Immediately after surgery, [[Intestine|intestinal]] [[adaptation]] initiates in three phases, including [[Acute (medicine)|acute]], adaptive and maintenance phase.
+
* Immediately after surgery, [[Intestine|intestinal]] [[adaptation]] develops in three phases, including [[Acute (medicine)|acute]], adaptive and maintenance phase.<ref name="ThompsonWeseman2011">{{cite journal|last1=Thompson|first1=Jon S.|last2=Weseman|first2=Rebecca|last3=Rochling|first3=Fedja A.|last4=Mercer|first4=David F.|title=Current Management of the Short Bowel Syndrome|journal=Surgical Clinics of North America|volume=91|issue=3|year=2011|pages=493–510|issn=00396109|doi=10.1016/j.suc.2011.02.006}}</ref>
*Structural, motility and functional changes occur to adapt [[intestine]] to the new situation.
+
*Structural, motility and functional changes occur to adapt [[intestine]] to the new situation.<ref name="EçaBarbosa2016">{{cite journal|last1=Eça|first1=Rosário|last2=Barbosa|first2=Elisabete|title=Short bowel syndrome: treatment options|journal=Journal of Coloproctology|volume=36|issue=4|year=2016|pages=262–272|issn=22379363|doi=10.1016/j.jcol.2016.07.002}}</ref>
*Patients with remaining [[Small intestine|small bowel]] of more than 200 cm length, usually do not need [[Total parenteral nutrition|parenteral nutrition]] and may be adapted easily.
+
*Patients with remaining [[Small intestine|small bowel]] of more than 120 cm length, usually do not need [[Total parenteral nutrition|parenteral nutrition]] and may be adapted easily.<ref name="pmid17198059">{{cite journal |vauthors=Misiakos EP, Macheras A, Kapetanakis T, Liakakos T |title=Short bowel syndrome: current medical and surgical trends |journal=J. Clin. Gastroenterol. |volume=41 |issue=1 |pages=5–18 |year=2007 |pmid=17198059 |doi=10.1097/01.mcg.0000212617.74337.e9 |url=}}</ref><ref name="ThompsonWeseman2011">{{cite journal|last1=Thompson|first1=Jon S.|last2=Weseman|first2=Rebecca|last3=Rochling|first3=Fedja A.|last4=Mercer|first4=David F.|title=Current Management of the Short Bowel Syndrome|journal=Surgical Clinics of North America|volume=91|issue=3|year=2011|pages=493–510|issn=00396109|doi=10.1016/j.suc.2011.02.006}}</ref>
*It is not common for patients who have [[Small intestine|small bowel]] length of less than 50 to be weaned off from [[Total parenteral nutrition|parenteral nutrition]].
+
*It is not common for patients who have [[Small intestine|small bowel]] length of less than 50 to be weaned off from [[Total parenteral nutrition|parenteral nutrition]].<ref name="pmid16770169">{{cite journal |vauthors=Steiger E, DiBaise JK, Messing B, Matarese LE, Blethen S |title=Indications and recommendations for the use of recombinant human growth hormone in adult short bowel syndrome patients dependent on parenteral nutrition |journal=J. Clin. Gastroenterol. |volume=40 Suppl 2 |issue= |pages=S99–106 |year=2006 |pmid=16770169 |doi=10.1097/01.mcg.0000212680.52290.02 |url=}}</ref><ref name="pmid15494290">{{cite journal |vauthors=Keller J, Panter H, Layer P |title=Management of the short bowel syndrome after extensive small bowel resection |journal=Best Pract Res Clin Gastroenterol |volume=18 |issue=5 |pages=977–92 |year=2004 |pmid=15494290 |doi=10.1016/j.bpg.2004.05.002 |url=}}</ref>
*Efforts must be applied to wean the patients from [[Total parenteral nutrition|parenteral nutrition]] to [[enteral nutrition]] and if it is possible to oral [[nutrition]].  
+
*Efforts must be applied to wean the patients from [[Total parenteral nutrition|parenteral nutrition]] to [[enteral nutrition]] and if it is possible to oral [[nutrition]].<ref name="pmid16207689">{{cite journal |vauthors=Matarese LE, O'Keefe SJ, Kandil HM, Bond G, Costa G, Abu-Elmagd K |title=Short bowel syndrome: clinical guidelines for nutrition management |journal=Nutr Clin Pract |volume=20 |issue=5 |pages=493–502 |year=2005 |pmid=16207689 |doi=10.1177/0115426505020005493 |url=}}</ref>
*However, complications might happen even if all the precautions are done.  
+
*However, complications might happen even if all the precautions are done.<ref name="pmid26818425">{{cite journal |vauthors=Limketkai BN, Parian AM, Shah ND, Colombel JF |title=Short Bowel Syndrome and Intestinal Failure in Crohn's Disease |journal=Inflamm. Bowel Dis. |volume=22 |issue=5 |pages=1209–18 |year=2016 |pmid=26818425 |doi=10.1097/MIB.0000000000000698 |url=}}</ref>
  
 
===Complications===
 
===Complications===
Common complications of short bowel syndrome may be classified to different categories, including malnutrition, surgery related, and chronic complications.<ref name="Wall2013">{{cite journal|last1=Wall|first1=Elizabeth A.|title=An Overview of Short Bowel Syndrome Management: Adherence, Adaptation, and Practical Recommendations|journal=Journal of the Academy of Nutrition and Dietetics|volume=113|issue=9|year=2013|pages=1200–1208|issn=22122672|doi=10.1016/j.jand.2013.05.001}}</ref><ref name="ThompsonWeseman2011">{{cite journal|last1=Thompson|first1=Jon S.|last2=Weseman|first2=Rebecca|last3=Rochling|first3=Fedja A.|last4=Mercer|first4=David F.|title=Current Management of the Short Bowel Syndrome|journal=Surgical Clinics of North America|volume=91|issue=3|year=2011|pages=493–510|issn=00396109|doi=10.1016/j.suc.2011.02.006}}</ref><ref name="pmid14642862">{{cite journal |vauthors=Vanderhoof JA, Young RJ |title=Enteral and parenteral nutrition in the care of patients with short-bowel syndrome |journal=Best Pract Res Clin Gastroenterol |volume=17 |issue=6 |pages=997–1015 |year=2003 |pmid=14642862 |doi= |url=}}</ref><ref name="pmid15330926">{{cite journal |vauthors=DiBaise JK, Young RJ, Vanderhoof JA |title=Intestinal rehabilitation and the short bowel syndrome: part 2 |journal=Am. J. Gastroenterol. |volume=99 |issue=9 |pages=1823–32 |year=2004 |pmid=15330926 |doi=10.1111/j.1572-0241.2004.40836.x |url=}}</ref><ref name="BoteyAlastrué2017">{{cite journal|last1=Botey|first1=Mireia|last2=Alastrué|first2=Antonio|last3=Haetta|first3=Henrik|last4=Fernández-Llamazares|first4=Jaume|last5=Clavell|first5=Arantxa|last6=Moreno|first6=Pau|title=Long-Term Results of Serial Transverse Enteroplasty with Neovalve Creation for Extreme Short Bowel Syndrome: Report of Two Cases|journal=Case Reports in Gastroenterology|volume=11|issue=1|year=2017|pages=229–240|issn=1662-0631|doi=10.1159/000452734}}</ref><ref name="pmid15494290">{{cite journal |vauthors=Keller J, Panter H, Layer P |title=Management of the short bowel syndrome after extensive small bowel resection |journal=Best Pract Res Clin Gastroenterol |volume=18 |issue=5 |pages=977–92 |year=2004 |pmid=15494290 |doi=10.1016/j.bpg.2004.05.002 |url=}}</ref><ref name="pmid11873098">{{cite journal |vauthors=Sundaram A, Koutkia P, Apovian CM |title=Nutritional management of short bowel syndrome in adults |journal=J. Clin. Gastroenterol. |volume=34 |issue=3 |pages=207–20 |year=2002 |pmid=11873098 |doi= |url=}}</ref><ref name="pmid24500909">{{cite journal |vauthors=Tappenden KA |title=Pathophysiology of short bowel syndrome: considerations of resected and residual anatomy |journal=JPEN J Parenter Enteral Nutr |volume=38 |issue=1 Suppl |pages=14S–22S |year=2014 |pmid=24500909 |doi=10.1177/0148607113520005 |url=}}</ref><ref name="pmid26818425">{{cite journal |vauthors=Limketkai BN, Parian AM, Shah ND, Colombel JF |title=Short Bowel Syndrome and Intestinal Failure in Crohn's Disease |journal=Inflamm. Bowel Dis. |volume=22 |issue=5 |pages=1209–18 |year=2016 |pmid=26818425 |doi=10.1097/MIB.0000000000000698 |url=}}</ref>
+
Common complications of short bowel syndrome may be classified to different categories, including malnutrition, surgery related, and chronic complications.<ref name="Wall2013">{{cite journal|last1=Wall|first1=Elizabeth A.|title=An Overview of Short Bowel Syndrome Management: Adherence, Adaptation, and Practical Recommendations|journal=Journal of the Academy of Nutrition and Dietetics|volume=113|issue=9|year=2013|pages=1200–1208|issn=22122672|doi=10.1016/j.jand.2013.05.001}}</ref><ref name="ThompsonWeseman2011">{{cite journal|last1=Thompson|first1=Jon S.|last2=Weseman|first2=Rebecca|last3=Rochling|first3=Fedja A.|last4=Mercer|first4=David F.|title=Current Management of the Short Bowel Syndrome|journal=Surgical Clinics of North America|volume=91|issue=3|year=2011|pages=493–510|issn=00396109|doi=10.1016/j.suc.2011.02.006}}</ref><ref name="pmid15494290">{{cite journal |vauthors=Keller J, Panter H, Layer P |title=Management of the short bowel syndrome after extensive small bowel resection |journal=Best Pract Res Clin Gastroenterol |volume=18 |issue=5 |pages=977–92 |year=2004 |pmid=15494290 |doi=10.1016/j.bpg.2004.05.002 |url=}}</ref><ref name="pmid26818425">{{cite journal |vauthors=Limketkai BN, Parian AM, Shah ND, Colombel JF |title=Short Bowel Syndrome and Intestinal Failure in Crohn's Disease |journal=Inflamm. Bowel Dis. |volume=22 |issue=5 |pages=1209–18 |year=2016 |pmid=26818425 |doi=10.1097/MIB.0000000000000698 |url=}}</ref><ref name="pmid14642862">{{cite journal |vauthors=Vanderhoof JA, Young RJ |title=Enteral and parenteral nutrition in the care of patients with short-bowel syndrome |journal=Best Pract Res Clin Gastroenterol |volume=17 |issue=6 |pages=997–1015 |year=2003 |pmid=14642862 |doi= |url=}}</ref><ref name="pmid15330926">{{cite journal |vauthors=DiBaise JK, Young RJ, Vanderhoof JA |title=Intestinal rehabilitation and the short bowel syndrome: part 2 |journal=Am. J. Gastroenterol. |volume=99 |issue=9 |pages=1823–32 |year=2004 |pmid=15330926 |doi=10.1111/j.1572-0241.2004.40836.x |url=}}</ref><ref name="BoteyAlastrué2017">{{cite journal|last1=Botey|first1=Mireia|last2=Alastrué|first2=Antonio|last3=Haetta|first3=Henrik|last4=Fernández-Llamazares|first4=Jaume|last5=Clavell|first5=Arantxa|last6=Moreno|first6=Pau|title=Long-Term Results of Serial Transverse Enteroplasty with Neovalve Creation for Extreme Short Bowel Syndrome: Report of Two Cases|journal=Case Reports in Gastroenterology|volume=11|issue=1|year=2017|pages=229–240|issn=1662-0631|doi=10.1159/000452734}}</ref><ref name="pmid11873098">{{cite journal |vauthors=Sundaram A, Koutkia P, Apovian CM |title=Nutritional management of short bowel syndrome in adults |journal=J. Clin. Gastroenterol. |volume=34 |issue=3 |pages=207–20 |year=2002 |pmid=11873098 |doi= |url=}}</ref><ref name="pmid24500909">{{cite journal |vauthors=Tappenden KA |title=Pathophysiology of short bowel syndrome: considerations of resected and residual anatomy |journal=JPEN J Parenter Enteral Nutr |volume=38 |issue=1 Suppl |pages=14S–22S |year=2014 |pmid=24500909 |doi=10.1177/0148607113520005 |url=}}</ref>
 
* Malnutrition
 
* Malnutrition
 
** Vitamin deficiency
 
** Vitamin deficiency

Latest revision as of 21:00, 8 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

The symptoms of short bowel syndrome usually develop immediately following bowel resection. Diarrhea may cause massive fluid and electrolyte loss. Immediately after surgery, intestinal adaptation develops in three phases, including acute, adaptive and maintenance phase. During the adaptation, structural, motility and functional changes happen. Patients need hydration and nutritional support via parenteral, enteral and oral routes. Length of remaining small bowel is the most important prognostic factor. patients with more than 200 cm length of small bowel, usually does not need parenteral nutrition. Patients with shorter small bowel may not weaned off from parenteral nutrition support. Complications might happen due to malnutrition, surgery and parenteral nutrition. Malnutrition presents with vitamin, mineral and essential fatty acids deficiencies. Complications related to surgery including thrombosis, infection, hemorrhage, atelectasis and anastomosis disruption might occur. Small intestinal bacterial overgrowth due to stasis and obstruction might happen. Chronic liver disease following parenteral nutrition is a common complication in short bowel syndrome. There is no definite cure for short bowel syndrome. However, medications and nutritional therapy significantly improve the quality of life and survival of the patients. Prognosis of short bowel syndrome depends on the location and size of the bowel resection, underlying pathology, nutrition support, pharmacotherapy, and extent of intestinal adaptation. The 2 and 5-year survival rate of patients with short bowel syndrome are approximately 80% and 70%, respectively.

Natural History, Complications, and Prognosis

Natural History

Complications

Common complications of short bowel syndrome may be classified to different categories, including malnutrition, surgery related, and chronic complications.[2][4][8][10][11][12][13][14][15]

Prognosis

  • There is no definite cure for short bowel syndrome. However, medications and nutritional therapy significantly improve the quality of life and survival of the patients.[16]
  • Prognosis of short bowel syndrome depends on the location and size of the bowel resection, underlying pathology, nutrition support, pharmacotherapy, and extent of intestinal adaptation.[11][14][5]
  • The quality of life for patients with short bowel syndrome depends on their ability to previous activities. Majority of them on effective treatment could have an excellent quality of life.[17]
  • The 2 and 5-year survival rate of patients with short bowel syndrome are approximately 80% and 70%, respectively.[12]
  • The 6-year survival rate of patients with short bowel syndrome is approximately 65% for patients who have remaining short bowel of more than 50 cm.[5]
  • Much hope is vested in Omegaven, a type of lipid TPN feed, in which recent case reports suggest the risk of liver disease is much lower.[18]
  • Although promising, the small intestine transplant has a mixed success rate, with a postoperative mortality rate of up to 30%. One-year and 4-year survival rates are 90% and 60%, respectively.[4]

References

  1. Wilmore, Douglas W.; Robinson, Malcolm K. (2014). "Short Bowel Syndrome". World Journal of Surgery. 24 (12): 1486–1492. ISSN 0364-2313. doi:10.1007/s002680010266. 
  2. 2.0 2.1 Wall, Elizabeth A. (2013). "An Overview of Short Bowel Syndrome Management: Adherence, Adaptation, and Practical Recommendations". Journal of the Academy of Nutrition and Dietetics. 113 (9): 1200–1208. ISSN 2212-2672. doi:10.1016/j.jand.2013.05.001. 
  3. Rodrigues, Gabriel; Seetharam, Prasad (2011). "Short bowel syndrome: A review of management options". Saudi Journal of Gastroenterology. 17 (4): 229. ISSN 1319-3767. doi:10.4103/1319-3767.82573. 
  4. 4.0 4.1 4.2 4.3 Thompson, Jon S.; Weseman, Rebecca; Rochling, Fedja A.; Mercer, David F. (2011). "Current Management of the Short Bowel Syndrome". Surgical Clinics of North America. 91 (3): 493–510. ISSN 0039-6109. doi:10.1016/j.suc.2011.02.006. 
  5. 5.0 5.1 5.2 Eça, Rosário; Barbosa, Elisabete (2016). "Short bowel syndrome: treatment options". Journal of Coloproctology. 36 (4): 262–272. ISSN 2237-9363. doi:10.1016/j.jcol.2016.07.002. 
  6. Misiakos EP, Macheras A, Kapetanakis T, Liakakos T (2007). "Short bowel syndrome: current medical and surgical trends". J. Clin. Gastroenterol. 41 (1): 5–18. PMID 17198059. doi:10.1097/01.mcg.0000212617.74337.e9. 
  7. Steiger E, DiBaise JK, Messing B, Matarese LE, Blethen S (2006). "Indications and recommendations for the use of recombinant human growth hormone in adult short bowel syndrome patients dependent on parenteral nutrition". J. Clin. Gastroenterol. 40 Suppl 2: S99–106. PMID 16770169. doi:10.1097/01.mcg.0000212680.52290.02. 
  8. 8.0 8.1 Keller J, Panter H, Layer P (2004). "Management of the short bowel syndrome after extensive small bowel resection". Best Pract Res Clin Gastroenterol. 18 (5): 977–92. PMID 15494290. doi:10.1016/j.bpg.2004.05.002. 
  9. Matarese LE, O'Keefe SJ, Kandil HM, Bond G, Costa G, Abu-Elmagd K (2005). "Short bowel syndrome: clinical guidelines for nutrition management". Nutr Clin Pract. 20 (5): 493–502. PMID 16207689. doi:10.1177/0115426505020005493. 
  10. 10.0 10.1 Limketkai BN, Parian AM, Shah ND, Colombel JF (2016). "Short Bowel Syndrome and Intestinal Failure in Crohn's Disease". Inflamm. Bowel Dis. 22 (5): 1209–18. PMID 26818425. doi:10.1097/MIB.0000000000000698. 
  11. 11.0 11.1 Vanderhoof JA, Young RJ (2003). "Enteral and parenteral nutrition in the care of patients with short-bowel syndrome". Best Pract Res Clin Gastroenterol. 17 (6): 997–1015. PMID 14642862. 
  12. 12.0 12.1 DiBaise JK, Young RJ, Vanderhoof JA (2004). "Intestinal rehabilitation and the short bowel syndrome: part 2". Am. J. Gastroenterol. 99 (9): 1823–32. PMID 15330926. doi:10.1111/j.1572-0241.2004.40836.x. 
  13. Botey, Mireia; Alastrué, Antonio; Haetta, Henrik; Fernández-Llamazares, Jaume; Clavell, Arantxa; Moreno, Pau (2017). "Long-Term Results of Serial Transverse Enteroplasty with Neovalve Creation for Extreme Short Bowel Syndrome: Report of Two Cases". Case Reports in Gastroenterology. 11 (1): 229–240. ISSN 1662-0631. doi:10.1159/000452734. 
  14. 14.0 14.1 Sundaram A, Koutkia P, Apovian CM (2002). "Nutritional management of short bowel syndrome in adults". J. Clin. Gastroenterol. 34 (3): 207–20. PMID 11873098. 
  15. Tappenden KA (2014). "Pathophysiology of short bowel syndrome: considerations of resected and residual anatomy". JPEN J Parenter Enteral Nutr. 38 (1 Suppl): 14S–22S. PMID 24500909. doi:10.1177/0148607113520005. 
  16. Kelly DG, Tappenden KA, Winkler MF (2014). "Short bowel syndrome: highlights of patient management, quality of life, and survival". JPEN J Parenter Enteral Nutr. 38 (4): 427–37. PMID 24247092. doi:10.1177/0148607113512678. 
  17. DiBaise JK, Young RJ, Vanderhoof JA (2004). "Intestinal rehabilitation and the short bowel syndrome: part 1". Am. J. Gastroenterol. 99 (7): 1386–95. PMID 15233682. doi:10.1111/j.1572-0241.2004.30345.x. 
  18. Gura KM, Duggan CP, Collier SB; et al. (2006). "Reversal of parenteral nutrition-associated liver disease in two infants with short bowel syndrome using parenteral fish oil: implications for future management". Pediatrics. 118 (1): e197–201. PMID 16818533. doi:10.1542/peds.2005-2662. 



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