Zie ook literatuurlijst van voeding, voedingsuppletie en weinig belastende behandelingen specifiek bij eierstokkanker van arts-bioloog drs. Engelbert Valstar

7 augustus 2023:

zie ook dit artikel: https://kanker-actueel.nl/bewegen-en-sporten-voorkomt-en-herstelt-ernstige-vermoeidheid-bij-kankerpatienten-blijkt-uit-grote-studies-iedere-kankerpatient-zou-een-bewegingsprogramma-moeten-worden-voorgeschreven-aldus-de-onderzoekers.html

7 augustus 2023: Bron: JAMA, 1 augustus 2023

Een zes maanden durend aerobics bewegingsprogramma naast chemotherapie verbetert statistisch significant de zelfgerapporteerde door chemotherapie geïnduceerde perifere neuropathie (CIPN) bij patiënten die worden behandeld voor eierstokkanker met chemotherapie. De gerandomiseerde studie Activity and Lifestyle Study in Connecticut (WALC) vergeleek een aerobicsprogramma met een aandachtcontrole aanpak bij totaal 134 patiënten waarvan 69 patiënten in de aerobicsgroep en 65 patiënten in de aandachtcontrolegroep. Tekst gaat verder onder grafiek.

Secondary analysis of the effect of exercise on chemotherapy-induced peripheral neuropathy (CIPN) among patients treated for ovarian cancer


Anlan Cao, M.B.B.S. en collega's, van de Yale University in New Haven, Connecticut ontdekten dat na zes maanden de zelfgerapporteerde perifere neuropathie (CIPN) -score 1,3 punten lager was in de bewegingsinterventiegroep (95 procent betrouwbaarheidsinterval, -2,3 tot -0,2) versus een toename van 0,4 punten in de aandachtscontrolegroep (95 procent betrouwbaarheidsinterval). interval, −0,8 tot 1,5). Het verschil tussen de groepen was −1,6 punten (95 procent betrouwbaarheidsinterval, −3,1 tot −0,2).
Onder deelnemers met al CIPN-symptomen bij aanvang van de studie was de puntschatting nog groter (−2,0; 95 procent betrouwbaarheidsinterval, −3,6 tot −0,5).

Conclusie van de onderzoekers:

Bevindingen van deze secundaire analyse suggereren dat lichaamsbeweging een veelbelovende behandeling is voor perifere neuropathie (CIPN) en het opnemen van verwijzingen naar oefenprogramma's in de standaard oncologische zorg kan CIPN-symptomen verminderen en de kwaliteit van leven verhogen voor overlevenden van eierstokkanker.

Het volledige studierapport is gratis in te zien of te downloaden. Klik op de titel van het abstract:

August 1, 2023

Effect of Exercise on Chemotherapy-Induced Peripheral Neuropathy Among Patients Treated for Ovarian CancerA Secondary Analysis of a Randomized Clinical Trial

Anlan Cao, MBBS1; Brenda Cartmel, PhD1,2; Fang-Yong Li, MPH6; et alLinda T. Gottlieb, MA1; Maura Harrigan, MS, RD1; Jennifer A. Ligibel, MD3; Radhika Gogoi, MD, PhD4; Peter E. Schwartz, MD5; Denise A. Esserman, PhD6; Melinda L. Irwin, PhD, MPH1,2; Leah M. Ferrucci, PhD, MPH1,2
Author Affiliations Article Information
JAMA Netw Open. 2023;6(8):e2326463. doi:10.1001/jamanetworkopen.2023.26463
visual abstract icon 
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Abstract
Secondary analysis of the effect of exercise on chemotherapy-induced peripheral neuropathy (CIPN) among patients treated for ovarian cancer
Key Points

Question  What is the effect of exercise on chemotherapy-induced peripheral neuropathy (CIPN)?

Findings  In this secondary analysis of a randomized clinical trial of 134 patients with ovarian cancer, the self-reported CIPN score was 1.6 points lower in those who were randomized to the exercise intervention compared with the attention control group, indicating significant improvement in CIPN symptoms.

Meaning  Findings of this secondary analysis suggest that exercise is a promising treatment for CIPN and incorporating exercise program referrals into the standard oncology care may reduce CIPN symptoms and increase quality of life for survivors of ovarian cancer.

Abstract

Importance  Chemotherapy-induced peripheral neuropathy (CIPN), one of the most common and severe adverse effects of chemotherapy, is associated with worse quality of life among survivors of ovarian cancer. Currently, there is no effective treatment for CIPN.

Objective  To evaluate the effect of a 6-month aerobic exercise intervention vs attention-control on CIPN among women treated for ovarian cancer in the Women’s Activity and Lifestyle Study in Connecticut (WALC) to provide evidence to inform the guidelines and recommendations for prevention or treatment of CIPN.

Design, Setting, and Participants  This prespecified secondary analysis evaluated the Women’s Activity and Lifestyle Study in Connecticut (WALC), a multicentered, open-label, population-based, phase 3 randomized clinical trial of an aerobic exercise intervention vs attention control for CIPN in patients who were diagnosed with ovarian cancer. Only WALC participants who received chemotherapy were included in this analysis. Participants were randomized 1:1 to either a 6-month aerobic exercise intervention or to attention control. All analyses were conducted between September 2022 and January 2023.

Interventions  The exercise intervention consisted of home-based moderate-intensity aerobic exercise facilitated by weekly telephone counseling from an American College of Sports Medicine/American Cancer Society–certified cancer exercise trainer. Attention control involved weekly health education telephone calls from a WALC staff member.

Main Outcomes and Measure  Change in CIPN was the primary outcome in this secondary analysis. This outcome was represented by CIPN severity, which was self-measured by participants at baseline and 6 months using the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group–Neurotoxicity scale, with a score range of 0 to 44. A mixed-effects model was used to assess the 6-month change in CIPN between the exercise intervention and attention control arms.

Results  Of the 134 participants (all females; mean age, 57.5 [8.3] years) included in the analysis, 69 were in the exercise intervention arm and 65 were in the attention control arm. The mean (SD) time since diagnosis was 1.7 (1.0) years. The mean (SD) baseline CIPN scores were 8.1 (5.6) in the exercise intervention arm and 8.8 (7.9) in the attention control arm (P = .56). At 6 months, the self-reported CIPN score was reduced by 1.3 (95% CI, −2.3 to −0.2) points in the exercise intervention arm compared with an increase of 0.4 (95% CI, −0.8 to 1.5) points in the attention control arm. The between-group difference was −1.6 (95% CI, −3.1 to −0.2) points. The point estimate was larger among the 127 patients with CIPN symptoms at enrollment (−2.0; 95% CI, −3.6 to −0.5 points).

Conclusions and Relevance  Findings of this secondary analysis of the WALC trial indicate that a 6-month aerobic exercise intervention vs attention control significantly improved self-reported CIPN among patients who were treated for ovarian cancer. While replication of the findings in other studies is warranted, incorporating referrals to exercise programs into standard oncology care could reduce CIPN symptoms and increase quality of life in patients with ovarian cancer.

Trial Registration  ClinicalTrials.gov Identifier: NCT02107066

Article Information

Accepted for Publication: June 20, 2023.

Published: August 1, 2023. doi:10.1001/jamanetworkopen.2023.26463

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2023 Cao A et al. JAMA Network Open.

Corresponding Author: Anlan Cao, MBBS, Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College St, New Haven, CT 06520-803 (anlan.cao@yale.edu).

Author Contributions: Drs Irwin and Ferrucci had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Ligibel, Schwartz, Esserman, Irwin, Ferrucci.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Cao.

Critical review of the manuscript for important intellectual content: All authors.

Statistical analysis: Cao, Li, Esserman.

Obtained funding: Irwin.

Administrative, technical, or material support: Cartmel, Harrigan, Gogoi, Schwartz, Ferrucci.

Supervision: Gogoi, Esserman, Irwin, Ferrucci.

Conflict of Interest Disclosures: Dr Cartmel reported receiving grants from National Cancer Institute during the conduct of the study. Dr Esserman reported receiving grants from the National Institutes of Health (NIH) during the conduct of the study. Dr Ferrucci reported receiving grants from National Cancer Institute during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was supported by grants NCI 5R01CA138556 and P30 CA016359 from the National Cancer Institute at the NIH, grant UL1TR000142 from the National Center for Advancing Translational Science at the NIH, and grant P30AG021342 from the Yale Claude D. Pepper Older Americans Independence Center.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 3.

Additional Contributions: Certain data were collected from the Connecticut Tumor Registry located in the Connecticut Department of Public Health. We thank all of the study participants and physicians; Rajni Mehta, MPH, Director of the Rapid Case Ascertainment Shared Resource, Yale Cancer Center; and the following Connecticut hospitals: Charlotte Hungerford Hospital, Bridgeport Hospital, Danbury Hospital, Hartford Hospital, Middlesex Hospital, New Britain General Hospital, Bradley Memorial Hospital, Yale/New Haven Hospital, St Francis Hospital and Medical Center, St Mary’s Hospital, Hospital of St Raphael, St Vincent’s Medical Center, Stamford Hospital, William W. Backus Hospital, Windham Hospital, Eastern Connecticut Health Network, Griffin Hospital, Bristol Hospital, Johnson Memorial Hospital, Day Kimball Hospital, Greenwich Hospital, Lawrence and Memorial Hospital, Milford Hospital, New Milford Hospital, Norwalk Hospital, Sharon Hospital, and Waterbury Hospital. None of these groups and individuals were financially compensated for their contributions.


References
1.
Siegel  RL, Miller  KD, Wagle  NS, Jemal  A.  Cancer statistics, 2023.   CA Cancer J Clin. 2023;73(1):17-48. doi:10.3322/caac.21763PubMedGoogle ScholarCrossref
2.
Torre  LA, Trabert  B, DeSantis  CE,  et al.  Ovarian cancer statistics, 2018.   CA Cancer J Clin. 2018;68(4):284-296. doi:10.3322/caac.21456PubMedGoogle ScholarCrossref
3.
Kim  A, Ueda  Y, Naka  T, Enomoto  T.  Therapeutic strategies in epithelial ovarian cancer.   J Exp Clin Cancer Res. 2012;31(1):14. doi:10.1186/1756-9966-31-14PubMedGoogle ScholarCrossref
4.
Gutiérrez-Gutiérrez  G, Sereno  M, Miralles  A, Casado-Sáenz  E, Gutiérrez-Rivas  E.  Chemotherapy-induced peripheral neuropathy: clinical features, diagnosis, prevention and treatment strategies.   Clin Transl Oncol. 2010;12(2):81-91. doi:10.1007/S12094-010-0474-zPubMedGoogle ScholarCrossref
5.
Chaudhry  V, Chaudhry  M, Crawford  TO, Simmons-O’Brien  E, Griffin  JW.  Toxic neuropathy in patients with pre-existing neuropathy.   Neurology. 2003;60(2):337-340. doi:10.1212/01.WNL.0000043691.53710.53PubMedGoogle ScholarCrossref
6.
Malik  B, Stillman  M.  Chemotherapy-induced peripheral neuropathy.   Curr Neurol Neurosci Rep. 2008;8(1):56-65. doi:10.1007/s11910-008-0010-5PubMedGoogle ScholarCrossref
7.
Brown  TJ, Sedhom  R, Gupta  A.  Chemotherapy-induced peripheral neuropathy.   JAMA Oncol. 2019;5(5):750-750. doi:10.1001/jamaoncol.2018.6771
ArticlePubMedGoogle ScholarCrossref
8.
Lee  CK, Gurney  H, Brown  C,  et al.  Carboplatin-paclitaxel-induced leukopenia and neuropathy predict progression-free survival in recurrent ovarian cancer.   Br J Cancer. 2011;105(3):360-365. doi:10.1038/bjc.2011.256PubMedGoogle ScholarCrossref
9.
Jing  Y, Lv  HY, Feng  SW.  The trend of chemotherapy-induced peripheral neurotoxicity in ovarian cancer survivors and its impacts on daily life during and one year after treatment.   Eur J Gynaecol Oncol. 2016;37(5):696-699.PubMedGoogle Scholar
10.
Jin  L, Zhang  Y, Yang  W.  Chemotherapy-induced peripheral neuropathy among patients with ovarian cancer.   Int J Gynaecol Obstet. 2020;149(3):303-308. doi:10.1002/ijgo.13137PubMedGoogle ScholarCrossref
11.
Seretny  M, Currie  GL, Sena  ES,  et al.  Incidence, prevalence, and predictors of chemotherapy-induced peripheral neuropathy: a systematic review and meta-analysis.   Pain. 2014;155(12):2461-2470. doi:10.1016/j.pain.2014.09.020PubMedGoogle ScholarCrossref
12.
Ezendam  NP, Pijlman  B, Bhugwandass  C,  et al.  Chemotherapy-induced peripheral neuropathy and its impact on health-related quality of life among ovarian cancer survivors: results from the population-based PROFILES registry.   Gynecol Oncol. 2014;135(3):510-517. doi:10.1016/j.ygyno.2014.09.016PubMedGoogle ScholarCrossref
13.
Loprinzi  CL, Lacchetti  C, Bleeker  J,  et al.  Prevention and management of chemotherapy-induced peripheral neuropathy in survivors of adult cancers: ASCO guideline update.   J Clin Oncol. 2020;38(28):3325-3348. doi:10.1200/JCO.20.01399PubMedGoogle ScholarCrossref
14.
Mayer  DK, Nasso  SF, Earp  JA.  Defining cancer survivors, their needs, and perspectives on survivorship health care in the USA.   Lancet Oncol. 2017;18(1):e11-e18. doi:10.1016/S1470-2045(16)30573-3PubMedGoogle ScholarCrossref
15.
Bonhof  CS, Mols  F, Vos  MC,  et al.  Course of chemotherapy-induced peripheral neuropathy and its impact on health-related quality of life among ovarian cancer patients: a longitudinal study.   Gynecol Oncol. 2018;149(3):455-463. doi:10.1016/j.ygyno.2018.03.052PubMedGoogle ScholarCrossref
16.
Fauci  JM, Whitworth  JM, Schneider  KE,  et al.  Prognostic significance of the relative dose intensity of chemotherapy in primary treatment of epithelial ovarian cancer.   Gynecol Oncol. 2011;122(3):532-535. doi:10.1016/j.ygyno.2011.05.023PubMedGoogle ScholarCrossref
17.
Hanna  RK, Poniewierski  MS, Laskey  RA,  et al.  Predictors of reduced relative dose intensity and its relationship to mortality in women receiving multi-agent chemotherapy for epithelial ovarian cancer.   Gynecol Oncol. 2013;129(1):74-80. doi:10.1016/j.ygyno.2012.12.017PubMedGoogle ScholarCrossref
18.
Au-Yeung  G, Webb  PM, DeFazio  A, Fereday  S, Bressel  M, Mileshkin  L.  Impact of obesity on chemotherapy dosing for women with advanced stage serous ovarian cancer in the Australian Ovarian Cancer Study (AOCS).   Gynecol Oncol. 2014;133(1):16-22. doi:10.1016/j.ygyno.2014.01.030PubMedGoogle ScholarCrossref
19.
Bandera  EV, Lee  VS, Rodriguez-Rodriguez  L, Powell  CB, Kushi  LH.  Impact of chemotherapy dosing on ovarian cancer survival according to body mass index.   JAMA Oncol. 2015;1(6):737-745. doi:10.1001/jamaoncol.2015.1796
ArticlePubMedGoogle ScholarCrossref
20.
Anuradha  S, Donovan  PJ, Webb  PM,  et al.  Variations in adjuvant chemotherapy and survival in women with epithelial ovarian cancer - a population-based study.   Acta Oncol. 2016;55(2):226-233. doi:10.3109/0284186X.2015.1054950PubMedGoogle ScholarCrossref
21.
Denduluri  N, Lyman  GH, Wang  Y,  et al.  Chemotherapy dose intensity and overall survival among patients with advanced breast or ovarian cancer.   Clin Breast Cancer. 2018;18(5):380-386. doi:10.1016/j.clbc.2018.02.003PubMedGoogle ScholarCrossref
22.
Olawaiye  AB, Java  JJ, Krivak  TC,  et al.  Does adjuvant chemotherapy dose modification have an impact on the outcome of patients diagnosed with advanced stage ovarian cancer? An NRG Oncology/Gynecologic Oncology Group study.   Gynecol Oncol. 2018;151(1):18-23. doi:10.1016/j.ygyno.2018.07.021PubMedGoogle ScholarCrossref
23.
Starbuck  KD, Szender  JB, Duncan  WD,  et al.  Prognostic impact of adjuvant chemotherapy treatment intensity for ovarian cancer.   PLoS One. 2018;13(11):e0206913. doi:10.1371/journal.pone.0206913PubMedGoogle ScholarCrossref
24.
Stevinson  C, Steed  H, Faught  W,  et al.  Physical activity in ovarian cancer survivors: associations with fatigue, sleep, and psychosocial functioning.   Int J Gynecol Cancer. 2009;19(1):73-78. doi:10.1111/IGC.0b013e31819902ecPubMedGoogle ScholarCrossref
25.
Streckmann  F, Kneis  S, Leifert  JA,  et al.  Exercise program improves therapy-related side-effects and quality of life in lymphoma patients undergoing therapy.   Ann Oncol. 2014;25(2):493-499. doi:10.1093/annonc/mdt568PubMedGoogle ScholarCrossref
26.
Zimmer  P, Trebing  S, Timmers-Trebing  U,  et al.  Eight-week, multimodal exercise counteracts a progress of chemotherapy-induced peripheral neuropathy and improves balance and strength in metastasized colorectal cancer patients: a randomized controlled trial.   Support Care Cancer. 2018;26(2):615-624. doi:10.1007/s00520-017-3875-5PubMedGoogle ScholarCrossref
27.
Bland  KA, Kirkham  AA, Bovard  J,  et al.  Effect of exercise on taxane chemotherapy-induced peripheral neuropathy in women with breast cancer: a randomized controlled trial.   Clin Breast Cancer. 2019;19(6):411-422. doi:10.1016/j.clbc.2019.05.013PubMedGoogle ScholarCrossref
28.
Andersen Hammond  E, Pitz  M, Steinfeld  K, Lambert  P, Shay  B.  An exploratory randomized trial of physical therapy for the treatment of chemotherapy-induced peripheral neuropathy.   Neurorehabil Neural Repair. 2020;34(3):235-246. doi:10.1177/1545968319899918PubMedGoogle ScholarCrossref
29.
Saraboon  C, Siriphorn  A.  Effects of foam pad balance exercises on cancer patients undergoing chemotherapy: a randomized control trial.   J Bodyw Mov Ther. 2021;28:164-171. doi:10.1016/j.jbmt.2021.07.013PubMedGoogle ScholarCrossref
30.
Schwenk  M, Grewal  GS, Holloway  D, Muchna  A, Garland  L, Najafi  B.  Interactive sensor-based balance training in older cancer patients with chemotherapy-induced peripheral neuropathy: a randomized controlled trial.   Gerontology. 2016;62(5):553-563. doi:10.1159/000442253PubMedGoogle ScholarCrossref
31.
Kneis  S, Wehrle  A, Müller  J,  et al.  It’s never too late - balance and endurance training improves functional performance, quality of life, and alleviates neuropathic symptoms in cancer survivors suffering from chemotherapy-induced peripheral neuropathy: results of a randomized controlled trial.   BMC Cancer. 2019;19(1):414. doi:10.1186/s12885-019-5522-7PubMedGoogle ScholarCrossref
32.
Streckmann  F, Lehmann  HC, Balke  M,  et al.  Sensorimotor training and whole-body vibration training have the potential to reduce motor and sensory symptoms of chemotherapy-induced peripheral neuropathy-a randomized controlled pilot trial.   Support Care Cancer. 2019;27(7):2471-2478. doi:10.1007/s00520-018-4531-4PubMedGoogle ScholarCrossref
33.
Dhawan  S, Andrews  R, Kumar  L, Wadhwa  S, Shukla  G.  A randomized controlled trial to assess the effectiveness of muscle strengthening and balancing exercises on chemotherapy-induced peripheral neuropathic pain and quality of life among cancer patients.   Cancer Nurs. 2020;43(4):269-280. doi:10.1097/NCC.0000000000000693PubMedGoogle ScholarCrossref
34.
Müller  J, Weiler  M, Schneeweiss  A,  et al.  Preventive effect of sensorimotor exercise and resistance training on chemotherapy-induced peripheral neuropathy: a randomised-controlled trial.   Br J Cancer. 2021;125(7):955-965. doi:10.1038/s41416-021-01471-1PubMedGoogle ScholarCrossref
35.
Kleckner  IR, Kamen  C, Gewandter  JS,  et al.  Effects of exercise during chemotherapy on chemotherapy-induced peripheral neuropathy: a multicenter, randomized controlled trial.   Support Care Cancer. 2018;26(4):1019-1028. doi:10.1007/s00520-017-4013-0PubMedGoogle ScholarCrossref
36.
Guo  S, Han  W, Wang  P, Wang  X, Fang  X.  Effects of exercise on chemotherapy-induced peripheral neuropathy in cancer patients: a systematic review and meta-analysis.   J Cancer Surviv. 2023;17(2):318-331. doi:10.1007/s11764-022-01182-3PubMedGoogle ScholarCrossref
37.
Zhou  Y, Cartmel  B, Gottlieb  L,  et al.  Randomized trial of exercise on quality of life in women with ovarian cancer: Women’s Activity and Lifestyle Study in Connecticut (WALC).   J Natl Cancer Inst. 2017;109(12):djx072. doi:10.1093/jnci/djx072PubMedGoogle ScholarCrossref
38.
Kriska  AM, Knowler  WC, LaPorte  RE,  et al.  Development of questionnaire to examine relationship of physical activity and diabetes in Pima Indians.   Diabetes Care. 1990;13(4):401-411. doi:10.2337/diacare.13.4.401PubMedGoogle ScholarCrossref
39.
Cheng  HL, Lopez  V, Lam  SC,  et al.  Psychometric testing of the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT/GOG-Ntx) subscale in a longitudinal study of cancer patients treated with chemotherapy.   Health Qual Life Outcomes. 2020;18(1):246. doi:10.1186/s12955-020-01493-yPubMedGoogle ScholarCrossref
40.
Bandura  A.  Social cognitive theory: an agentic perspective.   Annu Rev Psychol. 2001;52:1-26. doi:10.1146/annurev.psych.52.1.1PubMedGoogle ScholarCrossref
41.
Fitzmaurice  GM, Laird  NM, Ware  JH.  Applied Longitudinal Analysis. 2nd ed. John Wiley & Sons; 2011.
42.
Cao  A, Cartmel  B, Li  FY,  et al.  Effect of exercise on body composition among women with ovarian cancer.   J Cancer Surviv. Published online April 4, 2022. doi:10.1007/s11764-022-01207-xPubMedGoogle ScholarCrossref
43.
Cao  A, Cartmel  B, Li  FY,  et al.  Exercise adherence in a randomized controlled trial of exercise on quality of life in ovarian cancer survivors.   J Cancer Surviv. 2023;17(2):535-543. doi:10.1007/s11764-022-01325-6PubMedGoogle ScholarCrossref
44.
Heijnen  S, Hommel  B, Kibele  A, Colzato  LS.  Neuromodulation of aerobic exercise-a review.   Front Psychol. 2016;6:1890. doi:10.3389/fpsyg.2015.01890PubMedGoogle ScholarCrossref
45.
Chung  KH, Park  SB, Streckmann  F,  et al.  Mechanisms, mediators, and moderators of the effects of exercise on chemotherapy-induced peripheral neuropathy.   Cancers (Basel). 2022;14(5):1224. doi:10.3390/cancers14051224PubMedGoogle ScholarCrossref
46.
Rock  CL, Thomson  CA, Sullivan  KR,  et al.  American Cancer Society Nutrition and Physical Activity Guideline for cancer survivors.   CA Cancer J Clin. 2022;72(3):230-262. doi:10.3322/caac.21719PubMedGoogle ScholarCrossref




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