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Qian Y, Tao Y, Wu L, Zhou C, Liu F, Xu S, Miao H, Gao X, Ge X. Model based on the automated AI-driven CT quantification is effective for the diagnosis of refractory Mycoplasma pneumoniae pneumonia. Sci Rep 2024; 14:16172. [PMID: 39003340 PMCID: PMC11246496 DOI: 10.1038/s41598-024-67255-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 07/09/2024] [Indexed: 07/15/2024] Open
Abstract
The prediction of refractory Mycoplasma pneumoniae pneumonia (RMPP) remains a clinically significant challenge. This study aimed to develop an early predictive model utilizing artificial intelligence (AI)-derived quantitative assessment of lung lesion extent on initial computed tomography (CT) scans and clinical indicators for RMPP in pediatric inpatients. A retrospective cohort study was conducted on patients with M. pneumoniae pneumonia (MP) admitted to the Children's Hospital of Nanjing Medical University, China from January 2019 to December 2020. An early prediction model was developed by stratifying the patients with Mycoplasma pneumoniae pneumonia (MPP) into two cohorts according to the presence or absence of refractory pneumonia. A retrospective cohort of 126 children diagnosed with Mycoplasma pneumoniae pneumonia (MPP) was utilized as a training set, with 85 cases classified as RMPP. Subsequently, a prospective cohort comprising 54 MPP cases, including 37 instances of RMPP, was assembled as a validation set to assess the performance of the predictive model for RMPP from January to December 2021. We defined a constant Φ which can combine the volume and CT value of pulmonary lesions and be further used to calculate the logarithm of Φ to the base of 2 (Log2Φ). A clinical-imaging prediction model was then constructed utilizing Log2Φ and clinical characteristics. Performance was evaluated by the area under the receiver operating characteristic curve (AUC). The clinical model demonstrated AUC values of 0.810 and 0.782, while the imaging model showed AUC values of 0.764 and 0.769 in the training and test sets, respectively. The clinical-imaging model, incorporating Log2Φ, temperature(T), aspartate aminotransferase (AST), preadmission fever duration (PFD), and preadmission macrolides therapy duration (PMTD), achieved the highest AUC values of 0.897 and 0.895 in the training and test sets, respectively. A prognostic model developed through automated quantification of lung disease on CT scans, in conjunction with clinical data in MPP may be utilized for the early identification of RMPP.
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Affiliation(s)
- Yali Qian
- Department of Emergency/Critical Medicine, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yunxi Tao
- School of Pediatrics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lihui Wu
- Department of Emergency/Critical Medicine, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Changsheng Zhou
- Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Feng Liu
- Department of Respiratory Medicine, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shenglong Xu
- School of Pediatrics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hongjun Miao
- Department of Emergency/Critical Medicine, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiucheng Gao
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Xuhua Ge
- Department of Emergency/Critical Medicine, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Cai F, Li J, Liang W, Wang L, Ruan J. Effectiveness and safety of tetracyclines and quinolones in people with Mycoplasma pneumonia: a systematic review and network meta-analysis. EClinicalMedicine 2024; 71:102589. [PMID: 38596615 PMCID: PMC11001646 DOI: 10.1016/j.eclinm.2024.102589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 03/15/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024] Open
Abstract
Background The escalating resistance of Mycoplasma pneumoniae to macrolides has become a significant global health concern, particularly in low-income and middle-income countries (LMICs). Although tetracyclines and quinolones have been proposed as alternative therapeutic options, concerns regarding age-specific safety issues and the lack of consensus in recommendations across various national guidelines prevail. Thus, the primary objective of this study is to ascertain the most efficacious interventions for second-line treatment of M. pneumoniae infection while considering the age-specific safety issues associated with these interventions. Methods In this systematic review and network meta-analysis we searched PubMed, Embase, CNKI, and WanFang Data, from inception up to November 11th, 2023. Studies of quinolones or tetracyclines for the treatment of people with M. pneumoniae infection were collected and screened by reading published reports, with any type of study included, and no individual patient-level data requested. A systematic review and direct meta-analysis compared the efficacy of tetracyclines and quinolones regarding time to defervescence (TTD) and the rates of fever disappearance within 24 h and 48 h of antibiotic administration, for managing M. pneumoniae infection. Bayesian network meta-analysis (NMA) was employed to indirectly assess the relative effectiveness of different interventions in people with M. pneumoniae infection and the safety profile of medication in paediatric patients. This study is registered with PROSPERO, CRD42023478383. Findings The systematic review and direct meta-analysis included a total of 4 articles involving 246 patients, while the NMA encompassed 85 articles involving a substantial cohort of 7095 patients. The NMA measured the effectiveness across all ages and included 7043 patients, with a mean age of 37.80 ± 3.91 years. Of the 85 included studies, 14 (16.5%) were at low risk of bias, 71 (83.5%) were at moderate risk, and no studies were rated as having a high risk of bias. In the direct meta-analysis, no statistically significant differences were found between tetracyclines and quinolones concerning TTD (mean difference: -0.40, 95% CI: -1.43 to 0.63; I2 = 0%), fever disappearance rate within 24 h of antibiotic administration (OR: 0.37, 95% CI: 0.08-1.79; I2 = 58%), and fever disappearance rate within 48 h of antibiotic administration (OR: 1.10, 95% CI: 0.30-3.98; I2 = 59%). However, the comprehensive NMA analysis of clinical response (in 70 studies; n = 6143 patients), shortening of TTD (in 52 studies; n = 4363 patients), shortening length of cough relief or disappearance (in 39 studies; n = 3235 patients), fever disappearance rate at 48 h (in four studies; n = 418 patients) revealed that minocycline exhibited the most favourable outcomes across these various parameters, and the analysis of fever disappearance rate at 24 h (in three studies; n = 145 patients) revealed that levofloxacin may be the most effective, as indicated by the rank probabilities and surface under the cumulative ranking area (SUCRA) value. Moxifloxacin ranked second in clinical response and in shortening the length of cough relief or disappearance, and third in shortening TTD. Notably, when evaluating the occurrence of adverse reactions in paediatric patients (in four studies; n = 239 children), levofloxacin was associated with the highest SUCRA value rankings for the rate of adverse events. Interpretation Our findings suggest that tetracyclines and quinolones may be equally effective. Based on the age of participants in the included studies, minocycline may be the most effective intervention for children over eight years of age when all preventive measures are considered, whereas moxifloxacin may benefit people under eight years of age. However, these results should be interpreted with caution, given the limited number of studies and patients included, and the heterogeneity between included studies. Based on a limited number of studies in children, levofloxacin is likely to have one of the highest rates of adverse reactions. The majority of the studies included in the NMA were from the Asian region, and more randomised controlled trials comparing different therapeutic strategies in patients with M. pneumoniae are warranted. This comparative study provides clinical pharmacists and clinicians with important information to enable them to make informed decisions about treatment options, considering drug efficacy and safety. Funding The Natural Science Foundation of Fujian Province, China.
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Affiliation(s)
- Fangqing Cai
- The School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Jinglin Li
- The School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Weijie Liang
- The School of Pharmacy, Fujian Medical University, Fuzhou, China
| | - Ling Wang
- Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Molecular Biology Laboratory of Traditional Chinese Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Junshan Ruan
- Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China
- Molecular Biology Laboratory of Traditional Chinese Medicine, Fujian Provincial Hospital, Fuzhou, China
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Kim T, Kim J, Jeon J, Moon JS. Public health measures on COVID-19 in North Korea: a quantitative analysis of media programmes in 2020-2022. BMJ Open 2023; 13:e069492. [PMID: 37463820 PMCID: PMC10357300 DOI: 10.1136/bmjopen-2022-069492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES Details regarding the management of COVID-19 in North Korea are unknown. The aim of this paper was to analyse media programmes in North Korea in order to understand public health measures and policies concerning COVID-19. SETTING State-run news agency in North Korea. PRIMARY AND SECONDARY OUTCOME MEASURES The classification of television programmes on COVID-19 broadcast in a state-run news agency, from January 2020 to May 2022, and public health measures introduced in the programmes. RESULTS A total of 2671 programmes concerning COVID-19 were included in the study. These programmes provided detailed clinical guidelines to laypeople without medical expertise, including instructions for the usage of medication and preventive measures. An association between the media concern regarding COVID-19 and trade volume, as a proxy of border closure according to the concern of the authorities, provided hints to understand the priorities and aims of the authorities. CONCLUSIONS The research outcomes provided significant insights into the effort to understand an impaired healthcare system and prevalent drug abuse behaviours in North Korea. Findings from further studies on the recently collected data might suggest additional implications on the North Korean policies on COVID-19.
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Affiliation(s)
- Taehoon Kim
- Gojeon Public Health Subcenter, Gyeongsangnam-do, Korea (the Republic of)
- Korean Association of Public Health Doctors, Seoul, Korea (the Republic of)
| | - Jihyeong Kim
- Department of General Surgery, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea (the Republic of)
| | - Jieun Jeon
- Institute for Health and Unification Studies, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Jin Soo Moon
- Institute for Health and Unification Studies, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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Xie Q, Zhang X, Cui W, Pang Y. Construction of a Nomogram for Identifying Refractory Mycoplasma pneumoniae Pneumonia Among Macrolide-Unresponsive Mycoplasma pneumoniae Pneumonia in Children. J Inflamm Res 2022; 15:6495-6504. [PMID: 36474517 PMCID: PMC9719700 DOI: 10.2147/jir.s387809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/15/2022] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVE The individualized prediction of treatment regimens of macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) is scarce. The aim of this study was, therefore, to evaluate the relevant data of patients and construct a nomogram for identifying refractory Mycoplasma pneumoniae pneumonia (RMPP) among children continued to be treated with macrolide after the confirmation of MUMPP, providing a reference for the choice of treatment regimen. METHODS We performed a retrospective study involving 162 children who continued to be treated with macrolide (azithromycin) after the confirmation of MUMPP without antibiotic changes between January 2020 and January 2022. We collected data on clinical feature, hospitalization period, treatments, laboratory data, extrapulmonary symptoms, parapneumonic effusion, and connections with other respiratory pathogens. In addition, the independent risk factors for RMPP were determined through univariate and multivariate analyses, and then a nomogram was constructed and validated. RESULTS In this study, the multivariate logistic regression analysis showed that age, leukocyte count, neutrophil proportion, serum procalcitonin, and lactate dehydrogenase were independent risk factors for RMPP. Using the five independent associated factors, the nomogram for identification of RMPP was constructed. Moreover, the area under the ROC curve (AUC) was 0.925 (95% CI: 0.882-0.968) for the nomogram showing excellent discrimination. The calibration curve, close to the 45-degree line, exhibited good calibration of nomogram. CONCLUSION We constructed and validated a visual and user-friendly nomogram for individualized prediction of RMPP risk in children who continued to be treated with macrolide after the confirmation of MUMPP based on five variables. According to the nomogram model, continuation of macrolide should be considered rather than second-line antibiotics including tetracyclines (doxycycline or minocycline) and fluoroquinolones for MUMPP children with low predictive values.
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Affiliation(s)
- Qiaoyi Xie
- Department of Pediatrics, The Affiliated People’s Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Xiaote Zhang
- Department of Otolaryngology Head and Neck Surgery, Ningbo Yinzhou No.2 Hospital, Ningbo, People’s Republic of China
| | - Wei Cui
- Department of Pediatrics, The Affiliated People’s Hospital of Ningbo University, Ningbo, People’s Republic of China
| | - Yajiao Pang
- Department of Pediatrics, The Affiliated People’s Hospital of Ningbo University, Ningbo, People’s Republic of China
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Refractory Mycoplasma pneumoniae Pneumonia in Children: Early Recognition and Management. J Clin Med 2022; 11:jcm11102824. [PMID: 35628949 PMCID: PMC9144103 DOI: 10.3390/jcm11102824] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Refractory Mycoplasma pneumoniae pneumonia (RMPP) is a severe state of M. pneumoniae infection that has attracted increasing universal attention in recent years. The pathogenesis of RMPP remains unknown, but the excessive host immune responses as well as macrolide resistance of M. pneumoniae might play important roles in the development of RMPP. To improve the prognosis of RMPP, it is mandatory to recognize RMPP in the early stages, and the detection of macrolide-resistant MP, clinical unresponsiveness to macrolides and elevated proinflammatory cytokines might be clues. Timely and effective anti-mycoplasmal therapy and immunomodulating therapy are the main strategies for RMPP.
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Chen J, Qi X, Yin Y, Zhang L, Zhang J, Yuan S. Effects of minocycline on macrolide-unresponsive Mycoplasma pneumoniae pneumonia in children: a single-center retrospective study. Transl Pediatr 2021; 10:2997-3004. [PMID: 34976765 PMCID: PMC8649588 DOI: 10.21037/tp-21-356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/15/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Macrolide-resistant Mycoplasma pneumoniae (Mp) has become widespread in the world. We sought to determine the independently associated risk factors for refractory Mp pneumonia among macrolide-unresponsive Mp pneumonia children treated with minocycline and to investigate the effects of minocycline against macrolide-unresponsive Mp pneumonia. METHODS In our center, we retrospectively analyzed the data of hospitalized macrolide-unresponsive Mp pneumonia patients aged ≤18 years old who changed macrolide therapies to minocycline treatments between March 2013 and September 2018. Patient characteristics and defervescence after minocycline treatment were compared between refractory Mp pneumonia and non-refractory Mp pneumonia groups. Multivariable logistic regression analysis was performed among these macrolide-unresponsive Mp pneumonia patients. RESULTS Among 150 included macrolide-unresponsive Mp pneumonia children treated with minocycline; 30 cases (20.0%) were refractory Mp pneumonia. Duration of macrolide treatment before administration of minocycline (odds ratio =2.87, 95% CI: 1.79-4.61, P<0.001) and serum procalcitonin levels (odds ratio =13.50, 95% CI: 1.22-149.57, P=0.034) were independently associated with refractory Mp pneumonia. Defervescence after minocycline treatment was significantly longer among the refractory Mp pneumonia group than in the non-refractory Mp pneumonia group (median 2 vs. 1 day, P<0.001). Only one case (0.7%) suspected of a side effect of minocycline therapy was observed. CONCLUSIONS Two risk factors independently associated with refractory Mp pneumonia were determined. Early use of minocycline might safely prevent macrolide-unresponsive Mp pneumonia from progressing to refractory Mp pneumonia.
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Affiliation(s)
- Jiande Chen
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinyi Qi
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Yin
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Zhang
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shuhua Yuan
- Department of Respiratory Medicine, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Cho HK. Consideration in treatment decisions for refractory Mycoplasma pneumoniae pneumonia. Clin Exp Pediatr 2021; 64:459-467. [PMID: 33561337 PMCID: PMC8426095 DOI: 10.3345/cep.2020.01305] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 01/09/2021] [Accepted: 01/19/2021] [Indexed: 11/27/2022] Open
Abstract
Mycoplasma pneumoniae (MP) is the most common cause of childhood bacterial pneumonia. Although macrolide is known to be effective as a first-line therapy, the proportion of macrolide resistance in MP pneumonia has strikingly increased during recent 2 decades in East Asia. This is challenging to physicians since they have to decide more often whether to use secondary treatment. Diagnostic methods to detect macrolide-resistance of MP are currently not available in Korean hospitals. Even in the diagnosis of MP infection, both serologic and molecular test have limitation: inability to differentiate current illness from carriage or asymptomatic infection. Combining these 2 diagnostic methods and excluding infection caused by other respiratory pathogens allow a more reliable diagnosis. This effort is even more demanding in recent years to keep children from unnecessary exposure to secondary antibiotics. Although several observational studies have reported that tetracycline and fluoroquinolone, which are considered in the treatment of refractory MP pneumonia, have efficacy of shortening the duration of fever and respiratory symptoms, those findings need to be proven by well-designed prospective studies. The use of tetracycline and fluoroquinolone in children is generally tolerable, as supported by many observational data. However, since concerns about side effects still remain, careful consideration about benefits and risks is needed to decide their use.
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Affiliation(s)
- Hye-Kyung Cho
- Department of Pediatrics, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
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陈 丹, 张 娜, 张 婷, 孙 晓. [Detection of drug-resistance genes of Mycoplasma pneumoniae in bronchoalveolar lavage fluid of children with refractory Mycoplasma pneumoniae pneumonia]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:707-712. [PMID: 34266528 PMCID: PMC8292659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/19/2021] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To study the drug resistance of Mycoplasma pneumoniae (MP) in the bronchoalveolar lavage fluid (BALF) of children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and the distribution of drug-resistance genes, as well as the association of alleles at 2063 locus of 23SrRNA V region central ring with resistance to antimicrobial drugs. METHODS BALF specimens were collected from 245 children with RMPP who were admitted to the Children's Hospital Affiliated to Zhengzhou University from March 2016 to December 2020. A rapid cultured drug sensitivity assay was used to detect the resistance of MP isolates to nine commonly used antimicrobial drugs. The real-time PCR was used to measure MP DNA. The direct sequencing was used to detect gene mutations in MP 23SrRNA V region central ring. RESULTS Among the 245 BALF specimens, 207 tested positive for MP DNA, with a positive rate of 84.5%. The results of drug susceptibility test showed that the children with RMPP had a resistance rate of > 70% to macrolide antimicrobial drugs, with the highest resistance rate to clarithromycin, followed by roxithromycin, clindamycin, acetylspiramycin, erythromycin, and azithromycin, and these children had a resistance rate of < 5% to quinolone antimicrobial drugs. Among the 207 MP DNA-positive specimens, 41 (19.8%) had no drug-resistance gene mutations and 166 (80.2%) had drug-resistance gene mutations, among which 154 (74.4%) had an A→G mutation at 2063 locus of 23SrRNA V region central ring, 7 (3.4%) had an A→G mutation at 2064 locus, and 5 (2.4%) had mutations in both 2063 and 2064 loci. Among the 166 specimens with point mutations of the MP 23SrRNA gene, 159 (95.8%) had point mutations at 2063 locus. The A→G point mutation at 2063 locus of 23SrRNA V region central ring had a great impact on resistance to macrolide antimicrobial drugs. There was a significant difference in the distribution of alleles at 2063 locus between the children with resistance to clarithromycin, roxithromycin, clindamycin, acetylspiramycin, erythromycin, and azithromycin (P < 0.05). CONCLUSIONS MP in the BALF of children with RMPP has a relatively high resistance rate to macrolide antimicrobial drugs. Resistance to macrolide antimicrobial drugs is closely associated with the A→G point mutation in the 23SrRNA gene, and the point mutation at 2063 locus of 23SrRNA V region central ring may affect the drug-resistance mechanism of MP.
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Affiliation(s)
- 丹 陈
- 郑州大学附属儿童医院/河南省儿童医院/郑州儿童医院普内科, 河南郑州 450000Department of General Internal Medicine, Children's Hospital Affiliated to Zhengzhou University/Henan Children's Hospital/Zhengzhou Children's Hospital, Zhengzhou 450000, China
| | - 娜丽 张
- 郑州大学附属儿童医院/河南省儿童医院/郑州儿童医院普内科, 河南郑州 450000Department of General Internal Medicine, Children's Hospital Affiliated to Zhengzhou University/Henan Children's Hospital/Zhengzhou Children's Hospital, Zhengzhou 450000, China
| | - 婷 张
- 郑州大学附属儿童医院/河南省儿童医院/郑州儿童医院呼吸科, 河南郑州 450000
| | - 晓敏 孙
- 郑州大学附属儿童医院/河南省儿童医院/郑州儿童医院普内科, 河南郑州 450000Department of General Internal Medicine, Children's Hospital Affiliated to Zhengzhou University/Henan Children's Hospital/Zhengzhou Children's Hospital, Zhengzhou 450000, China
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陈 丹, 张 娜, 张 婷, 孙 晓. [Detection of drug-resistance genes of Mycoplasma pneumoniae in bronchoalveolar lavage fluid of children with refractory Mycoplasma pneumoniae pneumonia]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:707-712. [PMID: 34266528 PMCID: PMC8292659 DOI: 10.7499/j.issn.1008-8830.2104033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To study the drug resistance of Mycoplasma pneumoniae (MP) in the bronchoalveolar lavage fluid (BALF) of children with refractory Mycoplasma pneumoniae pneumonia (RMPP) and the distribution of drug-resistance genes, as well as the association of alleles at 2063 locus of 23SrRNA V region central ring with resistance to antimicrobial drugs. METHODS BALF specimens were collected from 245 children with RMPP who were admitted to the Children's Hospital Affiliated to Zhengzhou University from March 2016 to December 2020. A rapid cultured drug sensitivity assay was used to detect the resistance of MP isolates to nine commonly used antimicrobial drugs. The real-time PCR was used to measure MP DNA. The direct sequencing was used to detect gene mutations in MP 23SrRNA V region central ring. RESULTS Among the 245 BALF specimens, 207 tested positive for MP DNA, with a positive rate of 84.5%. The results of drug susceptibility test showed that the children with RMPP had a resistance rate of > 70% to macrolide antimicrobial drugs, with the highest resistance rate to clarithromycin, followed by roxithromycin, clindamycin, acetylspiramycin, erythromycin, and azithromycin, and these children had a resistance rate of < 5% to quinolone antimicrobial drugs. Among the 207 MP DNA-positive specimens, 41 (19.8%) had no drug-resistance gene mutations and 166 (80.2%) had drug-resistance gene mutations, among which 154 (74.4%) had an A→G mutation at 2063 locus of 23SrRNA V region central ring, 7 (3.4%) had an A→G mutation at 2064 locus, and 5 (2.4%) had mutations in both 2063 and 2064 loci. Among the 166 specimens with point mutations of the MP 23SrRNA gene, 159 (95.8%) had point mutations at 2063 locus. The A→G point mutation at 2063 locus of 23SrRNA V region central ring had a great impact on resistance to macrolide antimicrobial drugs. There was a significant difference in the distribution of alleles at 2063 locus between the children with resistance to clarithromycin, roxithromycin, clindamycin, acetylspiramycin, erythromycin, and azithromycin (P < 0.05). CONCLUSIONS MP in the BALF of children with RMPP has a relatively high resistance rate to macrolide antimicrobial drugs. Resistance to macrolide antimicrobial drugs is closely associated with the A→G point mutation in the 23SrRNA gene, and the point mutation at 2063 locus of 23SrRNA V region central ring may affect the drug-resistance mechanism of MP.
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Affiliation(s)
- 丹 陈
- 郑州大学附属儿童医院/河南省儿童医院/郑州儿童医院普内科, 河南郑州 450000Department of General Internal Medicine, Children's Hospital Affiliated to Zhengzhou University/Henan Children's Hospital/Zhengzhou Children's Hospital, Zhengzhou 450000, China
| | - 娜丽 张
- 郑州大学附属儿童医院/河南省儿童医院/郑州儿童医院普内科, 河南郑州 450000Department of General Internal Medicine, Children's Hospital Affiliated to Zhengzhou University/Henan Children's Hospital/Zhengzhou Children's Hospital, Zhengzhou 450000, China
| | - 婷 张
- 郑州大学附属儿童医院/河南省儿童医院/郑州儿童医院呼吸科, 河南郑州 450000
| | - 晓敏 孙
- 郑州大学附属儿童医院/河南省儿童医院/郑州儿童医院普内科, 河南郑州 450000Department of General Internal Medicine, Children's Hospital Affiliated to Zhengzhou University/Henan Children's Hospital/Zhengzhou Children's Hospital, Zhengzhou 450000, China
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Characteristics and Outcome of Severe Mycoplasma pneumoniae Pneumonia Admitted to PICU in Shanghai: A Retrospective Cohort Study. Crit Care Explor 2021; 3:e0366. [PMID: 33786442 PMCID: PMC7994047 DOI: 10.1097/cce.0000000000000366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objectives: We aimed to describe the characteristics and outcome in children with severe Mycoplasma pneumoniae pneumonia in a Chinese PICU. Design: A retrospective observational study from 2017 to 2019. Setting: A 36-bed university tertiary PICU at Shanghai Children’s Hospital. Patients: Patients admitted to a tertiary PICU 29 days to 18 years old screened for laboratory-confirmed severe M. pneumoniae pneumonia. Interventions: None. Measurements and Main Results: Descriptive analysis of baseline characteristics for patients included hospital mortality, organ dysfunctions, use of mechanical ventilation, continuous renal replacement therapy, and/or extracorporeal membrane oxygenation. A total of 817 children with severe pneumonia were admitted to PICU, and 203 of 817 cases (24.8%) with severe M. pneumoniae pneumonia were included in this study. The median age was 41 months (interquartile range, 20–67 mo), of which 77.3% (157/203) were younger than 6 years old. Among 163 patients with the test for macrolide resistance, 90.2% cases (147/163) were macrolide-resistant M. pneumoniae. Severe M. pneumoniae pneumonia-associated organ dysfunction included acute respiratory failure (203 cases, 100%), followed by cardiovascular disorder (79/203, 38.9%), gastrointestinal dysfunction (24/203, 11.8%). The main complications were pleural effusion (79/203, 38.9%), capillary leak syndrome (58/203, 28.6%), and plastic bronchitis (20/203, 9.9%). All patients needed respiratory support, including 64.5% patients (131/203) who received mechanical ventilation and 35.5% patients (72/203) who received high-flow nasal oxygen. Twenty-five patients (12.3%) treated with continuous renal replacement therapy and nine cases (4.4%) received extracorporeal membrane oxygenation. The case fatality rate was 3.9% (8/203). Furthermore, cardiovascular dysfunction, liver injury, or multiple organ dysfunction syndrome were associated with longer mechanical ventilation duration, delayed PICU discharge, and high hospital mortality. Coinfection was a risk factor of delayed PICU discharge. Conclusions: Children with severe M. pneumoniae pneumonia mainly occur under the age of 6 years, showing a high proportion of extrapulmonary organ dysfunction and macrolide resistances. Extrapulmonary organ dysfunction and coinfection are associated with worse outcomes. The overall mortality is relatively low after treated with appreciate antibiotics, respiratory support, and extracorporeal life support.
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He H, Wang X, Xiao Y, Zheng J, Wang J, Zhang B. Comparative efficacy and safety of traditional Chinese patent medicine in the treatment of Mycoplasma pneumoniae pneumonia in children: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e23747. [PMID: 33371133 PMCID: PMC7748181 DOI: 10.1097/md.0000000000023747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Mycoplasma pneumoniae pneumonia (MPP) is a common respiratory disease in children. Its incidence rate is increasing year by year. The drug resistance rate of macrolide antibiotics and other conventional treatment methods is higher, and there are limitations in clinical application. Traditional Chinese patent medicine (TCPM) is a powerful weapon to treat this disease. At present, there is no comparison of the safety and effectiveness of multiple TCPMs in the treatment of MPP in children. Therefore, we take the method of network meta-analysis to systematically compare the efficacy of various TCPMs in the treatment of this disease. METHODS We will conduct comprehensive searches of Cochrane Library, PubMed, Web of Science, Clinical Trials, China National Knowledge Infrastructure, Chinese Scientific Journals Database, Chinese BioMedical Literature, Wanfang Database, and other electronic databases. The time frame is set from the establishment of the database to October 2020. All randomized controlled trials that meet the inclusion criteria will be included in this study. The 2 researchers will independently screen the literature according to the inclusion criteria, extract the data, and assess the bias risk of the included study. We will evaluate all the obtained data and evidence through Bayesian network meta-analysis, and use Stata 15.0 to process and analyze the data. RESULTS Through this study, we will evaluate the efficacy and safety of a variety of TCPMs for the treatment of MPP in children. CONCLUSION The purpose of this study is to provide a strong reference for clinical application of TCPMs in the treatment of MPP in children, and to provide an important basis for clinicians to make correct judgments and put forward accurate treatment plans. ETHICS AND DISSEMINATION This review does not involve any human or animal experiments and therefore does not require ethical approval. INPLASY REGISTRATION NUMBER INPLASY 2020100108.
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Affiliation(s)
- Hongan He
- The First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Xiao Wang
- The First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Yanyan Xiao
- The First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Jialin Zheng
- The First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Jinjuan Wang
- The First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Baoqing Zhang
- The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
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Tsai TA, Tsai CK, Kuo KC, Yu HR. Rational stepwise approach for Mycoplasma pneumoniae pneumonia in children. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 54:557-565. [PMID: 33268306 DOI: 10.1016/j.jmii.2020.10.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 01/14/2023]
Abstract
Mycoplasma pneumoniae is a common pathogen that causes community-acquired pneumonia. In the past, M. pneumoniae was sensitive to macrolide antibiotics, and M. pneumoniae pneumonia (MPP) was usually a benign and self-limiting disease. However, despite use of the appropriate antibiotics, persistent fever and clinical deterioration may occur, leading to severe disease. Two major complicated conditions that may be clinically encountered are macrolide-resistant MPP and refractory MPP. Regarding the epidemics in Taiwan, before 2017, the mean rate of macrolide resistance was below 30%. Notably, since 2018, the prevalence of macrolide-resistant MPP in Taiwan has increased rapidly. Macrolide-resistant MPP shows persistent fever and/or no radiological regression to macrolide antibiotics and may even progress to severe and complicated pneumonia. Tetracyclines (doxycycline or minocycline) or fluoroquinolones are alternative treatments for macrolide-resistant MPP. Refractory MPP is characterized by an excessive immune response against the pathogen. In this context, corticosteroids have been suggested as an immunomodulator for downregulating the overactive host immune reaction. Overuse of macrolides may contribute to macrolide resistance, and thereafter, an increase in macrolide-resistant MPP. Delayed effective antimicrobial treatment is associated with prolonged and/or more severe disease. Thus, the appropriate prescription of antibiotics, as well as the rapid and accurate diagnosis of MPP, is important. The exact starting point, dose, and duration of the immunomodulator are yet to be established. We discuss these important issues in this review.
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Affiliation(s)
- Ti-An Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chang-Ku Tsai
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuang-Che Kuo
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hong-Ren Yu
- Department of Pediatrics, Chang Gung Memorial Hospital-Kaohsiung Medical Center; Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Zhang L, Wang L, Xu S, Li H, Chu C, Liu Q, Zhou J, Zhang W, Huang L. Low-Dose Corticosteroid Treatment in Children With Mycoplasma pneumoniae Pneumonia: A Retrospective Cohort Study. Front Pediatr 2020; 8:566371. [PMID: 33330269 PMCID: PMC7720903 DOI: 10.3389/fped.2020.566371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/31/2020] [Indexed: 11/25/2022] Open
Abstract
Background: The clinical value of corticosteroid treatment in Mycoplasma pneumoniae pneumonia (MPP) has been controversial. Our study aimed to identify the effects of low-dose corticosteroids on the recovery of children with MPP. Methods: In this retrospective cohort study, pediatric inpatients with MPP were included from the Shanghai Children's Mycoplasma pneumoniae pneumonia cohort study between August 2014 and July 2019. The multivariable logistic regression and propensity-score matching were used to investigate the effects of low-dose corticosteroid treatment on fever duration after admission, total fever duration, length of hospital stay, C-reactive protein recovery time, and imaging recovery time with the stratification of severe pneumonia, refractory pneumonia, inflammatory biomarkers, pulmonary images, and timing of corticosteroids. Results: There were 548 patients in the corticosteroid group and 337 in the no-corticosteroid group. The corticosteroid group showed severe clinical parameters such as more severe and refractory cases, higher laboratory values, and more abnormal imaging manifestations. The corticosteroid group also showed longer fever duration after admission [odds ratio (OR) = 1.9 (95% CI, 1.2-3.1), P = 0.008], longer total fever duration [OR = 1.6 (95% CI, 1.1-2.3), P = 0.011], longer hospital stay [OR = 2.8 (95% CI, 1.9-4.0), P < 0.001], and longer C-reactive protein (CRP) recovery time [OR = 2.1 (95% CI, 1.1-3.9), P = 0.021] in the regression model after the adjustment for severity. Although low-dose corticosteroids were associated with shortened imaging recovery time in patients with high level laboratory values, pulmonary imaging could be completely recovered in both groups. The trend of these results was consistent even after stratifications and a propensity scores matching analysis. Conclusions: Low-dose corticosteroids may not be beneficial in children inpatients with MPP, and further studies on proper treatment modality are needed in the MRMP era.
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Affiliation(s)
- Liya Zhang
- Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lijun Wang
- Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shanshan Xu
- Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huajun Li
- Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiting Chu
- Radiological Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Quanhua Liu
- Pediatric Respiratory Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jia Zhou
- Department of Pharmacy, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan
| | - Lisu Huang
- Pediatric Infectious Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Guo D, Hu W, Xu B, Li J, Li D, Li S, Wu Z, Wei R, Tian X, Shen K, Xin D. Allele-specific real-time PCR testing for minor macrolide-resistant Mycoplasma Pneumoniae. BMC Infect Dis 2019; 19:616. [PMID: 31299916 PMCID: PMC6626384 DOI: 10.1186/s12879-019-4228-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/26/2019] [Indexed: 11/17/2022] Open
Abstract
Background The point mutations in 23S rRNA gene of Mycoplasma pneumoniae (M. pneumoniae) can lead to high-level resistance to macrolides. This study aimed to evaluate allele-specific real-time PCR (ASPCR) to detect the resistance-related mutations located at positions A2063G and A2064G of 23S rRNA gene. Methods We detected 178 pharyngeal swab specimens and calculated the proportions of resistant and sensitive quasispecies using ASPCR assays. ASPCR assays can detect down to 10 copies of 23S rRNA gene and achieved sensitivities of < 0.1% for A2063G and A2064G. We also compared the findings of ASPCR with the results of nested PCR with sequencing. Results Of 178 samples, 164 were found to have M. pneumoniae including 90.85% (149/164) samples with macrolide-resistant M. pneumoniae (MRMP) quasispecies by ASPCR, while 153 were found to be M. pneumoniae-positive including 71.90% (110/153) samples with MRMP quasispecies by nested PCR with sequencing. Of the 164 M. pneumoniae-positive samples, 61.59% (101/164) had the mixed population of wild-type and mutant M. pneumoniae, and 56.44% (57/101) of the latter contained the mutations at low frequency (≤50%). Conclusion ASPCR indicated that sensitive and resistant quasispecies coexisted in most of the M. pneumoniae positive samples. The ASPCR was a highly sensitive, accurate and rapid method for detecting the macrolide resistance-associated mutations and it could provide earlier and more drug-resistant information for M. pneumoniae research and the clinical therapy.
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Affiliation(s)
- Dongxing Guo
- Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong an Road, Xicheng District, Beijing, China
| | - Wenjuan Hu
- Department of Paediatrics, Civil Aviation General Hospital, Beijing, China
| | - Baoping Xu
- Department of Respiratory, Beijng Children's Hospital, Capital Medical University, No. 56 South Lishi Road, Xicheng District, Beijing, China
| | - Jingyi Li
- Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong an Road, Xicheng District, Beijing, China
| | - Dan Li
- Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong an Road, Xicheng District, Beijing, China
| | - Shaogang Li
- Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong an Road, Xicheng District, Beijing, China
| | - Zhaoyong Wu
- Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong an Road, Xicheng District, Beijing, China
| | - Ran Wei
- Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong an Road, Xicheng District, Beijing, China
| | - Xiujun Tian
- Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong an Road, Xicheng District, Beijing, China
| | - Kunling Shen
- Department of Respiratory, Beijng Children's Hospital, Capital Medical University, No. 56 South Lishi Road, Xicheng District, Beijing, China.
| | - Deli Xin
- Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong an Road, Xicheng District, Beijing, China.
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Jo DS. Wanted: The Best Second Option to Treat Macrolide-Unresponsive Mycoplasmal Pneumonia in Children. J Korean Med Sci 2018; 33:e281. [PMID: 30344464 PMCID: PMC6193887 DOI: 10.3346/jkms.2018.33.e281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/02/2018] [Indexed: 11/20/2022] Open
Affiliation(s)
- Dae Sun Jo
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea
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