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MesoTox: The innovation for oily and acne prone skin

Updated: May 13, 2021



MesoTox: The innovation for oily and acne prone skin

Evidence Based Aesthetic Medicine Series By Dr Jean-Philippe Torre

Abstract

Micro-Needled MesoTox is a new safe treatment for oily and acne prone skin. It combines the advantages of MicroNeedling and Intra-Dermal Botulinum toxin. The superficial and homogeneous injections of low doses of toxin target the skin and not the deeper muscles (usual target for an anti-wrinkle effect). The properties of the toxin on the skin are used to improve the main factors causing Acne: sebum production, Propionibacterium acnes populations, and inflammation. It also reduces pore size and improves skin quality. The skin looks healthier, tighter and smoother.


Now available at French Touch Aesthetics, Make Me Feel and The French Pharmacy.


Introduction

Botulinum Toxin (BT) is a powerful neurotoxin which administered in low doses has been used for well over two decades in a long list of therapeutic applications (52). At its most simple, BT reduces muscular contraction, the amount depending on the dose administered. It does so by blocking a specific neurotransmitter responsible for muscular contraction. This has the effect of both reducing existing wrinkles but equally preventing formation of future ones (1). We know as a result of material studies and research that BT can also inhibit other neurotransmitters (2) or target non-neuronal cells (19). BT has a high level of proven efficacy and safety (2-14) which further expand the enormous therapeutic potential of this drug, evidenced by its constantly growing list of indications (1,15,16,17,18,19,20), especially in ‘cosmetic-dermatology’.


In a series of articles, I will concentrate on the evidence available for several applications that I consider particularly interesting because of their frequency in the general population, their aesthetic impact, and their consequences on quality of life and well-being. I will, in conjunction, explain a new and more effective delivery method which will render this treatment accessible while increasing efficacy and ensuring patient safety.


Botulinum Toxin and the treatment of Oily skin and Acne

Acne alone (without considering oily skin or enlarged pores) is estimated to affect almost 10 % of the global population. It is one of the 3 skin conditions in the top 10 most prevalent diseases worldwide and represents a prolonged burden on the patients over the course of their lifetime, with important social and psychological effects (35). It is estimated, depending on the country, that between 35% to 100% of adolescents suffer from acne at a time of significant transition (51). Nevertheless, treatments proposed have not really evolved over the last three decades. Furthermore, growing antimicrobial resistance (antibiotic being largely used as an acne treatment) and adverse effects of other classic treatments (including irritation, photosensitivity, bleaching effects, or even depression…) limit their use for general application (35). A new treatment would be more than welcome.


BT is a well-known drug, used for decades, with a high level of safety, particularly when administered in the very small doses used in aesthetic medicine (2-14). As a result, new applications have developed over the time in many medical specialities, including in aesthetic medicine (reduction of ‘sad look’ linked to a downturned mouth, gummy smile, Nefertiti face lift, teeth grinding…).


Research during the last 20 years has shown that BT can be an interesting treatment for oily skin, enlarged pores and acne (see references in the appendix for more details regarding research conducted) but also other frequent problems seen in ‘cosmetic-dermatology’ which I will explore in further articles.


But its application in those indications is still very limited, the lack of a sufficiently efficient delivery system being one of the main reasons.


Concerning Acne and oily skin, their treatment using BT have not become standardized, the primary reason being probably the lack of development of an appropriate delivery method. The classic use of BT for wrinkles allows the practitioner to target the areas for treatment using a few manual intra-muscular injections. In order to effectively treat oily skin, enlarged pores or acne, an intradermal (more superficial) low dose method covering the whole face is needed. In this case, a traditional manual injection technique has several setbacks including, time and precision needed (particularly in ensuring very superficial and uniform injection of BT), and comfort for the patient given the high level of injections needed to cover the whole face.

A new efficient and safe delivery method is now available: Micro-Needled MesoTox. With this new technique, the use of an automated Micro-Needling device allows to apply BT in micro doses with surgical precision to the affected areas. Micro-Needled MesoTox is inspired by the technique described in 2019 by F Calvani and al. (36), technique to which I have made a few modifications to make it easier to handle and more effective.


Micro-Needled MesoTox has many advantages.


Professional Micro-Needling devices propose different depth settings, allowing the practitioner to propose a personalized treatment adapted to each patient skin. Those precise depth settings assure to systematically reach the intradermal level which is shown to result in best oiliness improvements than the intramuscular level (27-29). The insurance of intradermal injections also assure that only small and regular amount of BT can reach the superficial muscle fibres. It preserves the function of the underlying muscle fibres and allows to treat areas of the face generally avoided with traditional manual technique because of the risk of diffusion of neurotoxin into untargeted muscles, resulting in potential asymmetrical or unwanted results (37,38,39).


MesoTox, using a micro-needles head, allows to treat homogeneously each square centimetre of the face to get the best result possible and avoid compensatory sebum production in zones that would be otherwise less treated or not treated at all.


This new delivery method and dosages used are not associated with the same risks of bruising or frozen look classicaly feared by patients when using the traditional manual technique.


Micro-Needled MesoTox is also a great technique for patients frightened of needles: the needles are very small (micro-needles) and hidden in the head of the device.


This technique offers the possibility to add products, carefully selected and adapted to each patient case, at the same time as BT to further enhance the results of the procedure.


Finally, Micro-Needled MesoTox combines, in one treatment, the benefits of 2 procedures allowing various facial improvements:

· MicroNeedling is a well-known and widely studied treatment, safe for all skin types, very well tolerated and with very low downtime. It increases the local microcirculation (better tissue metabolism and nutrition, more growth factors, better vitality), improves the regeneration power of the cells, the collagen and elastin production, and breaks fibrosis tissue. It results in a thicker and more elastic and tightened skin. It also improves facial laxity and sagging skin, fine lines and wrinkles, acne and facial scarring, enlarged pores, sun damages, stretch marks, age spots​​​​ and dark circle under the eyes (40-50). it creates temporary micro-channels enhancing (200 times) the absorption of topical products applied during the treatment to further improve the results of the procedure.

· Intra-dermal Botulinum Toxin is a safe and efficient treatment reducing facial pores size, having an anti-itch and anti-inflammatory effect and decreasing oiliness (improving dermatologic problems associated). Various other interesting effects have been described (18): improvement of cutaneous elasticity, pliability and viscoelastic properties, better wound healing, reduction of the thickness of hypertrophic scars, anti-photoageing potential… Furthermore, combined with micro-needling technique, the small quantities of BT injected intradermally relaxes the superficial muscle fibres and can bring a mild and natural anti-wrinkle preventive effect.


The frequency of oily skin problems and the burden associated with Acne deserve all our consideration. A new Acne treatment is needed. Micro-Needled MesoTox is a great option considering the positive effects of Botulinum Toxin on oily skin, its high safety profile and the advantages of this new delivery method. Patients who have tried other treatments without success can now benefit from this new technique.


Now available at French Touch Aesthetics, Make Me Feel and The French Pharmacy.


Dr Jean-Philippe Torre


Background of research underpinning efficacy of BT for Oily Skin and Acne

To the best of my knowledge, the first references concerning the interest of BT in oily skin can be found in a patent filled twenty years ago by the by Louisiana State University and Agricultural and Mechanical College (21). In this patent, the authors affirm they have discovered that ‘botulinum toxin can be used to inhibit the cascade of events that lead to acne’. According to them the result comes from the capacity of BT to inhibit the activity of the sweat gland (consequently decreasing the growth of Propionibacterium. acnes which have an important role in acne), stimulate the locomotion of keratinocytes (consequently preventing the follicular occlusion by keratinocytes) and its anti-inflammatory and anti-androgens effects. They describe a drastic improvement lasting for months after the injections of BT on 3 patients with recalcitrant acne. In a review in 2004, C.Zouboulis concludes, after examination of published material on the subject, that future drugs used to treat Acne should reduce sebum production, Propionibacterium acnes populations, and inflammation (22), which are, interestingly, the effects previously attributed to BT. A few years later, AR Shah, after noticing an improvement in skin quality in a patient treated with BT for facial lines, starts doing some research and discovers that, according to Kurzen et al. (23,24), Acetylcholine (one of the neurotransmitters blocked by BT) plays an important role in the regulation of keratinocyte differentiation, sebum production, microcirculation, and barrier protection of the skin. AR Shah then test BT intradermal injections in 20 patients complaining about larges pores and excessive sebum production. 85 % of his patients describe an improvement in skin oiliness and a decrease in facial pores size (25). The author explains the reduction of facial pores size by the effect of BT on the arrector pili muscle. It is also interesting to note that M. Roh et al. demonstrated (26) that enlarged pore sizes are associated with increased sebum output level. However, a weakness in AR Shah’s study being the lack of objective measures, in 2013 AE. Rose et al. decide to evaluate the effects of BT on 25 patients with oily skin using a satisfaction scale and a sebumeter (device used to objectively measure skin oiliness). A significantly lower sebum production was observed at 1, 2 and 3 months after BT injections, and 91% of patients were satisfied (27). The same year, Li et al. show that acetylcholine increases lipid synthesis by sebaceous glands in a dose-dependent manner, that a significative decrease in sebum production happens on the botulinum-treated side of healthy volunteers with oily skin, but that BT had no effect on the oiliness in the dry-to-normal skin group (28). Li et al. conclude that acetylcholine is a ‘promising target in the clinical management of disorders in which sebum production is increased, such as acne vulgaris’. In 2015, P. Min et al. (29), using a sebumeter on 42 female volunteers find a decrease of sebum production ranging approximately from 15% to 50% after intramuscular injections of BT. Two important findings can be highlighted: first, intramuscular injections seem to be less effective than intradermal injections used by AE Rose et al. (as intradermal injections resulted in an average reduction of sebum production of 80% at one month); secondly, sebum production is reduced at a radius of 2.5 cm around the injection site but increases beyond this limit (compensatory sebum production). It means that optimal results should be obtained by using intradermal BT injections spaced apart from each other by a maximum of 2.5cm on all the face. In 2017, after a review of treatments options for oily skin (30), DC Endly and RA Miller declare that ‘Considering the evidence and mechanism of action, intradermal botulinum toxin may be a promising treatment option for oily skin’. In 2019, L. Shuo, after reviewing the efficacy and possible treatment mechanisms of BT on oily skin conclude that BT ‘represent a promising new treatment for oily skin and other relevant dermatological problems, such as enlarged pores, acne, and seborrheic dermatitis’ (31). In 2020, K S Sayed and al. publish a split face-controlled study on 20 patients with enlarged facial pores and seborrhoea. It shows again that intradermal injections of BT significantly improve sebum secretion; and objective measures by Dermoscopy and Optical Coherence Tomography demonstrate a significant decrease in the average size of facial pores and a significant increase in dermal thickness. The authors conclude that ‘Intradermal injection of BT is an effective and safe procedure for the management of excess sebum and facial pores with acceptable results lasting for an average of 4 months’ (32). The same year, A Diaspro et al., using quantitative evaluation by skin-scanning technology, confirm the potential for skin improvement (skin texture, microroughness, and pore diameter) of intradermal injections of BT (33), and describe a high satisfaction rate among both physicians and patients. Finally, in 2021, JY Park et al., using a sebumeter and a three-dimensional scanner on 20 patients, find that intradermal injections of BT improve sebum secretion, mandibular length, facial pores and facial laxity (34).



References


1. Long-term effects of botulinum toxin type A (Botox) on facial lines: a comparison in identical twins. Binder WJ. Arch Facial Plast Surg. 2006 Nov-Dec;8(6):426-31.

2. Botulinum toxin: Non cosmetic and off-label dermatological uses. Journal of Dermatology & Dermatologic Surgery, Volume 19, Issue 1, January 2015, Pages 1-8. Ali S.Al-Ghamdi, Noah Alghanemy, Hanan Joharji, Dhafer Al-Qahtani, Hasan Alghamdi

3. Repeated botulinum toxin A injections for the treatment of lines in the upper face: a retrospective study of 4,103 treatments in 945 patients. Dermatol Surg. 2007 Jan;33(1 Spec No.):S18-25.Berthold Rzany , Dorothee Dill-Müller, Doris Grablowitz, Marc Heckmann, David Caird, German-Austrian Retrospective Study Group

4. Long-term safety and efficacy of a new botulinum toxin type A in treating glabellar lines. Arch Facial Plast Surg. Mar-Apr 2009;11(2):77-83.Ronald Moy, Corey Maas, Gary Monheit, M Barbara Huber, Reloxin Investigational Group.

5. Long-term safety of abobotulinumtoxinA for the treatment of glabellar lines: results from a 36-month, multicenter, open-label extension study. Dermatol Surg. 2014 Feb;40(2):176-83. Joel Schlessinger et al.

6. Patient satisfaction and safety with aesthetic onabotulinumtoxinA after at least 5 years: a retrospective cross-sectional analysis of 4,402 glabellar treatments. Dermatol Surg. 2015 Jan;41 Suppl 1:S19-28. Ada Trindade de Almeida , Jean Carruthers, Sue Ellen Cox, Mitchel P Goldman, Sarah Wheeler, Conor J Gallagher

7. Safety and Patient Satisfaction of AbobotulinumtoxinA for Aesthetic Use: A Systematic Review. Aesthet Surg J. 2017 May 1;37(suppl_1):S32-S44.Joel L Cohen, Nicolo Scuderi

8. Efficacy, Safety, and Subject Satisfaction After AbobotulinumtoxinA Treatment of Upper Facial Lines. Dermatol Surg. 2018 Dec;44(12):1555-1564. Doris Hexsel, Hugues Cartier, Per Hedén, Henry Delmar, Per Bergentz, Fernanda Camozzato, Carolina Siega, Cecilia Skoglund, Carolina Edwartz, Diane Rees, Philippe Kestemont.

9. A Prospective Observational Study of the Effectiveness and Safety of Botulinum Toxin in the Horizontal Neck Lines. Aesthetic Plast Surg. 2018 Oct;42(5):1370-1378. Jong Hun Lee, Yu Gil Park, Eun Soo Park.

10. Assessment of Subject and Physician Satisfaction after Long-Term Treatment of Glabellar Lines with AbobotulinumtoxinA . (Dysport ®/Azzalure ®): Primary Results of the APPEAL Noninterventional Study. Aesthetic Plast Surg. 2018 Dec;42(6):1672-1680.Elena Gubanova, May Haddad Tabet, Yvonne Bergerova, Olena Moiseieva, Andrey Chemeris, Elena Sanches, Alisa Sharova, Luisa Rodriguez Pose, Romain Raymond, Inna Prygova, Ian Carlisle.

11. Real-World Safety And Effectiveness Of OnabotulinumtoxinA Treatment Of Crow's Feet Lines And Glabellar Lines: Results Of A Korean Postmarketing Surveillance Study. Clin Cosmet Investig Dermatol. 2019 Nov 19;12:851-856. Dong-Jin Yi, Seongjin Hwang, JunHyuk Son, Irina Yushmanova, Krystal Anson Spenta, Suzanne St Rose.

12. Safety, Efficacy, and Patient Satisfaction With OnabotulinumtoxinA for the Treatment of Upper Facial Lines in Japanese Subjects. Dermatol Surg. 2020 Apr;46(4):483-490. Makoto Kawashima, Kiyonori Harii, Yuki Horiuchi, Emily Seidman, Xiaofang Lei, René Hopfinger, Elisabeth Lee

13. Efficacy, Safety, and Subject Satisfaction After AbobotulinumtoxinA Treatment for Moderate to Severe Glabellar Lines. Dermatol Surg. 2020 Jan;46(1):61-69.Gary D Monheit 1, Leslie Baumann 2, Corey Maas 3, Rhonda Rand 4, Rebecca Down.

14. Efficacy, Patient-Reported Outcomes, and Safety in Male Subjects Treated With OnabotulinumtoxinA for Improvement of Moderate to Severe Horizontal Forehead Lines. Dermatol Surg. 2020 Feb;46(2):229-239. Terrence C Keaney, Maurizio Cavallini, Christophe Leys, Anthony Rossi, Adrienne Drinkwater, Stephanie Manson Brown, Julie K Garcia, Cheri Mao

15. Botulinum Toxin Off-Label Use in Dermatology: A Review. Skin Appendage Disord. 2017 Mar;3(1):39-56.Anna Campanati, Emanuela Martina, Katia Giuliodori, Veronica Consales, Ivan Bobyr, Annamaria Offidani

16. The therapeutic usage of botulinum toxin (Botox) in non-cosmetic head and neck conditions - An evidence based review. Saudi Pharm J . 2017 Jan;25(1):18-24. Kamran Habib Awan

17. New Uses of AbobotulinumtoxinA in Aesthetics. Schlessinger J, Gilbert E, Cohen JL, Kaufman J.Aesthet Surg J. 2017 May 1;37(suppl_1):S45-S58.

18. New trends in botulinum toxin use in dermatology. Guida S, Farnetani F, Nisticò SP, Mariarosaria CG, Babino G, Pellacani G, Fulgione E.Dermatol Pract Concept. 2018 Oct 31;8(4):277-282

19. The non-neuronal and nonmuscular effects of botulinum toxin: an opportunity for a deadly molecule to treat disease in the skin and beyond. Br J Dermatol. 2018 May;178(5):1011-1019. S A Grando , C B Zachary

20. Therapeutic Use of Botulinum Neurotoxins in Dermatology: Systematic Review. Martina E, Diotallevi F, Radi G, Campanati A, Offidani A.Toxins (Basel). 2021 Feb 5;13(2):120.

21. Botulinum toxin in the treatment or prevention of acne. Google Patents. 2001. Application filled by Louisiana State University and Agricultural and Mechanical College

22. Acne and sebaceous gland function. Clin Dermatol. Sep-Oct 2004;22(5):360-6. Christos C Zouboulis

23. Novel aspects in cutaneous biology of acetylcholine synthesis and acetylcholine receptors. Exp Dermatol. 2004;13 Suppl 4:27-30. Hjalmar Kurzen, Karin U Schallreuter

24. The non-neuronal cholinergic system of human skin. Horm Metab Res. 2007 Feb;39(2):125-35.H Kurzen, I Wessler, C J Kirkpatrick, K Kawashima, S A Grando

25. Use of intradermal botulinum toxin to reduce sebum production and facial pore size. J Drugs Dermatol. 2008 Sep;7(9):847-50. Anil R Shah

26. Sebum output as a factor contributing to the size of facial pores. Br J Dermatol. 2006 Nov;155(5):890-4. M Roh , M Han, D Kim, K Chung

27. Safety and efficacy of intradermal injection of botulinum toxin for the treatment of oily skin. Dermatol Surg. 2013 Mar;39(3 Pt 1):443-8. Rose AE, Goldberg DJ.

28. Regulation of lipid production by acetylcholine signalling in human sebaceous glands. J Dermatol Sci. 2013 Nov;72(2):116-22. Zheng Jun Li, Seung Bae Park, Kyung Cheol Sohn, Young Lee, Young Joon Seo, Chang Deok Kim, Youn Sung Kim, Jeung Hoon Lee, Myung Im

29. Sebum Production Alteration after Botulinum Toxin Type A Injections for the Treatment of Forehead Rhytides: A Prospective Randomized Double-Blind Dose-Comparative Clinical Investigation. Aesthet Surg J. 2015 Jul; 35(5):600-10. Peiru Min, Wenjing Xi , Luca Grassetti , Aurelia Trisliana Perdanasari , Matteo Torresetti , Shaoqing Feng , Weijie Su , Zheming Pu , Yan Zhang , Sheng Han , Yi Xin Zhang , Giovanni Di Benedetto, Davide Lazzeri

30. Oily Skin: A review of Treatment Options J Clin Aesthet Dermatol. 2017 Aug; 10(8): 49–55. Dawnielle C. Endly, and Richard A. Miller.

31. Efficacy and possible mechanisms of botulinum toxin treatment of oily skin. J Cosmet Dermatol. 2019 Apr;18(2):451-457.Liu Shuo , Yang Ting , Wu KeLun , Zhao Rui , Zhao Rui , Wang Hang

32. The efficacy of intradermal injections of botulinum toxin in the management of enlarged facial pores and seborrhea: a split face-controlled study. J Dermatolog Treat. 2020 Jan 3;1-7. Khadiga S Sayed, Rehab Hegazy, Heba I Gawdat, Rania M Abdel Hay, Mona M Ahmed, Faisal Nouredin Mohammed, Riham Allam, Aya Fahim

33. Microbotulinum: A Quantitative Evaluation of Aesthetic Skin Improvement in 62 Patients. Plast Reconstr Surg. 2020 Nov;146(5):987-994.Alberto Diaspro, Lucia Calvisi, Veronica Manzoni, Giuseppe Sito

34. Intradermal Microdroplet Injection of Diluted Incobotulinumtoxin-A for Sebum Control, Face Lifting, and Pore Size Improvement. J Drugs Dermatol 2021 Jan 1;20(1):49-54. Je-Young Park, Soo Ick Cho, Keunyoung Hur, Dong Hun Lee

35. Reviewing the global burden of acne: how could we improve care to reduce the burden? Br J Dermatol. 2021 Feb;184(2):219-225. Review. Layton AM, Thiboutot D, Tan J.

36. Personal Technique of Microinfiltration With Botulin Toxin: The SINB Technique (Superficial Injection Needling Botulinum). Plast Surg (Oakv). 2019 May;27(2):156-161. Francesco Calvani , Stefania Santini , Emanuele Bartoletti , Alessandra Alhadeff

37. Introduction of the Microdroplet Technique with Incobotulinumtoxin A for the Treatment of Crow's Feet. J Clin Aesthet Dermatol. 2013 Jul;6(7):40-4. Matthias Imhof, Ulrich Kuhne

38. Intradermal Injection of Botulinum Toxin: A Safer Treatment Modality for Forehead Wrinkles Ann Dermatol. 2018 Aug;30(4):458-461.Ji-Young Jun, Ji-Hye Park, Choon Shik Youn, Jong Hee Lee

39. Are There Differences Between Intradermal and Intramuscular Injections of Botulinum Toxin on the Forehead? Dermatol Surg. 2020 Dec;46(12):e126-e131.Yu Jin Kim, Oh Kyung Lim, Won Jun Choi

40. Microneedling: A Review and Practical Guide. Alster TS, Graham PM.Dermatol Surg. 2018 Mar;44(3):397-404.

41. Microneedling: Where do we stand now? A systematic review of the literature. Ramaut L, Hoeksema H, Pirayesh A, Stillaert F, Monstrey S.J Plast Reconstr Aesthet Surg. 2018 Jan;71(1):1-14.

42. Microneedling: Advances and widening horizons. Singh A, Yadav S.Indian Dermatol Online J. 2016 Jul-Aug;7(4):244-54.

43. Microneedling. Litchman G, Nair PA, Badri T.2019 Jun 10. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan

44. Review of applications of microneedling in dermatology. Iriarte C, Awosika O, Rengifo-Pardo M, Ehrlich A.Clin Cosmet Investig Dermatol. 2017 Aug 8;10:289-298.

45. A systematic review of treatments for acne scarring. Part 1: Non-energy-based techniques. Kravvas G, Al-Niaimi F.Scars Burn Heal. 2017 Mar 30;3:2059513117695312.

46. Skin microneedling for acne scars associated with pigmentation in patients with dark skin. Al Qarqaz F, Al-Yousef A.J Cosmet Dermatol. 2018 Jun;17(3):390-395.

47. Treatment of acne vulgaris with fractional radiofrequency microneedling. Kim ST, Lee KH, Sim HJ, Suh KS, Jang MS. J Dermatol. 2014 Jul;41(7):586-91.

48. Microneedling of Scars: A Large Prospective Study with Long-Term Follow-Up. Alster TS, Li MKY.Plast Reconstr Surg. 2020 Feb;145(2):358-364.

49. Microneedling as a Treatment for Acne Scarring: A Systematic Review. Mujahid N, Shareef F, Maymone MBC, Vashi NA.Dermatol Surg. 2020 Jan;46(1):86-92.

50. Evaluation of Microneedling Therapy in Management of Facial Scars. Vijaya Lakshmi Y, Swetha Reddy L, Naga Neelima Devi K, Phani Kumar K, Guru Karthik G, Srinivas Chakravarthy P, Nageswar Rao K.J Craniofac Surg. 2020 Mar/Apr;31(2): e214-e217.

51. Systematic review of the epidemiology of acne vulgaris. Heng AHS, Chew FT.Sci Rep. 2020 Apr 1;10(1):5754. doi: 10.1038/s41598-020-62715-3.PMID: 32238884

52. AbobotulinumtoxinA: A 25-Year History Aesthet Surg J. 2017 May 1;37(suppl_1): S4-S11. Gary D Monheit, Andy Pickett


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