{"id":12356,"date":"2023-11-08T17:49:02","date_gmt":"2023-11-08T09:49:02","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&p=12356"},"modified":"2025-02-11T13:37:42","modified_gmt":"2025-02-11T05:37:42","slug":"ton-thuong-than-cap-va-dieu-tri-soc","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/ton-thuong-than-cap-va-dieu-tri-soc\/","title":{"rendered":"T\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p khi \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng b\u1eb1ng kh\u00e1ng sinh kinh nghi\u1ec7m"},"content":{"rendered":"\n

S\u1ed1c nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng l\u00e0 t\u00ecnh tr\u1ea1ng nguy hi\u1ec3m. M\u1ed7i n\u0103m c\u00f3 kho\u1ea3ng 55 tri\u1ec7u ng\u01b0\u1eddi b\u1ecb s\u1ed1c nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng, d\u1eabn \u0111\u1ebfn kho\u1ea3ng 11 tri\u1ec7u tr\u01b0\u1eddng h\u1ee3p t\u1eed vong1, 2. Ch\u1eadm tr\u1ec5 trong \u0111i\u1ec1u tr\u1ecb s\u1ed1c nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng b\u1eb1ng kh\u00e1ng sinh c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn ti\u1ebfn tri\u1ec3n s\u1ed1c, l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 t\u1eed vong \u0111\u1ebfn 30 \u2013 40%3. Bi\u1ec7n ph\u00e1p ki\u1ec3m so\u00e1t s\u1ed1c nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng hi\u1ec7n c\u00f3 t\u1eadp trung v\u00e0o vi\u1ec7c nh\u1eadn \u0111\u1ecbnh s\u1edbm t\u00ecnh tr\u1ea1ng c\u1ee7a b\u1ec7nh nh\u00e2n, kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng kh\u00e1ng sinh k\u1ecbp th\u1eddi v\u00e0 h\u1ed3i s\u1ee9c b\u1eb1ng d\u1ecbch [4]. Kh\u00e1ng sinh nh\u00f3m beta-lactam th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n trong ph\u00e1c \u0111\u1ed3 kinh nghi\u1ec7m \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb s\u1ed1c nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng, bao g\u1ed3m cefepime v\u00e0 piperacillin-tazobactam1. C\u00e1c kh\u00e1ng sinh n\u00e0y c\u00f3 ph\u1ed5 r\u1ed9ng, bao ph\u1ee7 c\u1ea3 vi khu\u1ea9n gram (+) v\u00e0 gram (-), trong \u0111\u00f3 c\u00f3 Pseudomonas aeruginosa<\/em>. Cefepime v\u00e0 piperacillin-tazobactam th\u01b0\u1eddng \u0111\u01b0\u1ee3c k\u00ea \u0111\u01a1n ph\u1ed1i h\u1ee3p v\u1edbi vancomycin \u0111\u1ec3 bao ph\u1ee7 c\u1ea3 Staphylococcus aureus <\/em>\u0111\u1ec1 kh\u00e1ng methicillin1.<\/p>\n\n\n\n

Nguy c\u01a1 tr\u00ean th\u1eadn c\u1ee7a kh\u00e1ng sinh kinh nghi\u1ec7m trong \u0111i\u1ec1u tr\u1ecb s\u1ed1c nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng<\/h2>\n\n\n\n

Piperacillin-tazobactam<\/h3>\n\n\n\n

Cefepime v\u00e0 piperacillin -tazobactam \u0111\u1ec1u c\u00f3 th\u1ec3 g\u00e2y ra nh\u1eefng bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i c\u1ee7a thu\u1ed1c. \u0110\u00e3 c\u00f3 nhi\u1ec1u b\u00e1o c\u00e1o ghi nh\u1eadn t\u00ecnh tr\u1ea1ng t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1ed1i h\u1ee3p piperacillin-tazobactam v\u00e0 vancomycin1. Ch\u00ednh \u0111i\u1ec1u n\u00e0y \u0111\u00e3 khi\u1ebfn nhi\u1ec1u b\u00e1c s\u0129 kh\u00f4ng l\u1ef1a ch\u1ecdn ph\u1ed1i h\u1ee3p n\u00e0y trong ph\u00e1c \u0111\u1ed3 kh\u00e1ng sinh kinh nghi\u1ec7m. M\u1ed9t ph\u00e2n t\u00edch g\u1ed9p \u0111\u00e3 cho th\u1ea5y ph\u1ed1i h\u1ee3p piperacillin-tazobactam v\u00e0 vancomycin c\u00f3 li\u00ean quan \u0111\u1ebfn vi\u1ec7c l\u00e0m t\u0103ng t\u1ef7 l\u1ec7 t\u1ed5n th\u01b0\u01a1ng th\u1eadp c\u1ea5p 5, 6. D\u1ef1a tr\u00ean d\u1eef li\u1ec7u n\u00e0y, C\u1ee5c Qu\u1ea3n l\u00fd Th\u1ef1c ph\u1ea9m v\u00e0 D\u01b0\u1ee3c ph\u1ea9m Hoa K\u1ef3 (FDA) \u0111\u00e3 \u0111\u01b0a ra c\u1ea3nh b\u00e1o t\u0103ng nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p c\u1ee7a ph\u1ed1i h\u1ee3p piperacillin-tazobactam v\u00e0 vancomycin.<\/p>\n\n\n\n

Li\u1ec7u r\u1eb1ng piperacillin-tazobactam v\u00e0 vancomycin c\u00f3 th\u1ef1c s\u1ef1 g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p v\u1eabn l\u00e0 m\u1ed9t c\u00e2u h\u1ecfi c\u00f2n b\u1ecf ng\u1ecf. C\u00e1c b\u00e1o c\u00e1o v\u1ec1 t\u00e1c \u0111\u1ed9ng g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p c\u1ee7a ph\u1ed1i h\u1ee3p piperacillin-tazobactam v\u00e0 vancomycin \u0111\u1ec1u d\u1ef1a tr\u00ean vi\u1ec7c \u0111o l\u01b0\u1eddng n\u1ed3ng \u0111\u1ed9 creatinine trong huy\u1ebft thanh. M\u1ed9t v\u00e0i b\u1eb1ng ch\u1ee9ng g\u1ea7n \u0111\u00e2y cho th\u1ea5y n\u1ed3ng \u0111\u1ed9 creatinine t\u0103ng c\u00f3 th\u1ec3 l\u00e0 do \u1ee9c ch\u1ebf ti\u1ebft creatinine t\u1eeb \u1ed1ng th\u1eadn m\u00e0 kh\u00f4ng c\u00f3 t\u1ed5n th\u01b0\u01a1ng tr\u00ean th\u1eadn 7 \u2013 9. M\u1ed9t s\u1ed1 d\u1ea5u \u1ea5n sinh h\u1ecdc cho t\u1ed5n th\u01b0\u01a1ng th\u1eadn ch\u1eb3ng h\u1ea1n nh\u01b0 kidney injury molecule 1 v\u00e0 cystatin C kh\u00f4ng t\u0103ng c\u00f3 \u00fd ngh\u0129a \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1ed1i h\u1ee3p piperacillin-tazobactam v\u00e0 vancomycin so v\u1edbi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111\u01a1n tr\u1ecb b\u1eb1ng piperacillin-tazobactam, vancomycin v\u00e0 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng ph\u1ed1i h\u1ee3p cefepime v\u00e0 vancomycin1.<\/p>\n\n\n\n

Cefepime<\/h3>\n\n\n\n

Cefepime c\u00f3 li\u00ean quan \u0111\u1ebfn \u0111\u1ed9c t\u00ednh tr\u00ean th\u1ea7n kinh, bao g\u1ed3m bi\u1ebfn \u0111\u1ed5i tr\u1ea1ng th\u00e1i t\u00e2m th\u1ea7n, gi\u1eadt c\u01a1 v\u00e0 \u0111\u1ed9ng kinh kh\u00f4ng co gi\u1eadt10. Nguy c\u01a1 m\u1eafc \u0111\u1ed9c t\u00ednh tr\u00ean th\u1ea7n kinh t\u0103ng \u1edf b\u1ec7nh nh\u00e2n r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn v\u00e0 d\u00f9ng cefepime li\u1ec1u cao (n\u1ed3ng \u0111\u1ed9 \u0111\u00e1y cao). V\u00ec r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1eadn l\u00e0 t\u00ecnh tr\u1ea1ng th\u01b0\u1eddng g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng, do v\u1eady nhi\u1ec1u nh\u00e2n vi\u00ean y t\u1ebf c\u0169ng lo ng\u1ea1i khi k\u00ea \u0111\u01a1n cefepime cho nh\u00f3m b\u1ec7nh nh\u00e2n n\u00e0y1.<\/p>\n\n\n\n

Nghi\u00ean c\u1ee9u so s\u00e1nh \u0111\u1ed9c t\u00ednh tr\u00ean th\u1eadn c\u1ee7a piperacillin-tazobactam v\u00e0 cefepime<\/h2>\n\n\n\n

Qian v\u00e0 c\u1ed9ng s\u1ef1 \u0111\u00e3 ti\u1ebfn h\u00e0nh th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng, ng\u1eabu nhi\u00ean c\u00f3 \u0111\u1ed1i ch\u1ee9ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh li\u1ec7u r\u1eb1ng piperacillin-tazobactam v\u00e0 cefepime c\u00f3 g\u00e2y \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn nguy c\u01a1 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p hay \u0111\u1ed9c t\u00ednh tr\u00ean th\u1ea7n kinh, nh\u1eb1m h\u1ed7 tr\u1ee3 vi\u1ec7c k\u00ea \u0111\u01a1n kh\u00e1ng sinh kinh nghi\u1ec7m trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng11. Nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh tr\u00ean 2511 b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng ho\u1eb7c nghi ng\u1edd s\u1ed1c nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb t\u1ea1i khoa c\u1ea5p c\u1ee9u 11. K\u1ebft c\u1ee5c ch\u00ednh c\u1ee7a nghi\u00ean c\u1ee9u l\u00e0 m\u1ee9c \u0111\u1ed9 t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p ho\u1eb7c t\u1eed vong sau 14 ng\u00e0y theo d\u00f5i.<\/p>\n\n\n\n

K\u1ebft qu\u1ea3 cho th\u1ea5y kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a gi\u1eefa 2 nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng piperacillin-tazobactam v\u00e0 cefepime v\u1ec1 bi\u1ebfn c\u1ed1 g\u00e2y t\u1ed5n th\u01b0\u01a1ng th\u1eadn c\u1ea5p hay t\u1eed vong sau 14 ng\u00e0y theo d\u00f5i11. B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng cefepime c\u00f3 s\u1ed1 ng\u00e0y s\u1ed1ng s\u00f3t v\u00e0 s\u1ed1 ng\u00e0y kh\u00f4ng r\u01a1i v\u00e0o t\u00ecnh tr\u1ea1ng m\u00ea s\u1ea3ng\/h\u00f4n m\u00ea trong v\u00f2ng 14 ng\u00e0y theo d\u00f5i \u00edt h\u01a1n c\u00f3 \u00fd ngh\u0129a so v\u1edbi nh\u00f3m piperacillin-tazobactam11. S\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0y ch\u1ec9 c\u00f3 \u00fd ngh\u0129a \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh s\u1ed1c nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng. \u0110\u1ed1i v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n x\u00e1c \u0111\u1ecbnh s\u1ed1c nhi\u1ec5m khu\u1ea9n h\u1ec7 th\u1ed1ng, kh\u00e1c bi\u1ec7t n\u00e0y kh\u00f4ng c\u00f3 \u00fd ngh\u0129a11.<\/p>\n\n\n\n

\u0110i\u1ec1u quan tr\u1ecdng \u0111\u00e1ng l\u01b0u \u00fd v\u1ec1 nghi\u00ean c\u1ee9u n\u00e0y ch\u00ednh l\u00e0 v\u1ea5n \u0111\u1ec1 v\u1ec1 ch\u1ebf \u0111\u1ed9 li\u1ec1u s\u1eed d\u1ee5ng c\u1ee7a piperacillin-tazobactam v\u00e0 cefepime. Trong th\u1eed nghi\u1ec7m, piperacillin-tazobactam \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh v\u1edbi li\u1ec1u 3.375 g\/q8h, truy\u1ec1n trong 4 gi\u1edd, tuy nhi\u00ean tr\u00ean th\u1ef1c t\u1ebf, piperacilin-tazobactam \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh v\u1edbi li\u1ec1u cao h\u01a1n, th\u01b0\u1eddng 3.375 \u2013 4.5 g\/q6h, truy\u1ec1n trong 30 \u2013 240 ph\u00fat 12, 13. C\u00f2n cefepime l\u1ea1i \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh ti\u00eam nhanh qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch. Nhi\u1ec1u b\u1eb1ng ch\u1ee9ng \u0111\u00e3 ghi nh\u1eadn c\u00e1ch d\u00f9ng thu\u1ed1c n\u00e0y l\u00e0m t\u0103ng \u0111\u1ed9c t\u00ednh h\u01a1n so v\u1edbi ti\u00eam gi\u00e1n \u0111o\u1ea1n ho\u1eb7c truy\u1ec1n k\u00e9o d\u00e0i 14, 15. Nh\u01b0 v\u1eady, ch\u1ebf \u0111\u1ed9 li\u1ec1u trong nghi\u00ean c\u1ee9u c\u00f3 xu h\u01b0\u1edbng l\u00e0m gi\u1ea3m \u0111\u1ed9c t\u00ednh tr\u00ean th\u1eadn c\u1ee7a piperacillin-tazobactam (do li\u1ec1u th\u1ea5p) v\u00e0 t\u0103ng \u0111\u1ed9c t\u00ednh c\u1ee7a cefepime (do ch\u1ebf \u0111\u1ed9 li\u1ec1u kh\u00f4ng ph\u00f9 h\u1ee3p).<\/p>\n\n\n\n

B\u00e0n lu\u1eadn<\/h2>\n\n\n\n

L\u1ef1a ch\u1ecdn kh\u00e1ng sinh kinh nghi\u1ec7m \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb s\u1ed1c nhi\u1ec5m khu\u1ea9n lu\u00f4n l\u00e0 m\u1ed9t th\u00e1ch th\u1ee9c. L\u1ef1a ch\u1ecdn kh\u00e1ng sinh lu\u00f4n ph\u1ea3i c\u00e2n nh\u1eafc d\u1ef1a tr\u00ean nhi\u1ec1u y\u1ebfu t\u1ed1, ch\u1eb3ng h\u1ea1n nh\u01b0 hi\u1ec7u qu\u1ea3 v\u00e0 t\u00ednh an to\u00e0n. Tuy r\u1eb1ng nghi\u00ean c\u1ee9u c\u1ee7a Qian v\u00e0 c\u1ed9ng s\u1ef1 c\u00f2n c\u00f3 m\u1ed9t s\u1ed1 h\u1ea1n ch\u1ebf, tuy nhi\u00ean k\u1ebft qu\u1ea3 ban \u0111\u1ea7u c\u1ee7a nghi\u00ean c\u1ee9u c\u0169ng \u0111\u00e3 cung c\u1ea5p c\u01a1 s\u1edf h\u1ed7 tr\u1ee3 cho vi\u1ec7c l\u1ef1a ch\u1ecdn kh\u00e1ng sinh kinh nghi\u1ec7m \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n s\u1ed1c nhi\u1ec5m khu\u1ea9n.<\/p>\n\n\n\n

\n\n\n\n

T\u00e0i li\u1ec7u tham kh\u1ea3o<\/h3>\n\n\n\n
    \n
  1. Tong SYC, Venkatesh B, McCreary EK. Acute Kidney Injury With Empirical Antibiotics for Sepsis. JAMA. Published online October 14, 2023. doi:10.1001\/jama.2023.18591<\/li>\n\n\n\n
  2. RuddKE, JohnsonSC, AgesaKM,et al.Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study. Lancet. 2020;395(10219):200-211. doi:10.1016\/S0140-6736(19)32989-7<\/li>\n\n\n\n
  3. VenkateshB, FinferS, CohenJ,et al; ADRENAL Trial Investigators and the Australian\u2013New Zealand Intensive Care Society Clinical Trials Group. Adjunctive glucocorticoid therapy in patients with septic shock.N Engl J Med. 2018;378(9):797-808. doi:10.1056\/NEJMoa1705835<\/li>\n\n\n\n
  4. EvansL, RhodesA, Alhazzani,et al.Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-1247. doi:10.1007\/s00134-021-06506-y<\/li>\n\n\n\n
  5. LutherMK, TimbrookTT, CaffreyAR, DosaD, LodiseTP, LaPlanteKL.Vancomycin plus piperacillin-tazobactam and acute kidney injury in adults: a systematic review and meta-analysis. Crit Care Med. 2018;46(1):12-20. doi:10.1097\/CCM.0000000000002769<\/li>\n\n\n\n
  6. AvedissianSN, PaisGM, LiuJ, RhodesNJ, ScheetzMH.Piperacillin-tazobactam added to vancomycin increases risk for acute kidney injury: fact or fiction?Clin Infect Dis. 2020;71(2):426-432. doi:10.1093\/cid\/ciz1189<\/li>\n\n\n\n
  7. ChangJ, PaisGM, MarianskiS,et al.Iohexol-measured glomerular filtration rate and urinary biomarker changes between vancomycin and vancomycin plus piperacillin-tazobactam in a translational rat model.Antimicrob Agents Chemother. 2023;67(8):e0030423. doi:10.1128\/aac.00304-23<\/li>\n\n\n\n
  8. ChangJ, PaisGM, ValdezK, MarianskiS, BarretoEF, ScheetzMH.Glomerular function and urinary biomarker changes between vancomycin and vancomycin plus piperacillin-tazobactam in a translational rat model.Antimicrob Agents Chemother. 2022;66(3):e0213221. doi:10.1128\/aac.02132-2<\/li>\n\n\n\n
  9. MianoTA, HennessyS, YangW,et al.Association of vancomycin plus piperacillin-tazobactam with early changes in creatinine versus cystatin C in critically ill adults: a prospective cohort study.Intensive Care Med. 2022;48(9):1144-1155. doi:10.1007\/s00134-022-06811-0<\/li>\n\n\n\n
  10. MaanG, KeitokuK, KimuraN,et al.Cefepime-induced neurotoxicity: systematic review.J Antimicrob Chemother. 2022;77(11):2908-2921. doi:10.1093\/jac\/dkac271<\/li>\n\n\n\n
  11. QianET, CaseyJD, WrightA,et al; Vanderbilt Center for Learning Healthcare and the Pragmatic Critical Care Research Group.Cefepime vs piperacillin-tazobactam in adults hospitalized with acute infection: the ACORN randomized clinical trial.JAMA. Published online October 14, 2023. doi:10.1001\/jama.2023.20583<\/li>\n\n\n\n
  12. Clinical Laboratory Standards Institute.Performance Standards for Antimicrobial Susceptibility Testing. 33rd ed, CLSI supplement M100. Clinical and Laboratory Standards Institute; 2023.<\/li>\n\n\n\n
  13. European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. Version 13.1; 2023. Accessed October 3, 2023. http:\/\/www.eucast.org<\/li>\n\n\n\n
  14. FoongKS, HsuehK, BaileyTC,et al.A cluster of cefepime-induced neutropenia during outpatient parenteral antimicrobial therapy.Clin Infect Dis. 2019;69(3):534-537. doi:10.1093\/cid\/ciy1112<\/li>\n\n\n\n
  15. SmithSE, HalbigZ, FoxNR, BlandCM, BrananTN.Outcomes of intravenous push versus intermittent infusion administration of cefepime in critically ill patients.Antibiotics (Basel). 2023;12(6):996. doi:10.3390\/antibiotics12060996<\/li>\n<\/ol>\n\n\n\n

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