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Using an oral syringe and other tapering techniques

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cats

Strawberry, I've been thinking the same. Thanks for your kind words.

 

Alto, when you refer to "the very top of the black rubber gasket" would you be holding the syringe with the tip pointing up or down?

 

The syringe I have is an orange Exacta-Med 5 ML. The thickness of the black rubber gasket is equivalent to .2 ML dosage.

 

To ensure greater accuracy in tapering from 2.5 ML to 2.25 ML I'm thinking I should get a different size. What do you suggest?

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Altostrata

The smaller oral syringes will have ticks at smaller amounts, e.g. tenths or hundredths of milligrams.

 

The top of the gasket is the part that's touching the liquid.

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Shanti

That's funny because I had the same question in my mind too! I just decided that it doesn't matter though, as long as I stay consistent with which to choose. So I chose the edge of the rubber part as marker instead of the tip of the rubber part in the middle. As long as I'm consistent, my drops in dosage will be right.

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Altostrata

Yes, consistency is the key.

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alexjuice

I need to get a 0.5 ml oral syringe to measure out my liquid Mirtazapine which only comes on the UK in 66ml/15 mg size. Hence my starting dose of 7.5mg = 0.49 ml.

 

I have tried every supplier but the smallest dosing syringe they do is 1ml which is no good for me at the lower doses.

 

I think I read a thread of Alto's which said you can buy this size in the USA.

 

I don't know how to get hold of one and wondered if any kind US person could get me a couple and mail them to me. Obviously I would reimburse. Unless anyone has any other suggestions?

 

Thanks anyway.

 

Angel

 

Hi Angel,

 

I'm a tad confused, pardon me, but the dose is 15mg per 66ml of liquid?

 

Or ... maybe something gets lost across the Atlantic via conversion but it seems to me that a 1ml syringe would be effective. What am I missing?

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Brandy

I hope I'm not misunderstanding your concern, but hope this might be helpful:

 

I'm on a w/d group for another type of med that does extremely small cuts microtapering, although I'm on a steady dose and can't start actually tapering yet.

 

When diluting the med into a liquid form, they dilute it was much as necessary so that they can use a 1 ml syringe to make cuts as low as thousandths of a mg. The key is diluting the liquid to the degree that you can accurately measure a volume of liquid containing such low doses of the active ingredient in a measurable amount of liquid (i.e., change the ratio).

 

I have no experience with mirtazepine so I leave it to the others here to help you with this and to make sure what I posted is relevant to your needs.

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Altostrata

You can use a 1mL syringe, Angel. It measures as accurately as a .5mL syringe.

 

For more info, read the above topic.

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Altostrata

I've got an oral syringe. Now how do I get the liquid out of the bottle?

 

If you're medication is in a bottle, you have 2 choices:

 

1) From the pharmacy, get a special cap for the bottle that has a hole in it. The syringe fits in this hole; you tip the bottle upside down to draw from it. See

 

http://survivingantidepressants.org/index.php?/topic/235-using-an-oral-syringe-and-other-tapering-techniques/page__view__findpost__p__2284

 

http://survivingantidepressants.org/index.php?/topic/235-using-an-oral-syringe-and-other-tapering-techniques/page__view__findpost__p__24470

 

http://survivingantidepressants.org/index.php?/topic/235-using-an-oral-syringe-and-other-tapering-techniques/page__view__findpost__p__21391

 

2) Pour your liquid into a small container with a wide mouth, into which you may stick your syringe and draw from the middle of the liquid, see http://survivingantidepressants.org/index.php?/topic/235-using-an-oral-syringe-and-other-tapering-techniques/page__view__findpost__p__21156

 

This is sloppier, harder to measure, and you probably will get bubbles in the syringe. To get them out, see http://survivingantidepressants.org/index.php?/topic/235-using-an-oral-syringe-and-other-tapering-techniques/page__view__findpost__p__23049

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Lilu

The most precise oral syringe?

 

The best oral syringes I've found, with the clearest markings, are from the Danish company Baxa. They are called ExactaMed oral syringes (with a non Luer tip).

[*]If your compounding pharmacy does not carry them, you might be able to write Baxa and ask where they can be found http://www.baxa.com/exactamed/

[*]Baxa offers free samples here http://www.baxa.com/exactamed/downloads.html You might be able to get your pharmacist (or doctor or nurse) to request 5mL, 3mL, 1mL, and .5mL oral syringes for you.

You do not need a prescription to get oral syringes, although pharmacy supply sites may require that you be a business to make an order.

 

Links no longer valid. New link is http://www.baxa.com/pharmacy-workflow/oralentertal.html

Didn't see any info about free samples though.

This one seems like it would be just as good, and probably available at any drugstore.

http://www.amazon.com/Ezy-Dose-Syringes-Dosage-Korcs/dp/B000VCF6FG/ref=sr_1_fkmr0_3?s=hpc&ie=UTF8&qid=1371523733&sr=1-3-fkmr0&keywords=exactamed+oral+syringe+5mL

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Lilu

If there are only 5 ticks between each marking, how exactly do you measure .05 ml?

 

Here's a nice large picture of a 1 ml syringe:

 

http://www.healthaccessories.com/products/1-ml-oral-syringe

 

Oh I just figured it out! Duh! .05 ml is half of .1 ml

But what if you then have to measure out something like 2.46?  or 2.07? It seems it would just be simpler to either round it off or get a .05 syringe.

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Lilu

I'm having trouble working out the figures for my liquid taper. 

 

My capsules are 75mg and they average 400 beads. I am on 4 beads so that's 1/100 of a capsule. 

 

Liquid is 10ml per 75mg. I have 1ml syringes. I think I'm going to have to dilute it, 

My head is aching with trying to work it out, I can't find a mark on the syringe for a small enough dose on 4 beads, 

how on earth will I manage when I get to less than 1?  What would I dilute with? any suggestions?

 

Hi, I can help you figure it out since I just figured it out with the help of my pharmacist.  

Ok, so you are only taking 4 beads of Effexor now and just now switching to liquid?

 

FYI - I strongly recommend to have your pharmacist DYE your liquid Effexor solution to red, it makes it so much easier to measure accurately.

And now, the numbers.  So, if

400 beads =10 ml (divided by 10, you get:)

40 beads =1 ml  (divided by 10 again, and you get:)

4 beads = .1 ml  (.1 ml is marked on the 1 ml syringe)

Then, divide by 4 and you get:

1 bead = .025 ml (which is slightly more than each tick on the syringe)

 

.1 ml is made up of 5 ticks each equivalent to .02 ml (.02, .04, .06, .08)

The 1 ml syringe is too large to measure out .025 ml, you can position the syringe plunger in between the ticks to add or subtract .01 ml or to get .01, .03, .05., .07, or .09. 

 

If you  need to make even smaller adjustments, you'll have to get a .5 ml syringe.  You can probably ask your pharmacist to order you one.

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Lilu

It's really hard to find a site on the web that sells .5 ml oral syringe and just one to boot. But I found one:

http://www.bug-de-lite.com/Products%20Page.html

 

I still think, the simplest way to obtain a .5 ml/cc oral syringe is to just ask your pharmacist to get one for you.  Insulin syringes are typically .5, so the pharmacist can just take out the needle from one of those.  Or stop by any pet clinic and ask for one there.

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Lilu

Thank you Lilu, that is very helpful, my poor brain just couldn't work that out! 

It seems ludicrous that we need to go to such tiny doses but even at those levels

it makes a huge difference to withdrawal.  I was going to wait till my next drop before

starting the liquid but have decided to start on the .1 ml for a while to get used to it

before dropping and get some .5ml syringes .

It is a good idea to switch to liquid to have your body adjust.  I just completed my first week on liquid Lexapro, and definitely noticed some symptoms that were not there before.  I don't know if it was just the switch or the reduction or both. But I went into the taper right away, and it would have been a good a idea to just try out the same dose as the tablets for at least a week.  

 

Also, I'm wondering if it's possible that the liquid is actually stronger than the pills? I've read numerous times people reporting feeling a difference when switching from a brand to a generic or from one generic to another.  Either way, it's definitely an adjustment period.

 

Oh and a question for you - does Effexor now come in a liquid or did you have it made at a compounding pharmacy?

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Altostrata

The liquid is absorbed faster than tablets.

 

Effexor XR cannot be made into a liquid.

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Skyler

Alto, in general, is the rate of absorption highly dependent on the particular diluent, or is there little difference as long as it is a liquid... Lexi had a miserable time when she went to liquid Ativan from tablets as mixed by her compounding pharmacist.  If she mixes tablets with water herself, might she have an easier time?  I'll ask Lexi what her pharmacist used but I can't locate the name of the particular diluent on the moment.

 

As it stands now, Lexi had to go back to Ativan tablets, and now her doc is proposing she switch to klonopin tabs, which of course need a liquid taper as well, though with milk as a diluent.  It all seems to be between the Devil and the Deep Blue.

 

Thanks!

 

Edit.. PS, Lexi, when you read this would you respond with the name of the diluent the pharmacist used?

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mammaP

 

Thank you Lilu, that is very helpful, my poor brain just couldn't work that out! 

It seems ludicrous that we need to go to such tiny doses but even at those levels

it makes a huge difference to withdrawal.  I was going to wait till my next drop before

starting the liquid but have decided to start on the .1 ml for a while to get used to it

before dropping and get some .5ml syringes .

It is a good idea to switch to liquid to have your body adjust.  I just completed my first week on liquid Lexapro, and definitely noticed some symptoms that were not there before.  I don't know if it was just the switch or the reduction or both. But I went into the taper right away, and it would have been a good a idea to just try out the same dose as the tablets for at least a week.  

 

Also, I'm wondering if it's possible that the liquid is actually stronger than the pills? I've read numerous times people reporting feeling a difference when switching from a brand to a generic or from one generic to another.  Either way, it's definitely an adjustment period.

 

Oh and a question for you - does Effexor now come in a liquid or did you have it made at a compounding pharmacy?

 

Effexor is available in a liquid, my doctor gave me the prescription. I just remembered that I am supposed to take it 4 times a day.

I've ordered .5 syringes so will wait for those so I can divide the dose.  

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Lilu

Effexor XR cannot be made into a liquid.

The liquid version of Effexor is just generic venlafaxine, which is probably why  MammaP said that she has to take it 4 times per day. It looks like it's not available in the US. Mamma P is in the UK, I guess it's available there.  

http://www.accessdata.fda.gov/scripts/cder/ndc/results.cfm?searchfield=venlafaxine&searchtype=ActiveIngredient&OrderBy=SubstanceName

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Lilu

 

 

The liquid is absorbed faster than tablets.

This really sucks. I had not anticipated that just switching from tablet to liquid would produce withdrawal side effects. It almost seems that the liquid is not as potent as the tablets? 

 

 

Lilu... do you know if the pharmacist is using the same generic or brand name you were previously?  If not, you may be experiencing WD from a differing dosage strength in addition to the effect Alto commented on.

 

 

It was all generic Lexapro, and each dose was from a different manufacturer. 10mg from one, 5 mg from another, and liquid from  yet a third.

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Altostrata

The variations in manufacturer may be the reason for the apparent variation in strength.

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lexicon

Hi Sky, the Compounding Pharmacy used Sorbitol,

and Propylene Glycol.

It completely messed me up, it stopped my brain from being able to form words,

or be able to write words. Everything was scrambled..

Also, I had blurry eyes, to where I could not see a thing, and overall it exacerbated my symptoms.

Truly a frightening time!!

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mammaP

I started my liquid this morning and this is how I am doing it. 

 

.1ml is such a tiny amount to divide into 4 doses per day so I experimented a bit.

I settled on this......draw up .1 ml into a 1ml syringe, then draw up water to .8ml.

I then tapped and shook the syringe until it was mixed ( blue food colouring 

helps to see properly)  I then squirted .2ml onto a spoon and left the rest in the

syringe for later as it is prescribed to be taken 4x daily. I feel this is probably

the best way for me, having the full days dose in the syringe means I won't

forget whether I've had it or not, and I can put it in an old thermometer tube I have

and take it with me when I go out. Hopefully this method will work well for me.

Can anyone see if it might be a problem?  

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cymbaltawithdrawal5600

To me, this sounds absolutely brilliant! I often read 'tapering' comments and the thought often occurred to me that 'why not add more diluent and then measure THAT out smaller' would work. 'Out of the box' thinking.......

 

The only problem I can see with 'micro' doses is not being able to reclaim that which is left on the spoon. Is there any way to skip the spoon step? (my brain is mushy right now and I have no 'tapering' experience).

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mammaP

The way I'm doing it needs the spoon really, but at least I lick it to make sure I have it all.

I tried decanting into a little container before diluting but reckoned that too much would be lost

as you say, that is why I chose the spoon. 

It's 3 hours since I took my first dose and now I have that awful feeling behind the eyes that 

usually comes with withdrawal and feel quite nauseous too but it can't be withdrawal already

and must be side effects. I felt fine before taking it! 

Not sure when to take the next, it's probably best to take it every 6 hours to keep it steady.

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Lilu

These look exactly like 1mL Baxa syringes http://www.amazon.com/Sklar-Luer-Slip-tip-Syringe-10-pack/dp/B00EFYQ830/ref=sr_1_cc_1?s=aps&ie=UTF8&qid=1383097047&sr=1-1-catcorr&keywords=sklar+syringe (Thanks to our member Lilu.) After a bit of hunting, I found the Basik / Sklar syringes are made in Denmark, and pet nurturers like them for their accuracy and durability. Here they are even cheaper http://www.henryspets.com/sklar-o-ring-syringe-1-cc/ http://store.birdiebitsnbites.com/catalog/product_info.php?products_id=284   The Danish company Baxa was purchased by Baxter, which still calls the Baxa-type syringes Exactamed syringes. http://www.baxterbiopharmasolutions.com/oral-dosing-devices-accessories/oral-dosing-devices.html   You may be able to get oral syringes locally from a compounding pharmacy, veterinarian, or medical supply store. Ask for a syringe WITHOUT the needle. Tuberculin or insulin syringe with a non-luer tip (aka luer-slip or plain tip) come in the 1mL size.   I've bought these in packs of 10 from a medical supply store. They were very inexpensive. Phone the medical supply store first to see what they have.   In the US, in  most places you are not required to have a prescription to purchase a syringe.   The Becton Dickinson syringes are okay but not as precise as the Exactamed syringes.   Here is a source in the UK http://www.ebay.co.uk/itm/BD-Syringe-Dispenser-For-Oral-Drug-Use-With-Tap-Cap-Like-Baxa-1ml-3ml-5ml-10ml-/151114428586   It's not clear whether these are Baxa or Becton Dickinson. The photo looks like Becton Dickinson.

 

You know, I did buy these, and I can't use them. The tip is too narrow and doesn't fit the adapter.  Also, because the gradations are at .01 ml, it's really hard to measure accurately - they're just too closer together. Maybe I'll invest in a  syringe magnifier.  But I also don't like that the gradations are marked as 0.X instead of just .X. Because of this you can only see EITHER the gradation or the number. Since when the syringe is turned toward the gradations you see a big 0 instead of the number next to it.

This has been such a pain... the free syringes that the pharmacy gives me don't fit snuggly into the bottle adaptor, and if I don't press the syringe tight against the bottle, I wind up with spills. It really is a maneuvering challenge, especially when you're trying to read the damn tiny lines.  Uggggghhhhhh!  And I have a year more of this bs to go through. Rats!

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Rhiannon

If anyone wants tips on how to use pipettes instead of syringes, let me know. They're much bigger so it's easier to read the gradations I think, although I haven't tried the syringes. I use a 10 mL pipette and a 5 mL, marked in gradations of 1 mL and 0.1 mL. If you want smaller gradations of course you have to use a smaller pipette.

 

Basically it's the same as a syringe, just that instead of drawing up using a plunger type thing, you get a "pipettor" or "pipette filler" which draws the liquid up using suction.

 

Here, in case I don't get back here soon (I'm pretty frazzled in withdrawal right now), some links.

 

Picture of serological pipettes (that's the kind you want for this):http://www.truelinelab.com/sites/www.truelinelab.com/files/product-images/Pipettes2.jpg?slideshow=true&slideshowAuto=false&slideshowSpeed=4000&speed=350&transition=fade

 

Pipette filler, one kind: http://www.sciencelabsupplies.com/Pipette_Pipet_Pump_Green_10_ml.html

 

or another kind: http://www.sciencelabsupplies.com/Pipette_Filler_Black.html

 

Let me know if you want me to start a topic on pipettes, if there's enough interest.

 

Edit to add: It's easiest to shop websites designed for students, science fairs and that sort of thing. Stay away from the big sites that market to institutions, hospitals and the like, their stuff is too expensive and mostly only available in large quantities.

I like this site:

http://www.hometrainingtools.com/search.asp?ss=pipettes&x=0&y=0

and the one above with the photos of pipette fillers. Pretty much any site designed for science fair type consumers is good though. And I think you can get them on Amazon too.

 

Edit 2: It looks like they're calling those fillers "pipette pumps." Those are the easiest to learn to use.

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Lilu

 

These look exactly like 1mL Baxa syringes http://www.amazon.com/Sklar-Luer-Slip-tip-Syringe-10-pack/dp/B00EFYQ830/ref=sr_1_cc_1?s=aps&ie=UTF8&qid=1383097047&sr=1-1-catcorr&keywords=sklar+syringe (Thanks to our member Lilu.) After a bit of hunting, I found the Basik / Sklar syringes are made in Denmark, and pet nurturers like them for their accuracy and durability. Here they are even cheaper http://www.henryspets.com/sklar-o-ring-syringe-1-cc/ http://store.birdiebitsnbites.com/catalog/product_info.php?products_id=284   The Danish company Baxa was purchased by Baxter, which still calls the Baxa-type syringes Exactamed syringes. 

 

You know, I did buy these, and I can't use them. The tip is too narrow and doesn't fit the adapter.  Also, because the gradations are at .01 ml, it's really hard to measure accurately - they're just too closer together. Maybe I'll invest in a  syringe magnifier.  But I also don't like that the gradations are marked as 0.X instead of just .X. Because of this you can only see EITHER the gradation or the number. Since when the syringe is turned toward the gradations you see a big 0 instead of the number next to it.

This has been such a pain... the free syringes that the pharmacy gives me don't fit snuggly into the bottle adaptor, and if I don't press the syringe tight against the bottle, I wind up with spills. It really is a maneuvering challenge, especially when you're trying to read the damn tiny lines.  Uggggghhhhhh!  And I have a year more of this bs to go through. Rats!

 

 

I found a way to use the Danish made blue 1 ml syringes.  I bought a small empty travel bottle in Walmart; It has a flip top, and these Sklar syringes fit perfectly in the hole of the cap.  So I just poured some of the liquid medicine in there, and voila - no more spills!

 

PS I bought these from Henry Pets, and they came in a pack of 10 - each one is individually sealed.  If anyone needs one or two, I'd be happy to put them in the mail for you...if you are in the USA, it'll just be the price of a stamp for me, so no big deal.  I've only used one so far, and I'm down to .6 ml of my medication. So, I have 8 unused syringes, for anyone who wants them. Just message me here with your name/mailing address.  

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Altostrata

Thank you so much, Lilu. Those are the best syringes I found.

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mlrp

Hello, dear Chicken,

 

I will defer to other more scientific types for the definitive answer, but the syringe pictured looks a lot like the syringe I use to dose my solutions. I'm just using an old veterinarian syringe left over from when I had to give medicine to pet bunnies :0) . 

 

I can't say about the "not for oral use" disclaimer, but I wouldn't think it would matter to what you are doing.

 

If I recall correctly, I think one of the most important factors in making homemade solutions is to maintain consistency in the equipment used so that, even if (for instance) 5 ml on the syringe you are using is 5.05 ml on someone else's syringe, your own measurements will be consistent and true to the equipment you are using. 

 

But, let another more knowledgeable than I weigh in...

 

I'm pulling for ya... You're on the path to full recovery!

 

Oh, how I long for the day I can copy and paste the part of your signature that reads "After removing the Remeron all my bad symptoms went away and I am stable" and use it for my own. Here's hoping....!

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Altostrata

It probably says "not for oral use" because this syringe is intended to be fitted with a needle.

 

The plastic body is the same as an oral syringe. I wouldn't think using this syringe for oral liquids would be a problem.

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chicken

Thanks alto. I wanted to make sure before I used it. I found several others of different sizes at a compounding pharmacy.

 I plan to order these

http://www.henryspets.com/sklar-o-ring-syringe-1-cc/

http://www.healthaccessories.com/liquid-meds-tools-oral-syringes/1-ml-oral-syringe

 

You had them listed and I checked them out. They look great for micro tapers.

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Altostrata

Both good choices, chicken. The ones with the blue marking (Baxa) are better, if you can get them.

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indigo

I switched over from Prozac in caps to liquid prozac from the pharmacy.

At the time I switched I did not drop the dose but had a severe WD reaction anyway.

I don't think the math was wrong in switching from grams to  liquid mLs because I had a mathematician friend

figure it out and he calibrated the dose taking into account weight of the gelatin capsule etc.etc.

Now I'm wondering if the prozac liquid s the same strength as the powder. Is there any way I can find that out?

Also, since I'm doing micro-tapering, the one drop I have done since switching to liquid was just 0.1 mL but had a strong

WD reaction. It was sudden and faster arriving than any other drop. Because 0.01 is half way between two small lines

on the 1 mL syringe there is a tiny bit of guesswork. Could that miniscule amount of  possible error have an effect?

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mammaP

People do have reactions when switching to liquid, or switching between brands of drugs. We are sensitive to variations that it doesn't take much to upset things. I would have a long hold before making any more changes to give your body time to get used to the change to liquid. 

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