Iatrogenic Creutzfeldt-Jakob disease at the millennium
Identifieur interne : 000393 ( PascalFrancis/Curation ); précédent : 000392; suivant : 000394Iatrogenic Creutzfeldt-Jakob disease at the millennium
Auteurs : P. Brown [États-Unis] ; M. Preece [Royaume-Uni] ; J.-P. Brandel [France] ; T. Sato [Japon] ; L. Mcshane [États-Unis] ; I. Zerr [Allemagne] ; A. Fletcher [Australie] ; R. G. Will [Royaume-Uni] ; M. Pocchiari [Italie] ; N. R. Cashman [Canada] ; J. H. D'Aignaux [France] ; L. Cervenakova [États-Unis] ; J. Fradkin [États-Unis] ; L. B. Schonberger [États-Unis] ; S. J. Collins [Australie]Source :
- Neurology [ 0028-3878 ] ; 2000.
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Abstract
The causes and geographic distribution of 267 cases of iatrogenic Creutzfeldt-Jakob disease (CJD) are here updated at the millennium. Small numbers of still-occurring cases result from disease onsets after longer and longer incubation periods following infection by cadaveric human growth hormone or dura mater grafts manufactured and distributed before the mid-1980s. The proportion of recipients acquiring CJD from growth hormone varies from 0.3 to 4.4% in different countries, and acquisition from dura mater varies between 0.02 and 0.05% in Japan (where most cases occurred). Incubation periods can extend up to 30 years, and cerebellar onsets predominate in both hormone and graft recipients (in whom the site of graft placement had no effect on the clinical presentation). Homozygosity at codon 129 of the PRNP gene is over-represented in both forms of disease; it has no effect on the incubation period of graft recipients, but may promote shorter incubation periods in hormone cases. Knowledge about potential high-risk sources of contamination gained during the last quarter century, and the implementation of methods to circumvent them, should minimize the potential for iatrogenic contributions to the current spectrum of CJD.
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Will</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>CJD Surveillance Unit, Western General Hospital</s1><s2>Edinburgh</s2><s3>GBR</s3><sZ>8 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Pocchiari, M" sort="Pocchiari, M" uniqKey="Pocchiari M" first="M." last="Pocchiari">M. Pocchiari</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Istituto Superiore de Sanità, Laboratory of Virology</s1><s2>Rome</s2><s3>ITA</s3><sZ>9 aut.</sZ></inist:fA14><country>Italie</country></affiliation></author><author><name sortKey="Cashman, N R" sort="Cashman, N R" uniqKey="Cashman N" first="N. R." last="Cashman">N. R. Cashman</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Canadian CJD Surveillance System</s1><s2>Ottawa</s2><s3>CAN</s3><sZ>10 aut.</sZ></inist:fA14><country>Canada</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>University of Toronto</s1><s3>CAN</s3><sZ>10 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author><author><name sortKey="D Aignaux, J H" sort="D Aignaux, J H" uniqKey="D Aignaux J" first="J. H." last="D'Aignaux">J. H. D'Aignaux</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>U 360 INSERM, Centre National de Référence de la Maladie de CJ, Hôpital de la Salpêtrière</s1><s2>Paris</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Cervenakova, L" sort="Cervenakova, L" uniqKey="Cervenakova L" first="L." last="Cervenakova">L. Cervenakova</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>Jerome H. Holland Laboratory, American Red Cross</s1><s2>Rockville, MD</s2><s3>USA</s3><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Fradkin, J" sort="Fradkin, J" uniqKey="Fradkin J" first="J." last="Fradkin">J. Fradkin</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Division of Diabetes, Endocrinology, and Metabolic Diseases, NIDDKD, NIH</s1><s2>Bethesda, MD</s2><s3>USA</s3><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Schonberger, L B" sort="Schonberger, L B" uniqKey="Schonberger L" first="L. B." last="Schonberger">L. B. 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Collins</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Department of Pathology, University of Melbourne</s1><s3>AUS</s3><sZ>7 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Australie</country></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">00-0521854</idno><date when="2000">2000</date><idno type="stanalyst">PASCAL 00-0521854 INIST</idno><idno type="RBID">Pascal:00-0521854</idno><idno type="wicri:Area/PascalFrancis/Corpus">005D77</idno><idno type="wicri:Area/PascalFrancis/Curation">000393</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Iatrogenic Creutzfeldt-Jakob disease at the millennium</title><author><name sortKey="Brown, P" sort="Brown, P" uniqKey="Brown P" first="P." last="Brown">P. Brown</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Laboratory of CNS Studies, NINDS</s1><s2>Bethesda, MD</s2><s3>USA</s3><sZ>1 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Preece, M" sort="Preece, M" uniqKey="Preece M" first="M." last="Preece">M. Preece</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Institute of Child Health, University College London</s1><s3>GBR</s3><sZ>2 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Brandel, J P" sort="Brandel, J P" uniqKey="Brandel J" first="J.-P." last="Brandel">J.-P. Brandel</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>U 360 INSERM, Centre National de Référence de la Maladie de CJ, Hôpital de la Salpêtrière</s1><s2>Paris</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Sato, T" sort="Sato, T" uniqKey="Sato T" first="T." last="Sato">T. Sato</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Khonodai Hospital</s1><s2>Ichikawa, Chiba</s2><s3>JPN</s3><sZ>4 aut.</sZ></inist:fA14><country>Japon</country></affiliation></author><author><name sortKey="Mcshane, L" sort="Mcshane, L" uniqKey="Mcshane L" first="L." last="Mcshane">L. Mcshane</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Biometric Research Branch NCI</s1><s2>Bethesda, MD</s2><s3>USA</s3><sZ>5 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Zerr, I" sort="Zerr, I" uniqKey="Zerr I" first="I." last="Zerr">I. Zerr</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Klinik und Poliklinik für Neurologie, Georg-August-Universität Göttingen</s1><s3>DEU</s3><sZ>6 aut.</sZ></inist:fA14><country>Allemagne</country></affiliation></author><author><name sortKey="Fletcher, A" sort="Fletcher, A" uniqKey="Fletcher A" first="A." last="Fletcher">A. Fletcher</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Department of Pathology, University of Melbourne</s1><s3>AUS</s3><sZ>7 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Australie</country></affiliation></author><author><name sortKey="Will, R G" sort="Will, R G" uniqKey="Will R" first="R. G." last="Will">R. G. Will</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>CJD Surveillance Unit, Western General Hospital</s1><s2>Edinburgh</s2><s3>GBR</s3><sZ>8 aut.</sZ></inist:fA14><country>Royaume-Uni</country></affiliation></author><author><name sortKey="Pocchiari, M" sort="Pocchiari, M" uniqKey="Pocchiari M" first="M." last="Pocchiari">M. Pocchiari</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Istituto Superiore de Sanità, Laboratory of Virology</s1><s2>Rome</s2><s3>ITA</s3><sZ>9 aut.</sZ></inist:fA14><country>Italie</country></affiliation></author><author><name sortKey="Cashman, N R" sort="Cashman, N R" uniqKey="Cashman N" first="N. R." last="Cashman">N. R. Cashman</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Canadian CJD Surveillance System</s1><s2>Ottawa</s2><s3>CAN</s3><sZ>10 aut.</sZ></inist:fA14><country>Canada</country></affiliation><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>University of Toronto</s1><s3>CAN</s3><sZ>10 aut.</sZ></inist:fA14><country>Canada</country></affiliation></author><author><name sortKey="D Aignaux, J H" sort="D Aignaux, J H" uniqKey="D Aignaux J" first="J. H." last="D'Aignaux">J. H. D'Aignaux</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>U 360 INSERM, Centre National de Référence de la Maladie de CJ, Hôpital de la Salpêtrière</s1><s2>Paris</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>France</country></affiliation></author><author><name sortKey="Cervenakova, L" sort="Cervenakova, L" uniqKey="Cervenakova L" first="L." last="Cervenakova">L. Cervenakova</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>Jerome H. Holland Laboratory, American Red Cross</s1><s2>Rockville, MD</s2><s3>USA</s3><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Fradkin, J" sort="Fradkin, J" uniqKey="Fradkin J" first="J." last="Fradkin">J. Fradkin</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Division of Diabetes, Endocrinology, and Metabolic Diseases, NIDDKD, NIH</s1><s2>Bethesda, MD</s2><s3>USA</s3><sZ>13 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Schonberger, L B" sort="Schonberger, L B" uniqKey="Schonberger L" first="L. B." last="Schonberger">L. B. Schonberger</name><affiliation wicri:level="1"><inist:fA14 i1="14"><s1>Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases CDC</s1><s2>Atlanta, GA</s2><s3>USA</s3><sZ>14 aut.</sZ></inist:fA14><country>États-Unis</country></affiliation></author><author><name sortKey="Collins, S J" sort="Collins, S J" uniqKey="Collins S" first="S. J." last="Collins">S. J. Collins</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Department of Pathology, University of Melbourne</s1><s3>AUS</s3><sZ>7 aut.</sZ><sZ>15 aut.</sZ></inist:fA14><country>Australie</country></affiliation></author></analytic><series><title level="j" type="main">Neurology</title><title level="j" type="abbreviated">Neurology</title><idno type="ISSN">0028-3878</idno><imprint><date when="2000">2000</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Neurology</title><title level="j" type="abbreviated">Neurology</title><idno type="ISSN">0028-3878</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Creutzfeldt Jakob disease</term><term>Epidemiology</term><term>Etiology</term><term>Human</term><term>Iatrogenic</term><term>Prion</term><term>Review</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Encéphalopathie spongiforme Creutzfeldt Jakob</term><term>Iatrogène</term><term>Article synthèse</term><term>Epidémiologie</term><term>Etiologie</term><term>Homme</term><term>Prion</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Homme</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The causes and geographic distribution of 267 cases of iatrogenic Creutzfeldt-Jakob disease (CJD) are here updated at the millennium. Small numbers of still-occurring cases result from disease onsets after longer and longer incubation periods following infection by cadaveric human growth hormone or dura mater grafts manufactured and distributed before the mid-1980s. The proportion of recipients acquiring CJD from growth hormone varies from 0.3 to 4.4% in different countries, and acquisition from dura mater varies between 0.02 and 0.05% in Japan (where most cases occurred). Incubation periods can extend up to 30 years, and cerebellar onsets predominate in both hormone and graft recipients (in whom the site of graft placement had no effect on the clinical presentation). Homozygosity at codon 129 of the PRNP gene is over-represented in both forms of disease; it has no effect on the incubation period of graft recipients, but may promote shorter incubation periods in hormone cases. Knowledge about potential high-risk sources of contamination gained during the last quarter century, and the implementation of methods to circumvent them, should minimize the potential for iatrogenic contributions to the current spectrum of CJD.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0028-3878</s0></fA01><fA02 i1="01"><s0>NEURAI</s0></fA02><fA03 i2="1"><s0>Neurology</s0></fA03><fA05><s2>55</s2></fA05><fA06><s2>8</s2></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Iatrogenic Creutzfeldt-Jakob disease at the millennium</s1></fA08><fA11 i1="01" i2="1"><s1>BROWN (P.)</s1></fA11><fA11 i1="02" i2="1"><s1>PREECE (M.)</s1></fA11><fA11 i1="03" i2="1"><s1>BRANDEL (J.-P.)</s1></fA11><fA11 i1="04" i2="1"><s1>SATO (T.)</s1></fA11><fA11 i1="05" i2="1"><s1>MCSHANE (L.)</s1></fA11><fA11 i1="06" i2="1"><s1>ZERR (I.)</s1></fA11><fA11 i1="07" i2="1"><s1>FLETCHER (A.)</s1></fA11><fA11 i1="08" i2="1"><s1>WILL (R. G.)</s1></fA11><fA11 i1="09" i2="1"><s1>POCCHIARI (M.)</s1></fA11><fA11 i1="10" i2="1"><s1>CASHMAN (N. R.)</s1></fA11><fA11 i1="11" i2="1"><s1>D'AIGNAUX (J. H.)</s1></fA11><fA11 i1="12" i2="1"><s1>CERVENAKOVA (L.)</s1></fA11><fA11 i1="13" i2="1"><s1>FRADKIN (J.)</s1></fA11><fA11 i1="14" i2="1"><s1>SCHONBERGER (L. B.)</s1></fA11><fA11 i1="15" i2="1"><s1>COLLINS (S. J.)</s1></fA11><fA14 i1="01"><s1>Laboratory of CNS Studies, NINDS</s1><s2>Bethesda, MD</s2><s3>USA</s3><sZ>1 aut.</sZ></fA14><fA14 i1="02"><s1>Institute of Child Health, University College London</s1><s3>GBR</s3><sZ>2 aut.</sZ></fA14><fA14 i1="03"><s1>U 360 INSERM, Centre National de Référence de la Maladie de CJ, Hôpital de la Salpêtrière</s1><s2>Paris</s2><s3>FRA</s3><sZ>3 aut.</sZ><sZ>11 aut.</sZ></fA14><fA14 i1="04"><s1>Khonodai Hospital</s1><s2>Ichikawa, Chiba</s2><s3>JPN</s3><sZ>4 aut.</sZ></fA14><fA14 i1="05"><s1>Biometric Research Branch NCI</s1><s2>Bethesda, MD</s2><s3>USA</s3><sZ>5 aut.</sZ></fA14><fA14 i1="06"><s1>Klinik und Poliklinik für Neurologie, Georg-August-Universität Göttingen</s1><s3>DEU</s3><sZ>6 aut.</sZ></fA14><fA14 i1="07"><s1>Department of Pathology, University of Melbourne</s1><s3>AUS</s3><sZ>7 aut.</sZ><sZ>15 aut.</sZ></fA14><fA14 i1="08"><s1>CJD Surveillance Unit, Western General Hospital</s1><s2>Edinburgh</s2><s3>GBR</s3><sZ>8 aut.</sZ></fA14><fA14 i1="09"><s1>Istituto Superiore de Sanità, Laboratory of Virology</s1><s2>Rome</s2><s3>ITA</s3><sZ>9 aut.</sZ></fA14><fA14 i1="10"><s1>Canadian CJD Surveillance System</s1><s2>Ottawa</s2><s3>CAN</s3><sZ>10 aut.</sZ></fA14><fA14 i1="11"><s1>University of Toronto</s1><s3>CAN</s3><sZ>10 aut.</sZ></fA14><fA14 i1="12"><s1>Jerome H. Holland Laboratory, American Red Cross</s1><s2>Rockville, MD</s2><s3>USA</s3><sZ>12 aut.</sZ></fA14><fA14 i1="13"><s1>Division of Diabetes, Endocrinology, and Metabolic Diseases, NIDDKD, NIH</s1><s2>Bethesda, MD</s2><s3>USA</s3><sZ>13 aut.</sZ></fA14><fA14 i1="14"><s1>Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases CDC</s1><s2>Atlanta, GA</s2><s3>USA</s3><sZ>14 aut.</sZ></fA14><fA20><s1>1075-1081</s1></fA20><fA21><s1>2000</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>6345</s2><s5>354000092624460030</s5></fA43><fA44><s0>0000</s0><s1>© 2000 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>19 ref.</s0></fA45><fA47 i1="01" i2="1"><s0>00-0521854</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Neurology</s0></fA64><fA66 i1="01"><s0>USA</s0></fA66><fC01 i1="01" l="ENG"><s0>The causes and geographic distribution of 267 cases of iatrogenic Creutzfeldt-Jakob disease (CJD) are here updated at the millennium. Small numbers of still-occurring cases result from disease onsets after longer and longer incubation periods following infection by cadaveric human growth hormone or dura mater grafts manufactured and distributed before the mid-1980s. The proportion of recipients acquiring CJD from growth hormone varies from 0.3 to 4.4% in different countries, and acquisition from dura mater varies between 0.02 and 0.05% in Japan (where most cases occurred). Incubation periods can extend up to 30 years, and cerebellar onsets predominate in both hormone and graft recipients (in whom the site of graft placement had no effect on the clinical presentation). Homozygosity at codon 129 of the PRNP gene is over-represented in both forms of disease; it has no effect on the incubation period of graft recipients, but may promote shorter incubation periods in hormone cases. Knowledge about potential high-risk sources of contamination gained during the last quarter century, and the implementation of methods to circumvent them, should minimize the potential for iatrogenic contributions to the current spectrum of CJD.</s0></fC01><fC02 i1="01" i2="X"><s0>002B17G</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Encéphalopathie spongiforme Creutzfeldt Jakob</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Creutzfeldt Jakob disease</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Encefalopatía espongiforme Creutzfeldt Jakob</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Iatrogène</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Iatrogenic</s0><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Iatrógeno</s0><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Article synthèse</s0><s5>16</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Review</s0><s5>16</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Artículo síntesis</s0><s5>16</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Epidémiologie</s0><s5>17</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Epidemiology</s0><s5>17</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Epidemiología</s0><s5>17</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Etiologie</s0><s5>18</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Etiology</s0><s5>18</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Etiología</s0><s5>18</s5></fC03><fC03 i1="06" i2="X" l="FRE"><s0>Homme</s0><s5>20</s5></fC03><fC03 i1="06" i2="X" l="ENG"><s0>Human</s0><s5>20</s5></fC03><fC03 i1="06" i2="X" l="SPA"><s0>Hombre</s0><s5>20</s5></fC03><fC03 i1="07" i2="X" l="FRE"><s0>Prion</s0><s5>25</s5></fC03><fC03 i1="07" i2="X" l="ENG"><s0>Prion</s0><s5>25</s5></fC03><fC03 i1="07" i2="X" l="SPA"><s0>Prión</s0><s5>25</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Infection</s0></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Infection</s0></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Infección</s0></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Système nerveux pathologie</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>37</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Système nerveux central pathologie</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>38</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Encéphale pathologie</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>39</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Maladie dégénérative</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Degenerative disease</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Enfermedad degenerativa</s0><s5>40</s5></fC07><fN21><s1>346</s1></fN21></pA></standard></inist></record>Pour manipuler ce document sous Unix (Dilib)
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