{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T20:49:17Z","timestamp":1793566157103,"version":"4.5.0"},"reference-count":39,"publisher":"American Medical Association (AMA)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Neurol"],"published-print":{"date-parts":[[2025,7,1]]},"abstract":"<jats:sec id=\"ab-noi250024-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Two monoclonal antibodies targeting amyloid plaques, lecanemab and donanemab, have received traditional US Food and Drug Administration (FDA) approval for the treatment of early symptomatic Alzheimer disease (AD). The most significant adverse events associated with these therapies are infusion-related reactions and amyloid-related imaging abnormalities (ARIA) with edema\/effusion (ARIA-E) and\/or hemorrhage\/hemosiderin deposition (ARIA-H). The feasibility and safety of providing these treatments in clinical practice is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250024-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the feasibility and safety of treating patients in specialty memory clinics with lecanemab.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250024-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This retrospective analysis of consecutive patients in whom lecanemab was initiated between August 1, 2023, and October 1, 2024, at Washington University Memory Diagnostic Center, an outpatient specialty memory clinic. Lecanemab was initiated in 234 patients with early symptomatic AD. Eligibility was based on the FDA label and appropriate use recommendations with occasional exceptions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250024-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>Patients were treated with lecanemab, 10 mg\/kg, intravenously  every 2 weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250024-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Infusion-related reactions, ARIA, and withdrawal from treatment were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250024-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The 234 patients treated with lecanemab had a mean age of 74.4 (SD, 6.7) years, 117 were female (50%), and 117 were male (50%). Infusion-related reactions occurred in 87 patients (37%) and were typically mild. Of the 194 patients at risk for ARIA during the study period, 44 had at least 1 microhemorrhage and\/or superficial siderosis before initiation of lecanemab (23%). Over an average treatment period of 6.5 months, 42 total patients (22%) developed ARIA; 29 developed ARIA-E with or without ARIA-H (15%) and 13 developed isolated ARIA-H (6.7%). Eleven patients (5.7%) developed symptomatic ARIA, 2 of those patients (1.0%) with clinically severe symptoms. No patients developed a macrohemorrhage or died. Patients with mild dementia had a 27% rate of symptomatic ARIA; those with mild cognitive impairment or very mild dementia had a 1.8% rate. Overall, 23 of 234 patients (9.8%) withdrew from treatment for various reasons, 10 for ARIA (4.3%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-noi250024-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>A single-specialty memory clinic initiated lecanemab treatment in 234 patients over 14 months. The frequency of significant adverse events, including ARIA, was manageable. These results may inform discussions about the risks of anti-amyloid treatments.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamaneurol.2025.1232","type":"journal-article","created":{"date-parts":[[2025,5,12]],"date-time":"2025-05-12T11:01:43Z","timestamp":1747047703000},"page":"655","source":"Crossref","is-referenced-by-count":121,"title":["Lecanemab Treatment in a Specialty Memory Clinic"],"prefix":"10.1001","volume":"82","author":[{"given":"Madeline","family":"Paczynski","sequence":"first","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Hofmann","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Posey","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maren","family":"Gregersen","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Rudman","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn","family":"Ellington","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Aldinger","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik S.","family":"Musiek","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David M.","family":"Holtzman","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Randall J.","family":"Bateman","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin M.","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nupur","family":"Ghoshal","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B.","family":"Carr","sequence":"additional","affiliation":[{"name":"Department of Medicine, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Dow","sequence":"additional","affiliation":[{"name":"BJC Healthcare, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheyda","family":"Namazie-Kummer","sequence":"additional","affiliation":[{"name":"BJC Healthcare, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayid","family":"Jana","sequence":"additional","affiliation":[{"name":"Department of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengjie","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Division of Biostatistics, Washington University in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Morris","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tammie L. S.","family":"Benzinger","sequence":"additional","affiliation":[{"name":"Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Department of Radiology, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne E.","family":"Schindler","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B. Joy","family":"Snider","sequence":"additional","affiliation":[{"name":"Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri"},{"name":"Knight Alzheimer Disease Research Center, Washington University School of Medicine in St Louis, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"2","key":"noi250024r1","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1007\/s40120-022-00338-8","article-title":"Alzheimer\u2019s disease: epidemiology and clinical progression.","volume":"11","author":"Tahami Monfared","year":"2022","journal-title":"Neurol Ther"},{"issue":"10284","key":"noi250024r2","doi-asserted-by":"publisher","first-page":"1577","DOI":"10.1016\/S0140-6736(20)32205-4","article-title":"Alzheimer\u2019s disease.","volume":"397","author":"Scheltens","year":"2021","journal-title":"Lancet"},{"issue":"9","key":"noi250024r3","doi-asserted-by":"publisher","first-page":"2187","DOI":"10.1038\/s41591-023-02505-2","article-title":"Emerging diagnostics and therapeutics for Alzheimer disease.","volume":"29","author":"Self","year":"2023","journal-title":"Nat Med"},{"issue":"1","key":"noi250024r4","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1056\/NEJMoa2212948","article-title":"Lecanemab in early alzheimer\u2019s disease.","volume":"388","author":"van Dyck","year":"2023","journal-title":"N Engl J Med"},{"issue":"6","key":"noi250024r5","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1001\/jama.2023.13239","article-title":"Donanemab in early symptomatic alzheimer disease: the TRAILBLAZER-ALZ 2 randomized clinical trial.","volume":"330","author":"Sims","year":"2023","journal-title":"JAMA"},{"issue":"6","key":"noi250024r8","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.14283\/jpad.2024.159","article-title":"Initial experience with lecanemab and lessons learned in 71 patients in a regional medical center.","volume":"11","author":"Shields","year":"2024","journal-title":"J Prev Alzheimers Dis"},{"issue":"11","key":"noi250024r9","doi-asserted-by":"publisher","first-page":"4414","DOI":"10.1093\/brain\/awad188","article-title":"Amyloid-related imaging abnormalities (ARIA): radiological, biological and clinical characteristics.","volume":"146","author":"Hampel","year":"2023","journal-title":"Brain"},{"key":"noi250024r10","article-title":"Alzheimer\u2019s disease anti-amyloid immunotherapies: imaging recommendations and practice considerations for ARIA monitoring.","author":"Cogswell","year":"2024","journal-title":"AJNR Am J Neuroradiol"},{"issue":"3","key":"noi250024r11","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1001\/jamaneurol.2021.5205","article-title":"Amyloid-related imaging abnormalities and \u00df-amyloid-targeting antibodies: a systematic review.","volume":"79","author":"Filippi","year":"2022","journal-title":"JAMA Neurol"},{"key":"noi250024r12","doi-asserted-by":"crossref","DOI":"10.1038\/s41582-024-01053-8","article-title":"Amyloid-related imaging abnormalities: manifestations, metrics and mechanisms.","author":"Greenberg","year":"2025","journal-title":"Nat Rev Neurol"},{"key":"noi250024r13","doi-asserted-by":"crossref","DOI":"10.1161\/STR.0000000000000480","article-title":"Vascular neurology considerations for antiamyloid immunotherapy: a science advisory from the American Heart Association.","author":"Greenberg","year":"2025","journal-title":"Stroke"},{"issue":"1","key":"noi250024r14","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1186\/s13195-024-01441-8","article-title":"Updated safety results from phase 3 lecanemab study in early Alzheimer\u2019s disease.","volume":"16","author":"Honig","year":"2024","journal-title":"Alzheimers Res Ther"},{"issue":"3","key":"noi250024r16","doi-asserted-by":"publisher","first-page":"362","DOI":"10.14283\/jpad.2023.30","article-title":"Lecanemab: appropriate use recommendations.","volume":"10","author":"Cummings","year":"2023","journal-title":"J Prev Alzheimers Dis"},{"issue":"11","key":"noi250024r17","doi-asserted-by":"publisher","first-page":"2412","DOI":"10.1212\/WNL.43.11.2412-a","article-title":"The Clinical Dementia Rating (CDR): current version and scoring rules.","volume":"43","author":"Morris","year":"1993","journal-title":"Neurology"},{"issue":"3","key":"noi250024r18","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini-mental state\u201d. A practical method for grading the cognitive state of patients for the clinician.","volume":"12","author":"Folstein","year":"1975","journal-title":"J Psychiatr Res"},{"issue":"5","key":"noi250024r19","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000209674","article-title":"Heed the warning signs to avoid serious ARIA.","volume":"103","author":"Salloway","year":"2024","journal-title":"Neurology"},{"issue":"11","key":"noi250024r20","doi-asserted-by":"publisher","first-page":"1460","DOI":"10.1016\/j.jalz.2018.01.013","article-title":"Cerebrospinal fluid biomarkers measured by Elecsys assays compared to amyloid imaging.","volume":"14","author":"Schindler","year":"2018","journal-title":"Alzheimers Dement"},{"issue":"11","key":"noi250024r21","doi-asserted-by":"publisher","first-page":"1505","DOI":"10.1016\/j.jalz.2018.07.220","article-title":"Appropriate use criteria for lumbar puncture and cerebrospinal fluid testing in the diagnosis of Alzheimer\u2019s disease.","volume":"14","author":"Shaw","year":"2018","journal-title":"Alzheimers Dement"},{"issue":"5","key":"noi250024r22","doi-asserted-by":"publisher","first-page":"3179","DOI":"10.1002\/alz.13764","article-title":"Clinical validation of the PrecivityAD2 blood test: A mass spectrometry-based test with algorithm combining %p-tau217 and A\u00df42\/40 ratio to identify presence of brain amyloid.","volume":"20","author":"Meyer","year":"2024","journal-title":"Alzheimers Dement"},{"issue":"15","key":"noi250024r23","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1001\/jama.2024.13855","article-title":"Blood biomarkers to detect Alzheimer disease in primary care and secondary care.","volume":"332","author":"Palmqvist","year":"2024","journal-title":"JAMA"},{"issue":"1","key":"noi250024r24","doi-asserted-by":"publisher","first-page":"e-1","DOI":"10.1016\/j.jalz.2013.01.002","article-title":"Appropriate use criteria for amyloid PET: a report of the Amyloid Imaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer\u2019s Association.","volume":"9","author":"Johnson","year":"2013","journal-title":"Alzheimers Dement"},{"key":"noi250024r25","doi-asserted-by":"publisher","DOI":"10.1002\/alz.14338","article-title":"Updated appropriate use criteria for amyloid and tau PET: a report from the Alzheimer\u2019s Association and Society for Nuclear Medicine and Molecular Imaging Workgroup.","author":"Rabinovici","year":"2025","journal-title":"Alzheimers Dement"},{"key":"noi250024r26","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1159\/000049147","article-title":"CT and MRI rating of white matter lesions.","volume":"13","author":"Fazekas","year":"2002","journal-title":"Cerebrovasc Dis"},{"issue":"1","key":"noi250024r28","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.ajo.2010.08.047","article-title":"Appropriate use and reporting of uncontrolled case series in the medical literature.","volume":"151","author":"Kempen","year":"2011","journal-title":"Am J Ophthalmol"},{"issue":"7","key":"noi250024r29","doi-asserted-by":"publisher","first-page":"426","DOI":"10.1038\/s41582-024-00977-5","article-title":"Acceptable performance of blood biomarker tests of amyloid pathology\u2014recommendations from the Global CEO Initiative on Alzheimer\u2019s Disease.","volume":"20","author":"Schindler","year":"2024","journal-title":"Nat Rev Neurol"},{"key":"noi250024r30","doi-asserted-by":"publisher","DOI":"10.1002\/alz.70062","article-title":"Modified titration of donanemab reduces ARIA risk and maintains amyloid reduction.","author":"Wang","journal-title":"Alzheimers Dement"},{"key":"noi250024r31","doi-asserted-by":"publisher","DOI":"10.1001\/jamaneurol.2025.0065","article-title":"Amyloid-related imaging abnormalities with donanemab in early symptomatic Alzheimer disease: secondary analysis of the TRAILBLAZER-ALZ and ALZ 2 randomized clinical trials.","author":"Zimmer","year":"2025","journal-title":"JAMA Neurol"},{"issue":"14","key":"noi250024r32","doi-asserted-by":"publisher","first-page":"e1424","DOI":"10.1212\/WNL.0000000000207674","article-title":"Association between socioeconomic factors, race, and use of a specialty memory clinic.","volume":"101","author":"Lewis","year":"2023","journal-title":"Neurology"},{"issue":"3","key":"noi250024r33","doi-asserted-by":"publisher","DOI":"10.1002\/alz.70054","article-title":"Demographic and clinical characteristics of initial patients receiving amyloid-targeting treatments in the United States after regulatory approval.","volume":"21","author":"Mattke","year":"2025","journal-title":"Alzheimers Dement"},{"issue":"1","key":"noi250024r34","doi-asserted-by":"publisher","DOI":"10.1002\/dad2.70095","article-title":"Opportunities to encourage adoption of a biomarker-enabled care pathway for Alzheimer\u2019s in primary care.","volume":"17","author":"Borson","year":"2025","journal-title":"Alzheimers Dement (Amst)"},{"issue":"8","key":"noi250024r35","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1038\/s43587-022-00269-x","article-title":"Designing the next-generation clinical care pathway for Alzheimer\u2019s disease.","volume":"2","author":"Hampel","year":"2022","journal-title":"Nat Aging"},{"issue":"3","key":"noi250024r36","doi-asserted-by":"publisher","first-page":"2089","DOI":"10.1002\/alz.13686","article-title":"Scalable plasma and digital cognitive markers for diagnosis and prognosis of Alzheimer\u2019s disease and related dementias.","volume":"20","author":"Tsoy","year":"2024","journal-title":"Alzheimers Dement"},{"issue":"5","key":"noi250024r37","doi-asserted-by":"publisher","first-page":"1480","DOI":"10.14283\/jpad.2024.103","article-title":"Digital health technologies for Alzheimer\u2019s disease and related dementias: initial results from a landscape analysis and community collaborative effort.","volume":"11","author":"Lott","year":"2024","journal-title":"J Prev Alzheimers Dis"},{"issue":"11","key":"noi250024r38","doi-asserted-by":"publisher","first-page":"8216","DOI":"10.1002\/alz.14184","article-title":"Recommendations for clinical implementation of blood-based biomarkers for Alzheimer\u2019s disease.","volume":"20","author":"Mielke","year":"2024","journal-title":"Alzheimers Dement"},{"issue":"2","key":"noi250024r39","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.55800","article-title":"Artificial intelligence assistive software tool for automated detection and quantification of amyloid-related imaging abnormalities.","volume":"7","author":"Sima","year":"2024","journal-title":"JAMA Netw Open"},{"key":"noi250024r27","first-page":"5","volume-title":"Common Terminology Criteria for Adverse Events (CTCAE)","author":"Services UDoHaH","year":"2017"},{"key":"noi250024r6","unstructured":"US Food and Drug Administration. Prescribing information for Leqembi. Accessed April 8, 2025. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2024\/761269s008lbl.pdf"},{"key":"noi250024r7","unstructured":"US Food and Drug Administration. Prescribing information for Kisunla. Accessed April 8, 2025. https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2024\/761248s000lbl.pdf"},{"key":"noi250024r15","unstructured":"US Food and Drug Administration. FDA Adverse Event Reporting System (FAERS) public dashboard.? 2025; https:\/\/www.fda.gov\/drugs\/fdas-adverse-event-reporting-system-faers\/fda-adverse-event-reporting-system-faers-public-dashboard."}],"container-title":["JAMA Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamaneurology\/articlepdf\/2833457\/jamaneurology_paczynski_2025_oi_250024_1751558093.19821.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T15:00:34Z","timestamp":1752505234000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamaneurology\/fullarticle\/2833457"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":39,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamaneurol.2025.1232","relation":{},"ISSN":["2168-6149"],"issn-type":[{"value":"2168-6149","type":"print"}],"subject":[],"published":{"date-parts":[[2025,7,1]]}}}