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Konamouse
Member
07-16-2001
| Thursday, November 09, 2006 - 7:07 am
Any Exercise Can Improve Diabetes Control NEW YORK (Reuters Health) - Combining resistance training, such as weight lifting, with aerobic workouts appears to be the most beneficial for type for long-term control of blood sugar control than either form of exercise alone, New Zealand researchers report. However, the outcomes according to type of exercise weren't very significant. The effects of exercise on blood sugar were small, Drs. Neil J. Snowling and Will G. Hopkins of the Auckland University of Technology note, and were similar to those achieved with medication and diet changes. This suggests that putting all three together could have a more substantial effect. Exercise is a mainstay of therapy for type 2 diabetes, Snowling and Hopkins note, given that physical inactivity increases diabetes risk. To determine which types of exercise might be most helpful in controlling blood sugar, they analyzed 27 studies including 1,003 patients to determine the effects of different types of exercise on hemoglobin A1C, a measure of how well a person's blood sugar is controlled long-term. For any type of exercise training lasting 12 weeks or longer, the researchers found, hemoglobin A1C levels fell by 0.8 percent. There was some evidence that combining aerobic exercise with resistance training had more of an effect than either type of exercise alone. But more intense exercise programs did not appear to be more effective, possibly because they were more difficult for people to stick with, the researchers note. The researchers also found that exercise had a stronger effect on people with more severe disease, which they call "a reassuring finding for those prescribing exercise to patients." The actual cardiovascular risk reduction with exercise for diabetes patients is small, the researchers note. But "one should not include that exercise is not worth the effort," they add, as exercise, diet and medication combined can produce a "moderate or even large" risk reduction. SOURCE: Diabetes Care, November 2006.
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Konamouse
Member
07-16-2001
| Thursday, November 09, 2006 - 7:10 am
Celiac Disease Common In Kids With Type 1 Diabetes NEW YORK (Reuters Health) - Celiac disease affects about one out of eight children with type 1 diabetes, and leads to stunted growth, according to a study conducted in Denmark. Celiac disease is caused by allergy to gluten, mainly found in wheat. It can cause intestinal cramping, pain, bloating, diarrhea, and weight loss. In the current study, the researchers found that a gluten-free diet relieved symptoms and restored normal growth patterns. Dr. Dorte Hansen and her associates first identified all patients younger than 16 years old with type 1 diabetes living in four counties in Denmark. Of these, 269 (89 percent) agreed to participate. Hansen, from Odense University Hospital, and her team found that 33 patients had celiac disease, corresponding to a prevalence of 12.3 percent. Children with celiac disease had significantly lower height and weight, the investigators report in the November issue of Diabetes Care. The kids with celiac disease were put on a strict gluten-free diet and followed for 2 years. Among the 24 children who stuck to the diet, symptoms of celiac disease resolved, weight rose significantly, and height also increased among those who were less than 14 years old. However, overall control of diabetes and blood sugar levels were not affected by the diet. Based on their results, Hansen's group recommends "regular screening for celiac disease in all children with type 1 diabetes." SOURCE: Diabetes Care, November 2006.
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Konamouse
Member
07-16-2001
| Thursday, November 09, 2006 - 7:16 am
Ace Inhibitors Beneficial In Type 2 Diabetes NEW YORK (Reuters Health) - Results of a study indicate that patients with high blood pressure and type 2 diabetes benefit from taking an angiotensin-converting-enzyme (ACE) inhibitor to lower blood pressure, even if they have no evidence of kidney or heart disease. Use of ACE inhibitors, and control of hypertension (high blood pressure), appears to have independent and additive protective effects in patients with type 2 diabetes, suggest early data from a large Italian study known as the BENEDICT trial. In the study of 1180 type 2 diabetic patients with hypertension, treatment with the ACE inhibitor trandolapril, or trandolapril combined with another BP lowering drug called verapamil (Veratran), delayed the onset of "microalbuminuria" -- a build-up of the blood protein albumin in the urine that can signal kidney disease. Diabetes is a leading cause of kidney disease. According to Dr. Piero Ruggenenti and colleagues at "Mario Negri" Institute for Pharmacological Research in Bergamo, Italy, "effective BP reduction has a specific and independent protective effect against the development of microalbuminuria." Systolic BP itself was the strongest predictor of microalbuminuria, and its reduction was the most protective factor. Moreover, the researchers found, "ACE inhibitor therapy has a further protective effect, in particular when the BP is poorly controlled." On the other hand, Veratran was most effective in reducing systolic BP. This agent was less likely to require concomitant treatment with other heart drugs like diuretics and beta blockers. Ruggenenti's team concludes that BP reduction, and not just less severe baseline hypertension, protects against the development of kidney damage. SOURCE: Journal of the American Society of Nephrology, December 2006.
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Konamouse
Member
07-16-2001
| Sunday, November 12, 2006 - 11:39 am
Sustained reduction of type 2 diabetes achieved with simple lifestyle interventions Giving people at high risk for type 2 diabetes intensive diet and exercise counselling can result in sustained lifestyle changes and a reduction in diabetes incidence, even after active counselling ceases, according to the extended follow-up of the Finnish Diabetes Prevention Study (FDPS) published in this week's Lancet. Around 50% of people with impaired glucose tolerance will develop diabetes during 10 years when no active intervention is applied. In the original FDPS study, overweight, middle-aged people with impaired glucose tolerance were randomly assigned to an intensive lifestyle intervention or control group. The intervention group were given detailed and individualised counselling to achieve lifestyle goals (weight loss, decreased intake of fat and saturated fat, increased fibre intake, and moderately intense physical activity 30 min per day or more). After 4 years of active counselling, the intervention group achieved a 58% reduction in relative risk of type 2 diabetes compared with the control group. The extended follow-up of the FDPS study assessed the extent to which the originally-achieved lifestyle changes and risk reduction remained after discontinuation of active counselling. Jaana Lindström (National Public Health Institute, Helsinki, Finland) and colleagues found that beneficial lifestyle changes achieved by participants in the intervention group were maintained after the discontinuation of the intervention, with a 36% reduction in relative risk. The overall risk reduction was related to the success in achieving the intervention goals of weight loss, reduced intake of total and saturated fat, and increased physical activity and intake of dietary fibre. The study (with a median follow-up of 3 years after active counselling) shows that a marked difference in the cumulative incidence of diabetes can be sustained after the discontinuation of active counselling. Jaakko Tuomilehto, the other principal investigator of the Finnish Diabetes Prevention Study states: "From a public health point of view there is an important message: an intensive lifestyle intervention lasting for a limited time can yield long-term benefits in reducing the risk of type 2 diabetes in high-risk individuals…Although a lifestyle intervention alone, even if successful, does not necessarily prevent type 2 diabetes in all individuals, it will still postpone the onset of the disease. Even delaying the onset of diabetes can have a substantial effect on subsequent morbidity, and therefore on the cost-effectiveness of diabetes prevention".
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Konamouse
Member
07-16-2001
| Wednesday, November 15, 2006 - 7:16 pm
Artificial Pancreas Testing to Begin Jan. 2007 Tuesday, November 14 @ 18:11:32 CST A team of scientists in Britain are in the process starting the first study of a closed loop system with 12 children with Type 1 diabetes. The device if successful promises to transform the lives of scores of youngsters. The team from the University of Cambridge say the new mechanism could enable young patients to lead more normal lives by freeing children with diabetes from their reliance on blood tests and injections and helping them to manage the condition better. It is apparently more difficult to regulate insulin in youngsters as their need for glucose fluctuates more than in adults. The artificial pancreas offers the solution of introducing the appropriate amounts of insulin when it is needed. The device is a combination of a glucose sensor and an insulin pump which together make what is called a 'closed loop' piece of apparatus. This would provide up to the minute glucose monitoring, which would be transferred onto a handheld computer that calculates the insulin for a patient's particular need; this data would then be sent to an insulin pump, allowing for the precise regulation of insulin. Lead researcher, Dr. Roman Hovorka, says insulin needs to be more accurately released to attain near-normal levels of blood glucose and to reduce the risk of dangerous low blood glucose levels. This he says is the greatest fear for parents of youngsters with diabetes as it can result in hospitalization, coma and occasionally permanent brain damage or death, if not treated in time. By delivering the correct amount of insulin as soon as it is needed, it should reduce long-term complications such as blindness, loss of sensation and ulceration of the feet, which can lead to amputation. Clinical trials for the instrument will start in January 2007 when 12 children aged between 5 and 18 will be fitted with a glucose monitor. Once they are used to it they will spend a night in hospital with the insulin pump fitted while a nurse watches the glucose monitor and adjusts it accordingly. On a second night in hospital the system will be controlled by a computer, programmed with information from the previous stay.
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Konamouse
Member
07-16-2001
| Wednesday, November 15, 2006 - 7:19 pm
Celiac Disease Triples Risk of Type 1 Diabetes Diagnosis Tuesday, November 14 @ 18:05:48 CST Children with celiac disease have a higher likelihood of a subsequent diagnosis of type 1 diabetes — approximately 3-fold higher — than the general population, according to results of a population-based cohort study in Sweden. Lead author Jonas F. Ludvigsson stated that, "We believe that celiac disease predisposes children to type 1 diabetes." Some children receive a type 1 diabetes diagnosis prior to identification of celiac disease, suggesting that the celiac disease has been asymptomatic and ongoing for several years." In a second study, also published in the November issue of Diabetes Care, Danish researchers established that celiac disease is common in children with type 1 diabetes. In contrast, there has been little focus on patients in whom celiac disease is diagnosed prior to a diagnosis of type 1 diabetes. For the current paper, Dr. Ludvigsson of the Orebro University Hospital and colleagues used the Swedish National inpatient register for the period between 1964 and 2003 to identify 9243 individuals with celiac disease diagnosed before age 20 years. Using the Total Population Register, they matched these patients to five reference subjects without celiac disease by age, gender, calendar year, and area of residence (n = 45,680). The median age at celiac disease diagnosis was 1 year, while the median age of type 1 diabetes diagnosis was 10 years among patients with a prior celiac disease diagnosis. To avoid surveillance bias, the investigators first estimated the risk of diabetes diagnosis at least 1 year following the celiac disease diagnosis. Children with celiac disease had a statistically significantly increased hazard ratio (HR) of 2.4 for a subsequent diagnosis of type 1 diabetes before age 20. The risk was further elevated when Dr. Ludvigsson's group included patients diagnosed with diabetes at any time following the first symptoms of celiac disease (HR = 3.9), and when they only included children diagnosed with diabetes 1 to 5 years after their first diagnosis of celiac disease (HR = 2.7). Neither the age at onset nor subjects' socioeconomic level affected outcomes. The researchers post that the association of celiac disease with subsequent type 1 diabetes could be due to autoantibodies expressed after early exposure to gluten in their diet. Other explanations include a common genetic susceptibility or shared human leucocyte antigen (HLA) profiles. "It could well be that a combination of these factors is responsible for the positive association between celiac disease and type 1 diabetes," Dr. Ludvigsson commented. "Even though our study design does not allow us to examine the etiology of either disease, if I had to choose one factor, it would probably be HLA characteristics." The Swedish investigators found no strong evidence that an earlier introduction of a gluten-free diet in patients with celiac disease protects against type 1 diabetes. When asked about the potential implications of his group's research, Dr. Ludvigsson replied, "Most children being investigated for celiac disease have already had their glucose tested. If blood tests or urinalysis have not been undertaken at diagnosis of celiac disease, I recommend that they be checked." He continued, "In the absence of increased blood glucose levels or lack of urinary glucose, I do not recommend further testing for type 1 diabetes. However, I inform patients with newly diagnosed celiac disease about typical symptoms of type 1 diabetes and urge them to contact their doctor in case they suspect type 1 diabetes. Such symptoms may include increased thirst, increased urination (polyuria), weight loss and fatigue." In the Danish study by Dr. Hansen, of Odense University Hospital, and her associates, there was no evidence that HbA1c was affected by the gluten-free diet during 2 years of follow-up. However, Dr. Ludvigsson added that "I am not convinced by their data that a gluten-free diet has no importance for the HbA1C level." For example, he suggested, longer duration of the diet could lower glucose levels. Another possibility, the investigator proposed, is that "maybe patients with celiac disease and type 1 diabetes inherently have worse HbA1C levels, and the lack of change in HbA1C in the Hansen et al. study actually represents a relative improvement." As to how the research team intends to proceed, he said, "Our aim is to describe the spectrum of complications and associated disorders in celiac disease. It would also be interesting to validate some of our earlier findings — the fourfold increased risk of tuberculosis and the twofold risk of depression associated with celiac disease." Practice Pearls: · Children with celiac disease have increased risk of developing type 1 diabetes before age 20 years and 1 to 5 years following celiac disease diagnosis, which is unrelated to age of celiac disease diagnosis and socioeconomic status. · Children with celiac disease have increased risk for ketoacidosis or diabetic coma before age 20 years. Diabetes Care. 2006;29:2483-2488.
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Konamouse
Member
07-16-2001
| Wednesday, November 15, 2006 - 7:22 pm
Three Years Later, Participants in the Diabetes Prevention Study Still Benefiting Tuesday, November 14 @ 17:46:49 CST Lifestyle intervention has lasting benefits in those at risk of diabetes. The effects of lifestyle intervention on diabetes risk do not disappear after active counseling has stopped, a new follow-up of the Finnish Diabetes Prevention Study shows. Three years after the end of the study, those in the intervention group still had a reduced incidence of type 2 diabetes compared with the control group, Dr Jaana Lindstrom (National Public Health Institute, Helsinki, Finland) and colleagues report in the Lancet. In an accompanying comment, Dr Ronald B Goldberg (Diabetes Research Institute, University of Miami, FL) says that the latest results from Finland show that the initial intervention in the lifestyle group "had a sustained effect that appeared to last almost as long again as the period of active counseling." The Finnish Diabetes Prevention Study assessed the effects of active counseling with regard to lifestyle changes in overweight middle-aged men and women, who were randomly assigned to the counseling arm (n=265) or the control group (n=257) for four years. At the end of this period, the incidence of new diabetes was cut by 58% in the intervention group. These results were reported in 2000 and published a year later in the New England Journal of Medicine. Two years later, the final results of the US Diabetes Prevention Program (DPP) showed an identical reduction in new type 2 diabetes with a similar intensive lifestyle intervention. Now the Finnish investigators have further followed up those who were still free of diabetes at the end of their study, for a median of three more years, monitoring diabetes incidence, body weight, physical activity, and dietary intake of fat, saturated fat, and fiber. At the end of this three years, the incidence of type 2 diabetes was 4.6 per 100 person-years in the group that had undergone the counseling, compared with 7.2 per 100 person-years in the control group (p=0.0401), indicating a 36% reduction in relative risk in the intervention group. The risk reduction was related to the success in achieving the intervention goals of weight loss, reduced intake of total and saturated fat, increased intake of dietary fiber, and increased physical activity. "From a public-health point of view there is an important message: an intensive lifestyle intervention lasting for a limited time can yield long-term benefits in reducing the risk of type 2 diabetes in high-risk individuals," say Lindstrom et al. Goldberg says that although the benefit seen in the follow-up period is smaller than in the original study, it is still significant. "Overall, the relative reduction in diabetes incidence over the entire seven-year follow-up in the lifestyle group was 43%, similar to the 46% reduction noted in the diet-plus-exercise intervention group of the six-year [Chinese] Da Qing study, reported in 1997," he notes. Sources: 1. Lindstrom J, Ilanne-Parikka P, Peltonen M, et al. Sustained reduction in the incidence of type 2 diabetes by lifestyle intervention: follow-up of the Finnish Diabetes Prevention Study. Lancet 2006; 368: 1673-1679. 2. Goldberg R B. Lifestyle interventions to prevent type 2 diabetes. Lancet 2006; 368: 1634-1636.
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Konamouse
Member
07-16-2001
| Wednesday, November 15, 2006 - 7:24 pm
Januvia™ Works For for First and Second-Line Management of Type 2 Diabetes Tuesday, November 14 @ 16:11:42 CST The FDA has approved sitagliptin for use with diet and exercise or in combination with metformin or the TZDs to improve glycemic control in adult patients with type 2 diabetes. According to a company news release, sitagliptin represents a new class of oral drugs called dipeptidyl peptidase-4 (DPP-4) inhibitors. These agents serve to increase the body's active incretin hormone levels, which trigger the pancreas to increase insulin and signal the liver to stop glucose production. Adding sitagliptin to insulin sensitizers, such as pioglitazone or metformin, therefore addresses the 3 key defects of diabetes: insulin resistance, beta-cell dysfunction, and alpha-cell dysfunction. Approval of sitagliptin monotherapy was based on data from 2 clinical studies of 24 and 18 weeks' duration (n = 473 and 296, respectively) in patients with mild to moderate baseline hemoglobin A1c levels (mean, 8.0%; range, 7.0% - 10.0%). Results showed that once-daily sitagliptin therapy yielded significant decreases in hemoglobin A1c levels relative to placebo (-0.8% and -0.6%, respectively; P < .001). The add-on indication for sitagliptin was based on separate 24-week studies, showing that the addition of sitagliptin to metformin or pioglitazone therapy yielded significant mean changes from placebo in hemoglobin A1c level (-0.7; P < .001 for both), with mean decreases of 0.7% and 0.9% from baseline hemoglobin A1c levels of 8.0% and 8.1% for metformin and pioglitazone, respectively. Also, more than twice as many patients receiving sitagliptin add-on therapy achieved a hemoglobin A1c goal of less than 7% compared with those receiving metformin alone (47% vs 18%; P < .001). Similarly, 45% of patients receiving sitagliptin in addition to pioglitazone achieved this goal compared with 23% of those receiving pioglitazone alone (P < .001). Sitagliptin has also been shown to provide a 24-hour glucose response at mealtime, between meals, and overnight. In a 24-week, placebo-controlled study of patients uncontrolled while receiving metformin, adding 100 mg of sitagliptin once daily substantially reduced postmeal and fasting plasma glucose levels by 51 and 25 mg/dL, respectively (P < .001 for both). The recommended regimen of sitagliptin for all approved indications is 100 mg once daily with or without food. No dosage adjustments are required for patients with mild to moderate hepatic insufficiency or in patients with mild renal insufficiency (creatinine clearance [CrCl], > 50 mL/minute). However, patients with moderate (CrCl, 30 to < 50 mL/minute) and severe (CrCl, < 30 mL/minute) renal insufficiency should receive reduced dosages of 50 and 25 mg once daily. Those with end-stage renal disease requiring hemodialysis should also receive daily doses of 25 mg. The FDA recommends that renal function be assessed prior to initiation of sitagliptin therapy and periodically thereafter. The most commonly observed adverse events that occurred more often in the sitagliptin group vs placebo (incidence, > 5%) included stuffy or runny nose and sore throat, upper respiratory tract infection, and headache. Sitagliptin should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis, as it would not be effective in these settings. Its safety and efficacy have not been established in patients younger than 18 years. Because there are no adequate and well-controlled studies in pregnant women, sitagliptin should only be used during pregnancy if clearly needed; caution should be exercised with use of sitagliptin in nursing women. Additional studies of sitagliptin are planned to evaluate its safety and efficacy in combination with insulin and sulfonylureas. In a news release, the company notes that 43 studies of sitagliptin have been completed or are underway (n = 6700 patients in the clinical studies; about 4700 patients from these trials are receiving sitagliptin); additionally, approximately 1100 patients thus far have been treated for more than a year. Four additional studies are set to begin this year, and use of sitagliptin as part of a single-tablet combination with metformin (MK-0431A) has been accepted for FDA review. According to a news release from Novartis AG, the DPP-4 inhibitor vildagliptin (Galvus), a once-daily oral treatment option for people with type 2 diabetes, is also currently under review for approval by the FDA. http://www.fda.gov/cder/whatsnew.htm
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Konamouse
Member
07-16-2001
| Thursday, November 16, 2006 - 6:28 am
Lifestyle Changes Shown To Cut Risk Of Diabetes LONDON (Reuters) - Losing weight, cutting down on saturated fats, eating more fiber and exercising 30 minutes a day can make a difference when it comes to diabetes. Finnish researchers have shown that lifestyle changes not only reduce the odds of high-risk people developing type 2 diabetes but can also postpone the onset of the illness. "From a public health point of view there is an important message: an intensive lifestyle intervention lasting for a limited time can yield long-term benefits in reducing the risk of type 2 diabetes," said Jaakko Tuomilehto of the National Public Health Institute in Helsinki. About 194 million people worldwide suffer from diabetes and public health experts predict the number could reach more than 300 million by 2025. Most cases are type 2 diabetes, which is caused by an inability to regulate glucose (sugar) in the body properly, and linked to being overweight and obese. Diabetes also raises risk of heart disease, stroke, blindness and kidney damage, so preventing or delaying the illness can have huge health benefits. "Lifestyle intervention works very well," Tuomilehto told Reuters. Tuomilehto and his colleagues compared the effects of lifestyle changes on more than 500 men and women in Finland with impaired glucose tolerance, a precursor to full-blown diabetes. Half were given intensive diet and exercise counseling while the other half acted as a control group. During a seven-year follow up of the patients, the scientists found a significant difference between the two groups. There was about a 15-20 percent reduction in diabetes risk in the intervention group, according to a report in The Lancet medical journal. "Although a lifestyle intervention alone, even if successful, does not necessarily prevent type 2 diabetes in all individuals, it will still postpone the onset of the disease," Tuomilehto said.
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Konamouse
Member
07-16-2001
| Thursday, November 16, 2006 - 6:31 am
Soy Yogurt Could Help Control Diabetes: Study WASHINGTON (Reuters) - Soy yogurt, especially with fruit in it, may help control both type 2 diabetes and high blood pressure, U.S. researchers reported on Thursday. Although people with diabetes are usually discouraged from eating sweet snacks, soy yogurt and some dairy yogurts rich in fruit seem to help regulate enzymes that affect blood sugar levels, the researchers report in the Journal of Food Biochemistry. "What one eats should be part of an overall approach to therapy," said Kalidas Shetty of the University of Massachusetts Amherst. Type 2 diabetes, which affects more than 15 million Americans and up to 150 million people globally, is characterized by an abnormal rise in blood sugar right after a meal. This effect, known as hyperglycemia, can damage blood vessels, the kidneys, heart, eyes and nerves. Shetty was interested in studying certain plant compounds that affect enzymes targeted by diabetes drugs, notably alpha-amylase and alpha-glucosidase. He also wanted to check on foods' effects on angiotensin converting enzyme or ACE inhibitors, medicines used to fight high blood pressure. Shetty and his team went to a local supermarket and bought peach, strawberry, blueberry and plain yogurt made by four different producers, including a soy brand. Tests in their lab showed that soy blueberry yogurt strongly affected all three of the enzymes. Peach and strawberry yogurt also affected alpha-amylase and alpha-glucosidase. The researchers tested the yogurt varieties for antioxidants and plant compounds called phenols. Phenols and polyphenols give red wine and tea some of their heart-healthy benefits. Plain soy yogurt was the most potent, with blueberry dairy yogurt scoring second on phenol and antioxidant content, the researchers said. Soy yogurt was also the best at inhibiting ACE, which causes blood vessels to narrow and raises blood pressure. Shetty noted that type 2 diabetes is most prevalent in poor communities and especially among Native Americans. "Cost-effective dietary changes are essential for fighting this disease, and traditional diets that have a higher content of these protective antioxidants are an important part of the solution," Shetty said. "We should be able to use diet along with other therapies, and diabetes is a disease where this especially makes sense." Diets rich in fruits and vegetables, along with regular exercise, can prevent and help control diabetes and high blood pressure alike.
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Mocha
Member
08-12-2001
| Thursday, November 16, 2006 - 7:04 am
Does soy yogurt taste better than regular yogurt?
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