Preoperative PET cuts unnecessary lung surgeries in half

New quantitative data suggests that 30 percent of the surgeries performed for non-small cell lung cancer patients in a community-wide clinical study were deemed unnecessary. Additionally, positron emission tomography (PET) was found to reduce unnecessary surgeries by 50 percent, according to research published in the March issue of the Journal of Nuclear Medicine.PET imaging prior to surgery helps stage a patient’s disease by providing functional images of tumors throughout the body, especially areas where cancer has spread, otherwise known as metastasis. Few studies have been able to pin down exactly what impact preoperative PET has on clinical decision-making and resulting treatment. Preliminary review of the data from this long-term, observational study of an entire community of veterans was inconclusive about the utility of PET, but after a more thorough statistical analysis accounting for selection bias and other confounding factors, the researchers were able to conclude that PET imaging eliminated approximately half of unnecessary surgeries.”It has become standard of care for lung cancer patients to receive preoperative PET imaging,” said Steven Zeliadt, PhD, lead author of the study conducted at VA Puget Sound Health Care System and associate professor for the University of Washington in Seattle, Wash. “The prevailing evidence reinforces the general understanding within the medical community that PET is very useful for identifying occult metastasis and that it helps get the right people to surgery while avoiding unnecessary surgeries for those who would not benefit.”For this study, researchers reviewed newly diagnosed non-small lung cancer patients who received preoperative PET to assess the real-life effectiveness of PET as a preventative measure against unnecessarily invasive treatment across a community of patients. A total of 2,977 veterans who underwent PET during disease staging from 1997 to 2009 were included in the study. Of these, 976 patients underwent surgery to resect their lung cancer. During surgery or within 12 months of surgery, 30 percent of these patients were found to have advanced-stage metastatic disease, indicating an unnecessary surgery.Interestingly, the use of PET increased during the study period from 9% to 91%. Conventional multivariate analyses was followed by instrumental variable analyses to account for unobserved anomalies, such as when patients did not undergo PET when it would have been clinically recommended to do so. This new data has the potential to change policy and recommendations regarding the use of oncologic PET for more accurate tumor staging.”We will likely build more quality measures around this research so that preoperative PET is more strongly recommended to improve the management of care for these patients,” added Zeliadt.Story Source:The above story is based on materials provided by Society of Nuclear Medicine. …

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To pump or not to pump?

I’ve been pumping and donating since Ivy was 2 weeks old. Every night, I hook myself up to the pump, settle back into the couch, and pump a cup of liquid gold for my donor family. Sometimes I would be so tired when it came time to pump. I just want to go to bed…maybe I’ll do it in the morning…but still every night I would sit down, plug in, and pump.I love nursing my children, and I would be devastated if I were unable to breastfeed. That’s why I pump, even when I don’t feel like it.I’ve wondered how long I could continue pumping after I was done nursing my last baby…months? years? decades? Some wet nurses continued to nurse babies into …

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My visit to Seattle

We’re back from a fun & busy visit to Seattle! Remind me that only having one baby is easy, but crossing 3 time zones and spending a full day traveling each way with a baby is rather tiring. Especially when your baby wants to wake up at 4 am, because it’s 7 am in her head!Eric came to attend the AWP Conference and to interview candidates for his sabbatical replacement. My mom was free that week, so I decided to come along and spend time with my youngest sister, who moved to Seattle about a year ago.WednesdayWe arrived on Tuesday evening and crashed at my sister’s house in Ballard. Eric didn’t have any conference obligations on Wednesday except for registering, so we spent the day together with my …

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Smoking linked with increased risk of most common type of breast cancer

Young women who smoke and have been smoking a pack a day for a decade or more have a significantly increased risk of developing the most common type of breast cancer. That is the finding of an analysis published early online in Cancer, a peer-reviewed journal of the American Cancer Society. The study indicates that an increased risk of breast cancer may be another health risk incurred by young women who smoke.The majority of recent studies evaluating the relationship between smoking and breast cancer risk among young women have found that smoking is linked with an increased risk; however, few studies have evaluated risks according to different subtypes of breast cancer.To investigate, Christopher Li, MD, PhD, of the Fred Hutchinson Cancer Research Center in Seattle, and his colleagues conducted a population-based study consisting of 778 patients with estrogen receptor positive breast cancer and 182 patients with triple-negative breast cancer. Estrogen receptor positive breast cancer is the most common subtype of breast cancer, while triple-negative breast cancer is less common but tends to be more aggressive. Patients in the study were 20 to 44 years old and were diagnosed from 2004-2010 in the Seattle-Puget Sound metropolitan area. The study also included 938 cancer-free controls.The researchers found that young women who were current or recent smokers and had been smoking a pack a day for at least 10 years had a 60 percent increased risk of estrogen receptor positive breast cancer. In contrast, smoking was not related to a woman’s risk of triple-negative breast cancer.”The health hazards associated with smoking are numerous and well known. This study adds to our knowledge in suggesting that with respect to breast cancer, smoking may increase the risk of the most common molecular subtype of breast cancer but not influence risk of one of the rarer, more aggressive subtypes,” said Dr. Li.Story Source:The above story is based on materials provided by Wiley. Note: Materials may be edited for content and length.

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Mosquito bites deliver potential new malaria vaccine

Sep. 11, 2013 — A study published in Vaccine could provide hope for new live-attenuated malaria vaccineThis study suggests that genetically engineered malaria parasites that are stunted through precise gene deletions (genetically attenuated parasites, or “GAP”) could be used as a vaccine that protects against malaria infection. This means that the harmless (attenuated) version of the parasite would interact with the body in the same way as the infective version, but without possibility of causing disease. GAP-vaccination would induce robust immune responses that protect against future infection with malaria.According to the World Health Organization, there were 219 million documented cases of malaria in 2010, causing the deaths of up to 1.2 million people worldwide. Antimalarial treatments are available to reduce the risk of infection, but as yet there is no effective vaccine against the disease.Last month, a team of scientists announced the results of a trial with a new kind of malaria vaccine, a whole-parasite preparation weakened by radiation. The trial showed promising results, but the method of vaccination was not optimal, requiring intravenous administration and multiple high doses. This current paper outlines a method of attenuation through genetic engineering rather than radiation, which offers hope for a more consistent vaccine that gives better protection.”Malaria is one of the world’s biggest killers, and threatens 40 percent of the world’s population, yet still no effective vaccine exists,” said Stefan Kappe, Ph.D., lead author of the paper and professor at Seattle BioMed. “In this paper we show that genetically engineered parasites are a promising, viable option for developing a malaria vaccine, and we are currently engineering the next generation of attenuated parasite strains with the aim to enter clinical studies soon.”For the first time, researchers created a weakened version of the human malaria parasite by altering its DNA. They tested the safety of the new modified parasite by injecting six human volunteers through mosquito bites. Five of the six volunteers showed no infection with the parasite, suggesting that the new genetic technique has potential as the basis for a malaria vaccine.”Our approach offers a new path to make a protective malaria vaccine that might overcome the limitations of previous development attempts. …

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Low childhood conscientiousness predicts adult obesity

Aug. 9, 2013 — Results from a longitudinal study show that children who exhibit lower conscientiousness (e.g., irresponsible, careless, not persevering) could experience worse overall health, including greater obesity, as adults. The Oregon Research Institute (ORI) study examines the relationship between childhood personality and adult health and shows a strong association between childhood conscientiousness (organized, dependable, self-disciplined) and health status in adulthood. ORI scientist Sarah Hampson, Ph.D., and colleagues at the Kaiser Permanente Center for Health, Hawaii report these findings in the August issue of Health Psychology. Hampson was recently the discussant for a panel on personality and health at the national American Psychological Association meeting in Honolulu, HI.”These results are significant and unique because they show the far-reaching effects of childhood conscientiousness on adult health. Others have shown that more conscientiousness children live longer. Now we have shown that these conscientious children are also healthier at midlife” noted Dr. Hampson.Hawaii school-children rated by their teachers in the 1960’s as less conscientious had worse global health status as adults and had significantly greater obesity, high cholesterol, and increased risk for cardiovascular disease. Childhood conscientiousness was significantly associated with decreased function of the cardiovascular and metabolic systems. This association was independent of the other Big Five personality childhood traits, adult conscientiousness, childhood socioeconomic status, ethnicity, and gender. …

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Breastfeeding duration appears associated with intelligence later in life

July 29, 2013 — Breastfeeding longer is associated with better receptive language at 3 years of age and verbal and nonverbal intelligence at age 7 years, according to a study published by JAMA Pediatrics, a JAMA Network publication.Evidence supports the relationship between breastfeeding and health benefits in infancy, but the extent to which breastfeeding leads to better cognitive development is less certain, according to the study background.Mandy B. Belfort, M.D., M.P.H., of Boston Children’s Hospital, and colleagues examined the relationships of breastfeeding duration and exclusivity with child cognition at ages 3 and 7 years. They also studied the extent to which maternal fish intake during lactation affected associations of infant feeding and later cognition. Researchers used assessment tests to measure cognition.”Longer breastfeeding duration was associated with higher Peabody Picture Vocabulary Test score at age 3 years (0.21; 95% CI, 0.03-0.38 points per month breastfed) and with higher intelligence on the Kaufman Brief Intelligence Test at age 7 years (0.35; 0.16-0.53 verbal points per month breastfed; and 0.29; 0.05-0.54 nonverbal points per month breastfed),” according to the study results. However, the study also noted that breastfeeding duration was not associated with Wide Range Assessment of Memory and Learning scores.As for fish intake (less than 2 servings per week vs. greater than or equal to 2 servings), the relationship between breastfeeding duration and the Wide Range Assessment of Visual Motor Abilities at 3 years of age appeared to be stronger in children of women with higher vs. lower fish intake, although this finding was not statistically significant, the results also indicate.”In summary, our results support a causal relationship of breastfeeding in infancy with receptive language at age 3 and with verbal and nonverbal IQ at school age. These findings support national and international recommendations to promote exclusive breastfeeding through age 6 months and continuation of breastfeeding through at least age 1 year,” the authors conclude.Breastfeeding and Cognition: Can IQ Tip the Scale?In an editorial, Dimitri A. Christakis, M.D., M.P.H., of the Seattle Children’s Hospital Research Institute, writes: “The authors reported an IQ benefit at age 7 years from breastfeeding of 0.35 points per month on the verbal scale and 0.29 points per month on the nonverbal one. Put another way, breastfeeding an infant for the first year of life would be expected to increase his or her IQ by about four points or one-third of a standard deviation.””However, the problem currently is not so much that most women do not initiate breastfeeding, it is that they do not sustain it. …

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Pain of artificial legs could be eased by real-time monitoring

July 23, 2013 — When Ron Bailey lost his right leg below the knee 10 years ago after a head-on collision, he was fitted with a prosthetic leg and began learning to use it in his daily life as a real estate agent in Federal Way, Wash.For a couple of years after the amputation, Bailey, 66, said the remaining part of his leg shrank, which is common after the surgery. This caused him discomfort in the socket, the connection point of his limb to the prosthesis. To make it comfortable enough to wear, Bailey swapped out sockets of different sizes and used fabric pieces called socks to cushion the impact and adjust the fit.”In the end, the socket is the most important part,” Bailey said. “You can have a great prosthetic foot, but if the socket isn’t comfortable, you’re not going to wear it.” Many people who use prostheses experience pain on a daily basis where their skin meets the socket, particularly those who have diabetes or other diseases that affect their physiology.University of Washington engineers aim to ease this discomfort with research that could help build better sockets. They have developed a device that tracks how much a person’s limb swells and shrinks when inside a prosthetic socket. The data could help doctors and patients predict how and when their limbs will swell, which could be used to build smarter sockets.”This provides us a window into what’s happening,” said principal investigator Joan Sanders, a UW professor of bioengineering. “I’m really encouraged by what we have so far.”Soft tissues in a prosthesis socket swell and shrink often during the day. This is a natural fluctuation that happens when we increase physical activity, sit or stand and even eat salty foods. But in a fixed socket, these fluid volume changes can be particularly painful, forcing people to seek relief by removing their artificial limb or adjusting the snugness of the fit by adding or removing fabric socks.If physicians can track when an individual typically experiences volume changes in his or her prosthesis socket, they can better fit patients with artificial limbs and reduce the amount of pain, said Kate Allyn, the team’s lead research prosthetist who has worked for years making and fitting artificial limbs to patients.The device measures the percent increase or decrease of fluid volume in a patient’s limb by receiving data from small electrodes placed in different spots on the leg. Instrument electronics can be worn in a fanny pack and include a circuit board that calculates the fluid volume change in the leg tissues, transmitting the data wirelessly to a computer or storing it on the device. …

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Taste rules for kids and healthy food choices

July 16, 2013 — Sweet and salty flavors, repeat exposure, serving size and parental behavior are the key drivers in children’s food choices, according to a July 15 panel discussion at the 2013 Institute of Food Technologists (IFT) Annual Meeting & Food Expo® held at McCormick Place.A standing-room only crowd of more than 200 conference attendees heard new insights into how children choose the foods they eat, what their eating behaviors are and how the industry and parents can give children access to healthy food environments that shape those food choices.”Children’s decision making has few dimensions,” explained Dr. Adam Drewnowski (CQ), director of the Center for Public Health Nutrition and professor of epidemiology at the School of Public Health, University of Washington, Seattle. Not surprisingly, children lean toward sweets like cookies, chocolate, fruits and juices as well as salty foods that make them feel full like French fries and pizza. But environment, peer groups, family, and exposure to a variety of menu items play a key role in children’s food choices.”Kids are not as complicated as adults and are not making food choices based on health,” said Dr. Jennifer Orlet Fisher, an associate professor of public health at Temple University, Philadelphia. “Preference trumps all. Children eat what they like and leave the rest.”In her studies, she found children like fat and sugar and somewhat surprisingly, fruit is at the top of the list of food choices, followed by starches, meat and eggs, dairy and vegetables. She said it’s not surprising kids like candy and cake over peas and carrots.”Children do not naturally like healthy foods. They need to learn to like those healthy foods,” Fisher said. “They also like what they know.”Repeat exposure creates a food familiarity that also drives food choices for children, which explains why many children repeatedly choose chicken nuggets and cheese, as she found in a study of preschoolers. …

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Great ape genetic diversity catalog frames primate evolution and future conservation

July 3, 2013 — A model of great ape history during the past 15 million years has been fashioned through the study of genetic variation in a large panel of humans, chimpanzees, gorillas and orangutans. The catalog of great ape genetic diversity, the most comprehensive ever, elucidates the evolution and population histories of great apes from Africa and Indonesia. The resource will likely also aid in current and future conservation efforts which strive to preserve natural genetic diversity in populations.More than 75 scientists and wildlife conservationists from around the world assisted the genetic analysis of 79 wild and captive-born great apes. They represent all six great ape species: chimpanzee, bonobo, Sumatran orangutan, Bornean orangutan, eastern gorilla, and western lowland gorilla, and seven subspecies. Nine human genomes were included in the sampling.Javier Prado-Martinez, working with Tomas Marques-Bonet at the Universitat Pompeu Fabra in Barcelona, Spain, and Peter H. Sudmant, with Evan Eichler at the University of Washington in Seattle, led the project. The report appears today, July 3, in the journal Nature.”The research provided us the deepest survey to date of great ape genetic diversity with evolutionary insights into the divergence and emergence of great-ape species,” noted Eichler, a UW professor of genome sciences and a Howard Hughes Medical Institute Investigator.Genetic variation among great apes had been largeley uncharted, due to the difficuty in obtaining genetic specimens from wild apes. Conservationists in many countries, some of them in dangerous or isolated locations, helped in this recent effort, and the research team credits them for the success of the project.Sudmant, a UW graduate student in genome sciences, said, “Gathering this data is critical to understanding differences between great ape species, and separating aspects of the genetic code that distinguish humans from other primates.” Analysis of great ape genetic diversity is likely to reveal ways that natural selection, population growth and collapse, geographic isolation and migration, climate and geological changes, and other factors shaped primate evolution.Sudmant added that learning more about great ape genetic diversity also contributes to knowledge about disease susceptibility among various primate species. Such questions are important to both conservation efforts and to human health. The ebola virus is responsible for thousands of gorilla and chimpanzee deaths in Africa and the origin of HIV, the virus which causes AIDs, is SIV, simian immunodeficiency virus.Sudmant works in a lab that studies both primate evolutionary biology and neuropsychiatric diseases such as autism, schizophrenia, developmental delay, and cognitive and behavioral disorders.”Because the way we think, communicate and act is what makes us distinctively human,” Sudmant said, “we are specifically looking for the genetic differences between humans and other great apes that might confer these traits.” Those species differences may direct researchers to portions of the human genome associated with cognition, speech or behavior, providing clues to which mutations might underlie neurological disease.In a companion paper published this week in Genome Research, Sudmant and Eichler wrote that they inadvertently found the first genetic evidence in a chimpanzee of a disorder resembling Smith-Magenis syndrome, a disabling physical, mental and behavioral condition in humans. …

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The genome’s 3-D structure shapes how genes are expressed

June 23, 2013 — Scientists from Australia and the United States bring new insights to our understanding of the three-dimensional structure of the genome, one of the biggest challenges currently facing the fields of genomics and genetics. Their findings are published in Nature Genetics, online today.Roughly 3 metres of DNA is tightly folded into the nucleus of every cell in our body. This folding allows some genes to be ‘expressed’, or activated, while excluding others.Dr Tim Mercer and Professor John Mattick from Sydney’s Garvan Institute of Medical Research and Professor John Stamatoyannopoulos from Seattle’s University of Washington analysed the genome’s 3D structure, at high resolution.Genes are made up of ‘exons’ and ‘introns’ – the former being the sequences that code for protein and are expressed, and the latter being stretches of noncoding DNA in-between. As the genes are copied, or ‘transcribed’, from DNA into RNA, the intron sequences are cut or ‘spliced’ out and the remaining exons are strung together to form a sequence that encodes a protein. Depending on which exons are strung together, the same gene can generate different proteins.Using vast amounts of data from the ENCODE project*, Dr Tim Mercer and colleagues have inferred the folding of the genome, finding that even within a gene, selected exons are easily exposed.”Imagine a long and immensely convoluted grape vine, its twisted branches presenting some grapes to be plucked easily, while concealing others beyond reach,” said Dr Mercer. “At the same time, imagine a lazy fruit picker only picking the grapes within easy reach.”The same principle applies in the genome. Specific genes and even specific exons, are placed within easy reach by folding.””Over the last few years, we’ve been starting to appreciate just how the folding of the genome helps determine how it’s expressed and regulated,””This study provides the first indication that the three-dimensional structure of the genome can influence the splicing of genes.””We can infer that the genome is folded in such a way that the promoter region — the sequence that initiates transcription of a gene — is located alongside exons, and they are all presented to transcription machinery.””This supports a new way of looking at things, one that the genome is folded around transcription machinery, rather than the other way around. Those genes that come in contact with the transcription machinery get transcribed, while those parts which loop away are ignored.”

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Parental cultural attitudes and beliefs associated with child’s media viewing and habits

June 17, 2013 — Differences in parental beliefs and attitudes regarding the effects of media on early childhood development may help explain increasing racial/ethnic disparities in child media viewing/habits, according to a study by Wanjiku F. M. Njoroge, M.D., of Seattle Children’s Hospital and the University of Washington, Seattle, and colleagues.Share This:A total of 596 parents of children ages 3 to 5 years completed demographic questionnaires, reported on attitudes regarding media’s risks and benefits to their children, and completed one-week media diaries in which they recorded all of the programs their children watched.According to study results, children watched an average of 462.0 minutes of TV per week, with African American children watching more TV/DVDs per week than did children of other racial/ethnic backgrounds. The relationship between child race/ethnicity and average weekly media time was no longer statistically significant after controlling for socioeconomic status (parental educational attainment and reported annual family income), indicating that the observed relationship between race/ethnicity and media time was significantly confounded by socioeconomic (SES) status. Significant differences were found between parents of ethnically/racially diverse children and parents of non-Hispanic white children regarding the perceived positive effects of TV viewing, even when parental education and family income were taken into account.”These findings point to an important relationship between parental attitudes/beliefs about child media use and time that could be useful for intervention work.” The study concludes, “Because of the strong relationship between SES and media exposure in our sample, future research with larger samples of children from diverse racial/ethnic backgrounds is warranted to better understand the complexities of race/ethnicity, family SES, and parental beliefs and attitudes on child media exposure.”Share this story on Facebook, Twitter, and Google:Other social bookmarking and sharing tools:|Story Source: The above story is reprinted from materials provided by American Medical Association (AMA). Note: Materials may be edited for content and length. For further information, please contact the source cited above. Journal Reference:Wanjiku F. M. Njoroge et al. …

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Diet may affect Alzheimer’s disease risk

June 17, 2013 — The lipidation states (or modifications) in certain proteins in the brain that are related to the development of Alzheimer disease appear to differ depending on genotype and cognitive diseases, and levels of these protein and peptides appear to be influenced by diet, according to a report published Online First by JAMA Neurology.Sporadic Alzheimer disease (AD) is caused in part by the accumulation of β-amyloid (Αβ) peptides in the brain. These peptides can be bound to lipids or lipid carrier proteins, such as apolipoprotein E (ApoE), or be free in solution (lipid-depleted [LD] Αβ). Levels of LD Αβ are higher in the plasma of adults with AD, but less is known about these peptides in the cerebrospinal fluid (CSF), the authors write in the study background.Angela J. Hanson, M.D., Veterans Affairs Puget Sound Health Care System and the University of Washington, Seattle, and colleagues studied 20 older adults with normal cognition (average age 69 years) and 27 older adults with amnestic mild cognitive impairment (average age 67 years).The patients were randomized to a diet high in saturated fat content (45 percent energy from fat, greater than 25 percent saturated fat) with a high glycemic index or a diet low in saturated fat content (25 percent of energy from fat, less than 7 percent saturated fat) with a low glycemic index. The main outcomes the researchers measured were lipid depleted (LD) Αβ42 and Αβ40 and ApoE in cerebrospinal fluid.Study results indicate that baseline levels of LD Αβ were greater for adults with mild cognitive impairment compared with adults with normal cognition. The authors also note that these findings were more apparent in adults with mild cognitive impairment and the Ɛ4 allele (a risk factor for AD), who had higher LD apolipoprotein E levels irrespective of cognitive diagnosis. Study results indicate that the diet low in saturated fat tended to decrease LD Αβ levels, whereas the diet high in saturated fat increased these fractions.The authors note the data from their small pilot study need to be replicated in a larger sample before any firm conclusions can be drawn.”Overall, these results suggest that the lipidation states of apolipoproteins and amyloid peptides might play a role in AD pathological processes and are influenced by APOE genotype and diet,” the study concludes.Editorial: Food for ThoughtIn an editorial, Deborah Blacker, M.D., Sc.D., of the Massachusetts General Hospital/Harvard Medical School, Boston, writes: “The article by Hanson and colleagues makes a serious effort to understand whether dietary factors can affect the biology of Alzheimer disease (AD).””Hanson et al argue that the changes observed after their two dietary interventions may underlie some of the epidemiologic findings regarding diabetes and other cardiovascular risk factors and risk for AD. The specifics of their model may not capture the real underlying biological effect of these diets, and it is unclear whether the observed changes in the intermediate outcomes would lead to beneficial changes in oligomers or plaque burden, much less to decreased brain atrophy or improved cognition,” she continues.”At some level, however, the details of the biological model are not critical; the important lesson from the study is that dietary intervention can change brain amyloid chemistry in largely consistent and apparently meaningful ways — in a short period of time. Does this change clinical practice for those advising patients who want to avoid dementia? Probably not, but it adds another small piece to the growing evidence that taking good care of your heart is probably good for your brain too,” Blacker concludes.

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