LATE NEUROSYPHILIS

Posted in Anti-Infectives on April 28th, 2011 with Comments Off
Central nervous system invasion by T. pallidum often occurs in the earliest stages of infection, as noted, and can be symptomatic or asymptomatic. The majority of untreated patients recover spontaneously from this initial infection, but a subset of patients goes on to develop chronic neurosyphilis. The persistence of CSF abnormalities for more than 5 years in the untreated patient is highly predictive of progression to clinical neurosyphilis.
Late neurosyphilis may be asymptomatic or symptomatic. Symptomatic neurosyphilis can be categorized as either meningovascular or parenchymatous neurosyphilis, although patients usually have overlapping features.
Asymptomatic neurosyphilis, the most common presentation of chronic neurosyphilis, is diagnosed by the finding of at least one CSF abnormality: a pleocytosis, an elevated protein level, a decreased glucose concentration, or a positive nontreponemal or reaginic test.
Meningovascular neurosyphilis, which occurs 4 to 7 years after infection, results from the pathologic finding of endarteritis obliterans of the small blood vessels of the brain, meninges, and spinal cord, which leads to multiple microscopic areas of infarction. Both stroke and progressive neurologic deficits may develop, causing hemiparesis, aphasia, and seizures.
Parenchymatous neurosyphilis typically occurs decades after infection and results from the destruction of nerve cells by direct invasion of spirochetes in the cerebral cortex, causing general paresis, and, in the spinal cord, causing tabes dorsalis. The result is a combination of psychiatric and neurologic manifestations. General paresis is a progressive dementing illness marked by changes in personality, affect, sensorium, and intellect. Speech may be slurred, reflexes are hyperactive, and the classic Argyll-Robertson pupils (small, irregular pupils that do not respond to light but accommodate to near vision) may be present.
In tabes dorsalis, there is demyelinization of the posterior column, dorsal roots, and dorsal root ganglia. This results in the characteristic ataxic, wide-based gait and foot slap. Patients may have paresthesias, “lightning” (sudden, severe) pains in the extremities, and urinary and fecal incontinence. On examination, there is a loss of position and vibratory sense, deep pain and temperature sensation, and decreased ankle and knee reflexes. The Argyll-Robertson pupil is typical of tabes dorsalis, and the Romberg sign is a classic finding. Loss of sensation may result in Charcot’s joints and traumatic sores on the feet and lower extremities.
Ocular syphilis is common in CNS infection with syphilis, and usually manifests as anterior uveitis, although any inflammatory process of the eye can occur. Patients who are HIV-infected or are receiving steroids are most prone to uveitis. Optic atrophy occurs most often in patients with tabes dorsalis, resulting in “gunbarrel sight.
Syphilitic otitis, causing asymmetric deafness and tinnitus, is a particular form of neurosyphilis that may occur at any stage of disease. Because the CSF profile is typically normal, it is difficult to diagnose. Therefore, any patient with unexplained hearing loss or other vestibular abnormality with a positive treponemal antibody test finding should be treated for syphilitic otitis.
*167/348/5*

LEARNING ABOUT ANEMIA

Posted in Cardio & Blood-Cholesterol on April 17th, 2011 with Comments Off
A condition caused by a loss of blood, or from the red blood cells being destroyed more rapidly than new blood cells can be produced. Sometimes the production of cells falls below the rate of destruction of cells. Sometimes the red coloring matter in the blood falls below normal. Following hemorrhage, the red blood cells and red coloring matter usually return to normal within two months, if the patient lives. If one-third of the blood is lost suddenly, death may follow immediately unless blood is given by transfusion.
Anemia may result from defective formation of the blood, due to a deficiency in nutrition. The lack of iron, proteins and some vitamins may produce what is known as an iron-deficiency anemia. The production of blood cells depends on a number of factors, involving various organs of the body. The bone marrow is especially important in producing red blood cells. Iron may be deficient when there is loss of blood, when it is not taken into the body in sufficient amounts or when it is not properly absorbed from the bowel. Women may lose so much blood during menstruation as to become anemic. The symptoms include a feeling of weakness, tiring easily, a shortness of breath on exertion, occasionally a swelling of the legs. If the anemia develops gradually, the number of red blood cells may fall as low as 1,000,000, instead of the normal 6,000,000.
In recovery from anemia, diet is important. Patients should have a nourishing diet containing spinach, meat, liver, eggs, apricots, peaches-foods rich in vitamins and proteins. Extra iron should be prescribed, in order to produce more hemoglobin, more red coloring matter and more red blood cells by speeding up the function of the bone marrow. Customary also is the taking of liver or lamb kidneys, which contain much of the necessary blood-stimulating material. Physicians may prescribe drugs if necessary, such as: folic acid, vitamin B12 or various liver extracts. Once the cause of blood-destruction is removed or the bone marrow properly stimulated, if that is needed, the ability of the body to grow blood cells is improved.
*7/318/5*

COMMON CONDITIONS OF THE NECK: COMPUTER-RELATED NECK ACHE – ONE CASE HISTORY

Posted in Pain Relief-Muscle Relaxers on March 30th, 2011 with No Comments »
A 23-year-old Asian girl in London worked for a High Street bank. She worked long hours at the computer and got very tired. Suddenly she noticed she had double vision and slight loss of vision on one side. Her mother took her to the GP who immediately referred her to Moorfield’s Eye Hospital, a leading eye hospital in London of world status. After careful examination and a few tests, a provisional diagnosis of MS was made. The family was devastated as she was to get married within a few months and such a diagnosis in an arranged marriage meant disaster and the wedding would be called off. Everybody was worried. In particular, the steroids that were prescribed did not help at all but on the contrary she felt worse as she had dizziness and occasional loss of balance.
This girl was brought to me for an opinion. Without any comment on her condition, I suggested a course of my treatment. As she had low blood pressure, I gave her a high-protein diet and some B-complex. She received a series of treatments with the Ali Technique and was taught yogic eye exercises to be done twice a day. Her condition steadily improved and a few weeks before the wedding her double vision was corrected fully, and she had no neurological symptoms.
Prolonged ill-treatment of the neck in the above manner can lead to degeneration of the discs and much later on to degeneration of the joints. Both can be prevented.
*172\330\8*

COMMON CONDITIONS OF THE NECK: COMPUTER-RELATED NECK ACHE – ONE CASE HISTORYA 23-year-old Asian girl in London worked for a High Street bank. She worked long hours at the computer and got very tired. Suddenly she noticed she had double vision and slight loss of vision on one side. Her mother took her to the GP who immediately referred her to Moorfield’s Eye Hospital, a leading eye hospital in London of world status. After careful examination and a few tests, a provisional diagnosis of MS was made. The family was devastated as she was to get married within a few months and such a diagnosis in an arranged marriage meant disaster and the wedding would be called off. Everybody was worried. In particular, the steroids that were prescribed did not help at all but on the contrary she felt worse as she had dizziness and occasional loss of balance.This girl was brought to me for an opinion. Without any comment on her condition, I suggested a course of my treatment. As she had low blood pressure, I gave her a high-protein diet and some B-complex. She received a series of treatments with the Ali Technique and was taught yogic eye exercises to be done twice a day. Her condition steadily improved and a few weeks before the wedding her double vision was corrected fully, and she had no neurological symptoms.Prolonged ill-treatment of the neck in the above manner can lead to degeneration of the discs and much later on to degeneration of the joints. Both can be prevented.*172\330\8*

CHILDBIRTH: WHEN COULD WE EXPECT A NEW AND MORE WHOLESOME ATTITUDE TOWARD REARING A FAMILY?

Posted in Men's Health-Erectile Dysfunction on March 22nd, 2011 with No Comments »
When once the importance of eugenics dawns on human beings, when an economic system is evolved in which childbirth will not be so great a sacrifice as it is today, and when parenthood becomes entirely voluntary so that the old nightmare of uncontrolled breeding is forever forgotten, then we may expect a new and more wholesome attitude toward rearing a family. There is latent in both men and women enough of the parental instinct, or the impulse to look after some creature, if no more than a pet dog or cat, for this instinct, if given half a chance, to express itself as a positive desire for children in most marriages. Especially with a change in moral emphasis from sex taboos to eugenics, parental feelings reinforced by the social encouragement of parenthood will finally give childbearing and rearing the prestige they deserve. And many persons who should be contributing to the racial stock, but who, under the influence of the current set of values or under the pressure of economic conditions are not so doing, will be found to take a different attitude, if the social and economic changes suggested can be made.
Even with the severe handicaps that are now placed upon parenthood, a married couple who are worthy of rearing a family should think twice before deferring indefinitely the occasion of childbirth. From a purely selfish standpoint there are good grounds for desiring children. The happiness of a lifetime is not measured alone by the round of pleasures, the convenience or the social prestige of the early years of marriage, though no one can deny that these things count.
But in later years the values centering about children prove to be the more enduring satisfactions. Many parents, after years of extreme hardship and suffering, have found the one saving grace of life in the satisfaction children bring. When one stops to consider what a childless old age may mean, one will see that there are not only eugenic and other social reasons for rearing a family but that parenthood has no small value from the standpoint of self-interest as well.
*136\275\8*

CHILDBIRTH: WHEN COULD WE EXPECT A NEW AND MORE WHOLESOME ATTITUDE TOWARD REARING A FAMILY?When once the importance of eugenics dawns on human beings, when an economic system is evolved in which childbirth will not be so great a sacrifice as it is today, and when parenthood becomes entirely voluntary so that the old nightmare of uncontrolled breeding is forever forgotten, then we may expect a new and more wholesome attitude toward rearing a family. There is latent in both men and women enough of the parental instinct, or the impulse to look after some creature, if no more than a pet dog or cat, for this instinct, if given half a chance, to express itself as a positive desire for children in most marriages. Especially with a change in moral emphasis from sex taboos to eugenics, parental feelings reinforced by the social encouragement of parenthood will finally give childbearing and rearing the prestige they deserve. And many persons who should be contributing to the racial stock, but who, under the influence of the current set of values or under the pressure of economic conditions are not so doing, will be found to take a different attitude, if the social and economic changes suggested can be made.Even with the severe handicaps that are now placed upon parenthood, a married couple who are worthy of rearing a family should think twice before deferring indefinitely the occasion of childbirth. From a purely selfish standpoint there are good grounds for desiring children. The happiness of a lifetime is not measured alone by the round of pleasures, the convenience or the social prestige of the early years of marriage, though no one can deny that these things count.But in later years the values centering about children prove to be the more enduring satisfactions. Many parents, after years of extreme hardship and suffering, have found the one saving grace of life in the satisfaction children bring. When one stops to consider what a childless old age may mean, one will see that there are not only eugenic and other social reasons for rearing a family but that parenthood has no small value from the standpoint of self-interest as well.*136\275\8*

BACH FLOWER REMEDIES: DR. BACH’S PHILOSOPHY – THE PRESCRIBING OF REMEDIES

Posted in Herbal on March 11th, 2011 with No Comments »
It is desirable that only one remedy should be prescribed at one time. But in practice at least 2 remedies are required to cover the case. Suppose a man has fear of cancer, but from his talk you find that he is burning with hatred for some man, then you have to prescribe for Mimulus’ and ‘HOLLY simultaneously, as it would be difficult to find which of the 2 remedies covers his mental state better than the other. However, a sincere effort should be made to find out which is the idea upper most in the mind of the patient at that time, and prescribe accordingly.
After taking the medicine if there is change in the mood of the patient, the medicine may be changed accordingly.
Sometimes the remedy is prescribed on physical symptoms if they correspond to the mental state of the patient. In case of repetitive ideas in the mind, when the patient cannot get rid of any ideas from the mind, if it is of the same type “White Chestnut’ is prescribed.
When a man is suffering from chronic cough which repeats in the same way or has chronic skin trouble say itch followed by burning and this trouble is also of the repetitive type, then White Chestnut is to be prescribed in this case also.
There is no fixed rule by which it can be determined how long it would be necessary to continue giving Floral Remedies. If it is a temporary sensation, it may go even with a single dose of ‘Crab Apple,’ but if the Floral Remedy is intended to change the very temperament of the person or if it has to remove a chronic ailment, it may require some months to do it. There is, however, no danger of over-dosing or “Prooving” in the use of Bach Flower Remedies.
*32\308\8*

BACH FLOWER REMEDIES: DR. BACH’S PHILOSOPHY – THE PRESCRIBING OF REMEDIESIt is desirable that only one remedy should be prescribed at one time. But in practice at least 2 remedies are required to cover the case. Suppose a man has fear of cancer, but from his talk you find that he is burning with hatred for some man, then you have to prescribe for Mimulus’ and ‘HOLLY simultaneously, as it would be difficult to find which of the 2 remedies covers his mental state better than the other. However, a sincere effort should be made to find out which is the idea upper most in the mind of the patient at that time, and prescribe accordingly.After taking the medicine if there is change in the mood of the patient, the medicine may be changed accordingly.Sometimes the remedy is prescribed on physical symptoms if they correspond to the mental state of the patient. In case of repetitive ideas in the mind, when the patient cannot get rid of any ideas from the mind, if it is of the same type “White Chestnut’ is prescribed.When a man is suffering from chronic cough which repeats in the same way or has chronic skin trouble say itch followed by burning and this trouble is also of the repetitive type, then White Chestnut is to be prescribed in this case also.There is no fixed rule by which it can be determined how long it would be necessary to continue giving Floral Remedies. If it is a temporary sensation, it may go even with a single dose of ‘Crab Apple,’ but if the Floral Remedy is intended to change the very temperament of the person or if it has to remove a chronic ailment, it may require some months to do it. There is, however, no danger of over-dosing or “Prooving” in the use of Bach Flower Remedies.*32\308\8*

COLONIC IRRIGATION: BALANCING THE MICROBES

Posted in Gastrointestinal on February 26th, 2011 with No Comments »
Microbes sound like another unmentionable, but in fact they are essential to our well-being. The colon contains between 3 and 4 lbs
of micro-organisms. There are about 400 varieties; most of which are fungi, along with viruses, bacteria and many others. Normally they function together in friendly co-existence, completing the digestion, producing vitamins and controlling infection, but this balance is fragile and easily upset. For example sudden exposure to the alkaline medium of the caecum causes yeasts to proliferate. Long-term constipation, harsh laxatives and any course of antibiotics or drugs will destroy the balance. When undesirable bacteria take the upper hand, the gut is in trouble, we may experience stomach pains and bloating, excess gas, headaches, allergies and skin conditions. This is the reason why upset stomachs often go hand in hand with courses of antibiotics. The proliferation of Candida Albicans and similar moulds and yeasts can give rise to whole sets of symptoms.
*166\326\8*

COLONIC IRRIGATION: BALANCING THE MICROBESMicrobes sound like another unmentionable, but in fact they are essential to our well-being. The colon contains between 3 and 4 lbsof micro-organisms. There are about 400 varieties; most of which are fungi, along with viruses, bacteria and many others. Normally they function together in friendly co-existence, completing the digestion, producing vitamins and controlling infection, but this balance is fragile and easily upset. For example sudden exposure to the alkaline medium of the caecum causes yeasts to proliferate. Long-term constipation, harsh laxatives and any course of antibiotics or drugs will destroy the balance. When undesirable bacteria take the upper hand, the gut is in trouble, we may experience stomach pains and bloating, excess gas, headaches, allergies and skin conditions. This is the reason why upset stomachs often go hand in hand with courses of antibiotics. The proliferation of Candida Albicans and similar moulds and yeasts can give rise to whole sets of symptoms.*166\326\8*

COPING WITH THE UNCERTAINTIES OF SEIZURES AND EPILEPSY: COPING WITH LABELS

Posted in Epilepsy on February 24th, 2011 with No Comments »
Everybody gets labelled. Some are labelled beautiful. Some are labelled dumb. These labels are undefined and, therefore, basically useless. If your child were labelled artistic, however, and as a result got into special art classes, that label would have been useful. A label of normal is not useful if a child’s learning style makes it difficult to learn in a normal class. He is denied the special help he needs. A label of mild or moderate mental retardation will be useful if the child is placed in a classroom that meets his special needs. But to put him in a class with other moderately retarded children does not alone meet his needs. All moderate retardation is not the same, just as all epilepsy is not. Labels can miscategorize and stigmatize a child. Will a label be an advantage to your child? If a label of “green” helps your child get the appropriate services, it will be a useful label.
It is important that your expectations for your child are realistic. Putting a handicapped child in a regular class may or may not be to his advantage. Mainstreaming has many advantages, but it may be a disadvantage for an individual child. The stress may be overwhelming.
The most important thing for your child is to get the appropriate services that he needs so that he can fulfill his own potential.
*195\208\8*

COPING WITH THE UNCERTAINTIES OF SEIZURES AND EPILEPSY: COPING WITH LABELSEverybody gets labelled. Some are labelled beautiful. Some are labelled dumb. These labels are undefined and, therefore, basically useless. If your child were labelled artistic, however, and as a result got into special art classes, that label would have been useful. A label of normal is not useful if a child’s learning style makes it difficult to learn in a normal class. He is denied the special help he needs. A label of mild or moderate mental retardation will be useful if the child is placed in a classroom that meets his special needs. But to put him in a class with other moderately retarded children does not alone meet his needs. All moderate retardation is not the same, just as all epilepsy is not. Labels can miscategorize and stigmatize a child. Will a label be an advantage to your child? If a label of “green” helps your child get the appropriate services, it will be a useful label.It is important that your expectations for your child are realistic. Putting a handicapped child in a regular class may or may not be to his advantage. Mainstreaming has many advantages, but it may be a disadvantage for an individual child. The stress may be overwhelming.The most important thing for your child is to get the appropriate services that he needs so that he can fulfill his own potential.*195\208\8*

SUMMARY OF INTENSIVE MANAGEMENT OF TYPE 1 DIABETES: SPECIAL ISSUES – PREGNANCY

Posted in Diabetes on February 14th, 2011 with No Comments »
There is no question that intensive glycemic management is necessary for excellent outcomes of pregnancy in type 1 diabetes. Ideally, the intensive program should start before conception and continue until delivery. It is best handled by alternating visits to the diabetes and obstetrics specialists, with increasing frequency often invoked as pregnancy progresses. Insulin requirements may transiently decrease in the first trimester, but then increase as pregnancy progresses, particularly in the third trimester. At delivery of the placenta, there is a rapid fall in requirements, usually to preconception levels. Regular ophthalmologic surveillance is neede, because retinopathy may progress during pregnancy. Monitoring of BP and urinary albumin are also indicated to recognize preeclampsia or the development of nephropathy.
*234\357\8*

SUMMARY OF INTENSIVE MANAGEMENT OF TYPE 1 DIABETES:  SPECIAL ISSUES – PREGNANCYThere is no question that intensive glycemic management is necessary for excellent outcomes of pregnancy in type 1 diabetes. Ideally, the intensive program should start before conception and continue until delivery. It is best handled by alternating visits to the diabetes and obstetrics specialists, with increasing frequency often invoked as pregnancy progresses. Insulin requirements may transiently decrease in the first trimester, but then increase as pregnancy progresses, particularly in the third trimester. At delivery of the placenta, there is a rapid fall in requirements, usually to preconception levels. Regular ophthalmologic surveillance is neede, because retinopathy may progress during pregnancy. Monitoring of BP and urinary albumin are also indicated to recognize preeclampsia or the development of nephropathy.*234\357\8*

REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: HANDLING STRESS – STRESS MANAGEMENT TECHNIQUES – GET ENOUGH REST & HAVE A PERSONAL HOBBY OR ACTIVITY

Posted in Cardio & Blood-Cholesterol on January 28th, 2011 with No Comments »
Get enough rest. To some degree, you can catch up on sleep lost during the week by getting a little extra rest on the weekends. Do not feel guilty about an occasional nap or sleeping in a little when you can do so. Try to break late-night television habits and avoid food and beverages right before bed. Many hospitals or large clinics have sleep disorder centers you can call if you have a serious problem sleeping.
Have a personal hobby or activity that gives you satisfaction outside work and/family spheres. (But try to avoid jetting the hobby grow into another job or a business unless you really have the time and interest for it.) Gardening, collections, crafts, and artistic activities are good choices. Reserve a little private space for yourself where you can work undisturbed.
Many of these suggestions may seem to apply primarily to married people who work outside the home or raise an active family. Single people and older persons no longer working may face different kinds of stress – loneliness, isolation, boredom, feelings of being unproductive. Pets can be extremely valuable as companions and something to care for. Volunteerism presents various opportunities for social interaction, and for contributing to society (especially for older persons), and, for young singles, for making new friends outside the v environment. Adult continuing education has proved extremely popular, especially among older persons.
*325\252\8*

REDUCING YOUR RISK OF CORONARY ARTERY DISEASE: HANDLING STRESS – STRESS MANAGEMENT TECHNIQUES – GET ENOUGH REST & HAVE A PERSONAL HOBBY OR ACTIVITYGet enough rest. To some degree, you can catch up on sleep lost during the week by getting a little extra rest on the weekends. Do not feel guilty about an occasional nap or sleeping in a little when you can do so. Try to break late-night television habits and avoid food and beverages right before bed. Many hospitals or large clinics have sleep disorder centers you can call if you have a serious problem sleeping.Have a personal hobby or activity that gives you satisfaction outside work and/family spheres. (But try to avoid jetting the hobby grow into another job or a business unless you really have the time and interest for it.) Gardening, collections, crafts, and artistic activities are good choices. Reserve a little private space for yourself where you can work undisturbed.Many of these suggestions may seem to apply primarily to married people who work outside the home or raise an active family. Single people and older persons no longer working may face different kinds of stress – loneliness, isolation, boredom, feelings of being unproductive. Pets can be extremely valuable as companions and something to care for. Volunteerism presents various opportunities for social interaction, and for contributing to society (especially for older persons), and, for young singles, for making new friends outside the v environment. Adult continuing education has proved extremely popular, especially among older persons.*325\252\8*

TYPES OF SURGERY FOR TREATMENT OF RHEUMATOID ARTHRITIS: TENDON RECONSTRUCTION AND TRANSFERS AND OTHERS

Posted in Arthritis on January 24th, 2011 with No Comments »
Tendon Reconstruction and Transfers
RA can damage or even rupture surrounding tendons and ligaments. If the tendon is ruptured, it is possible to reconstruct the tendon by connecting a separate but intact tendon to the ruptured one. This procedure is known as tendon transfer. Rupture is most common in tendons that travel along the top of the hands down to the fingers.
Joint Fusion
Joint fusion, or arthrodesis, is a surgical procedure that permits bone to be connected to bone across a joint. This procedure is only performed on painful and unstable joints, most commonly in the wrists, feet, ankles, and thumbs. It very effectively decreases pain and improves stability, but it permanently inhibits motion in the fused joint. For this reason, joint fusion is rarely performed on the shoulder or hip.
With long-standing RA involving the neck, the vertebrae can become unstable because of ligament and bone loss caused by the synovitis. In severe cases, an operation to fuse the vertebrae may be required to increase stability.
Osteotomy and Bone Resection
Osteotomy is a procedure that involves removing a wedge of bone to improve joint alignment and to compensate for deformity. This procedure is performed less frequently than it once was because improved joint replacement procedures provide more effective treatment.
Sometimes a section of bone is removed (resected) from the end nearest the joint. This form of bone resection is a simple procedure and is performed on joints in the shoulders, elbows, wrists, and feet to improve the joint’s range of motion.
*113/209/5*

TYPES OF SURGERY FOR TREATMENT OF RHEUMATOID ARTHRITIS: TENDON RECONSTRUCTION AND TRANSFERS AND OTHERSTendon Reconstruction and TransfersRA can damage or even rupture surrounding tendons and ligaments. If the tendon is ruptured, it is possible to reconstruct the tendon by connecting a separate but intact tendon to the ruptured one. This procedure is known as tendon transfer. Rupture is most common in tendons that travel along the top of the hands down to the fingers.
Joint FusionJoint fusion, or arthrodesis, is a surgical procedure that permits bone to be connected to bone across a joint. This procedure is only performed on painful and unstable joints, most commonly in the wrists, feet, ankles, and thumbs. It very effectively decreases pain and improves stability, but it permanently inhibits motion in the fused joint. For this reason, joint fusion is rarely performed on the shoulder or hip.With long-standing RA involving the neck, the vertebrae can become unstable because of ligament and bone loss caused by the synovitis. In severe cases, an operation to fuse the vertebrae may be required to increase stability.
Osteotomy and Bone ResectionOsteotomy is a procedure that involves removing a wedge of bone to improve joint alignment and to compensate for deformity. This procedure is performed less frequently than it once was because improved joint replacement procedures provide more effective treatment.Sometimes a section of bone is removed (resected) from the end nearest the joint. This form of bone resection is a simple procedure and is performed on joints in the shoulders, elbows, wrists, and feet to improve the joint’s range of motion.*113/209/5*

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