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Could Type 1 Diabetes Begin in Utero?

Infants might develop type 1 diabetes in the first 6 months of life and seems to be unrelated to known genetic risk factors; rather, it appears linked to low birth weight, say UK researchers.

They believe the discovery could mean the disease starts in utero.

Others are skeptical, however.

The team studied 166 infants with diabetes diagnosed before 6 months of age and compared them to babies with the more common neonatal diabetes and children diagnosed with type 1 diabetes at older ages.

The combination of high type 1 diabetes genetic risk score (T1D-GRS), presence of islet-specific autoantibodies, and evidence of a rapid loss of insulin secretion all suggest that the infants had type 1 diabetes.

And notably, they all had a lower median birth weight than international reference standards.

“This study proves that type 1 diabetes can present in the first few months of life, and in a tiny subset of infants may even begin before birth,” lead author Matthew B. Johnson, PhD, Institute of Biomedical and Clinical Science, University of Exeter Medical School, UK, said in a press release from Diabetes UK, which cofunded the research.

“We also found that diabetes diagnosed so young was associated with rapid progression to complete destruction of insulin producing beta cells,” he added.

Senior author Richard A. Oram, BMBCh, PhD, also from the Institute of Biomedical and Clinical Science, said the team now plans to study the immune system of the infants in greater detail. The hope is this will “help explain how it is possible for type 1 diabetes to develop so early and whether these insights could open up new ways to prevent or treat the condition in the future,” he added.

The research was published online on October 8 in Diabetologia.

Elizabeth Robertson, PhD, director of research at Diabetes UK, said: “These important findings rewrite our understanding of when the condition can strike and when the immune system can start to go wrong.”

“We now need to piece together how and why type 1 diabetes can develop at such a young age,” which could “unlock crucial insights into causes of type 1 diabetes more generally…and will be essential to develop treatments that stop or prevent this life-altering condition in babies,” she observed.

No Direct Evidence That Type 1 Diabetes Starts in the Womb

Asked to comment, Mikael Knip, MD, PhD, told Medscape Medical News that the study is “interesting” but the findings are “not perhaps as new as they claim,” nevertheless the research consists of “a large series of infants” and it is a “well done study.”

However, Knip doubts that type 1 diabetes develops in the womb.

“We have never seen diabetes-associated autoantibodies in a newborn infant in cord blood, except for those where the mother tests positive for autoantibodies,” said Knip, of the Children’s Hospital, University of Helsinki, Finland.

“These are IgG antibodies and that [type of immune reaction] is conferred from the maternal circulation to the fetal circulation during pregnancy, but we have never seen

Mice with diabetes successfully treated with EMFs

Researchers have worked out how to use electromagnetic fields to treat mice with type 2 diabetes.

Scientists have discovered that they can successfully treat type 2 diabetes in mouse models by exposing the rodents to electromagnetic fields.

The research, which appears in the journal Cell Metabolism, opens the door to further studies confirming the findings and exploring whether the therapy could be suitable for use in humans.

According to the Centers for Disease Control and Prevention (CDC), more than 34 million people — approximately 1 in 10 — in the United States have diabetes. Of these individuals, the vast majority have type 2 diabetes.

Type 2 diabetes occurs when a person’s cells do not react to the hormone insulin properly. Insulin, which the pancreas produces, mediates the ability of a person’s cells to receive blood sugar.

In this situation, a person’s body can tell that their cells are not receiving blood sugar properly, and the pancreas produces more insulin in response. At a certain point, the pancreas cannot meet the insulin demand, and, as a consequence, blood sugar levels increase.

The CDC highlight that high blood sugar levels can cause various serious health conditions, including vision loss, kidney disease, and heart disease.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, key approaches to treating type 2 diabetes include eating a more healthful diet and being more physically active.

There are also many medications that can help a person manage the symptoms of diabetes.

However, adherence to type 2 diabetes treatment is relatively low. Research has suggested that at least 45% of people with type 2 diabetes are unable to control their blood sugar levels effectively.

A range of factors may contribute to a person’s ability to keep diabetes symptoms in check, including the perceived difficulties around accessing and taking medications.

In this context, the scientists behind the present study believe that they may have made a significant discovery in the form of an effective and accessible way of treating mice with type 2 diabetes using electromagnetic fields.

The discovery came about by chance. Sunny Huang, an M.D.-Ph.D. student at the University of Iowa (UI) Carver College of Medicine and the co-lead author of the study, needed access to mice to practice taking their blood and measuring their blood sugar levels.

Dr. Calvin Carter, a postdoctoral researcher in the same lab, let Huang borrow the mice that he was using in an experiment on how electromagnetic fields affect the brains of the animals.

According to Huang: “It was really odd because normally these animals have high blood sugar and type 2 diabetes, but all of the animals exposed to [electromagnetic fields] showed normal blood sugar levels. I told Calvin, ‘There’s something weird going on here.’”

This was especially unusual given that the researchers had either genetically modified the mice in question to give them diabetes or induced the disease by feeding them a 60% high fat diet.

“That’s what sparked this project,” Dr. Carter adds. “Early

Treatment Reverses Young Man’s Type 1 Diabetes. Will It Last? | Health News

By Serena Gordon
HealthDay Reporter

(HealthDay)

WEDNESDAY, Oct. 7, 2020 (HealthDay News) — After starting a drug that’s officially approved to treat a type of blood cancer, a young man with type 1 diabetes was able to stop using insulin.

He’s been off insulin since August 2018 — more than two years.

Dr. Lisa Forbes — his doctor and co-author of a letter describing his case in the Oct. 8 issue of the New England Journal of Medicine — stopped short of calling the drug a cure for type 1 diabetes.

But Forbes, an assistant professor of pediatrics, immunology, allergy and rheumatology at Baylor College of Medicine in Houston, said the patient’s diabetes appears to have been reversed. She hopes it will stay that way as long as he keeps taking the oral medication called ruxolitinib (Jakafi). It’s in a class of medications known as JAK inhibitors.

Whether this drug can help others with type 1 diabetes isn’t yet known. This patient had a genetic mutation that ruxolitinib is known to work on. Forbes said it’s not clear if other people with type 1 diabetes also have this specific genetic mutation.

Type 1 diabetes is believed to be an autoimmune disease, though the exact cause is unknown. It develops when the immune system mistakenly attacks insulin-producing beta cells in the pancreas. Insulin is a hormone that ushers the sugars from foods into the body’s cells to be used as fuel.

People with type 1 diabetes produce little to no insulin and must take multiple daily injections of insulin (or use an insulin pump) to survive. No treatments are approved for reversing type 1 diabetes.

At 15, Forbes’ patient had been experiencing chronic yeast infections (of skin, nails, mouth and throat), chronic diarrhea, oral and rectal ulcers, recurrent sinus and lung infections and another autoimmune condition called hypogammaglobulinemia. At 17, he was diagnosed with type 1 diabetes.

Because he had multiple conditions, his doctors ordered whole genome sequencing to see if they could pinpoint a root cause. They saw one particular genetic mutation and thought ruxolitinib might help. He started the drug nine months after being diagnosed with type 1 diabetes.

“The drug had an unbelievable effect on his type 1 diabetes,” Forbes said. “A year after starting ruxolitinib, we took him off insulin, and he’s been insulin-free ever since.”

The patient is in college now, and Forbes said he calls the drug a “game-changer” because it’s a pill and so easy to take.

Forbes said this case provides potentially important information into a pathway that leads to type 1 diabetes. But more research is needed, she added.

Because ruxolitinib acts on the immune system, patients have a higher risk of certain infections. And their white blood cells, liver function and kidney function have to be checked every few months, according to Forbes.

She isn’t the only one excited about the potential of JAK inhibitors in type 1 diabetes.

JDRF (formerly the Juvenile Diabetes Research Foundation) has been funding research into

Improving blood sugar in Type 2 diabetes improves cognitive scores, study says

Oct. 5 (UPI) — Controlling blood sugar levels helped people with Type 2 diabetes who were overweight improve cognitive scores, but losing weight, exercise had mixed results, a new study shows.

More than a quarter of U.S. adults 65 or older have Type 2 diabetes, which doubles the risk of cognitive impairment and dementia, including Alzheimer’s disease, according to a statement from the Pennington Biomedical Research Center.

“It’s important to properly control your blood sugar to avoid the bad brain effects of your diabetes,” said study author Owen Carmichael said in a statement.

“Don’t think you can simply let yourself get all the way to the obese range, lose some of the weight, and everything in the brain is fine,” said Carmichael, a professor and director of Biomedical Imaging at Pennington Biomedical Research Center. “The brain might have already turned a corner that it can’t turn back from.”

The study, published in the latest issue of The Journal of Clinical Endrocrinology and Metabolism, analyzed whether markers such as body weight, blood sugar control, and physical activity would be associated with improved cognition in 1,089 participants, age 45 to 76, who have Type 2 diabetes.

Researchers theorized that greater improvements in all three markers would lead to better cognitive test scores, but that turned out to be only partially true. While reducing blood sugar levels improved test scores, losing more weight and exercising more didn’t always do so.

“Every little improvement in blood sugar control was associated with a little better cognition,” Carmichael said. “Lowering your blood sugar from the diabetes range to prediabetes helped as much as dropping from prediabetes levels to the healthy range.”

Meanwhile, results from weight loss varied depending on the mental skill, according to Carmichael. More weight loss improved participants short-term memory, planning, impulse control, attention and the ability to switch tasks, but verbal learning and overall memory still declined.

“The results were worse for people who had obesity at the beginning of the study,” he added.

Similarly, Carmichael said the study showed that increasing physical activity also benefited people who were overweight more than people with obesity.

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Fewer Deaths in Hospitalized COVID Diabetes Patients on Sitagliptin

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

Patients with type 2 diabetes hospitalized for COVID-19 who were taking just one glucose-lowering drug, the oral dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin, were 77% less likely to die compared with similar patients taking insulin, in a retrospective, observational, case-control study in Italy.

Sitagliptin (Januvia, Merck) treatment was also linked with significant and clinically meaningful drops in the rate of need for intensive care or mechanical ventilation compared with patients who received insulin, Sebastiano B. Solerte MD, PhD, and colleagues report in their study published online September 29 in Diabetes Care.

The authors acknowledge that the study’s design means this finding can’t be considered definitive. Despite this limitation, “We think it’s reasonable to try sitagliptin if a patient is admitted to the hospital with type 2 diabetes and COVID,” said Paolo Fiorina, MD, PhD, senior investigator of the study, in a statement. 

The researchers are about to start a prospective, randomized trial to try to confirm the benefit seen with sitagliptin in a total of about 170 patients in the SIDIACO (The Effect of Sitagliptin Treatment in COVID-19 Positive Diabetic Patients) study.

“I’m excited by our findings, because we still have very few therapeutic options for the many diabetic patients affected by COVID,” said Fiorino, a nephrologist and diabetes researcher affiliated with the Boston Children’s Hospital division of nephrology and the University of Milan. 

And, Fiorino told Medscape Medical News in an email, “Our data are related to sitagliptin but I believe that there will be a class effect [of DPP-4 inhibitors].” 

SARS-CoV-2 Virus May Bind to DPP-4 Receptor

The Italian group notes that type 2 diabetes has been associated with worse outcomes in COVID-19 and that the presence of diabetes increases the mortality risk associated with the virus, particularly in those with more severe COVID-19.

And poorly controlled blood glucose levels are associated with markedly higher mortality in patients with type 2 diabetes and COVID-19 compared with similar patients with better metabolic control.

The researchers decided to study a DPP-4 inhibitor such as sitagliptin because of evidence that the SARS-CoV-2 virus may bind DPP-4 when entering respiratory cells.

“We decided to try sitagliptin and collect the data. COVID-19 mortality in patients with diabetes is high, and the drug is very safe, so we felt there was no reason not to use it,” Fiorina explained.

During March and April 2020, they enrolled 338 consecutive adults with documented type 2 diabetes hospitalized with laboratory-confirmed SARS-CoV-2 infection at seven academic centers in Northern Italy. All patients stopped their diabetes treatment on admission, and then patients received either sitagliptin or insulin (intravenous or subcutaneous) as their sole diabetes intervention while hospitalized, in addition to all other standard-of-care medications.

Enrolled patients averaged 69 years old (> 90% were at least 70). Slightly more than two thirds were men, and average diabetes duration was about 9 years. Body mass index among the enrolled patients averaged just under 30 kg/m

Pancreas size, shape can return to normal in diabetes remission, study says

Reversing type 2 diabetes can restore the pancreas to its normal size and shape, a new study finds.

Previous research found that with remission of type 2 diabetes through significant weight loss, natural insulin-production can return to levels similar to people who have never had diabetes.

The new study is the first to show that reversing diabetes can also affect the size and shape of the pancreas, the researchers said.

The study included 64 people with type 2 diabetes and a control group 64 people without diabetes whose pancreas health was monitored for two years. At the start of the study, average pancreas volume was 20% smaller and organ borders were more irregular in people with diabetes than in the control group.

After five months of weight loss, pancreas volume was unchanged in people with diabetes who’d gone into remission — responders — as well as those who had not. But after two years, the pancreas had grown by an average of one-fifth in responders, but only about 1/12th in non-responders, the findings showed.

Responders also lost a significant amount of fat from their pancreas, at 1.6%, compared with non-responders, at around 0.5%, and achieved normal pancreas borders, the study found.

Only responders showed early and sustained improvement in beta-cell function, which is key to making and releasing insulin. After five months of weight loss, responders were making more insulin and levels were maintained at two years. There was no change in non-responders.

The findings were presented recently at an online annual meeting of the European Association for the Study of Diabetes. Research presented at meetings should be considered preliminary until published in a peer-reviewed journal.

“Our previous research demonstrated the return to long-term normal glucose control, but some experts continue to claim that this is merely ‘well-controlled diabetes’ despite our demonstration of a return to normal insulin production by the pancreas,” said study leader Roy Taylor, a professor of medicine and metabolism at Newcastle University in the United Kingdom.

“However, our new findings of major change in the size and shape of the pancreas are convincing evidence of return to the normal state,” he added.

Taylor noted in an association news release that large amounts of insulin cause tissues to grow or at least maintain their size.

“Normally, inside the pancreas the amounts of insulin present after a meal are very high. But in type 2 diabetes this does not happen. This new study suggests that achieving remission of type 2 diabetes restores this healthy, direct effect of insulin on the pancreas,” Taylor said.

It’s not clear why diabetes remission doesn’t occur in all patients who lose weight, said Elizabeth Robertson, director of research at Diabetes UK, which funded the study.

Type 2 diabetes affects one in 11 — or 415 million — adults worldwide.

More information

The American Diabetes Association has more on type 2 diabetes.

Copyright 2020 HealthDay. All rights reserved.

Pancrease size, shape can return to normal in diabetes remission, study says

Reversing type 2 diabetes can restore the pancreas to its normal size and shape, a new study finds.

Previous research found that with remission of type 2 diabetes through significant weight loss, natural insulin-production can return to levels similar to people who have never had diabetes.

The new study is the first to show that reversing diabetes can also affect the size and shape of the pancreas, the researchers said.

The study included 64 people with type 2 diabetes and a control group 64 people without diabetes whose pancreas health was monitored for two years. At the start of the study, average pancreas volume was 20% smaller and organ borders were more irregular in people with diabetes than in the control group.

After five months of weight loss, pancreas volume was unchanged in people with diabetes who’d gone into remission — responders — as well as those who had not. But after two years, the pancreas had grown by an average of one-fifth in responders, but only about 1/12th in non-responders, the findings showed.

Responders also lost a significant amount of fat from their pancreas, at 1.6%, compared with non-responders, at around 0.5%, and achieved normal pancreas borders, the study found.

Only responders showed early and sustained improvement in beta-cell function, which is key to making and releasing insulin. After five months of weight loss, responders were making more insulin and levels were maintained at two years. There was no change in non-responders.

The findings were presented recently at an online annual meeting of the European Association for the Study of Diabetes. Research presented at meetings should be considered preliminary until published in a peer-reviewed journal.

“Our previous research demonstrated the return to long-term normal glucose control, but some experts continue to claim that this is merely ‘well-controlled diabetes’ despite our demonstration of a return to normal insulin production by the pancreas,” said study leader Roy Taylor, a professor of medicine and metabolism at Newcastle University in the United Kingdom.

“However, our new findings of major change in the size and shape of the pancreas are convincing evidence of return to the normal state,” he added.

Taylor noted in an association news release that large amounts of insulin cause tissues to grow or at least maintain their size.

“Normally, inside the pancreas the amounts of insulin present after a meal are very high. But in type 2 diabetes this does not happen. This new study suggests that achieving remission of type 2 diabetes restores this healthy, direct effect of insulin on the pancreas,” Taylor said.

It’s not clear why diabetes remission doesn’t occur in all patients who lose weight, said Elizabeth Robertson, director of research at Diabetes UK, which funded the study.

Type 2 diabetes affects one in 11 — or 415 million — adults worldwide.

More information

The American Diabetes Association has more on type 2 diabetes.

Copyright 2020 HealthDay. All rights reserved.

City of Hope Distinguished Scientist Debbie Thurmond Named New Director of Diabetes & Metabolism Research Institute

Renowned diabetes researcher Arthur Riggs will continue to conduct research at the institute

Leading diabetes scientist Debbie C. Thurmond, Ph.D., has been named the new director of City of Hope’s Diabetes & Metabolism Research Institute, which continues diabetes research at City of Hope that was started more than 70 years ago. Arthur Riggs, Ph.D., who developed the technology in 1978 that resulted in the first synthetic human insulin, impacting millions of lives worldwide, will continue to conduct research within the institute.

This press release features multimedia. View the full release here: https://www.businesswire.com/news/home/20200930005207/en/

Debbie C. Thurmond, Ph.D., director of City of Hope’s Diabetes & Metabolism Research Institute (Photo: City of Hope)

“Debbie’s depth of experience as a highly successful diabetes scientist and leader, as well as her vision for the DMRI, will lead us to continue to be one of the premier diabetes institutes in the nation,” said Riggs, Samuel Rahbar Chair in Diabetes & Drug Discovery and director emeritus of Beckman Research Institute of City of Hope. “A rising star in the diabetes field, Debbie will continue to be an excellent mentor to younger, independent scientists who, along with our senior scientists, are working on innovative diabetes research.”

Thurmond joined City of Hope in 2015 as professor and founding chair of the Department of Molecular & Cellular Endocrinology within the Diabetes & Metabolism Research Institute. She became deputy director of the institute last year.

“I am absolutely delighted and humbled to be named director of City of Hope’s DMRI,” said Thurmond, Ruth B. & Robert K. Lanman Chair in Gene Regulation & Drug Discovery Research. “Art has built a phenomenal institute, and I have the great pleasure of facilitating its continued growth and prominence in the diabetes space.”

In addition to leading the institute’s support of ongoing diabetes research, Thurmond will support its focus on the intersection of diabetes and cancer, helping to answer the reasons why diabetes is significantly associated with an increase in cancer. As such, the institute recently established a new department – the Department of Diabetes & Cancer Metabolism. The institute also provides endocrinology care to cancer patients, since type 2 diabetes significantly increases the risk of cancer. In addition, a growing number of highly effective cancer therapies can also cause insulin-dependent diabetes.

“With the power of City of Hope’s comprehensive cancer center alongside us, we are the only diabetes institute uniquely designed to focus on how to cure both diseases and to develop treatments to help prevent them,” Thurmond added.

The Diabetes & Metabolism Research Institute’s research in other initiatives includes cellular therapies to treat type 1 and type 2 diabetes; discovering new biomarkers to identify those at risk for developing type 2 diabetes and its complications; developing drugs that precisely target the receptor molecules responsible for diabetes; improving islet cell transplantation; and reviving and/or replacing the cells that make insulin.

The institute plans to open a clinical trial for the first type 1 diabetes vaccine tested in the U.S., part of The

Ethnic Minorities Affected Most in Rise of Early Onset T2 Diabetes

Adult early onset type 2 diabetes disproportionately affects South Asian and African-Caribbean individuals, who have an earlier age of onset and, in the case of South Asian people, an accelerated development of the disease compared with White people, indicates a UK primary care data analysis.

The research was presented at the European Association for the Study of Diabetes (EASD) Virtual Meeting 2020 on September 24, which was held online due to the COVID-19 pandemic.

BMI ‘Dose Effect’

A team from Imperial College London examined data on more than 1.4 million primary care patients, finding that, compared with White people, the prevalence of early onset type 2 diabetes (defined as at age 18-44) was more than twice as high in African-Caribbean individuals, and over three times higher in South Asian people.

The results also showed that there was a “dose effect” of body mass index (BMI), with younger onset associated with an increased rate of overweight and obesity, and that the incidence of early onset type 2 diabetes rose much faster in South Asian individuals than their White counterparts.



Janthula Ranchagoda

Study author Janthula Ranchagoda, a fifth year medical student in the Department of Medicine, Imperial College London, said that, with the increasing incidence of early onset type 2 diabetes: “The burden this group is going to pose in the coming years is only going to rise.

“The other key point is that data from cardiovascular outcome trials in this group is severely lacking, because people with type 2 diabetes under the age of 40 are severely underrepresented in large clinical outcomes studies.”

Mr Ranchagoda added that, consequently, “our knowledge base to provide targeted treatments to this group is inhibited”.

The results also have “relevance to the current pandemic”, he said. “We know from studies that people with obesity and those from ethnic minority groups are particularly at risk from COVID-19 and there is some reflection to be had whether or not this early onset type 2 diabetes group in adults has an additional risk from the SARS-CoV-2 pandemic.”

‘Rising Problem’

Dr Shivani Misra, Department of Medicine, Imperial College London, who led the study, said that the “elephant in the room for any researcher working on early onset type 2 diabetes” is how to tackle the increasing incidence.

She told Medscape Medical News: “I think no single approach is going to be sufficient to deal with this huge, rising problem.

“Obviously there are some great public heath initiatives coming out of NHS England at the moment, both the diabetes prevention programme and also the type 2 diabetes remission programme.”

However, Dr Misra said that the “evidence base that those programmes work in people with early onset type 2 diabetes is lacking, and there’s some emerging evidence that those programmes will need to be tweaked for specific ethnic minority groups”.

Another issue is that many of the individuals with early onset type 2 diabetes have been hard to reach in terms of prevention and management campaigns.

“There’s often very strong family

Long-term use of acid reflux meds linked to 24% increase in diabetes: study

Long-term, regular use of medications to treat acid reflux was linked to a 24% increased risk of type 2 diabetes, says a new study.

The findings, by joint first authors Jinqiu Yuan and Qiangsheng He with The Seventh Affiliated Hospital, Sun Yat-Sen University in Shenzhen, China, were published Tuesday in the journal Gut.

These commonly used medications called proton pump inhibitors (PPIs) work by “inhibiting certain stomach cells from ‘pumping’ acid into the stomach,” reports Harvard Medical School.

While PPIs are generally deemed safe for short-term use, prolonged use may introduce health concerns like bone fractures from calcium malabsorption and enteric (intestinal) infections, among other adverse effects.

Long-term use of medications to treat acid reflux was linked to a 24% increased risk of type 2 diabetes, per a new study. (iStock)

Long-term use of medications to treat acid reflux was linked to a 24% increased risk of type 2 diabetes, per a new study. (iStock)

ARTIFICIAL PANCREAS MAINTAINED BLOOD SUGAR LEVELS IN CHILDREN WITH TYPE 1 DIABETES, STUDY SAYS

PPIs were said to have a “major impact on gut microbiome,” which could increase the risk of type 2 diabetes, though the evidence is still unclear.

The risk was said to increase along with longer duration of use. Researchers found that the association was stronger among those with a lower Body Mass Index (BMI) or normal blood pressure.

“For patients who have to receive long-term PPI treatment, screening for abnormal blood glucose and type 2 diabetes is recommended,” study authors wrote.

WHY CAN’T HUMANS DIGEST CORN?

The findings were drawn from an analysis of nearly 205,000 participants of three U.S. cohorts, Nurses’ Health Study (NHS), NHS II and Health Professionals Follow-up Study (HPFS), which revealed an increased risk even after adjusting for risk factors; “the absolute risk of diabetes among regular PPI users was 7.44/1000 person-years compared with 4.32/1000 person-years among non-users,” authors wrote.

“Owing to its wide usage, the overall number of diabetes cases associated with PPI use could be considerable,” authors concluded, adding that doctors should balance the risk-benefit ratio when prescribing PPIs for long-term use.

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