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A bulging midriff roughly doubles women's chances of gallstone surgery new
      #249992 - 03/04/06 12:56 PM
HeatherAdministrator

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A bulging midriff roughly doubles women's chances of gallstone surgery

Central adiposity, regional fat distribution, and the risk of cholecystectomy in women -
Gut 2006; doi 10.11.36/gut.2005.076133

A bulging midriff almost doubles a woman's chances of developing gallstones and the need for surgery to remove them, finds an extensive study published ahead of print in Gut.

In the developed world, gallstone disease is the most common abdominal illness requiring admission to hospital. And in the USA, more than 800,000 operations to remove gallstones are carried out every year. Most gallstones are nuggets of cholesterol.

The findings are based on comprehensive two yearly monitoring of more than 42,000 women in the United States, who were part of the Nurses Health Study.

The women were all aged between 39 and 66 in 1986, when the gallstone study began. None of the women had gallstones. All provided waist and hip measurements and details of their normal diet.

During the subsequent monitoring period to the year 2000, 3197 women required gallstone surgery.

After taking into account total body fat distribution as well as other risk factors for gallstone disease, women with waists of 36 inches or more were almost twice as likely to require surgery to remove gallstones as those whose waists measured 26 inches or less.

Waist to hip ratio, which divides the waist size by hip size, also boosted the risk by around 40% among women with a ratio of 0.86 compared with those whose ratio was 0.70 or less.

These results held true even if a woman was not generally overweight, as determined by body mass index.

The authors suggest that there are plausible biological explanations for a link between gallstones and the midriff bulge. The type of fat around the waist is more metabolically active than fat elsewhere on the body.

And previous research has also linked gallstones with the metabolic syndrome, a feature of which is excess abdominal fat.

http://www.eurekalert.org/pub_releases/2006-02/bsj-abm021006.php

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Gum Chewing Stimulates Bowel Activity and Reduces Surgical Recovery Time new
      #249994 - 03/04/06 01:04 PM
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Gum Chewing Reduces Ileus After Elective Open Sigmoid Colectomy

Rob Schuster, MD; Nina Grewal, MD; Gregory C. Greaney, MD; Kenneth Waxman, MD


Arch Surg. 2006;141:174-176.

Hypothesis Gum chewing after elective open colon resection may stimulate bowel motility and decrease duration of postoperative ileus.

Design and Setting Prospective, randomized study in a community-based teaching hospital.

Patients Thirty-four patients undergoing elective open sigmoid resections for recurrent diverticulitis or cancer.

Main Outcome Measures First feelings of hunger, time to first flatus, time to first bowel movement, length of hospital stay, and complications.

Results A total of 34 patients were randomized into 2 groups: a gum-chewing group (n = 17) or a control group (n = 17). The patients in the gum-chewing group chewed sugarless gum 3 times daily for 1 hour each time until discharge. Patient demographics, intraoperative, and postoperative care were equivalent between the 2 groups. All gum-chewing patients tolerated the gum. The first passage of flatus occurred on postoperative hour 65.4 in the gum-chewing group and on hour 80.2 in the control group (P = .05). The first bowel movement occurred on postoperative hour 63.2 in the gum-chewing group and on hour 89.4 in the control group (P = .04). The first feelings of hunger were felt on postoperative hour 63.5 in the gum-chewing group and on hour 72.8 in the control group (P = .27). There were no major complications in either group. The total length of hospital stay was shorter in the gum-chewing group (day 4.3) than in the control group (day 6.8), (P = .01).

Conclusions Gum chewing speeds recovery after elective open sigmoid resection by stimulating bowel motility. Gum chewing is an inexpensive and helpful adjunct to postoperative care after colectomy.


http://archsurg.ama-assn.org/cgi/content/abstract/141/2/174

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Pathophysiologic Mechanisms of IBS new
      #252520 - 03/16/06 12:16 PM
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Irritable Bowel Syndrome: New and Emerging Therapies

Pathophysiologic Mechanisms

Recent evidence strongly suggests that the primary pathophysiologic mechanism of IBS involves a dysregulation in brain-gut interactions. Many central and peripheral factors (genetic predisposition, environmental factors, chronic stress, inflammation or infection) may contribute to an altered brain-gut axis. Those alterations may eventually cause disorders of mucosal immune response, intestinal motility and permeability, and visceral sensitivity that produce abdominal pain or discomfort and compromised bowel function.

Altered Gastrointestinal Motility and Visceral Sensitivity

The pathogenesis of IBS, like that of most functional disorders of the gut, is controversial and evolving. Alterations in gastrointestinal motility and visceral hypersensitivity are not universally present in all individuals with IBS. Mechanisms associated with visceral hypersensitivity in IBS involve hypervigilance to expected aversive visceral events and hyperalgesia induced by sustained noxious visceral stimulation. Using various paradigms of balloon distention, studies have shown that, overall, IBS patients demonstrate lowered visceral perceptual thresholds, increased viscerosomatic referral areas, and increased sensory ratings when compared with healthy individuals.

Lucinda A Harris,a Lin Chang,b

aMayo Clinic College of Medicine, Scottsdale, Arizona, USA
bCenter for Neurovisceral Sciences and Women's Health, Division of Digestive Diseases, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, California, USA


Curr Opin Gastroenterol. 2006;22(2):128-135. 2006 Lippincott Williams & Wilkins

http://www.medscape.com/viewarticle/524223_2

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Role of Stress, Infection, Inflammation in IBS new
      #252523 - 03/16/06 12:22 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
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Irritable Bowel Syndrome: New and Emerging Therapies

Role of Stress

The role of stress may be particularly important in altering brain-gut interactions, resulting in the development or exacerbation of IBS symptoms. Rectal distention studies in IBS patients have shown altered visceral perception and neuro-endocrine responses to a stressor compared with healthy controls. Although stress affects the gut in both healthy individuals and IBS patients, new evidence suggests there may be greater reactivity in the major mediator of stress in the brain-gut axis, corticotrophin-releasing factor (CRF). Therapeutic agents targeted at CRF receptors are currently under development for IBS.

Infection and Inflammation
Postinfectious IBS has been identified in 7-30% of patients with a recent history of established bacterial gastroenteritis. A variety of mechanisms on the mucosal and cellular level are currently being investigated for their potential role in postinfectious IBS. Decreased ability to downregulate the inflammatory response to infection may result in such defects as increased inflammatory cytokines or mucosal cells, like enterochromaffin cells or proinflammatory cytokines. Researchers are also exploring the use of probiotics as possible immune modulators and small bowel intestinal overgrowth as a potentially pathogenetic mechanism of IBS.

Lucinda A Harris,a Lin Chang,b

aMayo Clinic College of Medicine, Scottsdale, Arizona, USA
bCenter for Neurovisceral Sciences and Women's Health, Division of Digestive Diseases, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, California, USA


Current Opinions in Gastroenterology. 2006;22(2):128-135. 2006 Lippincott Williams & Wilkins

http://www.medscape.com/viewarticle/524223_2


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Gender-related differences in visceral perception in health and irritable bowel syndrome new
      #258347 - 04/15/06 02:47 PM
HeatherAdministrator

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Gender-related differences in visceral perception in health and irritable bowel syndrome

Authors: KIM, HYUN SEO1; RHEE, POONG-LYUL; PARK, JUNGHO1; LEE, JUN HAENG1; KIM, YOUNG-HO1; KIM, JAE JUN1; RHEE, JONG CHUL1

Source: Journal of Gastroenterology and Hepatology, Volume 21, Number 2, February 2006, pp. 468-473(6)

Publisher:Blackwell Publishing

Irritable bowel syndrome (IBS) is more common in female subjects, and IBS patients generally exhibit reduced pain thresholds to rectal distension. The aim of the present paper was to determine gender-related differences in rectal perception in both healthy controls and IBS patients. Methods:

Fifty-nine IBS patients (age 2065 years; 31 women, 28 men) with symptoms that fulfilled Rome-II criteria and 21 healthy controls (age 2558 years; 11 women, 10 men) were recruited. Participants completed a questionnaire regarding bowel symptoms and psychological distress, and maximal tolerable pressures were evaluated via barostat tests. Results:

Although healthy women appear to have lower perception thresholds than men, significant gender differences in pain sensitivity were not detected. In addition, female patients with IBS also exhibited no enhanced colorectal perception, as compared with male IBS patients. Conclusions:

No gender differences in visceral perception were determined to exist between the healthy controls and the IBS patients. Therefore, the increased prevalence of IBS in women may be related to another set of pathophysiological factors, and not to gender-related differences in visceroperception.

http://www.ingentaconnect.com/content/bsc/jgh/2006/00000021/00000002/art00022;jsessionid=lp9l9jc1qwhm.henrietta

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Intestinal serotonin signalling in irritable bowel syndrome new
      #258351 - 04/15/06 02:59 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
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intestinal serotonin signalling in irritable bowel syndrome

Authors: MAWE, G. M.; COATES, M. D.1; MOSES, P. L.2

Source: Alimentary Pharmacology & Therapeutics, Volume 23, Number 8, April 2006, pp. 1067-1076(10)

Publisher:Blackwell Publishing


Alterations in motility, secretion and visceral sensation are hallmarks of irritable bowel syndrome. As all of these aspects of gastrointestinal function involve serotonin signalling between enterochromaffin cells and sensory nerve fibres in the mucosal layer of the gut, potential alterations in mucosal serotonin signalling have been explored as a possible mechanism of altered function and sensation in irritable bowel syndrome. Literature related to intestinal serotonin signalling in normal and pathophysiological conditions has been searched and summarized.

Elements of serotonin signalling that are altered in irritable bowel syndrome include: enterochromaffin cell numbers, serotonin content, tryptophan hydroxylase message levels, 5-hydroxyindoleacedic acid levels, serum serotonin levels and expression of the serotonin-selective reuptake transporter. Both genetic and epigenetic factors could contribute to decreased serotonin-selective reuptake transporter in irritable bowel syndrome. A serotonin-selective reuptake transporter gene promoter polymorphism may cause a genetic predisposition, and inflammatory mediators can induce serotonin-selective reuptake transporter downregulation.

While a psychiatric co-morbidity exists with IBS, changes in mucosal serotonin handling support the concept that there is a gastrointestinal component to the aetiology of irritable bowel syndrome. Additional studies will be required to gain a more complete understanding of changes in serotonin signalling that are occurring, their cause and effect relationship, and which of these changes have pathophysiological consequences.

http://www.ingentaconnect.com/content/bsc/apt/2006/00000023/00000008/art00004;jsessionid=11h69critg0l6.henrietta

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Prevalence of irritable bowel syndrome and depression in fibromyalgia new
      #258355 - 04/15/06 03:04 PM
HeatherAdministrator

Reged: 12/09/02
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Dig Dis Sci. 2006 Mar;51(3):454-60.

Prevalence of irritable bowel syndrome and depression in fibromyalgia.

Kurland JE, Coyle WJ, Winkler A, Zable E.

Department of Gastroenterology, Naval Medical Center San Diego, San Diego, California.

The purpose of this study was to determine the point prevalence of depressive symptoms, using the PRIME-MD questionnaire, and irritable bowel syndrome (IBS), while comparing the Rome II to the Rome I criteria, in patients with fibromyalgia (FM) and rheumatologic controls in an outpatient setting.

The prevalence of IBS in FM patients (n = 105) was 63% by Rome I and 81% by Rome II criteria. The prevalence of IBS in controls (n = 62) was 15% by Rome I and 24% by Rome II criteria (FM vs. control; P < 0.001). Depressive symptoms were met in 40% of FM patients and 8% of controls (P < 0.001). The coexistence of IBS and depressive symptoms in the FM patients was 31% (Rome I) and 34% (Rome II). The prevalence of IBS and depressive symptoms was higher in FM patients compared to the control population.

Identification of IBS and depressive symptoms in FM patients might enable clinicians to better meet the needs of this patient population.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16614951&query_hl=2&itool=pubmed_docsum

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Older Versus Younger Patients with Irritable Bowel Syndrome new
      #258356 - 04/15/06 03:11 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
Loc: Seattle, WA

Dig Dis Sci. 2006 Mar;51(3):446-53.

Prevalence, Sociodemography, and Quality of Life of Older Versus Younger Patients with Irritable Bowel Syndrome: A Population-Based Study.

Minocha A, Johnson WD, Abell TL, Wigington WC.

Department of Medicine, Division of Digestive Diseases, University of Mississippi Medical Center, Jackson, Mississippi, 39216-4505, USA.

We studied the prevalence as well as the sociodemographic characteristics and QOL of older adults (> 50 years) with irritable bowel syndrome (IBS) among the population at large and compared it to their younger counterparts'.

We hypothesized that IBS is less prevalent among older persons and they suffer poorer QOL compared to younger IBS patients. A total of 1000 adults fnine sites, including a medical center, churches, and a blood bank in our metropolitan area (670 African Americans, 320 Caucasians, and 10 others), completed self-administered questionnaires providing sociodemographic information and details regarding bowel habits and associated symptoms for diagnosing the IBS based on Rome II criteria.


QOL was assessed by the SF-12 questionnaire. The study database was divided into two groups, younger (< 50 years) and older (>/=50 years). The two age groups were similar with respect to gender and household income. Ninety-five of the 1000 participants had IBS, giving a total sample prevalence of 9.5% (< 50 years, 9.9%, vs >/=50 years, 7.6%). The prevalence of IBS was similar in the two groups irrespective of race, sex, marital status, size of household, location of residence (rural versus urban), level of educational status, and household income.

Compared to the older group, there was a trend toward a higher prevalence of IBS among divorced subjects (12.7% vs 0%; P = 0.1) and those below poverty level of income (15.3% vs 7.5%; P = 0.09) in the younger subjects. In contrast, older IBS patients were more likely to attend church regularly (32.5% vs 58.8%; P < 0.05).

There were no differences in histortraveler's diarrhea, food intolerance, and drug allergies between the two groups. Health care utilization was similar between the two IBS groups in terms of number of physician visits, use of prescription and alternative medications, and being disabled due to IBS. There was no difference in the overall QOL score means (27.8 vs 29.5; P = NS) or in its general health and physical functioning components. However, older IBS patients had better social functioning (9.1 vs 9.8; P < 0.05).

Although in our study IBS occurred less frequently among older adults than among younger patients, the difference is not statistically significant. While IBS affects QOL at all ages, social functioning was actually better on average among older compared to younger IBS patients.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16614950&query_hl=2&itool=pubmed_docsum

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Antibiotic use and irritable bowel syndrome (IBS).
      #258361 - 04/15/06 04:02 PM
HeatherAdministrator

Reged: 12/09/02
Posts: 7795
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Eur J Gastroenterol Hepatol. 1998 Jan;10(1):59-62.

Antibiotic use and irritable bowel syndrome (IBS).

Mendall MA, Kumar D.

Mayday Hospital, Thornton Health, Surrey, UK.

BACKGROUND: Antibiotics cause well defined short-lived disturbances in bowel habit. There is evidence to suggest that antibiotics may play a role in the pathogenesis of IBS. Atopy has been associated with small household size in childhood and could also play a role in IBS. We conducted a survey examining the relation of drug use and other epidemiological correlates of IBS.

SETTING: General practice health screening clinic.

SUBJECTS AND METHODS: 421 subjects (46% male, mean age 47 years (range 18-80 years) attending a general practice health screening clinic were interviewed by a research nurse and completed a previously validated questionnaire. Symptoms of IBS were said to be present if abdominal pain with 2 or more Manning criteria symptoms occurred more than once per month over the previous 6 months.

RESULTS: 48 subjects had symptoms of IBS. The following were strongly related to its presence: antibiotic use [adjusted OR 3.70 (1.80-7.60)], female sex and childhood living density < 1 person per room [OR 3.47 (1.57-7.64)], manual father's occupation [OR 0.35 (0.16-0.76)]. The use of NSAIDS, H2 antagonists or other types of medication was not greater in this group.

CONCLUSION: Antibiotic use is associated with IBS. The association with antibiotic use requires testing in prospective studies. Privileged childhood living conditions were also an important risk factor which is consistent with an allergic aetiology for IBS.

PMID: 9512954 [PubMed - indexed for MEDLINE]



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What IBS Patients Need - But Don't Get - From Their Physicians
      #262343 - 05/08/06 04:37 PM
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Reged: 12/09/02
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Press Release: What IBS Patients Need - But Don't Get - From Their Physicians

The first studies ever to assess Irritable Bowel Syndrome patients' knowledge regarding their disorder (conducted by researchers at Dartmouth-Hitchcock Medical Center in New Hampshire and recently presented at the 70th Annual Scientific Meeting of the American College of Gastroenterology) have found significant patient misconceptions about the causes of their condition and unawareness of how to manage symptoms.

However, IBS patient feedback from Help For IBS, the largest IBS community on the internet (with over 55,000 subscribers and 4.5 million visits annually), has found that many of the most common IBS patient misconceptions, as well as the lack of knowledge about symptom-management, stem directly from misinformation provided by these patients' own doctors.

Our findings highlight the top areas of concern for Irritable Bowel Syndrome patients - areas where their physicians provided either no information, or misinformation that in many cases actually worsened these patients' IBS symptoms.

1. Diet. Though it is well-established that fats and insoluble fiber foods (particularly wheat bran) can exacerbate Irritable Bowel Syndrome symptoms, while soluble fiber foods and supplements can help, IBS patients continue to be told that "diet doesn't matter". They are also often advised to "eat more fiber" without being told of the distinction between insoluble and soluble fiber foods. Lack of proper dietary information is by far the number one frustration for most IBS patients, and they report anger and disillusionment with their doctors for not providing accurate diet guidelines and additional dietary resources such as books or websites.

2. Hormonal issues. Three-quarters of IBS sufferers are female, and hormones have been shown to play a role in both the exacerbation and mitigation of IBS symptoms. IBS patients report a real need for understanding how pregnancy, hormonal birth control methods, and menopause can affect their IBS.

3. Alternative medicine. Over 50% of IBS patients turn to alternative medicine for help, and studies have shown successful results from gut-directed hypnotherapy, acupuncture, and yoga. IBS patients report a great deal of curiosity about trying alternative medicine for their symptoms and they would like to discuss these options with their doctors. However, they also note that their physicians rarely address these topics unless prompted and even then are rarely able to provide detailed information.

4. Medications. IBS patients repeatedly report being given inappropriate or ineffective medications for their IBS symptoms. Men and women with diarrhea-predominant IBS have been given prescriptions for Zelnorm, which is strictly for women with constipation-IBS and contraindicated for diarrhea. Many patients have questions about anti-depressants and anti-anxiety medications, but find that their doctors are unaware of how best to use these drugs for IBS. Patients commonly report that their doctors don't key medications to their specific IBS symptoms, and that their doctors seem surprised by the frequency of side effects or lack of good results.

5. Herbal medicine. More than half of all IBS patients try herbal medicines such as enteric coated peppermint oil capsules, fennel, or probiotics - all of which have clinical studies demonstrating their effectiveness for IBS symptoms. They would like their doctors to inform them of the best ways to use herbal medicines and if there are any safety concerns, but they commonly report that their doctors simply don't know anything about this subject.

6. Understanding their diagnosis. IBS patients see an average of three physicians over three years before receiving a diagnosis, but they are rarely given a clear explanation of what, exactly, IBS is. Patients frequently report uncertainty about the test results (or lack thereof) used to obtain their diagnosis, and they are looking for assurance that their diagnosis is accurate. They want to understand exactly what causes their symptoms, and they need to hear that IBS will not lead to other illnesses such as colon cancer. Many patients express frustration with the lack of basic IBS anatomical information provided by their physicians, including the frequent omission of any discussion of the brain-gut disorder that underlies IBS symptoms. Patients feel at a loss to treat their IBS when they're not even told what IBS is.

7. IBS is not taken seriously. IBS patients repeatedly report having their complaints diminished or outright dismissed by their own physicians. The most common refrain they hear is that IBS is "all in their heads", IBS is "not a serious problem", and that there is nothing that can be done for IBS so they should just "learn to live with it." Every one of these statements is false, and this type of denigration has catastrophic results.

The severity of IBS can be measured by its direct costs (use of healthcare-related services such as physician visits and diagnostic tests), which have been estimated to range from $1.5 to $10 billion annually in America. The indirect costs of IBS (loss of hourly wages resulting from missed work or diminished work productivity resulting from absences for physician visits or incapacitating symptoms) are estimated to be much greater - approaching $20 billion annually.

The costs of IBS can be measured not just in currency but in lives. In 2004 the American Gastroenterological Association reported that 38% of IBS patients in one study had contemplated suicide because of their symptoms. Hopelessness due to symptom severity, interference with life, and inadequacy of treatment were highlighted as crucial issues for all IBS patients. It's tragically clear that a significant number of IBS patients cannot "just live with it."

In summary, while the recent AGA presentation rightly concluded the need for effective IBS patient educational programs, Help For IBS patient feedback indicates that physician education clearly needs to come first. The AGA noted that physicians now have more scientific knowledge and an improved range of treatment options that can provide relief for IBS sufferers. However, as IBS patients themselves report, too many physicians continue to be completely unaware of this fact, and it is their patients who pay the price.

About Irritable Bowel Syndrome ~ IBS is a functional gastrointestinal (GI) disorder characterized by recurring symptoms of abdominal pain associated with altered bowel habits (constipation, diarrhea, or both). More than 20% of Americans suffer from IBS, which affects more women (75%) than men. The cause of IBS is unknown, and there is no cure, but there are many ways to effectively manage specific symptoms.

Help for IBS is the IBS patient support site of Heather's Tummy Care. The site offers extensive resources for Irritable Bowel Syndrome patients online at HelpForIBS.com, and free educational materials, including twice monthly newsletters and downloadable IBS dietary cheat sheets. The mission of Heather's Tummy Care is to offer education, support, and tangible help that allows people with Irritable Bowel Syndrome to successfully manage their symptoms through lifestyle modifications. Help for IBS and Heather's Tummy Care were founded by IBS author and patient Heather Van Vorous.





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Heather is the Administrator of the IBS Message Boards. She is the author of Eating for IBS and The First Year: IBS, and the CEO of Heather's Tummy Care. Join her IBS Newsletter. Meet Heather on Facebook!

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