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Type 1 Diabetes Complications After 20 Years

Long-term Complications Of Diabetes

Long-term Complications Of Diabetes

Helping kids with diabetes manage their blood sugar levels is a key part of preventing long-term diabetes problems. Here's why. What Long-Term Complications Can Diabetes Cause? Long-term complications related to diabetes are often linked to having high blood sugar levels over a long period of time. But blood sugar control isn't the only thing that determines someone's risk for complications. Things like genetics also can play a role. Many diabetes complications don't appear until after many years of having the disease. They usually develop silently and slowly over time. So even if kids show no symptoms, they still might eventually have problems. Managing diabetes with good nutrition, regular exercise, and medicine can help protect kids from these problems. The major organs and body systems involved in diabetes complications are the: People with diabetes have a greater risk for eye problems, including: Cataracts: A cataract is a thickening and clouding of the lens of the eye. The lens is the part of the eye that helps you focus on what you see. People with diabetes are more likely to develop cataracts. Cataracts can make vision blurry or impair night vision. Cataracts that affect vision can be surgically removed. Retinopathy: Diabetic retinopathy involves changes in the retina, the light-sensitive layer at the back of the eye. These are due to damage to, or abnormal growth of, the small blood vessels in the retina, which are thought to be related to high blood sugar levels over time. Someone with retinopathy may not have vision problems at first, but if the condition becomes severe, it can cause blindness. Retinopathy is more likely to become a problem in people with diabetes who also have high blood pressure or use tobacco. Kids with diabetes usually go for annual exa Continue reading >>

The 30-year Natural History Of Type 1 Diabetes Complications

The 30-year Natural History Of Type 1 Diabetes Complications

Declining incidences in Europe of overt nephropathy, proliferative retinopathy, and mortality in type 1 diabetes have recently been reported. However, comparable data for the U.S. and trend data for neuropathy and macrovascular complications are lacking. These issues are addressed using the prospective observational Pittsburgh Epidemiology of Childhood-Onset Diabetes Complications Study. Participants were stratified into five cohorts by diagnosis year: 1950–1959, 1960–1964, 1965–1969, 1970–1974, and 1975–1980. Mortality, renal failure, and coronary artery disease (CAD) status were determined on the complete cohort (n = 906) at 20, 25, and 30 years. Overt nephropathy, proliferative retinopathy, and neuropathy were assessed at 20 and 25 years on the subset of participants with a clinical examination. There was a decreasing trend by diagnosis year for mortality, renal failure, and neuropathy across all time intervals (P < 0.05), with the 1950–1959 cohort having a fivefold higher mortality at 25 years than the 1970s’ cohorts. Proliferative retinopathy and overt nephropathy showed nonsignificant declines at 20 years (P < 0.16 and P < 0.13, respectively) and no change at 25 years. CAD event rates, which were lower than the other complications, also showed no trend. Although some type 1 diabetes complications (mortality, renal failure, and neuropathy) are declining, others (CAD, overt nephropathy, and proliferative retinopathy) show less favorable changes by 30 years. RESEARCH DESIGN AND METHODS The EDC study is a representative (11) prospective type 1 diabetes cohort, now entering its 18th year of follow-up. The EDC baseline examinations were conducted between 1986 and 1988, and participants were examined biennially thereafter. Figure 1 shows the recruitment tre Continue reading >>

Why Some May Avoid Type 1 Diabetes Complications

Why Some May Avoid Type 1 Diabetes Complications

Why Some May Avoid Type 1 Diabetes Complications Researchers Say More Than Just Blood Sugar Control May Be at Work for Some Patients March 29, 2011 -- After years of living with diabetes , complications can occur, including problems affecting the eyes , heart , kidneys , and nerves. However, some type 1 diabetes ''veterans'' seem to escape many or most of these diabetes complications , according to a new study. ''This study clearly demonstrates and documents that there can be a large number of people who can go a very, very long time with type 1 diabetes and not suffer with dire complications," says researcher George L. King, MD, chief scientific officer at Joslin Diabetes Center and professor of medicine at Harvard Medical School. Explaining why is not simple, however. In the study, being free or nearly free of complications didn't correlate directly with control of blood sugar , King says. He isn't discounting the importance of blood sugar control. It's shown to reduce the risk of complications. However, his study suggests other mechanisms may help explain the protection from complications he found in some. King studied 351 so-called medalists who had received medals from Joslin Diabetes Center after living with type 1 diabetes for 50 years. In type 1 diabetes , the pancreas does not produce adequate insulin to control blood sugar. In type 2 diabetes , the body may not produce enough insulin or insulin resistance occurs where the body does not respond normally to insulin . Insulin moves glucose into the cells, where it's used for energy. The participants' average age was nearly 68. They were about 11 at the time of diagnosis. King's team looked at common complications, including eye problems known as retinopathy, nerve problems or neuropathies, kidney problems or nep Continue reading >>

3 Type 1 Diabetes

3 Type 1 Diabetes

Type 1 diabetes is an autoimmune disease in which the immune system destroys the insulin-producing beta cells of the pancreas. This results in a deficiency of insulin, causing chronic hyperglycemia. 3.1 PREVALENCE AND INCIDENCE A report from the SEARCH for Diabetes in Youth study, a national multicenter study sponsored by the CDC and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), found that between 2002 and 2005, 15,600 new cases of type 1 diabetes were diagnosed in the US37. The incidence and prevalence of type 1 diabetes are summarized in Tables 14-15. Table 14. Incidence of type 1 diabetes, United States youth. Source: Mayer-Davis et al. 200937 Table 15. Prevalence of type 1 diabetes, United States by age. Data Source Population Prevalence Reference SEARCH for Diabetes in Youth Age <20 years 0.148% (2001) Dabelea et al. 20141 0.193% (2009) NHANES 1999-2000 Age 20-39 years 0.34-0.42% Menke et al. 201338 Age 40-59 years 0.31-0.49% Age 60+ years 0.08-0.12% Type 1 diabetes incidence rates appear to be rising; assuming increases over time, the prevalence of type 1 diabetes may increase by as much as 144% by the year 2050 (Table 16). Table 16. Projected increases in type 1 diabetes prevalence among youth from 2010 to 2050. Source: Imperatore et al. 201239 Most recent studies place the prevalence of type 1 diabetes among US youth between 0.15% and 0.2%. Data from the SEARCH study indicated that the prevalence of type 1 diabetes among youth increased 21.1% between 2001 and 2009, with similar increases for boys and girls and in most racial/ethnic and age groups.1 The increase in prevalence in Scenario 2 was expected to occur especially among youths of minority race/ethnicity.39 3.2 DEMOGRAPHIC DIFFERENCES In the SEARCH for Diabetes in Youth Stud Continue reading >>

Long-term Survivors Are Helping Unlock The Mysteries Of Type 1 Diabetes

Long-term Survivors Are Helping Unlock The Mysteries Of Type 1 Diabetes

Long-term survivors are helping unlock the mysteries of type 1 diabetes Its hard to imagine what it was like to live with type 1 diabetes 80 years ago. Insulin was a brand new and relatively untested drug, the only way to check blood sugar levels was by testing boiled urine, syringes had to be sterilized, and needles sharpened by hand. Couple those challenges with the common complications of diabetesheart disease, kidney failure, nerve damage, blindness, and moreand life expectancy for someone with type 1 diabetes wasnt that long. Spencer M. Wallace, Jr., was diagnosed with type 1 diabetes in 1931, at age 7. Hes now an active 87-year-old who plays golf several times a week. He isnt alone as a long-term survivor. Since 1970, almost 3,500 men and women who have lived with the disease for a half century have been recognized by the Joslin Diabetes Center in Boston with bronze 50-year medals. Forty-five of them, including Mr. Wallace, have passed the 75-year mark. A study that includes several hundred 50-year Medalists is changing experts understanding of type 1 diabetes, and may uncover new ways to protect people from the damage it can cause. Type 1 diabetes was once called juvenile onset diabetes because it tends to strike at an early age. Over time, the high levels of blood sugar that are the hallmark of diabetes damage blood vessels, nerves, and various other tissues. Among people with type 1 diabetes, up to 90% experience damage to the eyes retina (a condition called diabetic retinopathy) within 20 years of their diagnosis. Among the Joslin Medalists, though, only half had diabetic retinopathy after 50 years living with the disease. As reported in the journal Diabetes Care , the Medalists also experienced much less kidney damage and nerve damage than would be expected Continue reading >>

Diabetes Life Expectancy

Diabetes Life Expectancy

Tweet After diabetes diagnosis, many type 1 and type 2 diabetics worry about their life expectancy. Death is never a pleasant subject but it's human nature to want to know 'how long can I expect to live'. There is no hard and fast answer to the question of ‘how long can I expect to live’ as a number of factors influence one’s life expectancy. How soon diabetes was diagnosed, the progress of diabetic complications and whether one has other existing conditions will all contribute to one’s life expectancy - regardless of whether the person in question has type 1 or type 2 diabetes. How long can people with diabetes expect to live? Diabetes UK estimates in its report, Diabetes in the UK 2010: Key Statistics on Diabetes[5], that the life expectancy of someone with type 2 diabetes is likely to be reduced, as a result of the condition, by up to 10 years. People with type 1 diabetes have traditionally lived shorter lives, with life expectancy having been quoted as being reduced by over 20 years. However, improvement in diabetes care in recent decades indicates that people with type 1 diabetes are now living significantly longer. Results of a 30 year study by the University of Pittsburgh, published in 2012, noted that people with type 1 diabetes born after 1965 had a life expectancy of 69 years.[76] How does diabetic life expectancy compare with people in general? The Office for National Statistics estimates life expectancy amongst new births to be: 77 years for males 81 years for females. Amongst those who are currently 65 years old, the average man can expect to live until 83 years old and the average woman to live until 85 years old. What causes a shorter life expectancy in diabetics? Higher blood sugars over a period of time allow diabetic complications to set in, su Continue reading >>

How Many Patients With Type 1 Diabetes Develop Kidney Disease After 50 Years?

How Many Patients With Type 1 Diabetes Develop Kidney Disease After 50 Years?

Insulin was discovered in 1921 which means that it hasn’t even been a 100 years since people with type 1 diabetes had a 100 percent death rate. For the first few decades since, most patients did not live into old age. As a result, it’s only been recently that more people with type 1 diabetes have reached older ages and scientists have been able to better research the long-term risks of living with type 1 diabetes. Researchers recently conducted a study with the objective of finding out the incidence of kidney disease in patients with type 1 diabetes. In their study abstract they wrote that, “A common belief is that only a minority of patients with type 1 diabetes (T1D) develop advanced kidney disease and that incidence is higher among men and lower in those diagnosed at a younger age.” Study Details The researchers checked the 50-year cumulative kidney complication risk in a cohort of 932 patients with type 1 diabetes who were diagnosed in childhood during 1950-1980. Their mean baseline age was 29 and the mean baseline duration of diabetes was 19 years. Of the 932 participants, 144 had died before baseline, 130 followed with periodic surveys, and 658 followed with biennial surveys and a maximum of nine examinations for 25 years. They defined micro-albuminuria and macro-albuminuria as an albumin excretion rate of 20-199 and ≥200 μg/min. End-stage renal disease was defined as dialysis or kidney transplantation. “Cumulative incidence was estimated at 10-year intervals between 20 and 50 years duration and compared by calendar year of diabetes onset,” wrote the researchers. How Many With Type 1 Diabetes Develop Kidney Disease? At 50 years of type 1 diabetes, 60% of the cohort had end-stage renal disease, 72% had macroalbuminuria, and 88% had microalbuminuria. Continue reading >>

Type 1 Diabetes Complications

Type 1 Diabetes Complications

Type 1 diabetes is complicated—and if you don’t manage it properly, there are complications, both short-term and long-term. “If you don’t manage it properly” is an important if statement: by carefully managing your blood glucose levels, you can stave off or prevent the short- and long-term complications. And if you’ve already developed diabetes complications, controlling your blood glucose levels can help you manage the symptoms and prevent further damage. Diabetes complications are all related to poor blood glucose control, so you must work carefully with your doctor and diabetes team to correctly manage your blood sugar (or your child’s blood sugar). Short-term Diabetes Complications Hypoglycemia: Hypoglycemia is low blood glucose (blood sugar). It develops when there’s too much insulin—meaning that you’ve taken (or given your child) too much insulin or that you haven’t properly planned insulin around meals or exercise. Other possible causes of hypoglycemia include certain medications (aspirin, for example, lowers the blood glucose level if you take a dose of more than 81mg) and alcohol (alcohol keeps the liver from releasing glucose). There are three levels of hypoglycemia, depending on how low the blood glucose level has dropped: mild, moderate, and severe. If you treat hypoglycemia when it’s in the mild or moderate stages, then you can prevent far more serious problems; severe hypoglycemia can cause a coma and even death (although very, very rarely). The signs and symptoms of low blood glucose are usually easy to recognize: Rapid heartbeat Sweating Paleness of skin Anxiety Numbness in fingers, toes, and lips Sleepiness Confusion Headache Slurred speech For more information about hypoglycemia and how to treat it, please read our article on hy Continue reading >>

Immune From Diabetes Complications

Immune From Diabetes Complications

Why do some people develop terrible complications from diabetes, while others skate through with no complications at all? Is there such a thing as immunity from complications, and if so how can you get that immunity for yourself? Unfortunately, nobody knows the answer to those questions, and until now, few have even looked into them. We know from the Diabetes Control and Complications Trial (DCCT) and from other studies that blood glucose control makes a big difference in complications of diabetes. But there is much more to the story. In the DCCT, and the long-term follow-up study called EDIC (Epidemiology of Diabetes Interventions and Complications) , people with Type 1 practicing intensive blood glucose control reduced diabetic kidney disease by 50%, heart attacks by 57%, nerve disease by 60%, and eye disease by 76%. Pretty good, but what about the 25% to 50% of intensive control subjects who got the complications anyway? And what about the 10% to 15% of people with Type 1 who never seem to get severe complications, without practicing intensive control? You would think such a basic question where do complications come from would have received more attention. People with diabetes certainly care. On the Web site TuDiabetes, a reader with Type 1 asked, I [have had diabetes for over 38 years] with no complications. [For many years] my control was impossible. Why has nothing untoward happened after it was drilled into me that [complications] and death would soon follow? Now Swedish scientists are finally starting to look at this basic question . Valeriya Lyssenko, MD, PhD, and Peter Nilsson, MD, PhD, both from Lund University Diabetes Center, are conducting the PROLONG (PROtective Genes in Diabetes and LONGevity ) study, looking at Swedes who have had diabetes for more th Continue reading >>

In The Absence Of Renal Disease, 20year Mortality Risk In Type 1 Diabetes Is Comparable To That Of The General Population: A Report From The Pittsburgh Epidemiology Of Diabetes Complications Study

In The Absence Of Renal Disease, 20year Mortality Risk In Type 1 Diabetes Is Comparable To That Of The General Population: A Report From The Pittsburgh Epidemiology Of Diabetes Complications Study

, Volume 53, Issue11 , pp 23122319 | Cite as In the absence of renal disease, 20year mortality risk in type 1 diabetes is comparable to that of the general population: a report from the Pittsburgh Epidemiology of Diabetes Complications Study The FinnDiane Study has reported that mortality in type 1 diabetes is not increased over a 7year follow-up in the absence of renal disease (RD). Using the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study population (n = 658) of childhood-onset type 1 diabetes (age <17years), the present study sought to replicate and expand these findings to a 20year follow-up (as of 1 January 2008) and examine cause of death by renal status. At baseline (19861988), mean age and duration of diabetes were 28 and 19years, respectively. RD was defined as an albumin excretion rate 20g/min from multiple samples and grouped as microalbuminuria (MA; 20200g/min), overt nephropathy (ON; >200g/min), or end stage renal disease (ESRD; dialysis or renal transplantation). At baseline, 311 (47.3%) individuals had RD (MA 21.3%, ON 22.2% and ESRD 3.8%). During a median 20year follow-up, there were 152 deaths (23.1%). Mortality was 6.2 (95% CI 5.27.2) times higher than expected, with standardised mortality ratios of 2.0 (1.22.8) for normoalbuminuria (NA); 6.4 (4.48.4) for MA; 12.5 (9.515.4) for ON; and 29.8 (16.842.9) for ESRD. Excluding those (n = 64) with NA who later progressed to RD, no significant excess mortality was observed in the remaining NA group (1.2, 0.51.9), whose deaths were largely unrelated to diabetes. These data confirm the importance of RD, including persistent microalbuminuria, as a marker of mortality risk and suggest that type 1 diabetes patients without renal disease achieve long-term survival comparable to the general population. Continue reading >>

Type 1 Diabetes: Complications After 20 Years' Duration

Type 1 Diabetes: Complications After 20 Years' Duration

Silvana Salardi, MD; Massimo Porta, MD, PHD; Giulio Maltoni, MD; Flavia Rubbi, MD; Silvia Rovere, MD; Franco Cerutti, MD; Dario Iafusco, MD; Stefano Tumini, MD; Vittoria Cauvin, MD In this case series of patients who developed type 1 diabetes after 1980, 55% had any DR and 15% had moderate-to-severe DR after almost 20 years' duration. These prevalence data are not readily comparable with those of previous reports. Pambianco et al.[ 14 ] reported higher prevalence of proliferative DR and renal failure, but their patients had been diagnosed with diabetes in an earlier era, the 1950s to 1970s. Donaghue et al.[ 6 ] reported data more similar to ours (52% for any DR and 21% for more severe DR), but their patients were younger and had a shorter disease duration. The study by Romero et al.[ 15 ] is comparable to ours both for patient characteristics and DR classification and reports the same prevalence of any DR (55.4%) but a higher rate of more severe DR (27%). In disagreement with Harjutsalo et al.,[ 16 ] we have not found differences between the sexes with regard to risk of severe DR; however, the differences observed by Harjutsalo et al.[ 16 ] were in patients with age at onset 15 years, whereas all our patients were age at onset <15 years. In the same series of patients, only 7% had micro-macroalbuminuria, a percentage eightfold lower than that of DR. Although it is well known that nephropathy is a complication less frequent and less related to glycemic control than DR, this low prevalence is not found in other studies, which, moreover, considered durations of disease shorter than ours, including 18% in Svensson et al.,[ 4 ] 14% in Olsen et al.,[ 8 ] and 41% in Romero et al..[ 15 ] Furthermore, this percentage would have been even lower if we had excluded the two patient Continue reading >>

5 Common Type 1 Diabetes Complications

5 Common Type 1 Diabetes Complications

3 0 Type 1 diabetes carries with it a much higher risk of developing some associated serious health problems. While in the past, getting diabetes-related health complications was almost a certainty, with modern blood glucose monitoring, control, and treatment, the risks have decreased significantly. Even a few decades ago, life expectancy for people with diabetes was regularly considered to be 10 years shorter than for people without the disorder. In 2012, however, a large-scale study found that life-expectancy was now only about 6 years less than average. For comparison, a lifetime of smoking will reduce life expectancy by 10 years. So what are the diabetes complications that you need to be looking out for? Largely, they fall into either cardiovascular or neuropathic categories. To make diabetes complications even more complicated, they tend to affect people of different sexes and different ethnicities differently. One more wild card is that recent studies have found that some people with Type 1 diabetes actually never develop most of the complications associated with diabetes. The good news is that with proper blood glucose control and a healthy lifestyle, the risks for developing Type 1 diabetes complications are drastically reduced. Some studies have actually found that careful monitoring and management can reduce the chances of developing any of these by as much as 50%. Still, everyone with Type 1 diabetes should keep a careful eye out for the five most common diabetes complications. Diabetic Ketoacidosis Diabetic Ketoacidosis (or DKA), is a condition caused by severe hyperglycemia (high blood sugar) which causes rapid fat breakdown in the body. As the fat breaks down, they release fatty acids which are then converted into chemicals called ketones, which are highly Continue reading >>

The Outcome Of Brittle Type 1 Diabetes—a 20 Year Study

The Outcome Of Brittle Type 1 Diabetes—a 20 Year Study

Aims: To determine the long-term (20 years from presentation) outcome of brittle type 1 diabetes characterized by recurrent episodes of ketoacidosis (DKA). Methods: The cohort studied was a group of brittle diabetic patients from various parts of UK originally identified between 1979 and 1985. Patients were traced, where possible, via their diabetic clinics and/or general practitioners. Data on survival or otherwise were obtained from hospital case notes and information from diabetes care team members. For survivors, clinical and demographic information obtained included complication status and whether they still had brittle characteristics. They were also compared with a matched case–control group of type 1 patients with no history of brittle behaviour. Results: The original cohort comprised 33 patients— all female and mean ± SD, aged 18 ± 5 years and diabetes duration 8 ± 4 years. Thirteen were not traceable and 10 of the remaining 20 (50%) had died during the mean 22 years of follow-up. Deaths occurred evenly throughout the period, and causes were chronic renal failure (3), DKA (3), hypoglycaemia (2), subarachnoid haemorrhage (1) and uncertain (1). Age at death ranged from 27 to 45 years. Of the 10 survivors, none remained brittle, but they had a substantial burden of complications. Compared with the non-brittle control group, there was a significant excess of nephropathy and autonomic neuropathy. Conclusions: We conclude that brittle diabetes characterized by recurrent DKA has high long-term outcome mortality. These deaths were premature and almost all diabetes related. Those who survived had resolution of brittleness, but suffered a significant complication burden. Background: The National Institute for Health and Clinical Excellence (NICE) recently released Continue reading >>

Complications Of Diabetes Mellitus

Complications Of Diabetes Mellitus

The complications of diabetes mellitus are far less common and less severe in people who have well-controlled blood sugar levels. Acute complications include hypoglycemia and hyperglycemia, diabetic coma and nonketotic hyperosmolar coma. Chronic complications occur due to a mix of microangiopathy, macrovascular disease and immune dysfunction in the form of autoimmune disease or poor immune response, most of which are difficult to manage. Microangiopathy can affect all vital organs, kidneys, heart and brain, as well as eyes, nerves, lungs and locally gums and feet. Macrovascular problems can lead to cardiovascular disease including erectile dysfunction. Female infertility may be due to endocrine dysfunction with impaired signalling on a molecular level. Other health problems compound the chronic complications of diabetes such as smoking, obesity, high blood pressure, elevated cholesterol levels, and lack of regular exercise which are accessible to management as they are modifiable. Non-modifiable risk factors of diabetic complications are type of diabetes, age of onset, and genetic factors, both protective and predisposing have been found. Overview[edit] Complications of diabetes mellitus are acute and chronic. Risk factors for them can be modifiable or not modifiable. Overall, complications are far less common and less severe in people with well-controlled blood sugar levels.[1][2][3] However, (non-modifiable) risk factors such as age at diabetes onset, type of diabetes, gender and genetics play a role. Some genes appear to provide protection against diabetic complications, as seen in a subset of long-term diabetes type 1 survivors without complications .[4][5] Statistics[edit] As of 2010, there were about 675,000 diabetes-related emergency department (ED) visits in the Continue reading >>

The Burden Of Type 1 Diabetes

The Burden Of Type 1 Diabetes

Epidemiology Overall, type 1 diabetes (T1D) accounts for approximately 5% of diabetes and affects about 20 million individuals worldwide. Among those younger than 20 years of age, T1D accounts for the majority of T1D cases (1,2). The current U.S. prevalence estimate of 1-3 million T1D patients may triple by 2050 due to a rising incidence of T1D (3). Worldwide, T1D incidence has been rising by approximately 3% per year (1,4), possibly in association with changes in the humoral autoimmune response to islet antigens (5). Other factors implicated in the rising incidence include early childhood infections, dietary protein makeup, insulin resistance, and inflammatory factors (6,7). Morbidity and Mortality Diabetic complications—retinopathy, nephropathy, neuropathy, and cardiovascular disease (CVD)—are the major causes of morbidity and mortality in persons with T1D, although severe hypoglycemia and diabetic ketoacidosis (DKA) are also associated with high mortality rates, particularly in younger patients (5-10). Although the role of glucose control in reducing the risk of diabetes complications is well-established (11,12), real-world data show that rates of complications remain high, particularly in patients with suboptimal control. An analysis of the Diabetic Control and Complications Trial (DCCT) and Pittsburgh Epidemiology of Diabetes Complications (EDC) study populations revealed that the 30-year cumulative incidence of retinopathy was 50% among DCCT patients randomly assigned conventional therapy at the start of that trial, while the observational EDC study population had a 47% cumulative incidence over 30 years. Nephropathy rates were 25% and 17% in the DCCT-conventional and EDC cohorts, respectively, and 14% of patients had CVD in these two groups. In contrast, 30-y Continue reading >>

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