By N. Delazar. University of Wisconsin-Superior. 2019.

This was clear with Jocelyn’s example: when her adrenal dysregulation was repaired purchase penegra 50 mg with mastercard, the thyroid problem resolved purchase penegra 100mg. As you may have learned in chapters 2 and 4 generic penegra 50mg without prescription, the glucocorticoids 50mg penegra free shipping, most notably cortisol, are the main modulators—the alpha hormones—of the hypothalamus and pituitary, and these in turn control the feedback to the ovaries, thyroid, and adrenals. Here’s how one woman in my medical practice described her antecedent: “I was medically boring until age twenty-eight, when my mother was dying of cancer, and I took care of her for six months until she died. As you read in chapters 6 and 9, a broad range of chemicals known as endocrine disruptors often can affect more than one hormonal system—for instance, bisphenol-A acts as a xenoestrogen and a thyroid disruptor, and sadly, levels are detectable in the urine of 93 percent of American adults. Awareness of how chemicals in the environment can affect your hormones is essential. Here I define dysregulated to mean that the body’s response to chronic stress is poorly modulated, or regulated, such that cortisol is not kept within an optimal range for the body and is either too high or too low, usually at different times within the same twenty- four-hour period. Low progesterone (estrogen dominance) and low thyroid hormone Cortisol Resistance: Is Cortisol Similar to Insulin? Just as too many doughnuts, excess stress, environmental toxins, and sedentary living collectively lead to insulin resistance, where your cells become numb to insulin, there is growing support for the scientific basis for cortisol resistance, where your cells similarly become numb to cortisol. When you do not manage optimally or follow healthy lifestyle design, several imbalances may occur at once, such as insulin and cortisol resistance. Our latest scientific understanding, however, is that the way cells react to cortisol—that is, whether the cells are sensitive (which is normal) or numb (which is not normal, and a sign of hormone imbalance, and in this case, hormone resistance)—may be more important than actual hormone levels in the blood. That leads to low cortisol inside the cells of your body, which makes you feel as if you have the symptoms of low cortisol, despite your high blood levels. In other words, your glucocorticoid receptors for cortisol become unable to respond to cortisol. Using the lock-and-key analogy, your “lock” (glucocorticoid receptor) becomes jammed, and cortisol can no longer open the door. The final result is inflammation, which we learned is not good—it creates the bad neighborhood that tends to alienate the other happy hormones and neurotransmitters and makes you more susceptible to illnesses and disease, such as cancer and diabetes. Prevent cortisol resistance (and insulin resistance) by applying the health-promoting lifestyle design of The Gottfried Protocol. Imbalance and Age In my practice, I’ve seen some distinct patterns when it comes to age and hormonal imbalances. These are the most common imbalances that I see and treat with The Gottfried Protocol. And although these younger patients come to me with symptoms, at this age the fix is often stunningly simple. Remember the theory that those of us who are aged thirty-five to fifty have the lowest psychological well- being of any age group? Before age thirty-five, there’s less stress and better resilience to meet it; there’s usually less hormonal upheaval from pregnancy; and there’s more organ reserve, longer telomeres, and a generally superior ability to roll with the punches. Women under the age of thirty-five are less likely to have multiple hits to their homeostasis, so it’s simpler to find the original cause for their hormonal problem. When I do, it’s most frequently women who have both cortisol problems and a thyroid issue, or high androgens together with wayward cortisol. I find that infertility is related to low progesterone, or sometimes low thyroid function. As women get closer to age thirty-five, the combination of the two hormonal imbalances appears more frequently. The most common hormone combination of this age group is dysregulated cortisol along with changes to thyroid, progesterone, or testosterone. Because cortisol is the most essential hormone that you make— you need it no matter what to deliver fuel to cells, which is the most basic task of a hormone in your body—and the nonessential sex hormones (progesterone, testosterone, thyroid) will be the first to get imbalanced when cortisol is the top priority. In other words, you will make cortisol, sometimes at very high levels, at the expense of your other hormones. Then, as a result, the secondary hormonal imbalances can be addressed and cleared up. But sometimes you have to address more than one hormonal problem at a time and treat them simultaneously for best results. That’s when the concept of Charlie’s Angels becomes increasingly important—you want the entire team of estrogen, thyroid, and cortisol working for you, not against you. You always want to first address the root cause, particularly when you have more than one hormonal issue. And all roads, not surprisingly, usually lead back to the limbic system, amygdala hijack, and the adrenal glands. In other words, adrenal function is the first place to look when you have multiple symptoms of hormonal imbalance, which is due to hormonal intercommunication—that is, there are classic patterns of hormonal and neurotransmitter consequences. When you’re stressed at twenty-five, you go to a yoga class, sleep it off, or call a good friend or maybe even your mother. When you’re forty-five, chronic and repetitive stress cranks up your cortisol until your adrenals can’t make enough, then your thyroid slows down and your joints get cranky, and as a result, your knee may hurt too much to go to yoga. When you’re stressed, your thyroid abruptly slows down production of the key thyroid hormones—and you feel cold and achy and your hair falls out. Next month, because your ovaries are semiretired, you don’t ovulate and then your estrogen is low. Serotonin levels fall, and because serotonin (Nature’s Prozac) manages sleep, appetite, and mood, you become an insomniac, which worsens your depression and ramps up your appetite. In other words, one imbalance (chronic stress and wayward cortisol—initially high, and then low) begets a cascading crescendo of hormonal problems. Dysregulated cortisol is linked to thyropause, low progesterone, and eventually, as you get closer to menopause, low estrogen. Keep in mind that the key differentiator for ages thirty- five to fifty is that the ovaries are sputtering and this makes many women feel like they are under siege: one day you want another child and feel blissed out, and the next day you want to run away from home to become a forest dweller. As I described in chapter 2, the boss of your Charlie’s Angels—your adrenals, ovaries, and thyroid —is in the brain, the hypothalamus. You want the boss, your hypothalamus, to be your ally since it controls the orchestra of your hormonal symphony, and the symphony can get extremely out of tune starting sometime between age thirty-five and forty-five. Your hypothalamus tells its neighbor, the pituitary, to make more or less of the control hormones for your adrenals, ovaries, and thyroid. Several important factors determine how much hormone your endocrine glands should make, including how much stress you perceive, changes in weight, light/dark cycles (especially how much light you are exposed to at night), quantity and quality of sleep, and medications (such as birth control pills), to name a few. Those hideous (and sometimes hilarious) dark corners of perimenopause are behind them. Women past menopause often no longer feel a need to endure the sacrifices and occasional masochism of selfless service. Have you noticed that women after fifty are more stress resilient, and seem to have more choices and actions to express their authentic needs and values? You come more fully into your own, and learn not to give a damn about other people’s opinions of you. Yes, there’s the unforgiving metabolism to contend with, but at least you are of relatively sound mind as you check your thyroid, take on a Paleo diet (see page 174), and make time for yoga. You can no longer put off the important stuff that you postponed while you were busy tending a family and career or running a household. There’s a planet to save, some other underdog that needs your voice, or a garden to water.

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Sometimes it takes five days to “catch up” on everything that needs to be done for the brain and get you sleeping buy generic penegra 50mg on-line. Meanwhile purchase penegra 50 mg with mastercard, of course purchase penegra 100mg with amex, you are planning to kill your parasites and be done with insomnia in the most effective way of all generic 100mg penegra. We are all so different in our metabolism details, we respond differently to herbs. Herbs, a tradition that precedes civilization, need to be forever off limits for intervention by government agencies. Tryptophane, another amino acid, is about twice as power- ful as ornithine, but was taken off the market a few years ago. Some persons taking it daily were seen to become quite ill and some deaths ensued. Since tryptophane had been used in prior years without noticing toxicity, something unusual should have been suspected. Persons with illness due to taking tryptophane developed an extremely high eosinophil count in their blood test—an index of parasitism, too. Were these unfortunate victims seeing the cause or the result of their tryptophane use? This tragic event should have led to a discovery of the heavy pollution, a revelation of the industrial manufacturing process, and a safeguarding against any repetition. The presence of filth contamination and toxins cannot be completely avoided but the consumer can make informed choices if he or she knows it is there. Ruby Adair, 14, ached all over, had ringing in her ears, sinus problems and chronic fatigue. In three weeks she had eliminated them with parasite herbs and she could go to sleep naturally. It can invade a variety of human tissues like the mouth (called thrush), skin (including some kinds of diaper rash), vagina, and the digestive tract. When chemicals are used in the diaper, the white blood cells go after the chemicals and let the yeast grow. Certainly not with cortisone containing salves that further reduce the immune competence of white blood cells. Switch to cloth diapers; do not bleach them with chlorine bleach, the residual chlorine trapped in the cloth is a chronic irritant, setting the stage for another rash and future chlorine- allergy. If you have homemade Lugol’s iodine (made by your pharmacist or by yourself, see Recipes), add a tsp. Vitamin C is acid and is our natural healing agent but it will sting on a broken skin surface. Zinc oxide is another natural healer because it competes away the iron that fungus and bacteria need for their reproduction. Never use commercially available zinc compounds though, simply purchase your own zinc oxide powder, mix it with cornstarch and keep in a large old salt shaker, dust it wherever there is moisture or fungus growth. It may be impossible to deprive the fungus of moisture, for example if your feet sweat and you must wear socks. Launder with borax only (soaps and detergents contain aluminum which pollutes the skin). They may have developed a foothold underneath the toe nail where a steady supply of moisture, iron and sugar is available to them. Nevertheless, your white blood cells will eventually gobble them up if you let them. In thrush (yeast infection of the mouth) you must again outwit its growth by doing everything possible at one time. Avoid trauma like eating abrasive foods (crusts, popcorn, nuts, lozenges) or sucking on things. Floss teeth only once a day (using monofilament fish line), followed immediately by brushing with white iodine (or Lugol’s, but this may temporarily stain). Since reinfection is constant, you must continue to do all the treatments given to permanently cure yourself of fungus disease. Clearing up fungus at one location but not another will not bring you a permanent cure, either. Although sheep, cattle, pigs and humans can be “natural” hosts to the adult stage, the other stages are meant to develop outdoors and in secondary hosts. When fluke stages other than the adult are able to develop in us, I call it fluke disease. Or, when an adult that “normally belongs” to another species is able to develop in us, I also call that fluke disease. Or even with adult flukes in their “normal” host, when they move from the organ that they “normally” colonize to other organs in the body I call this fluke disease, too. Four fluke varieties engaged in this extra territorial pursuit are the intestinal fluke, sheep liver fluke, pancreatic fluke, and human liver fluke. If an adult crosses the wall to the inside and then manages to get out through the fallopian tubes to the abdominal cavity it takes some endometrium with it— causing endometriosis. This is not an example of flukes straying into the wrong organs, but of having its stages reproducing where they never could before. Yet a human is big and makes a valiant effort to kill the stages, block access to tissues and otherwise battle them. The intelligent approach is to discover what enables these mighty monsters to do their reproducing in our bodies instead of the pond with its snail/minnow secondary hosts. The presence of isopropyl alcohol is associated in 100% of cancer cases (over 500 cases) with reproduction of the intestinal fluke stages in a variety of organs causing cancers in these organs. The presence of wood alcohol is associated in 100% of dia- betes cases (over 50 cases) with reproduction of pancreatic fluke stages in the pancreas. The presence of xylene and toluene is associated in 100% of Alzheimer cases (over 10 cases) with the reproduction of intes- tinal fluke stages in the brain. Much more work needs to be done to examine the relation- ship between fluke reproduction, the solvent and the chosen or- gan. Ideally, we should all pool our results, adding to the body of knowledge I have begun. In other words, the minute amounts that we inhale here and there do not accumulate to the point of serious damage. The sources of benzene and propyl alcohol that I found are given in special lists (page 354 and 335). But a pattern is emerging: foods and products that require sterilization of bottles and ma- chinery to fill these bottles are polluted with propyl alcohol or wood alcohol. Diabetes is quite old as an illness, too, and so is its associated solvent, wood alcohol. Should we conclude that benzene, xylene and toluene were used much less in the past? Fluke diseases could be eradicated with some simple ac- tions: monitoring of solvents in foods, feeds and products. It is in the interest of the consumer to have her or his own independent way of monitoring too. Chemical ways can be devised, besides the electronic way pre- sented in this book.

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Probably the two most common immunizations given in this instance are rubella and influenza order penegra 100mg on line. Needless to say order penegra 100mg overnight delivery, the mortality to both mother and neonate from tetanus is extremely high order 50 mg penegra with visa, and active immunization to the mother will pro- vide protection to the neonate in the range of 80–95 percent or greater if the mother has received at least two doses 2 weeks before delivery (Faix buy 100 mg penegra otc, 1991; Hayden et al. There are no reports of adverse fetal effects from any of these inactivated bacterial vaccines. The dose schedule recommended for hepatitis B immune globulin and for vaccina- tion is summarized in Table 2. However, several authors have recommended its use in susceptible pregnant women if it can be given within 96 h (Enders, 1985; Faix, 1991; MacGregor et al. Enders (1985) has published the most compelling data to support this recommendation. Although pregnancy is considered contraindicated in women within 3 months of receiving the rubella vaccine, the actual risk of congenital rubella syndrome from maternal vaccination would appear to be extremely small, if it exists at all (Preblud and Williams, 1985). Measles and mumps vaccines are also considered contraindicated during pregnancy, although pooled immune globulin (0. Obviously the benefits of rabies vaccination (considering the high mortality of rabies of nearly 100 percent) far outweigh any theoretical risk to the fetus, which is actually unknown. Although influenza vaccines are not routinely recommended for all pregnant women, they may be efficacious in cer- tain pregnant women with significant medical complications. The physician is concerned with whether a specific medication is safe for the fetus, remaining cognizant that most car- diac medications are chronically used to treat life-threatening conditions, and that these therapeutics cannot be discontinued when pregnancy is first diagnosed (Little and Gilstrap, 1989). Hence, embryos/fetuses of women with cardiovascular disease are exposed to these medications during the critical period of organogenesis (i. Since heart disease may be inherited in a multifactorial or polygenic fashion, pregnant women with many forms of heart disease may give birth to a newborn with congenital heart disease, and this mal- formation may in turn be blamed by both the patient and her attorney on specific car- diac medications. Scientific studies regarding the efficacy and safety of most cardiac medications during pregnancy are not conclusive, but the life-threatening nature of cardiovascular disease mandates that treatment be provided, even during pregnancy. The few investigations that are available indicate that dose and timing adjustment may be necessary because of (1) decreased drug serum concentrations (Cmax and steady state); (2) decreased half-life; and (3) increased clearance (Table 3. Cardiovascular medications may be classified into several categories: antiarrhythmic, cardiac glycosides, anticoagulants, diuretics, antihypertensives, and antianginals. This classification may prove useful in predicting both the efficacy and the toxicity of a specific agent (Brown and Wendel, 1989). Antiarrhythmics have been classified into six classes according to their major mode of action or effect (Vaughan Williams, 1984), as shown in Tables 3. Lidocaine Commonly used as an amide local anesthetic, lidocaine is also effective in the treatment of ventricular and supraventricular tachycardias. Lidocaine rapidly crosses the placenta and fetal levels reach about 50 percent of maternal levels within less than an hour 54 Cardiovascular drugs during pregnancy (Rotmensch et al. Lidocaine’s half-life is twice as long in the fetus/neonate (3 h) than in the mother (1. Importantly, most information available regarding pharmacokinetics of lidocaine in pregnant and postpartum women and newborns is from studies of regional or local anesthesia (Rotmensch et al. No published data are available on lidocaine from women who received the drug for cardiac arrhythmias. However, local anesthetics given in toxic doses may result in central nervous system and cardiac side effects in both the mother and the fetus. Lidocaine is not known to be ter- atogenic at acute therapeutic levels in humans or in chronic doses in animals (Fujinaga and Mazze, 1986; Heinonen et al. Toxicity risk is mini- mal when maternal lidocaine levels are maintained at less than 4 mg/mL (Bhagwat and Engel, 1995). Amide-type local anesthetics given for paracervical block are associated with spasm of the uterine arteries, causing decreased uterine blood flow. Procainamide Another amide compound, procainamide, is used to treat ventricular tachycardia. There is little information regarding the pharmacokinetics of this drug during pregnancy. However, it has been estimated that fetal levels are approximately one-fourth the mater- nal levels (Garite and Briggs, 1987). Scientific evidence of the safety of procainamide for use during pregnancy does not address possible human teratogenicity. However, given the safety profile of a closely related drug (lidocaine), procainamide seems to not pose a great risk when used during pregnancy (Little and Gilstrap, 1989). Chronic use of this drug should be avoided, unless necessary for life-threatening conditions, because a lupus-like syndrome may occur (Rotmensch et al. Breastfeeding is not contra- indicated in mothers on procainamide (American Academy of Pediatrics, 1994). Encainide and flecainide Two other lidocaine-related antiarrhythmic medications are encainide and flecainide. Encainide was not teratogenic in rats and rabbits when given at doses up to 9 and 13 times the human dose (data from the manufacturer’s insert). Flecainide has been reported to cause teratogenic and embryotoxic effects in some species of rabbits when given in doses four times the usual adult dose. It was not, however, teratogenic in rats, mice, and other species of rabbits when given in the usual adult dose, according to its manufacturer. Flecainide has been used to treat fetal arrhythmias, but fetal deaths have occurred with this treatment. Given the alternative related medications available, fle- cainide should be avoided, or at least the drug of last resort when others have failed. Tocainide Tocainide is another amide antiarrhythmic agent, closely related to lidocaine. It was not teratogenic in animals at doses several times the usual adult dose, but it may be embry- otoxic. There are no human studies during pregnancy, but it is closely related to lido- caine and its data may be extrapolated to tocainide. Antiarrhythmics 55 Disopyramide Similar in action to quinidine, disopyramide is used to treat supraventricular and ven- tricular arrhythmias. Dysopyramide crosses the placenta readily, with fetal levels approximately half those of the mother (Rotmensch et al. The drug was embryo- toxic in laboratory animals when given at several times the human dose, but no pattern or specific malformations were noted (data from the manufacturer’s insert). Disopyramide use during the third trimester has been associated with premature onset of labor (Leonard et al. Bretylium This drug is primarily indicated for life-threatening ventricular arrhythmias, such as ven- tricular tachycardia and ventricular fibrillation. Bretylium was reported to be ‘without effect’ in one rat study published by West (1962). Amiodarone This drug is used primarily to treat life-threatening ventricular arrhythmias (e. Amiodarone has limited ability to cross the placenta, with newborn concentrations reaching only 10–25 percent of maternal serum levels (Rotmensch et al.

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Injection/infusion-related: Local: Administration site reactions purchase 100 mg penegra with amex, particularly with prolonged infusion purchase penegra 100mg fast delivery. Other: Nausea discount penegra 50 mg without prescription, vomiting order penegra 100mg fast delivery, abdominal pain, flatulence, diarrhoea, constipation, headache, dry mouth, peripheral oedema, dizziness, sleep disturbances, fatigue, paraesthesia, arthralgia, myalgia, rash, and pruritus. Esomeprazole overdose is extensively plasma protein bound and is therefore not readily dialysable. This assessment is based on the full range of preparation and administration options described in the monograph. Etanercept 25-mg dry powder vials with solvent; 25-mg and 50-mg pre-filled syringes; 50-mg pre-filled pens * Etanercept is a cytokine modulator; it must only be used under specialist supervision. Pre-treatment checks * Do notgiveifthepatient hasanyactiveinfectionsincludingchronicorlocalisedinfections;record results on a patient alert card. There is a risk of false-negative tuberculin skin test results in patients who are severely ill or immunocompromised. Alternatively, 50mg may be given twice weekly for a maximum of 12 weeks followed, if required, by 25mg twice weekly or 50mg once weekly. For all presentations: Either withdraw the required dose or select the appropriate pre-filled syringe. Do not remove the needle cover on pre-filled syringes until room temperature is reached. Technical information Incompatible with Not relevant Compatible with Not relevant pH Not relevant Sodium content Negligible Excipients Pre-prepared solutions contain L-arginine (maycause hypersensitivityreactions). Displacement value Negligible Stability after From a microbiological point of view, should be used immediately; however, preparation reconstituted vials may be stored at 2--8 C for a maximum of 6 hours. Monitoring Measure Frequency Rationale Injection-site Post injection * Reactions including bleeding, bruising, erythema, itching, reactions pain, and swelling have been commonly reported. Infections During and after * Serious infections including tuberculosis may occur. Additional information Common and serious Injection-related: Local: Injection-site reactions including bleeding, bruising, undesirable effects erythema, itching, pain, swelling. Other: Infections (including upper respiratory tract infections, bronchitis, cystitis, skin infections), pruritus. This assessment is based on the full range of preparation and administration options described in the monograph. Ethanolam ine oleate (m onoethanolam ine oleate) 5% solution in 2-mL and 5-mL ampoules * Ethanolamine oleate is a sclerosing agent that, when injected into a vein, irritates the endothe- lium, resulting in thrombus formation and occlusion of the vein. Pre-treatment checks * Do not give in local or systemic infection, marked arterial or cardiac disease or severe renal impairment. Treatment may be given in the initial management of bleeding varices, then repeated at intervals (usually after 1 week, 6 weeks, 3 months and 6 months as indicated) until all varices are occluded. Slowly inject the prepared volume of solution into affected section(s) of varicose vein, or into oesophageal varix/varices, taking care not to leak solution into surrounding tissue (extravasation may cause necrosis of tissues, and there is a risk of sloughing and ulceration). Ethanolamine oleate | 331 Technical information Incompatible with Not relevant Compatible with Not relevant pH 8--9 Sodium content Nil Excipients Contains benzyl alcohol (must not be used in neonates). Monitoring Measure Frequency Rationale Observation of During injection and in * Extravasation may cause tissue damage, injection site immediate post-injection and potentially necrosis. Endoscopy Every 3--6 months or as * Monitor for recurrent bleeding, effective (for oesophageal indicated. Renal function Regular intervals * Acute nephrotoxicity reported in overdose -- throughout treatment monitor trends in renal function from baseline. Additional information Common and serious Immediate: Allergic reactions and anaphylaxis have been reported following undesirable effects use of sclerosing agents. Injection-related: Local: Extravasation can cause sloughing, ulceration, necrosis. Pharmacokinetics Systemic absorption is not expected, as ethanolamine oleate is a locally acting agent. Counselling Report injection site reactions, in order to detect tissue damage at earliest possible opportunity. This assessment is based on the full range of preparation and administration options described in the monograph. Exenatide 5 micrograms/dose and 10 micrograms/dose solution in pre-filled pen * Exenatide is a synthetic form of exendin-4, a 39-amino-acid peptide isolated from the venom of the Gila monster lizard. It is an incretin mimetic that "insulin secretion, #glucagon secretion, and slows gastric emptying. Pre-treatment checks * Do not use in type 1 diabetes mellitus or for the treatment of diabetic ketoacidosis. The dose can then be increased to 10 micrograms twice daily to further improve glycae- mic control. The solution should be clear and colourless, do not use if cloudy or discoloured or if particles are present. Although not specifically recommended by the manufacturer, it would be wise to vary the site of the injection. Technical information Incompatible with Not relevant Compatible with Not relevant pH Not relevant Sodium content Negligible Excipients Contains metacresol which may cause hypersensitivity reactions. Monitoring Measure Frequency Rationale Hypersensitivity At the start of * May very rarely cause hypersensitivity reactions reactions treatment including anaphylaxis. Capillary blood As clinically * Has caused hypoglycaemia with concomitant glucose appropriate sulfonylurea therapy. Action in case of Symptoms to watch for: Severe nausea, severe vomiting and rapidly declining overdose blood glucose concentrations. Counselling Use and storage of pens, disposal of pen and needles, discard pens that have been frozen. Warn about the "risk of hypoglycaemia at the start of therapy in patients being treated with a sulfonylurea. Warn about timing of concomitant antibiotic therapy and other medication if appropriate. This assessment is based on the full range of preparation and administration options described in the monograph. Fentanyl | 335 Fentanyl 50 micrograms/mL solution in 2-mL and 10-mL ampoules * Fentanyl citrate is a potent opioid analgesic chemically related to pethidine. Pre-treatment checks * Avoid in patients with respiratory depression or obstructive airways disease. Assisted respiration: initially 300--3500 micrograms followed by further doses of 100--200 micro- grams adjusted according to response. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present. Withdraw the required dose and add to a suitable volume of compatible infusion solution. Inspect visually for particulate matter or discolor- ation prior to administration and discard if present.

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