Trying to Conceive? Here’s the Difference Between IUI and IVF.

Updated on Dec 6, 2024 | Your Health

If you have been trying to conceive for some time and are considering fertility treatment, you may have been told about the options of intrauterine insemination (IUI) and in vitro fertilization (IVF).

In this Q&A, Devora Aharon, MD, reproductive endocrinologist and infertility specialist at RMA of New York, explains the advantages of each approach and how to choose the path that is right for you. RMA of New York is the Division of Reproductive Endocrinology and Infertility for the Department of Obstetrics, Gynecology and Reproductive Science at Mount Sinai Health System.

What is IUI?

Devora Aharon, MD

IUI involves preparing a concentrated sample of sperm that is inserted into the top of the uterus using a soft catheter. This brings the sperm in closer proximity to the egg to fertilize it, bypassing some of the barriers in the vagina and cervix. IUI is timed around ovulation, but for patients who do not ovulate regularly, oral medication may be used to augment your chances of success. In you ovulate monthly, these medications may cause multiple eggs to be released, increasing the chance that at least one egg will be healthy and result in pregnancy.

What is IVF?

IVF involves the use of injection medication for 1½ to 2 weeks to stimulate the ovaries to mature multiple eggs in one cycle. The eggs are extracted through a vaginal egg retrieval procedure under anesthesia and then fertilized with sperm to form embryos. The embryos can be biopsied to test for chromosomal abnormalities or specific genetic conditions before being frozen. In the same or subsequent cycle, the uterus is prepared for embryo implantation using estrogen and progesterone.

 

What are advantages of IUI vs. IVF?

From a practical perspective, an IUI cycle involves fewer medications and visits for monitoring and does not involve a procedure under anesthesia. However, IVF has a higher chance of success compared to IUI. Moreover, more than one healthy embryo is often created from one IVF cycle. All of these embryos can be tested and frozen for future use when age may present a greater barrier.

 What are specific situations in which one might choose IUI vs. IVF?

Depending on your individual diagnosis and personal circumstances, there are important factors to consider when choosing between IUI and IVF to build your family. While the following is not an exhaustive list, below are diagnoses and factors that might lead one to choose IUI or IVF: 

  • Male factor infertility: If sperm counts are low, IUI can help give sperm a boost and increase chances of pregnancy. If sperm counts are extremely low, IUI is less likely to work and IVF is typically recommended. 
  • Tubal factor infertility: If the fallopian tubes are blocked or abnormal, IVF is needed to bypass the tubes. 
  • Polycystic ovary syndrome (PCOS): Many patients with PCOS do not ovulate regularly. Oral medications can induce ovulation, and intercourse or IUI timed around ovulation can be effective in achieving pregnancy. IVF is also effective in patients with PCOS because these patients often have a high ovarian reserve, which can lead to a high response to ovarian stimulation.
  • Advanced reproductive age: Pregnancy becomes more difficult to achieve in your late 30s and 40s due to decreases in the quality and quantity of eggs. IVF with preimplantation genetic testing can help identify normal embryos that have a high chance of achieving a healthy pregnancy. 
  • Using sperm donation, egg donation, or surrogacy: Patients using a sperm donor will often start with IUI, especially if the patient does not have an underlying diagnosis of infertility. However, even in these cases, IVF can increase chances of achieving a healthy pregnancy sooner. Egg donors will undergo ovarian stimulation and egg retrieval, and the eggs will be fertilized with sperm and then transferred to a patient’s uterus or that of a gestational carrier. Patients using a gestational carrier with their own eggs will undergo ovarian stimulation and egg retrieval before the eggs are fertilized with partner or donor sperm, and an embryo will be transferred into the uterus of the gestational carrier.

The choice to undergo IUI or IVF is highly personalized based on individual factors like your age, diagnoses, timeline, and desired family size.

Learn more about your options or make an appointment with a reproductive specialist at RMA of New York
Learn more about Reproductive Endocrinology and Infertility services at Mount Sinai

Ten Holiday Wellness Tips From Mount Sinai

Nov 28, 2024 | Mental Health, Your Health

The holidays are a joyous time. But they can also be a very busy time, which can cause us to overlook the things we should be grateful for, the simple pleasures of life, and the importance of our health and well-being. Here are 10 holiday wellness tips from Mount Sinai Fit, whose staff of nutritionists—all certified diabetes educators—work year round to support the wellness of Mount Sinai employees and patients and help them to achieve their health goals. 

Express Gratitude

Take a moment to reflect on your relationships with family, friends, and colleagues and all that is positive in your life. As you prepare for the holidays, set your intention to approach each celebration with gratitude, less stress, and greater happiness. Many experts believe that feeling grateful and expressing gratitude is beneficial to your health.

Celebrate Together, in Person or Virtually

This year, some of us may not be able to be with family and friends to celebrate the holidays in large gatherings. Consider sharing a recipe with them to make in their homes, and enjoy it together virtually.

Scale Back

It is okay to scale back your menus, to reduce food waste and not feel obligated to eat leftovers for days. Consider making fewer dishes, or try healthy alternatives, like a whole roasted cauliflower head as the main course or as a side dish. Use the holidays to try something new and seasonal for you.

Follow the One Plate Rule

Put the one plate rule into practice by implementing mindful eating. Enjoying your food and eating slowly. Take time in between bites to drink water and catch up with friends or family. Practicing mindful eating and portion control is one of the best ways you can allow yourself some indulgences while sticking to your eating plan.

Eat Vegetables

Fill at least half of your plate with non-starchy vegetables such as salad, other greens, and roasted vegetables. These healthy options will add volume, fiber, vitamins, and minerals to your meal. You will still have room, but less room, on your plate for other types of dishes. Roasting cauliflower, broccoli, butternut or delicata squash or carrots are delicious, healthy and satisfying.  After they are roasted, they can be pureed with some olive oil and serve a nice substitution for mashed potatoes.

Keep Dessert to a Few Bites

Desserts can tack on a large amount of calories, fat, and sugar. Enjoy just a few bites of your favorite sweet treats and take a moment to savor them. Take time to appreciate the flavor and feel satisfied.

Drink Wisely

Sweet cocktails and beverages such as juice and soda are high in calories and sugar, which can increase blood sugar. Why not choose beverages such as seltzer, water or unsweetened iced tea to quench your thirst?

Move

Exercise and movement help to burn calories, improve blood sugar levels, increase energy and boost your mood. Plan to get in at least 30 minutes of activity each day. Invite family or friends to take a walk with you after each holiday meal.

Listen to Your Body

Eat slowly so that you notice when you are satisfied. Once you feel you are getting full, put down your fork and save the remaining contents of your dish for leftovers. Your body will feel better and you will be happy with your choices.

When Invited, Bring Your Own Healthy Dish (BYOHD)

Why not bring a healthy dish to share with your host and other guests? Everyone will appreciate your thoughtfulness.

 

Download a copy of the wellness tips to share with friends and family
Get more healthy eating tips from Mount Sinai
Learn More About Helping Kids Express Gratitude

Three Things You Need to Know About Lung Cancer

Nov 25, 2024 | Featured, Your Health

True or false: Lung cancer only affects those who have smoked a long time. The answer: False.

The actual connection between smoking and lung cancer is one of three key takeaways about lung cancer from the experts at Mount Sinai.

  • Smoking is the leading cause of lung cancer, but not the only cause. Smoking is responsible for about 80 to 90 percent of lung cancer cases. But a growing number of nonsmokers are being diagnosed with lung cancer. The risk of lung cancer increases with the number of cigarettes smoked and how long someone has smoked. For non-smokers, a family history, secondhand smoke and exposure to chemicals like radon and asbestos can increase the risk of lung cancer.
  • Lung cancer is the leading cause of cancer deaths. Lung cancer is the leading cause of cancer-related deaths worldwide, and is the deadliest type of cancer for both men and women.
  • Early diagnosis is important. Lung cancer is often diagnosed at advanced stages, when treatment options are limited. Early diagnosis can make a big difference in survival rates.

The symptoms of lung cancer are the same whether or not you have smoked. Some people have general symptoms of not feeling well or feeling tired all the time, according to the Centers for Disease Control and Prevention. Some people cough frequently, cough up blood, or have chest pain, wheezing, or shortness of breath. These symptoms can happen with other illnesses. If you have any of these symptoms, talk to your doctor, who can help find the cause.

Here are more important updates on lung cancer prevention and treatment from the Center of Excellence for Thoracic Oncology, led by co-directors Fred R. Hirsch, MD, PhD, and Andrew J Kaufman, MD, and the entire team at Mount Sinai Health System have vast experience researching, detecting, and treating lung cancers.

These experts note a number of important developments in the field, including improved cure rates thanks to early detection of lung cancer through low-dose computed tomography (CT) scans and by raising awareness of lung cancer risk in “never smokers.” Artificial intelligence (AI) technology is helping to find lung cancer earlier and more accurately, while a recent study points to disparities in lung cancer testing.

Cure Rate From Early Detection

Research led by Claudia Henschke, MD, PhD, Professor of Diagnostic, Molecular and Interventional Radiology and Director of the Early Lung and Cardiac Action Program (ELCAP) at the Icahn School of Medicine at Mount Sinai, indicates that early detection works. In a multi-decade study (1992-2022) involving more than 31,000 people, those who detected lung cancer early through low-dose CT scans had an 81 percent survival rate after 20 years. The average five-year survival rate for all lung cancer patients is 28 percent, according to the American Cancer Society. However, only 23 percent of lung cancers are diagnosed at an early stage.

“Early detection is crucial in the fight against lung cancer,” said Dr. Henschke. “Our research shows that annual low-dose CT screening significantly increases survival rates by identifying cancers at their most treatable stages. We encourage individuals, especially those at higher risk, to take advantage of these screening opportunities.”

Lung Cancer in Never Smokers

According to the American Cancer Society, up to 20 percent of lung cancer cases occur in people who have never smoked. This fact helps us understand that lung cancer can affect anyone, not just smokers. Factors like exposure to secondhand smoke, radon, air pollution, asbestos, or a family history of lung cancer may increase your risk of lung cancer. Researchers estimate that second-hand smoke contributes to about 7,300 and radon to about 2,900 of these cases. Mount Sinai offers a program that allows individuals 40 and older to be screened even if they have little to no smoking history.

“Lung cancer is often associated with smoking, but it’s important to recognize that it can develop in people who have never smoked or have smoked very little—fewer than 100 cigarettes in their lifetime,” said Raja Flores, MD, Chair of Thoracic Surgery at the Mount Sinai Health System. “In fact, about 10-20 percent of lung cancers in the United States occur in individuals who have never smoked. Lung Cancer Awareness Month is an important time to highlight that many factors beyond smoking influence an individual’s lifetime risk for lung cancer. We need education about exposure and subsequent access to testing to improve early detection in all populations, regardless of smoking history.”

Using Artificial Intelligence (AI) in Screening

Icahn Mount Sinai is advancing the use of AI technology to find lung cancer earlier and more accurately. Recently developed by the I-ELCAP team, the Open Source Automated Image Reading System (AIRS) will analyze CT scans to spot nodules that might be missed by the human eye and assess a patient’s risk for lung cancer based on their medical history and other factors. Designed as a future “rule out” tool for annual repeat and follow-up low-dose CT scans, AIRS is expected to cut radiologists’ reading time by approximately 85 percent.

“Artificial intelligence is revolutionizing the way we approach lung cancer screening. By enhancing the analysis of CT scans, AI can help us detect growths earlier and more accurately than ever before,” said David F. Yankelevitz, MD, Director of the Lung Biopsy Service at Icahn Mount Sinai. “This technology is a tool not only to improve diagnostic precision but also to allow us to tailor screening protocols to individual patients, ultimately leading to better outcomes and survival rates.”

Disparities in Lung Cancer Testing

A recent Mount Sinai study found that people with lung cancer face significant differences in getting important tests based on their race and income. This study, led by Emanuela Taioli, MD, PhD, and her team at the Institute for Translational Epidemiology at Icahn Mount Sinai, identifies a serious concern in cancer care.

“The results of this study are important because they show that if we can fix these gaps in testing, more people will be able to get the treatments they need and improve their chances of survival,” said Dr. Taioli. “For doctors, this means they need to make sure that everyone has equal access to these important tests. For patients, especially those from lower-income or minority backgrounds, it means there’s a need for better access to treatments that can improve their health and improve their chances of survival.”

Accessing Care at Mount Sinai

Mount Sinai has broad experience with a variety of diagnostic tools and some of the most advanced treatment options in the New York City area. Here are a few of our locations across New York City and Long Island:

  • Mount Sinai Brooklyn, 3201 Kings Highway, Brooklyn, NY
  • Lung and Thoracic Cancer Services at The Mount Sinai Hospital, 1190 Fifth Avenue

For more information, please visit www.mountsinai.org/lungcancer

Am I Getting Enough Vitamin D?

Updated on Nov 26, 2024 | Diet and Nutrition, Your Health

Vitamin D plays a crucial role in calcium absorption and bone health. Because we get most of our vitamin D from the sun, many people develop an insufficiency in the colder months. For older women at risk for osteoporosis, it is vital to ensure you are getting enough of this nutrient.

In this Q&A, Christopher Anthony Gold, DO, Assistant Professor, Medicine (General Internal Medicine), Icahn School of Medicine at Mount Sinai, explains why vitamin D is important and how to make sure you are getting enough.

Why is vitamin D important?

Vitamin D helps calcium absorb into your bones, which keeps them strong and healthy. This prevents bone diseases like osteoporosis, especially in menopausal and postmenopausal women. Vitamin D plays other important roles, such as assisting with your immune system and muscle function, and protecting the brain and central nervous system. It has some anti-inflammatory effects, and there is some small evidence that suggests high levels of vitamin D may decrease your risk for insulin resistance, potentially decreasing your risk for prediabetes or diabetes.

How much vitamin D do I need?

Vitamin D deficiency is not as common in the United States, though some studies suggest up to 25 percent of certain patient populations can be deficient. Vitamin D insufficiency, however, is more common, and can be seen in up to 30-40 percent of the population in some studies. To prevent this, the National Academy of Medicine recommends getting at least 600 international units (IU), or 15 micrograms (mcg), a day for adults under age 70, and 800 for those over age 70, through sun exposure, food, and/or supplements. If you live in a region with less sunlight, you should get at least 600 and up to 1,000 IU (15-25 mcg) of vitamin D a day. Menopausal and postmenopausal women should aim for at least 800 IU (20 mcg) a day and should pair vitamin D with 1,000 to 1,200 milligrams of calcium.

Keep in mind that too much vitamin D can lead to toxicity, but this is rare. The safe upper limit is defined as 4,000 IU a day (100 mcg).

What causes vitamin D insufficiency?

Lack of sunlight is the main cause in most cases. It can also be caused by not getting enough vitamin D-rich foods and supplements, especially in the winter. Aging also increases your risk because your skin has more difficulty synthesizing vitamin D from sunlight as you get older. Certain medical conditions, such as obesity, also increase your risk.

What are the symptoms of vitamin D insufficiency and deficiency?

Many people with vitamin D insufficiency do not have any symptoms, but some people may experience muscle weakness, bone pain, and fatigue. These could be signs that you have developed a vitamin D deficiency, which leads to bone disorders.

Quick tips to get more vitamin D:

  • Get 600 to 1,000 IU/15-25 mcg of vitamin D a day (depending on your age, medical conditions, and region)
  • Spend between 5-30 minutes a day in the sun between 10 am and 4 pm without sunscreen
  • Eat vitamin D-rich foods like wild salmon and foods that are fortified
  • Take vitamin D supplements

Who is most at risk?

Those most at risk include:

  • Older people
  • People with darker skin
  • People who live in northern regions with less sunlight
  • People with obesity
  • People who spend a lot of time indoors
  • People with certain medical conditions, such as osteoporosis, hyperparathyroidism, celiac disease, and inflammatory bowel disease

One serving of wild salmon meets the daily requirement of vitamin D for most adults under age 70

How can I make sure I’m getting enough vitamin D, especially in the winter?

The National Institutes of Health suggests getting 5-30 minutes of sun exposure a day between 10 am and 4 pm without sunscreen. Keep in mind that getting too much sun can damage your skin and increase your risk for skin cancer.

In terms of diet, there are foods that are naturally higher in vitamin D. These include fatty fish, such as salmon, tuna, and mackerel. One serving of wild salmon—about three and a half ounces—contains about 600 IU, or 15 mcg, of vitamin D, which meets the daily intake requirement for most adults under age 70. Other sources include mushrooms and eggs, especially in the yolks. Some foods are supplemented and fortified with vitamin D in the United States, including milk, orange juice, yogurts, and some cereals. In terms of supplements, vitamin D2 and D3 are both great. Some research suggests that vitamin D3 may be a little more beneficial.

What should I do if I suspect my vitamin D levels are low?

If you suspect you are insufficient in any nutrient, you should talk to your primary care provider.

Schedule an appointment with a primary care doctor

Three Healthy Holiday Dessert Recipes

Updated on Nov 18, 2024 | Recipes, Your Health

The holidays are a time to enjoy some sweets with friends and family. These festive dessert recipes include some nutritious ingredients for those who want healthier alternatives. Enjoy!

Gozinaki, Georgian Honey Walnut Brittle

Ingredients:

3 cups of raw walnuts (or other nuts, such as hazelnuts)
1 cup of good quality natural honey
1 tablespoon of sugar

Preparation:
Toast the walnuts in an ungreased pan on low heat. Stir them occasionally to avoid burning until the edges become a golden color. Set aside. When cool, remove husks by hand and chop the walnuts into very small pieces. Set aside.

Pour the honey into a thick-bottomed pan on low heat, stirring a few times with a wooden spoon. Bring to a boil and stir constantly to avoid burning. The honey should boil for 8 to 10 minutes before adding the sugar for texture. Continue stirring for an additional 2 to 3 minutes to reduce and thicken slightly.

Turn off the heat and add the chopped walnuts. Mix to fully incorporate the walnuts.

Moisten a wooden cutting board and wooden spoon with water. Pour the honey-walnut mixture onto moist board. Using the moist spoon, spread the mixture into a half-inch rectangular. Let it cool for 10 to 15 minutes. Cut the brittle into 2-inch diamond shapes or other shapes. Do not refrigerate the brittle; keep at room temperature. The brittle is best if eaten within a week.

25 servings, approximately 2” each
105 calories per piece

Gozinaki is a traditional dessert and snack from the country of Georgia. My mom made this for us on New Year’s Eve to symbolize the hopes and wishes for a sweet and healthy new year ahead. She instilled in me the love for cooking and appreciation for good quality ingredients. Now I make and enjoy Gozinaki all year round and I serve it on both the January first New Year’s day and the “old” New Year, celebrated on January 14 in Georgia.
– Ekaterine, Senior Immigration Specialist

Date and Nut Rolls—No Sugar Added

Ingredients
1 teaspoon butter, plus more for hands
1 cup dates, pitted and chopped
1/2 cup almonds, chopped
1/2 cup cashews, chopped
1/4 cup pistachios, shelled and chopped
Pinch of cardamom powder (optional)
Pinch of saffron (optional)
2 tablespoons coconut, coarsely chopped

PREPARATION

Place the butter and chopped dates into a frying pan over medium heat. Mix continuously until soft. Remove from the heat. Add the almonds, cashews, pistachios to the dates along with the cardamom and saffron to enhance the flavor if you are using. Mix well while dates are still warm. You may use your hands for the best results. Once mixed, divide the mixture in half with your hands coated with a bit of butter. Place the two halves on a cutting board and roll into two long logs.

Spread the coconut on the cutting board and roll each long in the coconut to cover. Wrap each in plastic and refrigerate for 2 hours. Once chilled, unwrap, place on the cutting board and slice each log into half-inch slices.

Nutritional Information for Entire Recipe
Approximately 1,431 calories
Carbohydrates: 144.8 grams
Fat: 78.6 grams
Protein: 33 grams

When we celebrate Diwali, I make these rolls as it is a sweet with simple and natural ingredients that gets its sweetness from the dates and no sugar. Our guests as well as my family members love them.
–Punita, Finance Manager, Network Operations, Corporate Office

Avocado Chocolate Cake

Ingredients:

1 cup of whole wheat pastry flour
6 tablespoons of cacao or unsweetened cocoa powder
1/2 teaspoon of baking soda
1/2 teaspoon of salt
3/4 cup of granulated sugar
1/2 cup of mini chocolate chips, optional
1/4 cup of yogurt
3/4 cup of water
1/4 cup of avocado, mashed
2 teaspoon of pure vanilla extract

Preparation:

Preheat oven to 350°F.

Grease an eight-inch square or round pan. Set aside.

In a large bowl, combine the flour, cocoa powder, baking soda, salt, sugar, and chocolate chips if using, and stir very well.

In a separate bowl, whisk together all remaining wet ingredients.

Pour wet into dry, and stir until just combined, being sure not to over-mix. Pour the batter into the greased pan.

Bake 25 minutes or until batter has risen and a toothpick inserted into the center of the cake comes out clean.

Refrigerate for at least 30 minutes before serving.

Makes 8 Servings
221 calories per serving

Recipe submitted by Jane Maksoud, Senior Vice President, Chief Human Resources Officer, Mount Sinai Health System

Click here for more healthy recipes in Mount Sinai's Calm & Fit Wellness Cookbook

Your Guide to Helping Kids Manage Diabetes

Updated on Nov 14, 2024 | Your Health

Just because your child has diabetes doesn’t mean they can’t live a normal life.

Diabetes is a chronic disease in which the body cannot regulate the amount of sugar in the blood. In the United States, about 30 million people, or 9 percent of the population, has been diagnosed with diabetes, which includes about 350,000 children and adolescents under 20 years old, according to the U.S. Centers for Disease Control and Prevention.

Meredith Wilkes, MD

There are two types of diabetes. In type 1 diabetes, the pancreas doesn’t make insulin, and in type 2 diabetes, the pancreas makes insulin, but the cells don’t respond to it as they should, meaning there is insulin resistance.

No matter the type of diabetes your child may have, there are many steps you can take to help them manage their condition and support, according to Meredith Wilkes, MD, Medical Director of Pediatric Diabetes at the Comprehensive Diabetes Care Clinic at Mount Sinai Kravis Children’s Hospital. She shares her key tips and insights.

A Checklist: Eight Ways You Can Help Your Child Manage Diabetes:

  • Check their blood sugar levels daily at mealtime and at bedtime.
  • Maintain a healthy diet and weight.
  • Exercise and participate in physical activity.
  • Make sure to administer insulin injections or other diabetes medicines as needed.
  • Eat main meals on time and eat snacks at certain times, and make sure to have plenty of time to finish each meal or snack.
  • Keep an eye out for high or low blood sugar and treat the level as needed.
  • Have them drink water regularly and have access to water.
  • Always have access to a bathroom and make time for bathroom breaks.

Together with family, friends, teachers and others in your community, there are ways you can support your child. Here are some tips from Dr. Wilkes:

Be positive. Although diabetes is a chronic disease, it should not define your child. Keep a positive mindset and allow your child to learn about the condition as they grow and develop. Let them play with friends and attend birthday parties. Let them grow and aspire from the situation and turn the challenges into great possibilities and opportunities. Don’t let diabetes impede their future and their dreams.

Ask siblings, family members, and teachers to help. Educate those who offer care to your child and make sure they understand your child’s condition, treatment plan, and what do to in case of an  emergency. When everyone in your circle understands and is educated about your child’s condition, you will feel comfortable and more relieved when they are taking care of your child. Engaging siblings, especially with simple tasks, will help empower them and help them feel closer to their brother or sister.

Embrace technology. The technology available today to treat diabetes is there to make your life easier, to help you and your child feel more at ease, and to offer flexibility to help you live a normal life. Keep an open mind and enjoy the positive features. For example, the insulin pump offers improved blood sugar control, and eliminates manual injections and finger pricks.

Connect with others and participate in support groups. Try to connect with other families who have kids living with diabetes so you can share experiences. This can provide a support circle for you and your family, which can help reduce stress, and allow you to learn and share information with others.

If you have questions or if you are concerned that your child may have diabetes, call 212-241-6936.

The Comprehensive Diabetes Care Center at Mount Sinai Kravis Children’s Hospital is designed to provide families with the tools and support to help navigate life with diabetes. The Center cares for children with all forms of diabetes including type 1 diabetes, medication-induced diabetes, atypical diabetes, and cystic fibrosis-related diabetes. The Center’s multidisciplinary team of providers consists of pediatric endocrinologists, nurse practitioners, a social worker, a dietician, a psychologist and an ophthalmologist. Patients are encouraged to see multiple providers at each visit, ensuring you receive individualized care for your child. The Center cares for children with type 2 diabetes who require insulin, however, parents are encouraged to take their children with type 2 diabetes to the Healthy Lifestyle Clinic

 

Learn more about the Comprehensive Diabetes Care Center
Learn more about Pediatrics at Mount Sinai

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