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Sanchez-Rodriguez, D., Annweiler, C. & Cederholm, T. (2019). A translational approach for the clinical application of recently updated definitions of malnutrition (GLIM) and sarcopenia (EWGSOP2). Maturitas, 122, 89-90
Open this publication in new window or tab >>A translational approach for the clinical application of recently updated definitions of malnutrition (GLIM) and sarcopenia (EWGSOP2)
2019 (English)In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 122, p. 89-90Article in journal, Editorial material (Other academic) Published
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-380665 (URN)10.1016/j.maturitas.2018.11.013 (DOI)000461403200014 ()30497786 (PubMedID)
Available from: 2019-04-01 Created: 2019-04-01 Last updated: 2019-04-01Bibliographically approved
van Egmond, L., Tan, X., Sjögren, P., Cederholm, T. & Benedict, C. (2019). Association between Healthy Dietary Patterns and Self-Reported Sleep Disturbances in Older Men: The ULSAM Study. Nutrients, 11(5), Article ID 1029.
Open this publication in new window or tab >>Association between Healthy Dietary Patterns and Self-Reported Sleep Disturbances in Older Men: The ULSAM Study
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2019 (English)In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 11, no 5, article id 1029Article in journal (Refereed) Published
Abstract [en]

To date, little is known about how dietary patterns may link to measures of sleep quality in older subjects, who often suffer from sleep problems. Here, we investigated, in an older male population from Sweden (n = 970; aged 71 +/- 1 year), whether adherence to the Healthy Diet Indicator (HDI; based on recommendations from the World Health Organization) or the Mediterranean Diet (MD) is linked to sleep disturbances. The diet scores were calculated using a seven-day food diary, and self-reported sleep initiation or maintenance problems were assessed by questionnaires. When adjusted for potential confounders, no associations between dietary scores and sleep parameters were found. In contrast, low consumption of milk and dairy products one of the dietary features of the MD was associated with better subjective sleep initiation. This association was, however, not found in men with adequate reports of daily energy intake (similar to 54% of the cohort). To summarize, our findings do not suggest that older men can mitigate perceived difficulties to fall and stay asleep by adhering to either the HDI or MD. Whether low consumption of milk and dairy products can facilitate sleep initiation must be confirmed in future studies by utilizing objective measures of sleep such as polysomnography. Finally, when investigating associations between dietary patterns and sleep, particular attention should be paid to the potential confounder of inadequate reporting of energy intake.

Place, publisher, year, edition, pages
MDPI, 2019
Keywords
mediterranean diet, healthy diet indicator, sleep problems, elderly population, dietary adherence
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-389873 (URN)10.3390/nu11051029 (DOI)000471021600089 ()31071943 (PubMedID)
Funder
Swedish Research Council, 2015-03100Novo Nordisk, NNF14OC0009349The Swedish Brain FoundationÅke Wiberg Foundation, M17-0088Fredrik och Ingrid Thurings Stiftelse, 2017-00313Swedish Society for Medical Research (SSMF)
Available from: 2019-07-31 Created: 2019-07-31 Last updated: 2019-07-31Bibliographically approved
Volkert, D., Kiesswetter, E., Cederholm, T., Donini, L. M., Egiseer, D., Norman, K., . . . Visser, M. (2019). Development of a Model on Determinants of Malnutrition in Aged Persons: A MaNuEL Project. Gerontology and geriatric medicine, 5
Open this publication in new window or tab >>Development of a Model on Determinants of Malnutrition in Aged Persons: A MaNuEL Project
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2019 (English)In: Gerontology and geriatric medicine, E-ISSN 2333-7214, Vol. 5Article in journal (Refereed) Published
Abstract [en]

In older persons, the origin of malnutrition is often multifactorial with a multitude of factors involved. Presently, a common understanding about potential causes and their mode of action is lacking, and a consensus on the theoretical framework on the etiology of malnutrition does not exist. Within the European Knowledge Hub "Malnutrition in the Elderly (MaNuEL)," a model of "Determinants of Malnutrition in Aged Persons" (DoMAP) was developed in a multistage consensus process with live meetings and written feedback (modified Delphi process) by a multiprofessional group of 33 experts in geriatric nutrition. DoMAP consists of three triangle-shaped levels with malnutrition in the center, surrounded by the three principal conditions through which malnutrition develops in the innermost level: low intake, high requirements, and impaired nutrient bioavailability. The middle level consists of factors directly causing one of these conditions, and the outermost level contains factors indirectly causing one of the three conditions through the direct factors. The DoMAP model may contribute to a common understanding about the multitude of factors involved in the etiology of malnutrition, and about potential causative mechanisms. It may serve as basis for future research and may also be helpful in clinical routine to identify persons at increased risk of malnutrition.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
older persons, malnutrition, determinants, etiology, model
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-390676 (URN)10.1177/2333721419858438 (DOI)000475379700001 ()31259204 (PubMedID)
Available from: 2019-08-15 Created: 2019-08-15 Last updated: 2019-08-15Bibliographically approved
Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Goisser, S., Hooper, L., . . . Bischoff, S. C. (2019). ESPEN guideline on clinical nutrition and hydration in geriatrics. Clinical Nutrition, 38(1), 10-47
Open this publication in new window or tab >>ESPEN guideline on clinical nutrition and hydration in geriatrics
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2019 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 38, no 1, p. 10-47Article in journal (Refereed) Published
Abstract [en]

Background: Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats.

Aim: To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons.

Methods: This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process.

Results: We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach.

Conclusion: A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.

Keywords
Guideline, Recommendations, Geriatrics, Nutritional care, Malnutrition, Dehydration
National Category
Nutrition and Dietetics Geriatrics
Identifiers
urn:nbn:se:uu:diva-382669 (URN)10.1016/j.clnu.2018.05.024 (DOI)000463462400002 ()30005900 (PubMedID)
Available from: 2019-05-07 Created: 2019-05-07 Last updated: 2019-05-07Bibliographically approved
Jensen, G. L., Cederholm, T., Correia, M. I., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., . . . Van Gossum, A. (2019). GLIM Criteria for the Diagnosis of Malnutrition: A Consensus Report From the Global Clinical Nutrition Community. JPEN - Journal of Parenteral and Enteral Nutrition, 43(1), 32-40
Open this publication in new window or tab >>GLIM Criteria for the Diagnosis of Malnutrition: A Consensus Report From the Global Clinical Nutrition Community
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2019 (English)In: JPEN - Journal of Parenteral and Enteral Nutrition, ISSN 0148-6071, E-ISSN 1941-2444, Vol. 43, no 1, p. 32-40Article in journal (Refereed) Published
Abstract [en]

Background: This initiative aims to build a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings.

Methods: The Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. Empirical consensus was reached through a series of face‐to‐face meetings, telephone conferences, and e‐mail communications.

Results: A 2‐step approach for the malnutrition diagnosis was selected, that is, first screening to identify at risk status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among GLIM participants that selected 3 phenotypic criteria (non‐volitional weight loss, low body mass index, and reduced muscle mass) and 2 etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least 1 phenotypic criterion and 1 etiologic criterion should be present. Phenotypic metrics for grading severity are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology‐related diagnosis categories.

Conclusions: A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The construct should be re‐considered every 3–5 years.

Keywords
assessment, diagnosis, malnutrition, screening
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-375844 (URN)10.1002/jpen.1440 (DOI)000455817700006 ()30175461 (PubMedID)
Note

This article is simultaneously published by The European Society for Clinical Nutrition and Metabolism in the journal Clinical Nutrition (doi: 10.1016/j.clnu.2018.08.002) and by the American Society for Parenteral and Enteral Nutrition in the Journal of Parenteral and Enteral Nutrition (doi:10.1002/jpen.1440) and will be subsequently published by The Society on Sarcopenia, Cachexia and Wasting Disorders in the Journal of Cachexia, Sarcopenia and Muscle (doi: 10.1002/jcsm.12383). Minor differences in style may appear in each publication, but the article is substantially the same in each journal.

De 2 första författarna delar förstaförfattarskapet.

Available from: 2019-02-01 Created: 2019-02-01 Last updated: 2019-05-14Bibliographically approved
Jernerén, F., Cederholm, T., Refsum, H., Smith, A. D., Turner, C., Palmblad, J., . . . Freund-Levi, Y. (2019). Homocysteine Status Modifies the Treatment Effect of Omega-3 Fatty Acids on Cognition in a Randomized Clinical Trial in Mild to Moderate Alzheimer's Disease: The OmegAD Study. Journal of Alzheimer's Disease, 69(1), 189-197
Open this publication in new window or tab >>Homocysteine Status Modifies the Treatment Effect of Omega-3 Fatty Acids on Cognition in a Randomized Clinical Trial in Mild to Moderate Alzheimer's Disease: The OmegAD Study
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2019 (English)In: Journal of Alzheimer's Disease, ISSN 1387-2877, E-ISSN 1875-8908, Vol. 69, no 1, p. 189-197Article in journal (Refereed) Published
Abstract [en]

Background: Trials of supplementation with omega-3 fatty acids (omega 3-FAs) in patients with mild cognitive impairment or Alzheimer's disease (AD) have produced inconsistent effects on cognitive decline. There is evidence of an interaction between B vitamin status and omega 3-FAs in relation to brain atrophy and cognitive decline.

Objective: We investigated whether baseline levels of plasma total homocysteine (tHcy), a marker of B vitamin status, modify the effects of omega 3-FAs supplementation on cognitive performance in moderate AD.

Methods: This post hoc analysis of the OmegAD trial included 171 community-based patients with AD (MMSE >= 15): 88 patients received daily doses of 1.7 g docosahexaenoic acid and 0.6 g eicosapentaenoic acid for 6 months. Treatment outcome on cognition was analyzed according to baseline levels of tHcy using a general linear model and ANCOVA.

Results: We found significant interactions between omega 3-FA supplementation and tHcy on cognition and clinical stage assessed by MMSE (p = 0.040), global CDR (p = 0.059), and CDRsob (p = 0.023), but not on ADAS-cog (p = 0.649). In patients with tHcy levels <11.7 mu mol/L, omega 3-FA supplementation improved cognitive performance as measured by MMSE (+7.1%, 95% CI: 0.59 to 13.7%, p = 0.033) and clinical status as measured by CDRsob (-22.3%, 95% CI: -5.8 to -38.7%, p = 0.009) compared with placebo.

Conclusion: The effect of omega 3-FA supplementation on MMSE and CDR appears to be influenced by baseline tHcy, suggesting that adequate B vitamin status is required to obtain beneficial effects of omega 3-FA on cognition.

Keywords
Alzheimer's disease, B vitamins, cognition, dementia, homocysteine, omega-3 fatty acids
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-384475 (URN)10.3233/JAD-181148 (DOI)000467519100017 ()30958356 (PubMedID)
Funder
The Swedish Brain FoundationThe Dementia Association - The National Association for the Rights of the DementedThe Karolinska Institutet's Research FoundationStiftelsen Gamla TjänarinnorÅke Wiberg Foundation, M16-0251Swedish Nutrition Foundation (SNF)Gun och Bertil Stohnes StiftelseSwedish Society of Medicine
Available from: 2019-06-11 Created: 2019-06-11 Last updated: 2019-06-11Bibliographically approved
Modig, K., Erdefelt, A., Meliner, C., Cederholm, T., Talbäck, M. & Hedström, M. (2019). "Obesity Paradox" Holds True for Patients with Hip Fracture: A Registry-Based Cohort Study. Journal of Bone and Joint Surgery. American volume, 101(10), 888-895
Open this publication in new window or tab >>"Obesity Paradox" Holds True for Patients with Hip Fracture: A Registry-Based Cohort Study
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2019 (English)In: Journal of Bone and Joint Surgery. American volume, ISSN 0021-9355, E-ISSN 1535-1386, Vol. 101, no 10, p. 888-895Article in journal (Refereed) Published
Abstract [en]

Background: Hip fractures are associated with high mortality and reduced quality of life. Studies have reported a high body mass index (BMI) as being positively associated with survival when linked to old age and some chronic diseases. This phenomenon is called the "obesity paradox." The association between BMI and survival after hip fracture has not been thoroughly studied in large samples, nor has to what extent the association is altered by comorbidities, sex, and age. The objective of this study was to investigate the association of BMI with survival after hip fracture and with the probability of returning to living at home after hip fracture.

Methods: This cohort study was based on data from a prospectively maintained national registry of patients with hip fracture. A total of 17,756 patients >= 65 years of age who were treated for hip fracture during the period of 2013 to 2016, and followed until the end of 2017, were included. BMI was clinically assessed at hospital admission, comorbidity was measured with the American Society of Anesthesiologists (ASA) score, and the date of death was retrieved from a national database. Self-reported data on living arrangements were assessed on admission and 4 months after fracture. Multi-variable regression models were used to estimate the associations.

Results: Despite ASA scores being similar among all BMI groups, obese patients had the highest 1-year survival and patients with a BMI of <22 kg/m(2) had the lowest. Adjustment for potential confounders strengthened the associations. For the chance of returning to living at home, no advantage was seen for obese patients, but patients with a BMI of <22 kg/m(2) had clearly worse odds compared with patients who were of normal weight, overweight, or obese.

Conclusions: The obesity paradox appears to be true for hip fracture patients aged 65 and older. Attention should be given to patients with malnutrition and underweight status rather than to those with overweight status or obesity when developing the orthogeriatric care.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2019
National Category
Orthopaedics
Identifiers
urn:nbn:se:uu:diva-386160 (URN)10.2106/JBJS.18.01249 (DOI)000468109600011 ()31094980 (PubMedID)
Available from: 2019-06-20 Created: 2019-06-20 Last updated: 2019-06-20Bibliographically approved
Cederholm, T., Compher, C., Correia, M. I., Gonzalez, M. C., Fukushima, R., Higashiguchi, T., . . . Jensen, G. L. (2019). Response to the letter: Comment on "GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community": Some considerations about the GLIM criteria - A consensus report for the diagnosis of malnutrition by Drs. LB da Silva Passos and DA De -Souza [Letter to the editor]. Clinical Nutrition, 38(3), 1480-1481
Open this publication in new window or tab >>Response to the letter: Comment on "GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community": Some considerations about the GLIM criteria - A consensus report for the diagnosis of malnutrition by Drs. LB da Silva Passos and DA De -Souza
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2019 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 38, no 3, p. 1480-1481Article in journal, Letter (Other academic) Published
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-387987 (URN)10.1016/j.clnu.2019.02.033 (DOI)000469891800066 ()30904187 (PubMedID)
Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2019-06-27Bibliographically approved
Cruz-Jentoft, A. J., Bahat, G., Bauer, J., Boirie, Y., Bruyere, O., Cederholm, T., . . . Zamboni, M. (2019). Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing, 48(1), 16-31
Open this publication in new window or tab >>Sarcopenia: revised European consensus on definition and diagnosis
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2019 (English)In: Age and Ageing, ISSN 0002-0729, E-ISSN 1468-2834, Vol. 48, no 1, p. 16-31Article in journal (Refereed) Published
Abstract [en]

Background: In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) published a sarcopenia definition that aimed to foster advances in identifying and caring for people with sarcopenia. In early 2018, the Working Group met again (EWGSOP2) to update the original definition in order to reflect scientific and clinical evidence that has built over the last decade. This paper presents our updated findings.

Objectives: To increase consistency of research design, clinical diagnoses and ultimately, care for people with sarcopenia.

Recommendations: Sarcopenia is a muscle disease (muscle failure) rooted in adverse muscle changes that accrue across a lifetime; sarcopenia is common among adults of older age but can also occur earlier in life. In this updated consensus paper on sarcopenia, EWGSOP2: (1) focuses on low muscle strength as a key characteristic of sarcopenia, uses detection of low muscle quantity and quality to confirm the sarcopenia diagnosis, and identifies poor physical performance as indicative of severe sarcopenia; (2) updates the clinical algorithm that can be used for sarcopenia case-finding, diagnosis and confirmation, and severity determination and (3) provides clear cut-off points for measurements of variables that identify and characterise sarcopenia.

Conclusions; EWGSOP2's updated recommendations aim to increase awareness of sarcopenia and its risk. With these new recommendations, EWGSOP2 calls for healthcare professionals who treat patients at risk for sarcopenia to take actions that will promote early detection and treatment. We also encourage more research in the field of sarcopenia in order to prevent or delay adverse health outcomes that incur a heavy burden for patients and healthcare systems.

Place, publisher, year, edition, pages
OXFORD UNIV PRESS, 2019
Keywords
sarcopenia, muscle strength, physical performance, muscle assessment, EWGSOP2, older people
National Category
Geriatrics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-381926 (URN)10.1093/ageing/afy169 (DOI)000462546500008 ()30312372 (PubMedID)
Available from: 2019-04-18 Created: 2019-04-18 Last updated: 2019-04-18Bibliographically approved
Franzon, K., Zethelius, B., Cederholm, T. & Kilander, L. (2019). The impact of muscle function, muscle mass and sarcopenia on independent ageing in very old Swedish men. BMC Geriatrics, 19, Article ID 153.
Open this publication in new window or tab >>The impact of muscle function, muscle mass and sarcopenia on independent ageing in very old Swedish men
2019 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, article id 153Article in journal (Refereed) Published
Abstract [en]

Background Preserved functions of daily life and cognition are cornerstones of independent aging, which is crucial for maintaining a high quality of life. The aim of this study was to examine the impact of sarcopenia, and its underlying components, on independent ageing in a cohort study of very old men.

Methods The presence of sarcopenia and independent ageing at a mean age of 87 was investigated in 287 men from the Uppsala Longitudinal Study of Adult Men. Five years later 127 men were re-evaluated for independent ageing. Sarcopenia was defined by two different definitions from the European Working Group on Sarcopenia in Older People. In the first definition sarcopenia was defined as skeletal muscle index < 7.26 kg/m2 and either gait speed ≤0.8 m/s or hand grip strength < 30 kg. In the later up-dated definition, HGS < 27 kg and/or chair stand test > 15 s defines probable sarcopenia, which is confirmed by SMI < 7.0 kg/m2. Independent ageing was defined as a Mini-Mental State Examination score of ≥25 points, absence of diagnosed dementia, community-dwelling, independency in personal care and ability to walk outdoors alone.

Results Sarcopenia at baseline was observed in 21% (60/287) and 20% (58/287), respectively, due to definition. The prevalence of independent ageing was 83% (239/288) at baseline and 69% (87/127) five years later. None of the sarcopenia diagnoses were associated with independent ageing. In contrast, gait speed was both in cross-sectional (odds ratio (OR) per one standard deviation increase 2.15, 95% confidence interval (CI) 1.47–3.15), and in longitudinal multivariate analyses (OR 1.84, 95% CI 1.19–2.82). In the cross-sectional analysis also higher hand grip strength was associated with independent ageing (OR 1.58, 95% CI 1.12–2.22), while a slower chair stand test was inversely associated (OR 0.61, 95% CI 0.43–0.86). Muscle mass; i.e. skeletal muscle index, was not associated with independent ageing.

Conclusions For very old men, especially a higher gait speed, but also a higher hand grip strength and a faster chair stand test, were associated with independent ageing, while skeletal muscle index alone, and the composite sarcopenia phenotype measured with two different definitions, were not.

Keywords
Sarcopenia, EWGSOP1, EWGSOP2, Muscle mass, Muscle function, Gait speed, Hand grip strength, Chair stand test, Independent ageing
National Category
Geriatrics
Research subject
Geriatrics
Identifiers
urn:nbn:se:uu:diva-380155 (URN)10.1186/s12877-019-1142-y (DOI)000469459000001 ()31142271 (PubMedID)
Available from: 2019-03-25 Created: 2019-03-25 Last updated: 2019-06-20Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3705-0725

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