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Continuing Medical Apprenticeship Information

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ACCREDITATION STATEMENT

The Endocrine Association is accustomed by the Accreditation Council for Continuing Medical Apprenticeship to accommodate continuing medical apprenticeship for physicians.

The Endocrine Association has accomplished Accreditation with Commendation.

The Endocrine Association designates this constant actual for a best of 27 AMA PRA Category 1 Credits™. Physicians should alone affirmation acclaim adequate with the admeasurement of their accord in the activity.

LEARNING OBJECTIVES

Upon accomplishment of this educational activity, learners will be able to:

Diagnose a ambit of endocrine and metaic disorders based on analytic manifestations

Select amid accustomed options for administering and assay of endocrine and metaic disorders and co-morbid conditions

TARGET AUDIENCE

This continuing medical apprenticeship action should be of abundant assimilation to practicing endocrinologists and trainees.

STATEMENT OF INDEPENDENCE

As a provider of continuing medical apprenticeship (CME) accustomed by the Accreditation Council for Continuing Medical Education, The Endocrine Association has a action of ensuring that the agreeable and affection of this educational action are balanced, independent, objective, and scientifically rigorous. The analytic agreeable for this action was developed by the authors with the blank of JCEM’s Editor-in-Chief, Leonard Wartofsky, MD

DISCLOSURE POLICY

The faculty, lath members, and agents complex in planning this CME action are adapted to acknowledge to The Endocrine Association and learners any accordant banking relationship(s) that accept occurred aural the aftermost 12 months with any bartering interest(s) whose accessories or casework are discussed in the CME content. Banking relationships are authentic by accomplishment in any bulk from the bartering interest(s) in the anatomy of grants; assay support; consulting fees; salary; buying assimilation (e.g., stocks, banal options, or buying assimilation excluding adapted alternate funds); honoraria or added payments for accord in speakers’ bureaus, advising boards, or boards of directors; or added banking benefits. The absorbed of this acknowledgment is not to anticipate CME planners with accordant banking relationships from planning or commitment of content, but rather to accommodate learners with advice that allows them to accomplish their own judgments of whether these banking assimilation or relationships may accept afflicted the educational action with attention to account or conclusion. The Endocrine association has advised all disclosures and bound or managed all articular conflicts of interest, as applicable.

The afterward authors appear accordant banking relationships: Samuel Refetoff, MD, is an Academic Associate for Quest Diagnostics; Laszlo Hegedüs, MD, has accustomed honoraria from, serves on the advising lath of, and has provided able attestant for Genzyme; Jason A. Wexler, MD, has accustomed assay allotment from Amgen, Pfizer Inc., and Exelixis; André Lacroix, MD, serves on the Speaker’s Agency for Novartis Canada, and on the Consultant/Advisory Lath for Novartis, and has accustomed admission or assay abutment from Novartis Canada, Pfizer, and OSI Pharmaceutical, and royalties from UpToDate; Aaron Vinik, MD, PhD, FCP, MACP, is a adviser for Ansar, Merck, Pfizer, Sanofi-Aventis, Targacept, and is on the speakers agency for Merck; Marsha A. Davenport, MD, is currently an investigator in a analytic abstraction sponsored by Eli Lilly, postmarketing surveillance studies sponsored by Eli Lilly, Pfizer, and Genentech and is accepting admission abutment from Pfizer; Laurence Katznelson, MD, receives assay funds from Ipsen, Novartis Pharmaceuticals, and Pfizer; Harold E. Carlson, MD, has ahead consulted for Eli Lilly, Inc.

The afterward authors appear no accordant banking relationships: Bryan R. Haugen, MD; Madeleine A. Kane, MD; Fausto Bogazzi, MD; Luigi Bartalena, MD; Enio Martino, MD; Roy E. Weiss, MD; Alexandra Dumitrescu, MD; Victor Bernet, MD; Steen J. Bonnema, MD; Rebecca S. Bahn, MD; M. Regina Castro, MD; Marco Boscaro, MD; Giorgio Arnaldi, MD; Lynnette K. Nieman, MD; Elizabeth R. Seaquist, MD; Hassan N. Ibrahim, MD; Lois Jovanovič MD; Jennifer Larsen, MD; Whitney Goldner, MD; James T. Lane, MD; Samuel Dagogo-Jack, MD; Thomas A. Buchanan, MD; Kathleen A. Page, MD; Philip Zeitler, MD, PhD; Andrew J. Bauer, MD; Sharon E. Oberfield, MD; Aviva B. Sopher, MD; Adrienne T. Gerken, AB; Alison M. Boyce, MD; Rachel I. Gafni, MD; Stephen H. LaFranchi, MD; Robert H. Eckel, MD; Christopher P. Houk, MD; Reema L. Habiby, MD; Peter A. Lee, MD, PhD; Robert Udelsman, MD.

The Editor-in-Chief, Leonard Wartofksy, MD, has no accordant banking disclosures.

Endocrine Association agents and the medical biographer associated with the development of agreeable for this action appear no accordant banking relationships.

DISCLAIMER

The advice presented in this action represents the assessment of the adroitness and is not necessarily the official position of The Endocrine Society.

COMMERCIAL SUPPORT

This action is not accurate by grants, added funds, or in-kind contributions from bartering grants.

POLICY ON UNLABELED/OFF-LABEL USE

The Endocrine Association has bent that acknowledgment of unlabeled/off-label or investigational use of bartering product(s) is advisory for audiences and accordingly requires this advice to be appear to the learners at the alpha of the presentation. Uses of specific ameliorative agents, devices, and added accessories discussed in this educational action may not be the aforementioned as those adumbrated in artefact labeling accustomed by the Food and Drug Administering (FDA). The Endocrine Association requires that any discussions of such “off-label” use be based on accurate assay that conforms to about accustomed standards of beginning design, abstracts collection, and abstracts analysis. Afore advising or prescribing any ameliorative abettor or device, learners should analysis the complete prescribing information, including indications, contraindications, warnings, precautions, and adverse events.

PRIVACY AND CONFIDENTIALITY STATEMENT

The Endocrine Association will almanac learner’s claimed advice as provided on CME evaluations to acquiesce for arising and tracking of CME certificates. The Endocrine Association may additionally clue accumulated responses to questions in activities and evaluations and use these abstracts to acquaint the advancing appraisal and advance of its CME program. No alone accomplishment abstracts or any added claimed advice calm from evaluations will be aggregate with third parties.

COMMERCIAL SUPPORT

This action is not accurate by grants, added funds, or in-kind contributions from bartering grants.

METHOD OF PARTICIPATION

This constant actual is presented in book and online. The estimated time to complete this activity, including analysis of material, is 27 hours.

Access to the online PDF of this action requires Adobe Acrobat clairvoyant software.

To accept a best of 27 AMA PRA Category 1 Credits™ participants charge adeptness anniversary article, reflect on its recommendations, complete an action evaluation, as able-bodied as a post-test accomplishing a minimum account of 70%. If learners do not accomplish a casual account of 70%, they accept the advantage to change their answers and accomplish added attempts to accomplish a casual score. Learners additionally accept the advantage to bright all answers and alpha over. To affirmation your CME credit, amuse appointment www.endo-society.org/clinicalapproach to complete the post-test and evaluation.

SYSTEM REQUIREMENTS

To complete this activity, participants must: Accept admission to a computer with an Internet affiliation Use a aloft web browser, such as Internet Explorer 7 , Firefox 2 , Safari, Opera, or Google Chrome; in addition, accolade and Javascript charge be enabled in the browser’s options.

Last Analysis Date: May 2012

Release date: June 2012

Expiration date: June 2015

For questions about agreeable or about accepting CME credit, amuse acquaintance The Endocrine Association at [email protected]

CHAPTER-SPECIFIC LEARNING OBJECTIVES

After account these chapters, learners will be able to do the following:

Chapter 1. Thyroid Blight Accommodating with Extracervical Metastases

Monitor patients with extracervical metastatic thyroid blight for affirmation of progression or adapted disease

Consider advantages and disadvantages of treatments accessible for extracervical metastatic thyroid cancer

Select treatments that will advance adaptation and abatement anguish associated with ache progression

Chapter 2. Accommodating with Amiodarone-Induced Thyrotoxicosis

Differentiate the two capital forms of AIT

Choose the added adapted assay for either anatomy of AIT

Predict the acknowledgment to glucocorticoids in patients with blazon 2 AIT

Select patients who adeptness booty advantage from thyroidectomy

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Chapter 3. Accommodating with Attrition to Thyroid Hormone and Pregnancy

Recognize the accent of prenatal analysis of RTH by amniocentesis

Identify the affection and signs that accreditation assay in a gravida with RTH

Understand that RTH mothers harboring an artless fetus should be accustomed propylthiouracil to advance a serum chargeless T4 not college than 20% aloft the aerial absolute of normal

Chapter 4. Accommodating with Accidental Papillary Microcarcinoma

Determine the adapted admeasurement of anaplasty based on assorted analytic ambit begin in cases of thyroid microcarcinoma

Decide back radioactive iodine ablation is adapted for patients with accidental microcarcinoma

Review risk-adjusted TSH aishment goals for thyroid microcarcinoma patients

Provide recommended aftereffect administering of patients with accidental microcarcinoma

Chapter 5. Administering of the Accommodating with Primary or Accessory Intrathoracic Goiter

Describe the analytic account and archetypal affection of intrathoracic goiter, including the accessible accident of thyroid blight and the appulse on the respiration

Establish a accordant analytic accoutrement for the accommodating with intrathoracic goiter

Select amid ameliorative options for intrathoracic goiter, because limitations and risks of the assorted treatments

Chapter 6. Accommodating with Non-Toxic Multinodular Goiter

Recognize ultrasound appearance of amiable and cancerous thyroid nodules to abetment in the alternative of nodules that crave FNA biopsy

Establish a analytic assignment up for patients with non baneful multinodular goiter

Select amid altered ameliorative modalities for the analysis of patients with non baneful multinodular goiter based on analytic affection and concrete findings

Chapter 7. Thyroid Blight Accommodating with Cartilage Metastases

Recognize the limitations of the assorted radiological and radionuclide studies acclimated to ascertain cartilage metastases from thyroid cancer

Discuss the adeptness and limitations of radioiodine in the analysis of patients with ashen metastases from thyroid cancer

Incorporate intravenous bisphosphonates and subcutaneous monoclonal antibodies to RANKL in the administering of patients with cartilage metastases from thyroid cancer

Evaluate atypical modalities, such as radiofrequency ablation and cryotherapy, in the administering of patients with cartilage metastases from thyroid cancer

Chapter 8. Accommodating with Accessible Cushing’s Syndrome

None

Chapter 9. Accommodating with an Adrenal Incidentaloma

Assess the anticipation of blight based on radiographic features

Obtain pre-operative testing afore resection of an incidentaloma

Predict improvements in patients with subclinical Cushing’s affection afterwards resection of an adenoma

Chapter 10. Accommodating with Adrenocortical Carcinoma

Review the approaches to investigate and amusement patients with an adrenal accumulation that is advised at aerial accident of actuality an adrenal carcinoma

Implement anti-neoplastic assay as adapted based on adeptness of analysis indications, access of administration, ancillary effects, and requirements for ecology and hormone replacement

Provide adapted aftereffect of patients afterwards the surgical resection of adrenal blight and best of added therapies if backsliding occurs

Chapter 11. Accommodating with Blazon 2 Diabetes and Accelerating Branch Disease

Identify how to adapt the administering of glycemic ascendancy and claret burden in the ambience of accelerating renal disease

Recognize back a accommodating with blazon 2 diabetes and renal ache should be referred to a nephrologist for administering of approaching renal failure

Chapter 12. Accommodating with Diabetes During Pregnancy

Recognize the dangers of undiagnosed diabetes during pregnancy

Facilitate accomplishment and aliment of normoglycemia in all abundant women

Explain the account for carbohydrate brake in women with diabetes during pregnancy

Chapter 13. Administering of the Accommodating with Neuropathic Pain

Perform cogwheel analysis of aching diabetic neuropathy

Make a decisions based on the numbers bare to amusement vs. the numbers bare to abuse as able-bodied as the likelihood of success or abortion of treatment

Understand pathogenesis-based management

Chapter 14. Ailing Accommodating with Severe Insulin Resistance

Know accustomed guidelines for glucose ambition ethics in the ailing patient

Evaluate abeyant causes of cogent insulin attrition that can blemish the adeptness to accomplish those glucose ambition values

Understand abeyant strategies for acclamation insulin attrition in the hospital as able-bodied as catechumen from intravenous to subcutaneous insulin injections in the ailing patient

Chapter 15. Accommodating with New-Onset Diabetes afterwards Transplant (NODAT)

Identify accident factors for the development of diabetes afterwards solid agency transplantation

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Discuss the best contempo concepts and recommendations apropos the pathophysiology, analysis and administering of new-onset diabetes afterwards transplant

Chapter 16. Accommodating with Gestational Diabetes afterwards Delivery

Recognize the accident of diabetes afterwards gestational diabetes and the spectrum of causes of beta corpuscle dysfunction that underlie that risk

Select analytic approaches to abbreviation diabetes accident and appraise success of those approaches

Chapter 17. Accommodating with Turner Syndrome

Address cardiac, growth, gonadal and adorning abnormalities in patients with Turner syndrome

Implement recommended bloom affliction screening tests for patients with Turner Syndrome

Chapter 18. Adipose Boyish with New-Onset Diabetes

Formulate an access to the assurance of diabetes blazon in the adipose boyish with new-onset diabetes

Design an antecedent analysis action for the adipose boyish with new access diabetes and adapt this action based on analytic course

Incorporate an compassionate of autoimmunity and insulin attrition accompanying disorders in the access to analysis of the adipose boyish with new-onset diabetes

Chapter 19. Pediatric Accommodating with Graves’ Disease: Back Is Absolute Assay Warranted?

Distinguish the differences in analytic presentation amid pre- and post-pubertal accouchement with Graves’ disease

Identify and altercate the accessible analysis options for Graves’ ache and back the advantages and disadvantages for anniversary ameliorative option

Define the predictors associated with a decreased likelihood of absolution in the pediatric patient

Debate the allowances and limitations of abiding use of antithyroid medications compared to absolute therapy

Chapter 20. Babe with Aboriginal Access Pubic Hair

Evaluate a boyish babe who presents with aboriginal access of pubic hair

Manage the analytic affliction of a boyish with abortive adrenarche

Describe the progression of metaic abnormalities in some girls with abortive adrenarche

Chapter 21. Boyish with Fractures

Recognize the abundant primary and accessory causes of adolescence osteoporosis

Perform a complete appraisal of a boyish with fractures, including the accent of a absolute history and concrete exam

Consider abashing variables in the estimation of DXA scans in pediatric patients, including anatomy size, cartilage age and pubertal status

Select the best adapted pharmacologic and non-pharmacologic therapies for the administering of low cartilage body in children

Chapter 22. Analysis and Analysis of Neonatal Hypothyroidism

Select an optimal starting dosage of levothyroxine in breed with complete hypothyroidism, dressmaking the dosage to the severity of hypothyroidism

Undertake tests to adviser thyroid hormone analysis at recommended intervals in the aboriginal three years of activity in breed diagnosed with complete hypothyroidism

“Problem-solve” affidavit for serum chargeless T4 and/or TSH levels alfresco the recommended ambition ambit (e.g, low levothyroxine dosing, problems with GI absorption, acquiescence issues) and fix the botheration in breed diagnosed with complete hypothyroidism

Chapter 23. Accommodating Who Is Intolerant of Statin Therapy

Review the definition, frequency, pathopharmacology, and the analytic and ameliorative strategies of statin intolerance, accurately myopathy

Outline accomplish to be taken to appraise patients with myalgias and/or CK elevations on statin therapy

Characterize ameliorative options for patients with statin-induced myopathy based on the attendance or absence of affection and/or CK elevation, LDL and non-HDL cholesterol goals, statin pharmacokinetics, and appear reports

Chapter 24. Accommodating with Assiduous Acromegaly afterwards Pituitary Surgery

Identify the medical co-morbidities associated with acromegaly, and accept the adapted tests to appraise these co-morbidities

Assess alone accommodating profiles to actuate the adapted assay for a postoperative accommodating with assiduous and alive acromegaly

Identify the medical assay options for acromegaly, and actuate the adapted medical assay for an alone patient

Chapter 25. Assigning Gender in 46,XX Complete Adrenal Hyperplasia with Male External Genitalia: Replacing Dogmatism with Pragmatism

Appreciate the actual analytic administering of 46,XX breed built-in with complete adrenal hyperplasia

Become accustomed with the factors to be advised in the baby acute gender assignment

Be acquainted with guidelines for the analytic access to breed with DSD based on analytic findings

Chapter 26. Accommodating with Gynecomastia

Discuss the hormonal pathogenesis of gynecomastia

Appropriately appraise and acclaim assay for patients with gynecomastia

Chapter 27. Accommodating with Assiduous or Recurrent Primary Hyperparathyroidism

Manage a accommodating who undergoes anaplasty in the ambience of primary hyperparathyroidism but fails to access a alleviative result

Undertake the adapted imaging studies for such a patient

Describe the surgical adjuncts accessible to abetment in the administering of this accommodating both in and out of the operating room

Predict post-operative problems that should be advancing in such a patient

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Giorgio Arnaldi, MD

Polytechnic University of Marche

Ancona, Italy

Rebecca S. Bahn, MD

Mayo Clinic, Roer, Minnesota

Luigi Bartalena, MD

University of Insubria

Varese, Italy

Andrew J. Bauer, MD

Walter Reed Army Medical Center

Washington, DC

Uniformed Casework University

Bethesda, MD

The Thyroid Center

Children’s Hospital of Philadelphia

Philadelphia, PA

Victor Bernet, MD

Mayo Clinic

College of Medicine

Jacksonville, FL

Fausto Bogazzi, MD

University of Pisa

Pisa, Italy

Steen J. Bonnema, MD

Odense University Hospital

Odense, Denmark

Marco Boscaro, MD

Polytechnic University of Marche

Ancona, Italy

Alison M. Boyce, MD

Eunice Kennedy Shriver National Institute of Boyish Bloom and Human Development

National Institutes of Health

Bethesda, MD

Thomas A. Buchanan, MD

Keck School of Medicine of the University of Southern California

Los Angeles, CA

Harold E. Carlson, MD

Stony Brook University

Stony Brook, NY

M. Regina Castro, MD

Mayo Clinic, Roer, Minnesota

Samuel Dagogo-Jack, MD

University of Tennessee

Health Science Center

Memphis, TN

Alexandra Dumitrescu, MD

The University of Chicago

Chicago, IL

Robert H. Eckel, MD

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University of Colorado

Anschutz Medical Campus

Aurora, CO

Rachel I. Gafni, MD

National Institute of Dental and Craniofacial Research

National Institutes of Health

Bethesda, MD

Adrienne T. Gerken, AB

Columbia University Medical Center

New York, NY

Whitney Goldner, MD

University of Nebraska Medical Center, Omaha, NE

Reema L. Habiby, MD

Children’s Memorial Hospital

Chicago, IL

Bryan R. Haugen, MD

University of Colorado Denver

University of Colorado Blight Center

Aurora, CO

Laszlo Hegedüs, MD

Odense University Hospital

Odense, Denmark

Christopher P. Houk, MD

Medical College of Georgia

Augusta, GA

Hassan N. Ibrahim, MD

University of Minnesota

Minneapolis, MN

Lois Jovanovič, MD

Sansum Diabetes Assay Institute

Santa Barbara, CA

Madeleine A. Kane, MD

University of Colorado Denver

University of Colorado Blight Center

Aurora, CO

Laurence Katznelson, MD

Stanford University School of Medicine

Stanford, CA

André Lacroix, MD

Université de Montréal

Centre de Recherche du Centre hospitalier de

l’Université de Montréal (CRCHUM)

Québec, Canada

Stephen H. LaFranchi, MD

Oregon Bloom & Science University

Portland, OR

James T. Lane, MD

Harold Hamm Oklahoma Diabetes Center

University of Oklahoma Bloom Sciences Center

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Jennifer Larsen, MD

University of Nebraska Medical Center, Omaha, NE

Peter A. Lee, MD, PhD

Riley Hospital for Children

Indiana University School of Medicine

Indianapolis, IN

Pennsylvania State College of Medicine

Hershey, PA

Enio Martino, MD

University of Pisa

Pisa, Italy

Lynnette K. Nieman, MD

The Eunice Kennedy Shriver National Institute of Boyish Bloom and Human Development

National Institutes of Health

Bethesda, MD

Sharon E. Oberfield, MD

Columbia University Medical Center

New York, NY

Kathleen A. Page, MD

Keck School of Medicine of the University of Southern California

Los Angeles, CA

Samuel Refetoff, MD

The University of Chicago

Chicago, IL

Elizabeth R. Seaquist, MD

University of Minnesota

Minneapolis, MN

Aviva B. Sopher, MD

Columbia University Medical Center

New York, NY

Aaron Vinik, MD, PhD, FCP, MACP

Eastern Virginia Medical School, Strelitz Diabetes Center

Norfolk, VA

Robert Udelsman, MD

Yale-New Haven Hospital

Yale University School of Medicine

New Haven, CT

Roy E. Weiss, MD

The University of Chicago

Chicago, IL

Jason A. Wexler, MD

Washington Hospital Center

Georgetown University

School of Medicine

Washington, DC

Philip Zeitler, MD, PhD

University of Colorado Denver

Aurora, CO

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The ample accepted success of the aboriginal aggregate of A Analytic Access to Endocrine & Metaic Diseases in 2010 has now prompted the advertisement of the accustomed accumulating of these a analysis accessories that abode accustomed issues adverse the analytic endocrinologist. As before, the capacity accept been adopted from the pages of the Endocrine Society’s foremost analytic journal, The Account of Analytic Endocrinology & Metaism (JCEM) and are as appropriate today as back originally published. The authors of anniversary affiliate are accustomed experts in their corresponding areas of endocrinology and were accurately nominated and called by the Editors of the JCEM for their accustomed analytic skills. Thus, the capacity covered are those that are faced circadian in the clinician’s office, and this book provides a awful applied and advantageous advertence abstract of the experts’ claimed ‘Approaches’ to anniversary botheration from the point of appearance of both analysis and management. In adverse to the aboriginal articles, these adapted versions are all calm in a accessible one aggregate architecture that now can be readily accessed from your appointment bookshelf as needed.

In accession to their accustomed expertise, authors of these capacity were called because of their brittle and acute autograph appearance which was able-bodied accepted to the editors of the JCEM. The authors’ adapted versions reflect any contempo developments back their aboriginal advertisement in the JCEM that adeptness adapt or added clarify the access to administering of the assorted disorders. The capacity called represent barbed and generally arguable capacity such as the thyroid incidentaloma, and administering of patients with advancing thyroid blight with bounded aggression or metastases to bone. Adrenal neoplasms alignment from the incidentaloma to blight are additionally considered. Approaches to difficult issues in diabetes mellitus such as neuropathy, branch disease, and insulin attrition are covered as able-bodied as the administering of diabetes in abundance and afterwards transplantation.

I accept that some of the best advantageous and applied capacity are those ambidextrous with situations adverse the analyst back acceptable therapies accept bootless or accept been contrarily inadequate. Thus, there are capacity on what to do with the hyperlipidemic accommodating who cannot abide statin therapy, the acromegalic accommodating with elevations of serum hGH afterwards pituitary surgery, and the accommodating with assiduous hypercalcemia afterwards parathyroid adenomectomy. Clinicians who see pediatric patients will acquisition awful admired the capacity on the adipose adolescent, Turner’s syndrome, and accouchement who advance fractures or aboriginal access of pubic hair. Still added capacity accommodate ‘pearls’ of acumen from the experts on a array of frequently encountered ‘bread and er’ endocrine topics.

We owe acknowledgment to the Senior Director and Publisher of The Endocrine Society, Eleanore Tapscott, the Managing Editor of the JCEM, Scott C. Herman, and the agents of the Publications Department for bringing this superb aggregate to fruition. It is assertive to prove a admired ability that will account both endocrinologists and their patients for years to come.

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