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    Sentinel visits in emergency department patients with diabetes mellitus as a warning sign for hyperglycemic emergencies.
    CJEM 2017 Jul 25:1-8. Epub 2017 Jul 25.
    ‡Department of Emergency Medicine,University of Ottawa,Ottawa,ON.
    Objectives: Patients with poorly controlled diabetes mellitus may have a sentinel emergency department (ED) visit for a precipitating condition prior to presenting for a hyperglycemic emergency, such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). This study's objective was to describe the epidemiology and outcomes of patients with a sentinel ED visit prior to their hyperglycemic emergency visit.

    Methods: This was a 1-year health records review of patients≥18 years old presenting to one of four tertiary care EDs with a discharge diagnosis of hyperglycemia, DKA, or HHS. Read More

    Emergency Department Management of Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic State: National Survey of Attitudes and Practice.
    Can J Diabetes 2017 Jul 19. Epub 2017 Jul 19.
    The University of Ottawa, Ottawa, Ontario, Canada; The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
    Objectives: In 2013, the Association, now Diabetes Canada, published national clinical practice guidelines for the effective management of diabetic ketoacidosis and hyperosmolar hyperglycemic states in adults. We sought to determine emergency physician compliance rates and attitudes toward these guidelines and to identify potential barriers to their use in Canadian emergency departments.

    Methods: An online survey consisting of questions related to the awareness and use of the Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada was distributed to 500 randomly selected members of the Canadian Association of Emergency Physicians. Read More

    Risk factors for recurrent emergency department visits for hyperglycemia in patients with diabetes mellitus.
    Int J Emerg Med 2017 Dec 12;10(1):23. Epub 2017 Jul 12.
    The Department of Emergency Medicine, The University of Ottawa, Ottawa, ON, Canada.
    Background: Patients with poorly controlled diabetes mellitus may present repeatedly to the emergency department (ED) for management and treatment of hyperglycemic episodes, including diabetic ketoacidosis and hyperosmolar hyperglycemic state. The objective of this study was to identify risk factors that predict unplanned recurrent ED visits for hyperglycemia in patients with diabetes within 30 days of initial presentation.

    Methods: We conducted a 1-year health records review of patients ≥18 years presenting to one of four tertiary care EDs with a discharge diagnosis of hyperglycemia, diabetic ketoacidosis, or hyperosmolar hyperglycemic state. Read More

    Central Diabetes Insipidus and Hyperglycemic Hyperosmolar State Following Accidental Carbon Monoxide Poisoning.
    Cureus 2017 Jun 3;9(6):e1305. Epub 2017 Jun 3.
    Nephrology, Shifa International Hospital, Islamabad, Pakistan.
    Carbon monoxide poisoning is common and carries significant morbidity and mortality. The nervous system, particularly the brain, is frequently affected by it, owing to its high metabolic activity and oxygen requirements. Carbon monoxide damages the nervous system by both hypoxic and inflammatory mechanisms. Read More

    Management of Hyperglycemia and Diabetes in the Emergency Department.
    Curr Diab Rep 2017 Aug;17(8):56
    Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02215, USA.
    Purpose Of Review: Hyperglycemia in the emergency department (ED) is being recognized as a public health problem and presents a clinical challenge. This review critically summarizes available evidence on the burden, etiology, diagnosis, and practical management strategies for hyperglycemia in the ED.

    Recent Findings: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are hyperglycemic emergencies that commonly present to the ED. Read More

    A case report of hyperosmolar hyperglycemic state in a 7-year-old child: An unusual presentation of first appearance of type 1 diabetes mellitus.
    Medicine (Baltimore) 2017 Jun;96(25):e7369
    Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
    Rationale: A hyperosmolar hyperglycemic state (HHS) is a rare presentation of a hyperglycemic crisis in children with diabetes mellitus. As this condition can be fatal and has high morbidity, early recognition and proper management are necessary for a better outcome. Here, we report a rare case of HHS as the first presentation of type 1 diabetes mellitus (T1DM) in a 7-year-old girl. Read More

    Hepatocyte nuclear factor 1β maturity-onset diabetes of the young in a Chinese child presenting with hyperglycemic hyperosmolar state.
    Acta Diabetol 2017 Jun 8. Epub 2017 Jun 8.
    Department of Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, No. 109, Xueyuanxi Road, Wenzhou, 325000, Zhejiang, People's Republic of China.

    [Evaluation and perioperative management of patients with diabetes mellitus. A challenge for the anesthesiologist].
    Rev Bras Anestesiol 2017 May 30. Epub 2017 May 30.
    Hospital Santa Genoveva, Centro de Ensino e Treinamento, Uberlândia, MG, Brasil.
    Diabetes mellitus (DM) is characterized by alteration in carbohydrate metabolism, leading to hyperglycemia and increased perioperative morbidity and mortality. It evolves with diverse and progressive physiological changes, and the anesthetic management requires attention regarding this disease interference in multiple organ systems and their respective complications. Patient's history, physical examination, and complementary exams are important in the preoperative management, particularly glycosylated hemoglobin (HbA1c), which has a strong predictive value for complications associated with diabetes. Read More

    Endocrine Emergencies With Neurologic Manifestations.
    Continuum (Minneap Minn) 2017 Jun;23(3, Neurology of Systemic Disease):778-801
    Purpose Of Review: This article provides an overview of endocrine emergencies with potentially devastating neurologic manifestations that may be fatal if left untreated. Pituitary apoplexy, adrenal crisis, myxedema coma, thyroid storm, acute hypercalcemia and hypocalcemia, hyperglycemic emergencies (diabetic ketoacidosis and hyperglycemic hyperosmolar state), and acute hypoglycemia are discussed, with an emphasis on identifying the signs and symptoms as well as diagnosing and managing these clinical entities.

    Recent Findings: To identify the optimal management of endocrine emergencies, using formal clinical diagnostic criteria and grading scales such as those recently proposed for pituitary apoplexy will be beneficial in future prospective studies. Read More

    "Diabetic striatopathy" and ketoacidosis: Report of two cases and review of literature.
    Diabetes Res Clin Pract 2017 Jun 9;128:1-5. Epub 2017 Apr 9.
    Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. Electronic address:
    "Diabetic striatopathy" is characterized by dyskinesias with basal ganglia hyperintensities on neuroimaging. It is usually reported in elderly females with hyperglycemic hyperosmolar state and rare in patients with diabetic ketoacidosis. Here, we report two young males with diabetic ketoacidosis presenting as striatopathy, along with review of literature. Read More

    Management of Hyperglycemic Crises: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.
    Med Clin North Am 2017 May;101(3):587-606
    Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, 69 Jesse Hill Jr. Drive Southeast, 2nd Floor, Atlanta, GA 30303, USA. Electronic address:
    Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are the most serious and life-threatening hyperglycemic emergencies in diabetes. DKA is more common in young people with type 1 diabetes and HHS in adult and elderly patients with type 2 diabetes. Features of the 2 disorders with ketoacidosis and hyperosmolality may coexist. Read More

    Treatment of Diabetic Ketoacidosis (DKA)/Hyperglycemic Hyperosmolar State (HHS): Novel Advances in the Management of Hyperglycemic Crises (UK Versus USA).
    Curr Diab Rep 2017 May;17(5):33
    Division of Endo, Metabolism & Lipids, Emory University School of Medicine, Atlanta, GA, USA.
    Purpose Of Review: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are diabetic emergencies that cause high morbidity and mortality. Their treatment differs in the UK and USA. This review delineates the differences in diagnosis and treatment between the two countries. Read More

    Ascariasis and hyperosmolar hyperglycemic state: a surprising ultrasound finding in the emergency department.
    Int J Emerg Med 2017 Dec 21;10(1):12. Epub 2017 Mar 21.
    Emergency Department, Centre Hospitalier Universitaire de Kigali, University of Rwanda, Butare, Rwanda.
    Background: We report the ultrasound finding of ascariasis in a patient with hyperosmolar hyperglycemic state (HHS). Although ascariasis is common in low-resource settings, there has been no previous report associating ascariasis with HHS.

    Case Presentation: A 26-year-old Rwandan man was admitted to the emergency department in coma, with a glycemia of 600 mg/dl. Read More

    Controversies in the management of hyperglycaemic emergencies in adults with diabetes.
    Metabolism 2017 Mar 25;68:43-54. Epub 2016 Nov 25.
    Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
    Hyperglycaemic emergencies are associated with significant morbi-mortality and healthcare costs. Management consists on fluid replacement, insulin therapy, and electrolyte correction. However, some areas of patient management remain debatable. Read More

    Predictors of Recurrent Hospital Admission for Patients Presenting With Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State.
    J Clin Med Res 2017 Jan 24;9(1):35-39. Epub 2016 Nov 24.
    University of Missouri School of Medicine, One Hospital Drive, Columbia, MO 65212, USA.
    Background: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are two serious, preventable complications of diabetes mellitus. Analysis of variables associated with recurrent DKA and HHS admission has the potential to improve patient outcomes by identifying possible areas for intervention. The aim of this study was to evaluate potential predictors of recurrent DKA or HHS admission. Read More

    A case of mediastinitis accompanied with hyperosmolar nonketotic coma.
    Turk J Emerg Med 2016 Jun 8;16(2):75-76. Epub 2016 May 8.
    Dicle University, School of Medicine, Department of Endocrinology and Metabolism, Diyarbakir, Turkey.
    Mediastinitis is a serious infection involving mediastinal spaces after cervical infections spread along the facial planes. A late diagnosis of mediastinitis may result in death. Here we present a diabetic patient suffered from mediastinit accompanied with hyperosmolar nonketotic coma. Read More

    Secular Trends in Admissions and Mortality Rates from Diabetes Mellitus in the Central Belt of Ghana: A 31-Year Review.
    PLoS One 2016 22;11(11):e0165905. Epub 2016 Nov 22.
    Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
    Introduction: Diabetes Mellitus is currently a leading cause of morbidity and mortality throughout the world, particularly in sub-Saharan Africa where a significant proportion of diabetes cases are now found. Longitudinal profiling of in-patient admissions and mortality trends from diabetes provide useful insights into the magnitude of the burden of diabetes, serve as a sentinel on the state of out-patient diabetes care and provide effective tools for planning, delivering and evaluating the health care needs relating to the disease in sub-Saharan Africa.

    Objective: To evaluate the 31-year trend in diabetic admissions and mortality rates in central Ghana. Read More

    Reversible splenial lesion syndrome with a hyperosmolar hyperglycemic state and neuroleptic malignant syndrome caused by olanzapine.
    J Diabetes Investig 2017 May 6;8(3):392-394. Epub 2017 Jan 6.
    Department of Endocrinology and Metabolism, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital, Mito, Ibaraki, Japan.
    A 27-year-old woman with panic disorder taking 20 mg olanzapine daily for 4 months was admitted to Mito Kyodo General Hospital, Mito, Ibaraki, Japan, because of disturbed consciousness with fever, hyperglycemia, hyperosmolarity and elevated creatine phosphokinase. She was diagnosed with a hyperosmolar hyperglycemic state and neuroleptic malignant syndrome. Brain magnetic resonance imaging showed transiently restricted diffusion in the splenium of the corpus callosum, with a high signal intensity on diffusion-weighted imaging. Read More

    Prognostic Factors in Patients Hospitalized with Diabetic Ketoacidosis.
    Endocrinol Metab (Seoul) 2016 Sep 1;31(3):424-432. Epub 2016 Sep 1.
    Department of Medicine, King George's Medical College, Lucknow, India.
    Background: Diabetic ketoacidosis (DKA) is characterized by a biochemical triad of hyperglycemia, acidosis, and ketonemia. This condition is life-threatening despite improvements in diabetic care. The purpose of this study was to evaluate the clinical and biochemical prognostic markers of DKA. Read More

    Cerebral edema among adults with diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome: Incidence, characteristics, and outcomes.
    J Diabetes 2017 Feb 31;9(2):208-209. Epub 2016 Aug 31.
    Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
    Ischemic stroke is an uncommon complication among adults with DKA, that confers a worse prognosis. Traditional risk factors for stroke including older age, stroke history, hypertension and hyperlipidemia appear to predict the risk of IS in these patients. Demographic and clinical characteristics of patients with diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome patients, with and without cerebral edema. Read More

    Inverse relationship between ambient temperature and admissions for diabetic ketoacidosis and hyperglycemic hyperosmolar state: A 14-year time-series analysis.
    Environ Int 2016 Sep 6;94:642-8. Epub 2016 Jul 6.
    Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
    This study aimed to investigate the association of admissions for diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) with ambient temperature and season, respectively in patients with diabetes mellitus (DM), after excluding known co-morbidities that predispose onset of acute hyperglycemia events. This was a time series correlation analysis based on medical claims of 40,084 and 33,947 episodes of admission for DKA and HHS, respectively over a 14-year period in Taiwan. These episodes were not accompanied by co-morbidities known to trigger incidence of DKA and HHS. Read More

    Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia.
    Nat Rev Endocrinol 2016 Apr 19;12(4):222-32. Epub 2016 Feb 19.
    Division of Endocrinology and Metabolism, University of Pittsburgh, 3601 Fifth Avenue, Suite 560, Pittsburgh, Pennsylvania 15213, USA.
    Diabetic ketoacidosis (DKA), hyperglycaemic hyperosmolar state (HHS) and hypoglycaemia are serious complications of diabetes mellitus that require prompt recognition, diagnosis and treatment. DKA and HHS are characterized by insulinopaenia and severe hyperglycaemia; clinically, these two conditions differ only by the degree of dehydration and the severity of metabolic acidosis. The overall mortality recorded among children and adults with DKA is <1%. Read More

    Myxoedema coma in the setting of hyperglycaemic hyperosmolar state.
    BMJ Case Rep 2016 Jan 11;2016. Epub 2016 Jan 11.
    Anaesthesia and Critical Care, Tameside Hospital NHS Foundation Trust, Lancashire, UK.
    Decompensated hypothyroidism is a rare endocrine emergency but a differential that should be considered in patients presenting critically unwell with systemic illness. We report a case of myxoedema coma in a woman presenting with respiratory failure, hypotension, hypothermia and a reduced level of consciousness, all of which are poor prognostic features in decompensated hypothyroidism. The patient was admitted to critical care for mechanical ventilation and cardiovascular support and treated with a combination of insulin, liothyronine and levothyroxine, making a good recovery. Read More

    Antipsychotic Therapy-Induced New Onset Diabetic Ketoacidosis.
    Am J Ther 2016 Nov/Dec;23(6):e1944-e1945
    1Department of Internal Medicine and Pediatrics, Western Michigan University Homer Stryker M.D., School of Medicine, Kalamazoo, MI; 2Department of Internal Medicine, Mayo Clinic Health System, Mankato, MN; and 3Department of Cardiology, Michigan State University, Borgess Medical Center, Kalamazoo, MI.
    Atypical antipsychotics are very widely used for various psychiatric ailments because of their less extrapyramidal side effects. Various reports of disturbances in glucose metabolism in the form of new onset diabetes mellitus, exacerbation of preexisting diabetes mellitus, diabetic ketoacidosis, hyperosmolar nonketotic coma, acute pancreatitis, and increased adiposity have been reported. We present a case of new onset diabetic ketoacidosis in a patient without a history of glucose intolerance who was being treated with olanzapine for bipolar disorder. Read More

    Complications of hyperglycaemia with PI3K-AKT-mTOR inhibitors in patients with advanced solid tumours on Phase I clinical trials.
    Br J Cancer 2015 Dec 10;113(11):1541-7. Epub 2015 Nov 10.
    Drug Development Unit, The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK.
    Background: PI3K-AKT-mTOR inhibitors (PAMi) are promising anticancer treatments. Hyperglycaemia is a mechanism-based toxicity of these agents and is becoming increasingly important with their use in larger numbers of patients.

    Methods: Retrospective case-control study comparing incidence and severity of hyperglycaemia (all grades) between a case group of 387 patients treated on 18 phase I clinical trials with PAMi (78 patients with PI3Ki, 138 with mTORi, 144 with AKTi and 27 with PI3K/mTORi) and a control group of 109 patients treated on 10 phase I clinical trials with agents not directly targeting the PAM pathway. Read More

    Case report: severe reversible cardiomyopathy associated with systemic inflammatory response syndrome in the setting of diabetic hyperosmolar hyperglycemic non-ketotic syndrome.
    BMC Cardiovasc Disord 2015 Oct 14;15:123. Epub 2015 Oct 14.
    Department of Internal Medicine, Texas Tech University Health Sciences Center, School of Medicine, 3601 4th St Stop 9410, Lubbock, TX, 79416, USA.
    Background: This case study features a woman who presented with clinical and laboratory findings consistent with hyperosmolar hyperglycemic non-ketotic syndrome (HHNS), systemic inflammatory response syndrome (SIRS), and non-thyroidal illness syndrome (NTIS) who was noted to have a transient decrease in myocardial function. To our knowledge, this is the first case discussing the overlapping pathophysiological mechanisms could increase susceptibility to SIRS-induced cardiomyopathy. It is imperative that this clinical question be investigated further as such a relationship may have significant clinical implications for prevention and future treatments, particularly in patients similar to the one presented in this clinical case. Read More

    Predictors and treatment outcome of hyperglycemic emergencies at Jimma University Specialized Hospital, southwest Ethiopia.
    BMC Res Notes 2015 Oct 11;8:553. Epub 2015 Oct 11.
    Departments of Internal Medicine, School of Medicine, Jimma University, Jimma, Ethiopia.
    Background: Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) commonly known as hyperglycemic emergencies are the two most common life-threatening acute metabolic complications of diabetes. The objective of this study is to assess predictors and treatment outcome of hyperglycemic emergencies (HEs) among diabetic patients admitted to Jimma University Specialized Hospital (JUSH).

    Methods: It is a three year retrospective review of medical records of patients admitted with HEs at JUSH. Read More

    Diabetes in older people.
    Clin Med (Lond) 2015 Oct;15(5):465-7
    University Hospital Aintree, Liverpool, UK.
    The management of diabetes in older people is often challenging and poorly researched. The prevalence of cognitive impairment, chronic kidney disease and other co-existing comorbidities increase with age and have a significant impact on glycaemic control targets and treatment options. This conference examined current clinical practice, highlighted differences in the management of diabetes in the older person and suggested potential areas of future research. Read More

    Hyperglycaemic hyperosmolar syndrome in children: Patient characteristics, diagnostic delays and associated complications.
    J Paediatr Child Health 2016 Jan 30;52(1):80-4. Epub 2015 Jul 30.
    Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, United States.
    Aims: The aim of this study was to describe the demographical and clinical characteristics, diagnostic difficulties, and morbidity and mortality in children with hyperglycaemic hyperosmolar syndrome (HHS).

    Methods: Retrospective cross-section descriptive study of children (<18 years of age) at an urban, tertiary, academic Children's Hospital diagnosed with HHS from January 2002 to December 2011.

    Results: Six patients met inclusion criteria for the diagnosis of HHS. Read More

    Urinary incontinence a first presentation of central pontine myelinolysis: a case report.
    Age Ageing 2015 Sep 23;44(5):898-900. Epub 2015 Jul 23.
    Ipswich Hospital, Ipswich, UK.
    An 84-year-old lady was treated for hyperosmolar hyperglycaemia with IV insulin, fluids and catheterisation for fluid balance monitoring. Trial without catheter failed as the patient complained of new-onset urinary incontinence and lack of awareness of bladder filling. In light of her breast cancer history, we excluded cauda equina. Read More

    Subsequent mortality after hyperglycemic crisis episode in the non-elderly: a national population-based cohort study.
    Endocrine 2016 Jan 27;51(1):72-82. Epub 2015 Jun 27.
    Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, No.1, Daxue Rd., East Dist., Tainan City, 701, Taiwan.
    Hyperglycemic crisis episodes (HCEs)-diabetic ketoacidosis and the hyperosmolar hyperglycemic state-are the most serious acute metabolic complications of diabetes. We aimed to investigate the subsequent mortality after HCE in the non-elderly diabetic which is still unclear. This retrospective national population-based cohort study reviewed, in Taiwan's National Health Insurance Research Database, data from 23,079 non-elder patients (≤65 years) with new-onset diabetes between 2000 and 2002: 7693 patients with HCE and 15,386 patients without HCE (1:2). Read More

    [Hyperosmolar hyperglycemic state].
    Vnitr Lek 2015 May;61(5):451-7
    The hyperglycemic hyperosmolar state (HHS) is a serious acute complication of diabetes decompensation, especially in type 2 diabetes (T2DM), and with critical prognosis. Primary characteristics of HHS include extreme hyperglycemia, severe dehydration (with prerenal hyperazotaemia), plasma hyperosmolarity, frequent disorders of consciousness, absent or minimum ketoacidosis (with higher values, only found in combined forms). Both DKA and HHS have a common pathogenetic mechanism, but both states are opposite extreme deviations, and the boundaries between them are not entirely clear. Read More

    Presentation of youth with type 2 diabetes in the Pediatric Diabetes Consortium.
    Pediatr Diabetes 2016 06 8;17(4):266-73. Epub 2015 May 8.
    Pediatric Endocrinology, Yale University, New Haven, CT, USA.
    Objective: Type 2 diabetes (T2D) in youth is recognized as a pediatric disease, but few reports describe the characteristics during diagnosis. We describe the clinical presentation of 503 youth with T2D.

    Methods: The Pediatric Diabetes Consortium (PDC) T2D Clinic Registry enrolled T2D participants from eight pediatric diabetes centers in the USA. Read More

    Prolonged hypernatremia triggered by hyperglycemic hyperosmolar state with coma: A case report.
    World J Nephrol 2015 May;4(2):319-23
    Darlene Vigil, Yijuan Sun, Antonios H Tzamaloukas, Karen S Servilla, Nephrology Section, Medicine Service, Raymond G Murphy Veterans Affairs Medical Center, Albuquerque, NM 87108, United States.
    A man with past lithium use for more than 15 years, but off lithium for two years and not carrying the diagnosis of diabetes mellitus or nephrogenic diabetes insipidus (NDI), presented with coma and hyperglycemic hyperosmolar state (HHS). Following correction of HHS, he developed persistent hypernatremia accompanied by large volumes of urine with low osmolality and no response to desmopressin injections. Urine osmolality remained < 300 mOsm/kg after injection of vasopressin. Read More

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