Prostate Cancer: Peaking Behind the Pathologist Screen

 OLYMPUS DIGITAL CAMERA
An aggressive prostate cancer.

In the past few days, two members of Chicago media, radio host  Dave Fogel and newscaster Hosea Sanders have shared that they are undergoing prostate surgery for prostate cancer. In both cases the cancers were discovered when abnormal Prostate Specific Antigen (PSA ) blood test results were followed by their doctors finding cancer on subsequent prostate biopsies.

Should every man have PSA screening. There is no universal agreement on that sticky question. I believe that men from about 50 to 75 years of age benefit from testing and careful, rationale, evaluation of abnormal results. In men with strong family histories of prostate cancer the need is even greater and may begin at a younger age. And as pointed out by Mr. Sanders, this is especially true of African-American men.

Not every abnormal result requires a biopsy, but a value abnormally high for age group, or rising steadily from previous results, needs to be evaluated. Urologists are well trained in triaging and determining when a biopsy is needed. Doesn’t this mean  some men have to endure the discomfort of a biopsy when in fact they don’t have cancer? Yes, but in our laboratory practice, and in similar ones around the country, about 50% of the men whose specimens we see do in fact have cancer.

Do all men with prostate cancer need treatment? No, prostate cancer is not aggressive in all men. A great deal of the decision whether to treat or not is based on the microscopic appearance of the tumor, usually summarized as a “Gleason Score.” And it is here that my pathology associates and I in the lab have our most pitched battles.

At our daily case review we examine on a video screen every cancer case that each of us have seen that day. Most cases are straight-forward, but applying the scoring criteria in other cases is like throwing spaghetti at the wall. Only some of it will stick. Though each of us is thoroughly trained in the “rules” for the different scores and have each examined thousands of biopsies, we also bring our subjective opinions, our natural inclinations and the whispers of our teachers and national experts. The questions we ask, “Are those glands merging or just squeezed together? Is that a glomeruloid pattern or just telescoping?” do not always have a concrete answer.

What do we do to reach a consensus? We probe, we quote books and articles, we pull out pictures, we pull out our hair. We have never reached delivering blows or cussing each other out (at least aloud), but we each work hard to support our position. On some occasions we seek input from the East Coast or West Coast gurus. The elusive answers may impact how the patient faces their future. And yes, though we are behind the scenes and we rarely meet the men in question, we think of them as our patients too. That way we know we are giving them all our best.

And just as a reminder:

Please
Screen
Annually

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Does Something Haunt our Suburban Home?

monsters“The stairs creak as I sleep,
It’s keeping me awake
It’s the house telling you to close your eyes”
Little Talks-Of Monsters and Men

Crash!! Barb jolts up, awakened by the boom reverberating through the house, cutting through her dreams and leaving her disoriented and uneasy. A hard nudge to my ribs and I join her in 3 a.m. confusion.

“Did you hear that? I think it came from the basement.”

So we rise together and head for the stairs, not sure what we will find below. For a moment I wish I had Lucille, Negan’s spike wrapped baseball bat* at hand. We flip on the many basement light switches and do a groggy but thorough search.  We find nothing.

“Maybe it was from the bathroom.”

A search in the master bath is more fruitful. The suction cup holding the squeegee to the shower wall has loosened, and the dislodged squeegee has tumbled to the ceramic floor. In the enclosed space of the shower stall the bounces and echoes have made up the thunderclap that woke Barb. We go back to bed, mumbling about what it will be that wake us up next.

Because nights have been anything but peaceful in the new house. The evening before, we finally made it to bed at midnight following a small Academy Awards gathering lengthened by both losing the sound on our new super wide screen television and the La La – Moonlight Madness. Less than an hour after we closed our eyes we were awakened by our house alarm, warning us that a sensor had failed. Not an intrusion, just a failed sensor. Checking it out, responding to the monitoring company’s phone call, bypassing the forbidden zone, tossing and turning, and soon an hour of much needed sleep was gone.

The night before that? First Max, our aging pup, woke Barb at about 4 a.m. Before she could settle back to sleep she heard the  chime warning that an outside door had opened — a feature I hate but now know why Barb appreciates. She rose to take a look, once again without the benefit of Lucille, and found the side door open and blowing in the breeze. She woke me and we did a search, responded to the monitoring company, and tried to get a last few moments of sleep.

Is the house talking to us? Is it having its fun with us? Is this a Poltergeist situation? Not being a believer in the supernatural, I doubt it. But I think that all of us, me, Barb, Max–everyone but the kitten–are still experiencing the unsettledness of living in a new home, even one as customized to our needs as this one. The little flaws and failures feel magnified, and we just haven’t gotten around yet to adding the final touches.

Hopefully soon the televisions will all work all the time, alarm sensors won’t fail, the $6.00 paper shades on the windows will be replaced by lovely window treatments, and  a smart system will help manage all the light switches (any suggestions/advice on smart systems appreciated.) The house will feel like home.

I am sure we will return to good nights of sleep. Until then, if you see me yawning, now you know why.

*Walking Dead reference.

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High School Nerd Factor-Can it be Overcome?

safety-cropped
Love those sweater vests!

A former classmate began a new Facebook group last week, dedicated to our high school graduating class, Chicago’s Roger C. Sullivan High School, Class of 1972. Since this coincided with unpacking the moving box that contained my final high school yearbook  I took the opportunity to find my pages, my pictures, my prophecies. I was on the Navillus staff (Sullivan spelled backward-get it?) and had joined lots of clubs to polish my college applications, so my face popped up in quite a few places. But with the jaundiced eye of someone who is far closer to his oldest grandchild’s high school days (11 years in the future) to his own (45 years in the past), I thought I would revisit all those activities that were meant to make my college application stand out and rate them for nerdliness. So here, with a rating scale of Nerd Factor of 1 (hey that’s cool) to 10 (complete loser activity) I present the high school life of Lester Raff, Sullivan Class of ’72.

1—————————————10

Cooler                                         Loser

  • National Honor Society-Nerd Factor 6 with extra nerd point for being President.
  • Local Honor Society-Nerd Factor 10. This was just another name for the National Honor Society.
  • National Merit Finalist-Nerd Factor 8. Doing well on a test (PSAT) no one else cared about. And “Finalist” is another name for loser.
  • It’s Academic-Nerd Factor 4. Yeah, being on TV was pretty cool. But of course losing on local TV prepared me for losing on Jeopardy on national TV a few years later.
  • Freshman, Sophomore and Junior Councils- Nerd Factor 7 for each year. Did anyone care?
  • Navillus Layout Editor-Nerd Factor 8. And if the rest of the staff was having wild “creative type of people” parties, I was never invited.
  • Rangers-Nerd Factor 9. Who were the Rangers? The smart guys confined to a small cubicle outside the main office were they ran the ditto machine. Or as described by one of the shop teachers “A bunch of brainiacs who don’t know their asses from their elbows.”  I guess he wanted to have that ditto machine in his office!
  • Safety Unit-Nerd Factor 10. The Rangers+Arm Badges. We guarded the exits during fire drills.
  • Key, German, Bridge and Chess Clubs-Nerd Factor ?– I don’t know, I never went to the meetings.

By my reckoning that averages out to a 7.6 on the Nerd Factor scale. How good of a predictor of future life was that? I think I have done a few cool things in life, and on the whole been pretty successful, but sad to say, when you look up nerd in the dictionary, you see the picture of a pathologist. Somethings are just destiny, you know?

How about you? How well did High School predict your life? And were those four years your high point, your low, or somewhere in-between?

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Neil Diamond vs U2. Who Do You Love?

shirtsjpgWith the weather warming, Barb and I have been looking ahead to our personal spring concert series, Neil Diamond at the United Center followed by U2 under the stars at Soldier Field. It will be our fourth visit with U2 as they tour to celebrate the 30th anniversary of their massive hit album “The Joshua Tree.” It will be about our 40th evening with Mr. Diamond as he tours to celebrate…well he tours to celebrate being Neil Diamond.

Barb has been a Diamond Girl since her teens, when she coaxed her parents to drive her and a friend to Kenosha for a performance of what was then a soul fulled,black-garbed troubadour. I discovered Bono, the Edge, Adam and Larry when “The Joshua Tree’ first arrived in the late 80’s and “With or Without You” filled the FM radio. In addition to dozens of Chicago shows, we have seen the now glittery Neil in Montreal (no poutine in the arena), and strutting Bono with a monster stage set in Las Vegas.

A little Google research shows that U2 and Diamond have never played live together, though U2 has played a few Diamond tunes in concert. No evidence Neil has ever returned the favor by belting out “Streets with No Name” or “Vertigo.”

A few notable U2/Diamond parallels:

In any case, both U2 and Neil Diamond are Rock’n’Roll Hall of Famers who put on great live shows. So who do you prefer. Leave a comment either on the ChicaoNow blog or on Facebook rating each from 1 to 10, and then share. Let’s see who is King of the Road.

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We Don’t Have What it Takes to Work for the Trumps-Ten Reasons Why.

jobsYup, Barb and I are still basking in our new suburban Chicago home. No moving vans are lining up to whisk us off to the nation’s capital. The President seems to have rescinded my invitation to be his science advisor, and Ivanka has lost interest in using Barb to decorate the White House. I’ve wracked my brain for what went wrong, and have unearthed a few reasons why our adventure down the rabbit hole into Wonderland D. C. seems to have short-circuited. In part it was our fault, in part the failure can be blamed on the Trumps and their cronies, and part…well that’s just the way things go sometimes.

Ten Reasons We Aren’t Working the White House

  1. The freakily warm Chicago weather has Secretary of State Tillerson worried that I may be channeling global warming via my hidden super powers. The former head of Exxon-Mobil has no interest in a climate changer as science advisor.
  2. Barb bought a pair of shoes at Nordstrom’s last week. We all know how Trump feels about THAT. But Ivanka’s interest may explain why my credit card company flagged the purchase with a potential fraud warning.
  3. Following Melissa McCarthy’s Saturday Night Live performance, all new hires from Illinois are subject to “double secret extreme vetting” to guarantee we don’t do cross-gender impersonations. It is rumored I failed that investigation.
  4. Barb’s “some of the decorating can wait until next year” philosophy was considered too slow for an administration that might not make it past cherry blossom season.
  5. Our lack of foreign language skills was a real drawback. Trump wants all new employees to be able to say “Get out of my country” in at least three languages.
  6. We get vaccinated–a lot.
  7. Our niece works for Marco Rubio. New Trump regulations exclude staffers with any relation to Lyin’ Ted or Little Marco.
  8. We texted POTUS asking for contracts guaranteeing us more than 24 days on the job. He tweeted back “Only Kellyanne Conway gets that kind of guarantee.”
  9. Our two china policy (Wedgewood and Rosenthal) was in conflict with this week’s foreign policy (but maybe not next week’s.)
  10. We filled out the wrong application. The New York Times published the right one a few days ago.

So Barb and I will just have to bide our time until Chris Kennedy calls us to Springfield in 2018. It might not be D.C., but our bags are packed!

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Playing “3 for Free” is Like Everything In Life-10 Tips for Being Prepared

scarWhen at last I am given my dues,
And injustice deliciously squared.
Be prepared!
The Lion King-1994

Show me a trivia contest. Tell me about a tricky word puzzle.  Offer me a mental challenge. You will have my mostly undivided attention and a  ball point pen will magically appear at my fingertips–pencils are for losers. Every vacation is preceded by a trip to Barnes and Noble to pick up the latest edition of Games Magazine, a publication my dad introduced me to 40 years ago and which still features the best variety of brain teasers on paper. The drive to tennis on Sunday mornings always includes listening to Will Shortz and the weekly puzzle on NPR. Every shot I miss can be blamed on my mind being lost in the maze of challenges like  “Take six different letters. Repeat them in the same order. Then repeat them again — making 18 letters altogether. Finally add “tebasket” at the end. If you have the right letters and you space them appropriately, you’ll complete a sensible sentence. What is it?” Got that?

But my current addiction is “3 for Free,” the challenge Lin Brehmer and Mary Dixon feature every morning at 6:40 on WXRT. They play clips from three songs or movies, you tweet in the titles, and first one in with the right response gets a “shout out” on the radio. No cash, no tickets, no swag, just a shout out.  But the competition is fierce with the names of repeat winners etched in my frontal cortex.

In the interest of universal access, I present some tips for being a champion and having your name spread over the airwaves by Mr. Brehmer, your best friend in the whole world. Be prepared to shine.

  1.  Get a twitter account. Not something everyone in the ‘XRT demographic (old rockers who saw the Beatles live in 1966) necessarily have.
  2. Get a radio. Forget online streaming for this one. Because of the buffering delay your answer will be too late to win (of course most of this demographic has never heard of online streaming.)
  3. Listen to the dynamic duo at 6:30. They most likely will give a hint to the subject of that day’s clips.
  4. Find a website that lists movies/songs that feature the topic in #3. Memorize the list.
  5. Pre-enter @93xrt and some likely answeres into a tweet. Nothing wrong with getting a head start, and you can always delete.
  6. Twiddle your thumbs during the song playing from 6:37 to 6:40.
  7. 6:40. OK, here come the clips. Listen and fill in your answers. Avoid brain freeze, that panicky moment when you could even forget your wife’s name. A delay of a millisecond is deadly.
  8. Proof read, especially if  Autocorrect is on. “The Devil Wears Pravda” is not, and never will be, a Meryl Streep movie title.
  9. Send your tweet and pray.
  10. Swear loudly as Lin announces that Joel Reese has won again.

Yes, just as in life, no matter how you prepare, you will probably lose more than you win. But all that planning keeps your brain sharp, and in our demographic, don’t we need that?

For more ways to keep your brain sharp, don’t forget to subscribe. See details below.

 

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Richard Dufour-National Educator, My Third Mentor

dufourI never chose my mentors, they just “were”. And then they are gone. I lost two of the men who helped shape my life within days of each other in 1993. My first real boss, Dr. Earl Suckow, passed away while undergoing aggressive therapy for recently diagnosed lung cancer. He was a smoker, a brawler, and let you know in no uncertain terms when you had crossed him. But in my first professional gig he took me under his wing, making sure I had the capability and the confidence to make my own diagnostic decisions. He encouraged me to go to night school for an MBA, emphasizing that in the years to come mastering the business of medicine would be as valuable to me as mastering the art of pathology. He was a family man, treasuring his annual trip to a Wisconsin resort with wife Char, his five daughters, and all the grandkids. Barb and I still look forward to the annual holiday cards picturing the whole Suckow clan.

My dad, Harold Raff, whom I have written about before and who I resemble in so many ways, died two weeks after Earl. His long, painful fight against prostate cancer  informs my decisions each day as I look at dozens and dozens of cores of prostate tissue under my microscope. I can only hope that I have been nearly the role model to my kids that my dad was to me.

Dr. Richard Dufour entered my life two years after those two men left it. In 1995, after doing some school related community service, I was asked by members of the Adlai Stevenson High School Board of Education to run for election to join them. It was as a Board member that I met Rick, superintendent and undisputed master of the school, the district, and possibly the universe. Under Rick’s guidance Stevenson had entered the realm of high performing high schools, battling it out for suburban supremacy along with perpetual powerhouse New Trier. Rick was tough, decisive, but with the capacity to listen. Our annual retreats were filled white white boards and wild thinking.

I know Rick had fun teasing me as the perpetual “junior member” of a Board mostly composed of old veterans, but he was always kind as he explained why my questions were way off base, my suggestions a bit bizarre. And we shared a love of music, Rick being one of the few people who could hold his own against me in a round of “Name that Tune.”

Rick was not “my” superintendent. He belonged to the old-timers who had chosen him. Most of my tenure as President of the Board was spent with his successor, Dr. Tim Kanold at the helm. By that time, Rick was making his mark on the national scene as a leading proponent of Professional Learning Communities. I had the pleasure of writing a review of one of his earliest books, Professional Learning Communities at Work. I submitted that review to a medical journal, fully believing that Rick’s ideas were so universal they could be applied in any setting. Apparently the editors of the American Journal of Clinical Pathology agreed and published the review a few months later.

It was in September of 2014 that I received a call from Rick, telling me he had just been diagnosed with lung cancer, and asking for some information and guidance. I cannot describe the  shock and sadness I felt as I spoke with him. Though not an expert in the field, I knew the statistics and the overwhelming odds he faced. But Rick was never a quitter, and along with wife Becky, he would not quit in his last battle. Barb and I followed his progress via the wonderful blog he wrote, always uplifting, never pitying. The last time I saw him, in the summer of 2015, he made it clear that he, and not the cancer, was running his life.

Yesterday, Becky wrote the blog post that we knew would be coming. It was brief, but loving as always, as she told us all that Rick had passed away.

For the third time cancer has taken my mentor. Perhaps I am too old to find another, but perhaps there will be someone for me right around the corner.

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Whose House is it Anyway? It is all Good.

It’s been awhile since you’ve heard from me. It isn’t a case of writer’s block or the nefarious (among bloggers) “fear to publish” syndrome. It certainly isn’t about a lack of things to write about. It’s more a case of trying to pack 30 lbs of stuff to do into a 20 lb bag of time. There just hasn’t been enough of me to go around.

Early January was filled with a monsoon of sub-contractors working on the new home, or “the big” as our granddaughter likes to call it. Once we gave builders Ham and Jeff an absolute deadline, we found the house filled with wall-to-wall workers. Painters, tilers, electrician, cleaners, the butcher, the baker and our favorite cabinet maker all stepped on each others toes in an effort to get us a certificate of occupancy. In the meantime, I collected contractor’s waivers and negotiated with the title company, part of our slightly unconventional way of financing the project.

And then there was the process of packing up our furnished apartment. What we thought would be a 2 hour job turned into a two day one. We stacked the living room with boxes, making it a challenge to get to the front door. Max and Phoebe certainly seemed befuddled.

moving-day
Moving Day-Barb Shares Lunch with the Gang

Moving day was smooth but not perfect, challenging but not chaotic. The move in crew wasn’t quite as sharp as the move out crew had been, and we detected a few broken pieces, although some damage remained hidden within the layers of cardboard, bubble wrap and packaging paper. Nothing too major, but disappointing none the less.

During the next week of frenetic unpacking we were assaulted by the odor of freshly stained wood floors and a gas-like (but according to North Shore Gas not actual natural gas) miasma–the result of all those last minute paints and stains. Tradesmen continued their round the clock assault, working on AV, alarms and back-up power systems. We escaped for a wonderful relaxing week with friends at our Cabo San Lucas timeshare, though even that was interrupted by a text from the lab–“Two inspectors just turned up at the door for a surprise lab inspection.” That was one day of the vacation spent mostly on the phone, though my work associates tell me they could hear the gentle poolside breeze in the background. At least they couldn’t see the gentle poolside Margarita in my hand!

Returning home I was faced with learning a new computer system at the lab while clearing up the paper work from the inspection, and more unpacking in “the big.” There were plenty of house tours to family and friends, with more than a few celebratory bottles of wine uncorked. When we realized one of our old TV sets was too small for the allotted wall space off we went to BestBuy for a new smart TV. We discovered the smartest party in the TV equation are the sellers of TV brackets, which are more expensive than the UltraHigh Def 10G Supersonic Sets that hang on them.

Yesterday was a major milestone. Handymen hung our artwork and unfurled area rugs on the now thoroughly cured wood floors. The cardboard cartons were all sent for recycling and the properly stickered garbage bags hauled away so I can once again park in the garage. Now in every room in the house we have something familiar. There is something old, something new. But as we were going to bed Barb said to me “I feel like an imposter in this house.” So it is still with a little trepidation and a little uncertainty that we walk past the newly painted walls and the glistening chandeliers, negotiate the kitchen island-continent, and struggle with finding the new light switches. It is our home, but just doesn’t quite feel like it yet. But I know deep down and without hesitation, the best is yet to come!

++++

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Kitchen Confessions – The Wall Street Journal Says We Blew It

kitchen
A book that cooks

You could have held a contractors convention at the construction site last week. Painters in one bedroom, trim carpenters in the next. The plumbers who were scrunching under bathroom fixtures making final hook-ups were following hot on the heels of the tilers, who were busy grouting and sealing the stone floors. Electricians were scaling ladders hanging the chandeliers, while cabinet artistes were on their knees installing the latest batch of knobs and handles.

Since final inspection has been scheduled for Wednesday, and move-in date is less than a week after that, the pressure is multiplying. Every absent sub-contractor has us texting, calling, or grilling the GC.  Yet I am convinced that with a Three Musketeers ethos of “all for one and one for all” we will defy conventional wisdom and be sleeping in our new home in less than ten days. So imagine my disappointment when a recent double paged, picture-packed article in the bastion of design, the Wall Street Journal, informed me that as far as kitchens go, we blew it.

Let me describe our new kitchen. Rows and rows of meticulously hand crafted cabinets covered by highly polished counter tops. Accessory garages you can park a medium sized Kia in. A double sink, personally chosen by me, big enough to contain an entire dinner party for six–not just the dishes, the guests too. Dueling built-in ovens and a microwave that disappears into the cabinetry with the touch of a button. A light fixture that is close to Barb’s heart, and the pièce de résistance, an island roughly the size of Madagascar. We thought we had designed the most glorious galley that could be imagined.

So what was in the WSJ article that smashed our dreams? It seems that these days, those chichi New York homes now feature HIS AND HERS kitchens. That’s right, once is never enough!

Now his and hers walk-in closets I understand. I can even grasp the concept of separate (but equal) bathroom facilities. But kitchens?

Once or twice a year I make my damn good heart healthy turkey chili. And in any given winter I am prone to pull  the crock pot out of the recesses of the pantry to slow cook a tasty, but not too peppery, beef goulash. But other than those occasional incidents, and sometimes spreading chopped vegies over a Home Run Inn frozen pizza before popping it in to a preheated 450º oven, I don’t really do all that much cooking.

Yes, I do much of the clean-up. But I was more than content to share the counters and cabinets, the continental island and the oceanic sink, with Barb. But now I know the truth. Because of our solo kitchen we can never be a truly hip, up-to-date, 21st century couple. So do you think I can convince Barb to that we need to do this one more time, and this time maybe we will get it right?

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Ivanka has Designs on Barb

ivanka-barbWith my acceptance of the Scientist in Chief position in the incoming administration, Barb and I  faced the possibility of a long-distance relationship for the first time in our 38+ years of marriage. Facing the unfaceable, we decided we had to find a way to put Barb to work in the nation’s capital too. And in doing so, we hoped to make a life long dream come true!

All of you are familiar with the incredible job Barb has done as the supreme visionist and manager for our almost complete new suburban home. But you may not know that for Barb, this has only been practice. Her desire for years has been to take on the White House. It is old, it is big, it is important, and it needs a makeover. What better project to refresh the batteries — and get us both to Washington at the same time! So we pulled in  favors with a congressional aide here, a senatorial counsel there, a tweet or two to Mr. Trump himself. Our diligence paid off as we managed to arrange a very special job interview for Barb.

Last week, in a secret meeting in our friend’s apartment in Trump Tower downtown, Barb met with our First Lady to Be, the glamorous Ivanka Trump. I am pleased to say the meeting went swimmingly. The two ladies immediately bonded in a discussion of fabrics and window coverings. Ivanka’s face gleamed as they shared their admiration of marble. When Barb mentioned that our architect Jefferson had once worked on Hugh Hefner’s Chicago Playboy Mansion, Ivanka let it slip that President Trump had expressed  a desire for a hidden Man Cave below the Oval Office, and maybe they could borrow some of the Playboy plans?

The designing ladies sealed their admiration for each other with their mutual distaste of green, the newly declared Color of the Year. “Greeen may be OK as an accent color here and there, but if you paint a room in it, it makes my skin look pallid,” Trump was heard to say. “I know we can do lots of things with different shades of white, the Color of the Year in 2016. And what year has ever been better than 2016?”

So while it is not yet official, I think we (or Vladimir Putin) can confidently leak  that Barb will be accompanying me to Washington as Ivanka’s White House Decorator and personal confidante. Look out Washington, the Raffs are on the loose. It’s going to be a fun four years!

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