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Your Baby

Can Prenatal Supplements Reduce Baby’s Risk of Autism?

2:00

According to the Centers for Disease Control and Prevention (CDC), 1 in 68 U.S. children have been identified with autism spectrum disorder.  

While there is no one cause attributed to the developmental disability, a new study suggests that taking folic acid and multivitamins during pregnancy may reduce your child's risk of developing autism.

 “Reduced risk of [autism] in offspring is a consideration for public health policy that may be realized by extended use of folic acid and multivitamin supplements during pregnancy," the researchers concluded in the report.

The international team of scientists, led by Stephen Levine from the University of Haifa in Israel, gathered data on tens of thousands of children born in Israel between 2003 and 2007, and followed their progress until 2015.

Researchers gathered prescription data, to see whether the kids' mothers had been prescribed folic acid or multivitamin supplements either prior to or during pregnancy.

Results showed that women who took supplements prior to pregnancy were 61 percent less likely to have a child diagnosed with autism, compared with moms who didn't take supplements.

In addition, taking supplements during pregnancy was linked to a 73 percent reduced risk of an autism diagnosis, the findings showed.

These study results indicate that taking folic acid and multivitamins could be a way to protect babies against the development of autism, said Tom Frazier, chief science officer for Autism Speaks, a group that promotes advocacy and support for individuals with autism and their families.

"The study suggests this is not a trivial recommendation. This is something that people really should pay attention to," Frazier said. "The reduction in risk isn't huge, but it isn't small either."

Pregnant women are advised to take folic acid to prevent abnormal fetal neural development. A lack of the vitamin could possibly set the stage for later onset of autism, Frazier said. He's not sure how the protective effect of multivitamins might work.

The study is not without its’ critics. The study cannot prove a direct cause-and-effect link between supplements and autism due to its design, and suffers from some major limitations, said Dr. Ruth Milanaik, director of the neonatal neurodevelopmental follow-up program at Cohen Children's Medical Center, in New Hyde Park, N.Y.

"I don't have a problem with saying folic acid is good for pregnant women. You should not only take folic acid during pregnancy, you should also take folic acid before pregnancy," Milanaik said. "But this study does not show that [not taking supplements] is a cause of autism in any way, shape or form."

Prescription records can't show whether women follow through and take their supplements, she said. Supplements also are available over-the-counter, and some of the moms could have purchased and taken them without waiting for a prescription, Milanaik notes.

The study was published online in January, in the journal JAMA Psychiatry.

Story source: Dennis Thompson, https://consumer.healthday.com/cognitive-health-information-26/autism-news-51/prenatal-vitamins-tied-to-lower-autism-risk-in-kids-study-finds-729864.html

Daily Dose

Cord Blood Banking

1:30 to read

Expectant parents (including my own children) often ask me about banking their newborns cord blood. They see a lot of information about “cord blood banking” in their obstetricians offices, on the internet and comments on their social media sites.

 

The American Academy of Pediatrics just released updated guidelines on “cord blood banking for potential future transplantations”.  The AAP (as well as most professional societies in both the U.S. and Europe) is in favor of public cord blood banking systems. 

 

There are definitely important differences between public and private cord blood banks. Public cord blood banks are non profit and serve the needs of the general public, while private cord blood banks are for the use of an infant or family member who may have a serious disease.  Public banks do not charge parents a fee for storing cord blood, while private cord blood banks typically charge several thousand dollars for the initial banking followed by annual fees. 

 

Accreditation of cord blood banks is extremely important and public cord blood banks are held to better quality control than private banks. The process of collecting, processing and utilizing cord blood cells for possible transplantation to an infant or child with malignancies, metabolic disorders or immune deficiencies is arduous and should be supervised by regulatory agencies. At this point private cord banks do not all have to follow the same regulations and there is nothing to ensure that all cord blood banks comply. 

 

Many parents are also under the false assumption that their child’s stem cells harvested from the cord blood might be used if their child develops childhood leukemia. In fact, scientists have found that those stem cells already contain pre-malignant leukemic cells and would not prevent a reoccurrence of leukemia. In other words, those stem cells would not be used for transplantation, but rather another donor’s stem cells would be used for your child if they developed leukemia. 

 

Lastly, the chance that an infant’s cord blood stem cells will be utilized for transplantation to help another child is 30 times greater in the public cord blood banking system than from a private cord blood bank.

 

The pediatric hematologists and oncologists (doctors who take care of children with blood diseases and malignancies) I know do not recommend private cord blood banks and have had their own children’s cord blood donated to public cord blood banks. This is also the recommendation I gave to my own children.

 

So if you are having a baby and are getting asked if you want to participate in cord blood banking, I would skip the private companies and donate to the public cord blood bank where your child’s stem cells might help save another child’s life. 

 

Your Baby

Which Fish is Healthier for Pregnant Women?

1:45

New federal nutrition guidelines say that pregnant and breastfeeding women should eat 2 to 3 servings of fish every week. However, there are certain fish that should be eaten only once per week and other fish that should be avoided entirely by pregnant and nursing women.

One reason for the differentiation between certain types of fish is its likelihood of containing either very low or high levels of mercury.

Nearly all fish and shellfish contain traces of mercury. But some contain high levels.  A type of mercury called methylmercury is most easily accumulated in the body and is particularly dangerous.

Eating large amounts of these fish and shellfish can result in high levels of mercury in the human body. In a fetus or young child, this can damage the brain and nervous system.

The highest mercury concentration belongs to fish that typically live a long time. Pregnant and breastfeeding women should avoid King mackerel, Marlin, Orange roughy, Shark, Swordfish, Tilefish from the Gulf of Mexico and Bigeye Tuna. These are fish that usually contain high levels of mercury.

The new guidelines come with a handy chart that gives you the best choices of fish, good choices and fish to avoid.

Naturally, many pregnant women are concerned about eating fish after hearing about the possibility of consuming any mercury whatsoever. It’s important to remember that most of the fish consumed by Americans falls into the safe category.

Studies show that fish provide an array of nutrients that are important for your baby's early development. Most experts agree that the key nutrients are two omega-3 fatty acids – DHA and EPA – that are difficult to find in other foods. Fish is also low in saturated fat and high in protein, vitamin D, and other nutrients that are crucial for a developing baby and a healthy pregnancy.

How do fish end up consuming mercury? Some of the sources (such as volcanoes and forest fires) are natural. It's also released into the air by power plants, cement plants, and certain chemical and industrial manufacturers, landfills and farming runoff.

When mercury settles into water, bacteria convert it into a form called methylmercury. Fish absorb methylmercury from the water they swim in and the organisms they eat. Methylmercury binds tightly to the proteins in fish muscle and remains there even after the fish is cooked. Fish that live a long time consume more mercury.

There are many benefits to eating fish; you just need to be aware of the kinds of fish you eat. To help you make the best choices, the new chart released by the FDA and EPA is shown below.

Story sources: Megan Thielking, https://www.statnews.com/2017/01/19/fda-guidelines-fish/

http://www.babycenter.com/0_eating-fish-during-pregnancy-how-to-avoid-mercury-and-still_10319861.bc

http://www.fda.gov/downloads/Food/FoodborneIllnessContaminants/Metals/UCM536321.pdf

Your Baby

Kids of Obese Mothers at Higher Risk for Autism, ADHD

1:45

A new study points out another reason that obesity and pregnancy can be a bad combination not only for the mother but for her future child as well.

Researchers found that six-year-olds whose mothers were severely obese before pregnancy are more likely to have developmental or emotional problems than kids of healthy-weight mothers.

The lead author of the study, Heejoo Jo of the Centers for Disease Control and Prevention (CDC), and her team reviewed data on 1,311 mother-child pairs collected between 2005 and 2012, including the mothers’ body mass index (BMI, a height-to-weight ratio) before pregnancy and their reports of the children’s psychosocial difficulties at age six.

The researchers also incorporated the children’s developmental diagnoses and receipt of special needs services.

Kids of moms who were severely obese, with a BMI greater than 35, were twice as likely to have emotional symptoms, problems with peers and total psychosocial difficulties compared to kids of moms who had a healthy BMI, between 18.5 and 25.

Their children were three times as likely to have a diagnosis of autism spectrum disorder and more than four time as likely to have attention-deficit/hyperactivity disorder (ADHD), as reported in the journal Pediatrics.

Previous studies have shown a connection with autism and maternal diabetes and obesity.

Researchers took into account pregnancy weight gain, gestational diabetes, breastfeeding duration, postpartum depression and infant birth weight. None of these explained the apparent association.

“We already do know that obesity is related to health problems during pregnancy and throughout the lifetime,” Jo said. “I think this adds to that by suggesting that not only does severe obesity affect a woman’s health but the health of her future children.”

This study could not analyze the mechanism linking severe obesity and later risk for developmental problems, Jo noted.

“One theory that we could not look at and needs further research was some small studies have linked maternal obesity to increased inflammation, which might affect fetal brain development,” she told Reuters Health by phone.

While it sounds cliché because we’ve heard it so much; obesity in America has reached epidemic status. Almost 30 percent of Americans are obese and the prevalence of maternal obesity has risen rapidly in the last two decades.

In the USA, approximately 64% of women of reproductive age are overweight and 35% obese.

Women’s health specialists recommend that obese women considering pregnancy lose weight before they conceive to help reduce health risks for themselves as well as their child.

The Academy of Pediatrics recommends that all children be screened for developmental delay or disability at nine, 18 and 24 or 30 months of age.

Health experts strongly suggest that women who were obese or severely obese when they became pregnant make sure that their children receive these developmental screenings.

Sources: Kathryn Doyle, http://www.reuters.com/article/2015/04/28/us-obese-pregnancy-adhd-kids-idUSKBN0NJ2FC20150428

James R. O'Reilly, Rebecca M. Reynolds, http://www.medscape.com/viewarticle/776504

Your Baby

Pregnancy: Too Much, Too Little Weight Gain Adds to Health Risks

2:30

If you’re thinking about becoming pregnant, starting your pregnancy at a normal weight is best for baby and you, according to new study.

The study found that too much or even too little weight, increases an expectant mom's risk for severe illnesses and death. 

"Not only for baby's sake, but also for your own sake, have a healthy diet and get regular exercise before pregnancy," said study lead author Dr. Sarka Lisonkova. She's an assistant professor in the department of obstetrics and gynecology at the University of British Columbia and the Children's and Women's Health Centre in Vancouver. 

"It's never too late, even if you're already pregnant," Lisonkova said, adding that weight gain during pregnancy can also increase the risk for severe illnesses and even death in expectant mothers.

The study was large, including information on three-quarter of a million women. The average age of the women was 28 years old.

The researchers found that the more a woman weighed, the more likely she was to have a severe illness or to die during pregnancy. Underweight women also had an increased risk for these outcomes. Severe illness included such conditions as eclampsia (convulsions or coma brought on by high blood pressure), sudden kidney failure, sepsis, hemorrhage and respiratory problems.

While the results sound scary, the risk to any one particular woman is low. For instance, the study found that, compared with normal-weight pregnant women, there were about 25 more cases of either severe illness or death for every 10,000 pregnant women if the woman was obese.

"The chance that any one woman dies in pregnancy is about 1 in 6,000 in the United States," said Dr. Aaron Caughey, who chairs the department of obstetrics and gynecology at Oregon Health and Science University in Portland

However, what's especially concerning about this study's findings, he said, is that more and more women are entering pregnancy obese or super-obese. With higher levels of obesity, "there's an incredibly high inflammatory state that increases the risk of rare outcomes, like thromboembolism," a blood clot, Caughey said.

He said that underweight women likely had a chronic illness that increased their risk. 

Both Caughey and Lisonkova said that ideally, women should be at a normal weight before getting pregnant. If a woman isn't at her ideal weight, pregnancy is a good time to start focusing on things such as eating a healthy diet and getting regular exercise, they said. 

Pregnancy can be a "focusing event for affecting behavior change in women," Caughey said, because once pregnant, a woman often focuses on doing what she can to have a healthy baby.

"Pregnancy is a great time to think about diet and exercise, especially because women often drive health behaviors in the family, so there's no time like the present to make healthy changes," he said. 

Lisonkova also emphasized the importance of good prenatal care. "Clinicians can catch signs of potential complications earlier with regular checkups," she said. 

A woman will naturally gain weight while pregnant and that’s as it should be, but if you begin a pregnancy overweight it’s more difficult to keep the weight gain within the normal range. It’s healthier for mom and baby to begin a pregnancy at or close to a normal weight.

The study was published in the November edition of Journal of the American Medical Association.

Story source: Serena Gordon, https://consumer.healthday.com/vitamins-and-nutrition-information-27/overweight-and-underweight-health-news-516/weighing-too-much-or-too-little-when-pregnant-can-be-risky-728505.html

 

 

Your Baby

Babies in 3D Virtual Reality

1:45

3D imaging of fetuses has been around for a while, but the images are typically static and lacking in depth. That may change however, with a new virtual reality technique that can be rotated 360 degrees, according to a team of researchers from Brazil.

The researchers said that they hope that these enhanced fetal models are the next step in not only allowing parents to visualize their future children, but also in helping researchers to better understand fetal anatomy.

In their research, the researchers were able to use the technique to visualize and make 3D models of 25 fetuses. There were two cases in which the technique didn't work In those, the levels of amniotic fluid were too low for the researchers to get images of the fetus that were high enough in their resolution to make the 3D model, Werner told Live Science.

But in the cases where the technique worked, "we found these images more real, and the possibility that we can see in 360 degrees presents us with a greater interaction with the exam," said study co-author Dr. Heron Werner Jr., who is from a company called Clinical Diagnostic Imaging that is based in Rio de Janeiro. Heron and his colleagues recently presented the technique at the annual meeting of the Radiological Society of North America.

The technique involves creating a 3D model of the fetus using MRI and ultrasound, or a combination of the two. A pregnant woman would undergo an imaging exam similar to a regular obstetric ultrasound or MRI. Next, the researchers would use frames of these images, in sequence, to begin to make a 3D model of the fetus, the researchers said.

The most exciting part is that the parents would then be able to view the final image - which can include the inside of the womb, the umbilical cord and the placenta along with the fetus — through a virtual reality device like a headset.

Werner and his team used a virtual reality headset in their research. They found that women could not only experience what it would look like if they were flying through and around their fetus by merely looking around, but also they could hear the fetal heartbeat, by way of the ultrasound.

Another benefit of this new technology is in its ability to allow medical professionals new options for evaluating the health and development of a fetus, the researchers said.

For example, the researchers said, a doctor could zoom through the entire length of a fetus’s airway to look for masses that could block it and to better determine delivery options.

What once seemed like science fiction is well on its way to being a part of everyday science.

Story source: Taylor Kubota, http://www.livescience.com/57221-vrtual-reality-shows-unborn-babies-in-3d.html

 

Your Child

Will 60% of U.S. Children be Obese by Age 35?

2:00

As many as six in ten U.S. children could be obese by the time they are 35 years old. That sobering news comes from a study conducted by "Childhood Obesity Intervention Cost-Effectiveness Study" (CHOICES).

The numbers are a result of data entered into a computer. The investigators first combined height and weight data from five studies involving about 41,500 children and adults. The computer then generated a representative sample of 1 million "virtual" children up to the age of 19, living in the year 2016. The model then predicted how obesity rates would unfold until all the virtual children turned 35.

The model indicated that being overweight or obese early in life bumped up the risk for being obese later in life. In addition, the more overweight or obese someone was as a child, the greater the person's chance of being obese by age 35.

According to the U.S. Centers for Disease Control and Prevention (CDC), roughly 20 percent of American children between the ages of 6 and 19 years of age are currently obese. That reflects a tripling of the number since the 1970s.

The study’s lead author, Zachary Ward, a doctoral candidate in health policy with the Harvard T.H. Chan School of Public Health's Center for Health Decision Science, in Boston, noted that the results were not unexpected.

"It should not be surprising that we are heading in this direction. We are already approaching this level of adult obesity for certain subgroups [and] areas of the country." Ward said.

Still, Ward expressed some surprise at how strongly being obese at a very young age predicted obesity decades down the road. 

"For example, we found that three out of four 2-year-olds with obesity will still have obesity at age 35," he said. "For 2-year-olds with severe obesity, that number is four out five."

Lona Sandon, an assistant professor of clinical nutrition at the University of Texas Southwestern Medical Center in Dallas, was also not surprised at the findings.

"Trends show obesity occurring earlier in adulthood, and [the] current level of childhood obesity suggests that the trend will continue," said Sandon, who was not involved with the analysis. 

Because "obesity is difficult to reverse at any age," she said, prevention is key. Parents should not rely solely on public school nutrition and activity programs to do the job.

Earlier studies have suggested that obesity in children may begin in the womb if the mother is obese when she becomes pregnant, and develops gestational diabetes. This combination can produce a large child at birth. Studies have shown that babies born with higher amounts of fat at birth tend to continue having more body fat in childhood and on into adulthood.

Experts recommend that overweight women that are considering becoming pregnant, first lose the extra weight and be tested for type2 diabetes. If they are found to have type2 diabetes before they're pregnant, they should be treated beforehand; this will help their pregnancy and prevent complications.

Sandon also notes that there are other things parents can do to help insure a healthier child. "Concerned parents can make efforts to prepare and provide healthier foods at home, plan regular scheduled mealtimes, limit screen time, encourage participation in sports, encourage participation in active leisure time activities instead of more sedentary activities and, most of all, set an example by being active, having a healthy relationship with their own food choices and having regular mealtimes as well."

The study by Ward and his colleagues appears in the November issue of the New England Journal of Medicine.

Story sources: Alan Mozes, https://www.webmd.com/children/news/20171129/60-percent-of-us-kids-could-be-obese-by-age-35#1

Lucilla Poston, Professor, https://www.news-medical.net/news/20170111/Childhood-obesity-starts-in-the-womb.aspx

 

 

Your Baby

Eating Fish During Pregnancy Benefits Baby’s Brain Development

2:00

Can eating more fish during pregnancy help babies’ brains function better as they grow older? Yes, according to a new study from Spain. The researchers say that mothers who eat three substantial servings of fish – each week- during pregnancy may be giving their children an advantage as they mature.

Researchers followed nearly 2,000 mother-child pairs from the first trimester of pregnancy through the child’s fifth birthday and found improved brain function in the kids whose mothers ate the most fish while pregnant, compared to children of mothers who ate the least.

Even when women averaged 600 grams, or 21 ounces, of fish weekly during pregnancy, there was no sign that mercury or other pollutants associated with fish were having a negative effect that offset the apparent benefits.

“Seafood is known to be an important source of essential nutrients for brain development, but at the same time accumulates mercury from the environment, which is known to be neurotoxic,” lead author Jordi Julvez, of the Center for Research in Environmental Epidemiology in Barcelona, said in an email to Reuters Health.

This important health concern prompted the U.S. Food and Drug Administration (FDA) to come up with a guideline for pregnant women in 2014. It encourages women to eat more fish during pregnancy, but limit the intake to no more than 12 ounces per week.

For this study, researchers analyzed data from the Spanish Childhood and Environment Project, a large population study that recruited women in their first trimester of pregnancy, in four provinces of Spain, between 2004 and 2008.

Julvez and colleagues focused on records of the women’s consumption of large fatty fish such as swordfish and albacore tuna, smaller fatty fish such as mackerel, sardines, anchovies or salmon, and lean fish such as hake or sole, as well as shellfish and other seafood.

Women were tested for blood levels of vitamin D and iodine, and cord blood was tested after delivery to measure fetal exposure to mercury and PCB pollutants. At ages 14 months and five years, the children underwent tests of their cognitive abilities and Asperger Syndrome traits to assess their neuropsychological development.

On average, the women had consumed about 500 g, or three servings, of seafood per week while pregnant. But with every additional 10 g per week above that amount, children’s test scores improved, up to about 600 g. The link between higher maternal consumption and better brain development in children was especially apparent when kids were five.

The researchers also saw a consistent reduction in autism-spectrum traits with increased maternal fish consumption.

Mothers’ consumption of lean fish and large fatty fish appeared most strongly tied to children’s scores, and fish intake during the first trimester, compared to later in pregnancy, also had the strongest associations.

“I think that in general people should follow the current recommendations,” Julvez said. “Nevertheless this study pointed out that maybe some of them, particularly the American ones, should be less stringent.”

Julvez noted that there didn’t appear to be any additional benefit when women ate more than 21 ounces (about 595 g) of fish per week.

“I think it's really interesting, and it shed a lot more light on the benefits of eating fish during pregnancy,” said Dr. Ashley Roman, director of Maternal Fetal Medicine at NYU Langone Medical Center in New York.

“I think what's interesting about this study compared to some data previously is that they better quantify the relationship between how much fish is consumed in a diet and then the benefits for the fetus and ultimately the child,” said Roman, who was not involved in the study.

Roman also noted that pregnant women should avoid certain fish such as tilefish, shark, swordfish and giant mackerel. These are larger fish with longer life spans that may accumulate more mercury in their tissue.

While fish may be a great source of protein and benefit brain development in utero, most experts agree that women should consult their obstetrician about what fish are safer to eat and how much they should eat during pregnancy.

The study was published online in the January edition of the American Journal of Epidemiology

Source: Shereen Lehman, http://www.reuters.com/article/us-health-pregnancy-fish-idUSKCN0UW1S4

 

 

 

Your Baby

First U.S. Baby Born After Uterus Transplant!

2:30

An amazing event that could give hope to women who have been told they could never have a child because their uterus is nonfunctioning, unfolded recently in Dallas, Texas.

For the first time in the United States, a woman who was born without a uterus gave birth to a baby. The landmark birth took place at Baylor University Medical Center at Dallas, a part of Baylor Scott & White.

In an exclusive report by TIME, the details and background of this major undertaking are revealed.

The birth took place at Baylor — the first birth in the hospital’s ongoing uterus transplant clinical trial. Women who participate in the trial have what’s called absolute uterine factor infertility (AUI), which means their uterus is nonfunctioning or nonexistent. Most of the women in the trial have a condition called Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome — and have lived their entire lives under the assumption that they would never be able to be pregnant or give birth to a baby. The procedure could also work for women with other medical issues, such as certain cancers.

The women in the clinical trial are transplanted with a uterus from either a living or deceased donor. The woman who gave birth received her transplant from Taylor Siler, a registered nurse in the Dallas area, who was a so-called “altruistic” living donor: a stranger who volunteered to donate her uterus to a woman without one. So far, Baylor says they’ve had over 70 women express interest in donating their uterus.

Baylor will complete a total of 10 uterus transplants as part of its first trial. So far the hospital has completed eight. At least three have failed. The hospital has confirmed to TIME that there is another woman in the trial who is pregnant, using a living donor uterus.

Baylor’s uterus transplant program is one of a handful to launch in the United States in recent years, and it’s the first to use both living and deceased donors. Successful uterus transplants from live donors have taken place in Sweden — a medical team at Sahlgrenska University Hospital in Gothenburg pioneered the first uterus transplant trial that resulted in eight births. This birth at Baylor is the first to replicate that success.

“We do transplants all day long,” says Dr. Giuliano Testa, the leader of the uterus transplant clinical trial at Baylor, and surgical chief of abdominal transplant for Baylor Annette C. and Harold C. Simmons Transplant Institute. “This is not the same thing. I totally underestimated what this type of transplant does for these women. What I’ve learned emotionally, I do not have the words to describe.”

The recipients in the clinical trial are between the ages of 20 to 35, and the donors must be between ages 30 to 60. “When you donate a kidney, you do it to help someone live longer and get off dialysis,” says Dr. Testa. “For these women, they are donating an experience.”

Once the women in the trial are transplanted with the uterus, they wait to recover and achieve menstruation, usually about four weeks from transplant. Women whose transplant is successful can then attempt in vitro fertilization (IVF). (The women in the trial have functioning ovaries that are not attached to their wombs, which is why IVF is required to get pregnant.)

Although the successful transplant and birth may give hope to many women, it comes at a steep cost. Uterus transplants are expensive, with some estimates putting the cost at up to $500,000. Like other infertility treatments, it’s very rare that an insurance company would cover the procedure, which is largely viewed as elective. Baylor covered the cost of the first 10 transplants in the clinical trial, but the medical team is now seeking funding—largely through donations from institutions and private donors—in order to continue. The team says many more transplants need to be done before it could be provided as a standard treatment. “The reality is that it’s going to be very difficult for many women to afford this,” says Testa.

Baylor says they do not view uterus transplants as a replacement for other approaches like adoption or surrogacy, but as another option for women and their partners.

Baylor will continue to follow the health of the baby as part of the study. The goal is for the birth to mark the beginning of a new field of infertility treatment research, rather than be an outlier.

For the complete exclusive TIME story you can click on http://time.com/5044565/exclusive-first-u-s-baby-born-after-a-uterus-transplant/

 

 

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