Everything You Need to Know About Lynch Syndrome

Catching Cancer in Patients with Lynch Syndrome

Does your patient have cancer in their family history? If they have Lynch Syndrome, a simple screening can catch cancer before it’s too late.

It’s easy to merely glance over the obligatory medical history form that new patients fill out, scanning for information pertinent only to their presenting problem. But, as we at IntimMedicine Specialists look over a new patient’s medical history, we are always on the “look out” for a family history of cancer. How about a family history of colon, uterine, or ovarian cancer? These and a number of other cancers could indicate that you and your family has Lynch Syndrome.

Lynch Syndrome is named after Dr. Henry Lynch, who is considered the father of hereditary cancer. He named this syndrome the “Cancer Family Syndrome” in 1966, which was later called “Lynch Syndrome” in 1984 by other authors, after which point Lynch himself began calling it Hereditary Nonpolyposis Colorectal Cancer, or HNPCC. It is now known as HNPCC or Lynch Syndrome, and it is characterized by members of the same family line born with a predisposition to develop ovarian, colo-rectal, endometrial, or other cancers.

For those of us in the fields of sexual health, we are in a unique position to be able to spot this syndrome and help our patients get the screenings they need to catch these potential cancers early. 1 in 400 people are at risk for Lynch Syndrome. It is projected that up to 1 million people in the United States have Lynch Syndrome, but due to a lack of public education about it, only about 5% of people who have Lynch Syndrome have been diagnosed with it.1 Patients with Lynch Syndrome are at a much higher risk of developing these cancers, and it is recommended that their screenings start at an earlier age and are repeated more frequently than patients without Lynch Syndrome. For example, a patient with a family history of colon cancer starting before age 50 might have Lynch Syndrome, and it is recommended that they begin colonoscopies at age 20-25, rather than wait until it may be too late.


  • If a patient has a family history of colon cancer – particularly if a family member developed colon cancer before age 50
  • If a patient has a family history of extracolonic cancers including endometrial, ovarian, small bowel, biliary, renal pelvis, ureter, or glioblastoma (a particular brain cancer)
  • If a female patient has abnormal uterine bleeding and a diagnosis of complex endometrial hyperplasia or endometrial cancer and she is younger than age 50

If any of these criteria are met, it is time to order a hereditary cancer panel. This panel will test for multiple cancer syndromes at once and is now the standard of care.

We are in a unique position to be able to catch cancer before it strikes. Ask your patients more about their family history of cancer. A simple screening process can make all the difference.

The specialists at IntimMedicine are experts in post-cancer sexual health. If you or a loved one is being treated for cancer or has been treated for cancer, talk to us at 202.293.1000, or email us at info@intimmedicine.com.

Learn more about Lynch Syndrome in this article.

1 https://www.contemporaryobgyn.net/gynecologic-cancers/keys-identifying-lynch-syndrome

Let's talk about IT - MonaLisa Touch

Let’s Talk About IT

Introducing MonaLisa Touch, a groundbreaking vaginal treatment for menopausal women.

“IT” is vaginal discomforts, including dryness, burning, itching, and painful sex, all which fall under the umbrella term, “vaginal atrophy.” Vaginal atrophy can occur after vaginal childbirth and/or during menopause. Around 40% of menopausal women suffer from vaginal atrophy, but these women rarely talk to their gynecologists about it. If you’re one of them, it is time to stop suffering in silence and get back to enjoying your sex life!

We at IntimMedicine Specialists are very happy to offer you a vaginal laser procedure called MonaLisa Touch from our office here in Washington, DC. MonaLisa Touch is a painless and minimally invasive therapy that requires 1-3 treatments over the course of a few months. We know you have questions – we have answers!

Who is MonaLisa Touch for?

MonaLisa Touch is for any woman who wants to prevent or treat vaginal symptoms related to a decrease in estrogen, which can occur during menopause, after childbirth during breast feeding, or after many different cancer treatments, especially following breast cancer. If you are looking for a treatment that does not require hormones or surgery, MonaLisa Touch might be your answer!

How does MonaLisa Touch work?

MonaLisa Touch is a laser treatment that reactivates the production of collagen and rebalances the conditions of the superficial vaginal tissues. It does this by gently acting on the vaginal walls. This is a safe and painless process that only takes a few minutes.

Does it hurt?

MonaLisa Touch is completely painless! Patients have reported feeling a slight vibration, and some say that it feels no different than getting a pap smear. For extremely sensitive patients, a form of “Novocaine” can be topically applied without injections to eliminate any discomfort of the procedure.

How long is the recovery, and how long does it take to start working?

We recommend refraining from vaginal intercourse for 3-4 days after each treatment, but you’ll start to notice a positive difference almost right away! More treatments may be recommended depending on the severity of symptoms, but typically 3 sessions are needed for best results.

How long does the treatment last?

Treatments can last for at least a year, depending on the severity of symptoms and your age and lifestyle. We can revisit the need for additional treatment sessions with you after a year or if symptoms recur.

We can help you restore your vivacity! If MonaLisa Touch vaginal therapy sounds right for you, give us a call at 202.293.1000 or email us to make an appointment for a consultation at IntimMedicine in Washington, DC.

As the number of postmenopausal women continues to grow — reaching an estimated 1 billion worldwide — patients might believe that doctors have a good sense of the full range of menopausal symptoms and how they affect daily life. But despite numerous studies, detailed information on the full spectrum of menopausal complaints are actually lacking in large randomized trials.

But following a recent study that measured the quality of life in postmenopausal women aged 50-70, researchers hope to more fully identify menopause-related symptoms and help clinicians connect symptomatology with overall health.

The Connection Between Age and Menopausal Symptom Severity

During menopause, women may find themselves experiencing a range of associated symptoms, like hot flashes, night sweats, joint stiffness, vaginal dryness, pain with sexual activity, mood swings and insomnia. Researchers in this study wanted to evaluate the relationship between the severity of these menopausal symptoms and women’s reported quality of life.

The Menopause-Specific Quality of Life-Intervention (MENQOL) questionnaire was given to 932 women enrolled in the Minnesota Green Tea Trial, a larger study that was examining whether green tea extract influences the odds of developing breast cancer. Responses to the questionnaire — which assessed vasomotor, physical, sexual and psychosocial symptoms in the years following menopause — were scored on a range of 1 to 8, with higher scores indicating more severe symptoms.

Initial results suggested that menopausal symptoms — including negative mood, more frequent night sweats and hot flashes, decreased memory, and decreased energy — were reported as most severe in women aged 50-55 and steadily declined in severity as age increased.

While it’s clear that menopause can significantly affect the quality of life, there was some maybe good news reported by these women: There were no reported differences among age groups in the Sexual domain of the MENQOL. Women of all age groups suffered a similar decrease.

What These Findings Mean for Postmenopausal Women

While managing menopause-related symptoms might seem like a challenge, there is a silver lining: As women age past their early 50s, the severity of symptoms seems to lessen significantly. But that doesn’t mean menopausal symptoms should be taken lightly, as they can have significant effects on a woman’s daily life.

And because women are remaining active and productive long after menopause, clinicians like us can offer services tailored to this unique population.

The results of this study continue to inform us as we initiate important conversations with postmenopausal patients about their sexual health and the physical and psychosocial changes associated with aging. Many women are reluctant to talk about vaginal dryness, for example, so health providers must be prepared to discuss sensitive issues like these with their patients and cover symptoms and conditions that might not traditionally be associated with menopause. But we’re here to help you.

By implementing these findings into practical solutions, we can offer their clients helpful, actionable advice for postmenopausal women as they manage their expectations and search for menopause treatment options.

If you have questions about menopause or your sexual health, please call our compassionate staff at (202) 293-1000 to make an appointment.

Women have the only organ in the human body exclusively dedicated to pleasure: the clitoris! This humorous brief documentary educates people and reveals something very telling: the clitoris has been ignored and hidden—by society, medical professionals, and educators. For many women, their early sexual partners provided them with their only sex education; with little knowledge and much fumbling, clitoral pleasure was discovered almost by accident.

Think about it. Have you ever been taught how to look at your clitoris? Has a doctor ever asked you about your clitoris or examined it? Medical professionals are not routinely taught the anatomy of the clitoris (Even some of the most famous textbooks don’t mention it!), and it is not considered part of the routine female pelvic exam. This poses a big problem. If doctors don’t know what a normal clitoris looks like, how will they know what to do when questions or problems come up? What kind of doctor do you see if you have a problem with your clitoris? (Pssst: There is no such thing as a clitorologist!)

Clitoral Problems
Pain in the clitoris (called “clitorodynia”) is considered a localized form of vulvodynia (vulvar pain) and is thought to occur in 5% of women who complain of painful intercourse. Pain can be due to adhesions or scarring of the clitoris where the clitoral hood (aka the prepuce) gets stuck to the glans clitoris. This can lead to trapping and buildup of oils and dead skin cells which cause underlying irritation and infection. Women describe the pain as burning, stinging, or sharp—some have likened it to the sensation of having a grain of sand in your eye. It can affect the whole pelvis and just feel like “pain down there.” Clitorodynia can make a sexual experience difficult, if not impossible. As well as potentially leading to female sexual dysfunction, it can also make everyday life excruciating because the “pain down there” can be present all the time, even without sexual activity.

Help is here
Doctors trained in sexual medicine can diagnose and treat clitoral problems! With a specialized physical exam and several diagnostic tests, the underlying cause for your pain can be found. Luckily a number of successful medical and surgical treatment options are available.

For example, at a recent national conference, our newest practice member urologist Rachel Rubin, MD, presented research on a new minimally invasive in-office procedure to remove clitoral adhesions. In this study, 15 women with clitorodynia reported complete resolution of their adhesions after the treatment, with the majority reporting improvement in or elimination of their pain symptoms.

Speak up
Sexual health is an important part of your general health. You deserve a pleasurable, pain-free sexual experience. If you have discomfort or pain, we are here to help. Please call us at (202) 293-1000 if you are experiencing any symptoms so we can work together to improve your sexual health.

healthy middle aged woman stretching outdoors

In different ways, cultures around the world celebrate when young girls become women around the time of their first menstrual period, but few celebrate the milestone of menopause. Why is that? Perhaps because we focus on the negative aspects of menopause, the effects that leave some women experiencing hot flashes at inopportune moments, and so we view this process in a negative light. But it can be perceived and experienced positively, according to medical experts.

Understanding Study Outcomes
As clinical professor of obstetrics and gynecology at the George Washington University in Washington, DC, and a Past President of the North American Menopause Society (NAMS) I’ve studied these issues closely. I revisited the menopausal hormone therapy research in the Women’s Health Initiative (WHI) first reported in 2002, which was loosely translated to mean that all forms of estrogen, and all types of progesterone were risky for all women, always. But when looking more closely at the patient population in that study, it showed that some of the women were already at high risk health issues and underlying disease.

“Be aware that the findings for the two WHI hormone studies should not be compared directly because of differences in the women’s characteristics at the time of their enrollment. For example, those in the estrogen-alone study had a higher risk of cardiovascular disease than those in the estrogen-plus-progestin study. Women in the estrogen-alone study were more likely to have such heart disease risk factors as high blood pressure, high blood cholesterol, diabetes, and obesity,” according to the National Institutes of Health (NIH).

Mitigating Symptoms
In wanting to help my patients find helpful ways to treat their symptoms, I analyzed a database of 13 million patients to investigate whether two forms of estrogen (oral versus transdermal) differed in how patients experienced negative side effects, particularly focusing on heart attack, stroke and deep vein thrombosis (blood clots in the veins). I concluded that patients who used transdermal estrogens had significantly fewer: blood clots in their veins, pulmonary emboli, and heart attacks than those who took an oral estrogen pill. Stroke risks were also slightly lower for transdermal estrogens.

“The women who were using transdermal estrogens had a lower risk of blood clots in the legs deep vein thrombosis (DVT), had a lower risk of pulmonary embolism—those blood clots in the legs traveling up to the lungs—and a decreased risk of heart attacks” I said in a video on My Menopause Mag, run by Editor Mache Seibel, MD., former 20-year veteran of Harvard Medical School faculty. I caution though, that patients who are at risk for blood clots may need to talk with their doctor to weigh the benefits versus the risks of all estrogen therapies.

Questions to Ask Your Doctor

  • When does menopause begin?
  • How long does it last?
  • Should I take hormones?
  • What kind of hormones should I take and for how long?

Available Resources
Great online resources such as this website help educate women to know more about how menopause effects the whole person and how to navigate this new time in life.

“Women don’t learn about menopause until they are going through it. I think if we as young women know about it and understand it, then we’ll be much more equipped.” from the trailer for the movie, “Hot Flash Havoc” available on local PBS stations. I have a cameo appearance.

In addition, this website:  www.mymenopausemag.com answer a lot of these questions women have, understanding that there is no one-size-fits-all model for making the transition.

Understanding Perimenopausal Symptoms
Women commonly experience the following perimenopause symptoms:

  • Hot flashes
  • Lower sex drive
  • Irregular periods
  • Difficulty sleeping
  • Mood swings
  • And many others

Many of these symptoms often continue into menopause. Women in menopause may also experience:

  • Vaginal dryness
  • Urinary problems, including incontinence and/or urgency
  • Night sweats
  • Weight gain and slowing metabolism
  • Thinning hair
  • Loss of breast fullness
  • And others




Hot Flashes

For women going through the menopausal transition, there’s no better discovery than a safe, natural, nonhormonal treatment for hot flashes that really works.

So a study just presented at the annual scientific meeting of the American College of Obstetricians and Gynecologists caught our eye. It focused on an over-the-counter botanical extract derived from pollen. Could such a simple remedy really improve symptoms and quality of life?

To learn more, we spoke with the study’s author, James A. Simon, MD, an ob-gyn in private practice in Washington, DC, and professor at The George Washington University School of Medicine and former president of the North American Menopause Society.

Relizen, the brand name in the US of the botanical extract, was developed after an accidental discovery—a Swedish beekeeper noticed that when bees feasted on the pollen of a particular flower, they seemed more energetic. So he wondered if giving that pollen to men and women would make them more energetic, too.

“It didn’t work,” said Dr. Simon. “But menopausal women who took it said that their hot flashes were better.” So the extract was developed using just the cytoplasm (material inside the cell) of the pollen—according to the manufacturer, that removes the pollen allergens. It’s actually been available in Europe under different names for about 15 years, and it is backed up by peer-reviewed research. In a 2005 double-blind placebo-controlled study of 64 menopausal women, 65% of those who took it had fewer hot flashes—compared with 38% of those who took a placebo. It’s been used by more than a million women in Europe.

In the new study, 324 women going through the menopausal transition took Relizen daily for three months. To get into the study, the women had to be having hot flashes—and be bothered by them.

Results: 86% had fewer hot flashes, and for 91%, their hot flashes were less severe. What the new study adds is an emphasis on self-assessed quality of life—fatigue, irritability, sleep quality. These all got better, says Dr. Simon, who has no financial stake in the company that makes Relizen. “Their sense of well-being improved,” he said. The mechanism—how this extract works—isn’t well understood. Side effects, such as stomach upset, were rare and tended to go away after a week or two.


Because research has confirmed that it doesn’t affect hormones, Relizen may have a particular role to play for women who have survived breast cancer who have been told that hormonal treatments aren’t safe for them. Currently, the only nonhormonal FDA-approved prescription for relief of menopausal symptoms such as hot flashes is the antidepressant paroxetine (Brisdelle, which has the same active ingredient as the antidepressant Paxil). But this antidepressant not only has side effects such as headaches, nausea, weight changes, reduced sex drive and interference with the ability to have an orgasm—it may also interfere with the action of Tamoxifen, the drug that is often prescribed after breast cancer treatment to prevent recurrence. Relizen, according to a recent study in Menopause, doesn’t affect the action of Tamoxifen.


If you want relief from hot flashes and night sweats, Relizen is one of many options, said Dr. Simon. Hormone therapy, such as estrogen, is certainly the most effective for symptomatic relief, but many women want to avoid taking systemic hormones based on safety concerns. (We’ll revisit this controversial issue in an upcoming article.)

Plant-based supplements that have estrogenic effects can help, and Dr. Simon occasionally recommends Remifemin, an over-the-counter product that contains the estrogenic herb black cohosh. “I double the dose on the package insert to achieve the best results,” he said. Purified soy phytoestrogens also work for some patients, he notes. If you decide to pursue either option, he recommends that you work with a health-care professional, as there are safety questions for some women in taking estrogenic compounds, especially women with or at high risk of developing breast cancer.

Among nondrug approaches, he’s seen success with hypnosis. Even acupuncture, which hasn’t been shown in studies to be effective for hot flashes, appears to work for some people, said Dr. Simon.

What he likes about Relizen is that it’s so safe—for any woman, including those with a history of hormone-sensitive breast cancer—that it’s fine to try on your own. “A patient can acquire it by herself and see if it’s beneficial—before seeing her practitioner,” said Dr. Simon. “If it doesn’t work after two or three months, she can see her health-care professional for other options.” (Note: Relizen is currently available through the manufacturer’s website.)

Sources: Study titled “Nonhormonal Treatment of Perimenopausal and Menopausal Climacteric Symptoms” by James A. Simon, MD, CCD, NCMP, clinical professor of obstetrics and gynecology, The George Washington University School of Medicine, and René Druckman, MD, presented at the American College of Obstetricians and Gynecologists Annual Scientific and Clinical Meeting 2016. Dr. Simon is a Washington, DC–based physician who provides patient-focused care for women across the reproductive life cycle, from adolescence to childbirth, and through the menopausal transition.


Electronic Medical Records (EMR) –A Balanced View

screenshot_5148_432x324One of the cornerstones of The New Government Health Plan is the use of the electronic medical record (EMR), sometimes called Electronic Health Records (EHR).  Proponents offer these as some of the advantages of those systems:

  • Universal coding of medical diagnoses and procedures so that insurers can better understand the public’s health and properly allocate resources
  • Avoidance of problems interpreting various handwriting styles
  • Ability to incorporate automated reminders and alerts (i.e. patient due for colonoscopy or bone density test, or vaccination) as part of the system.

Most hospitals and large practice administrators support the EMR concept. In addition to having the staff and resources to make the system  function, the system is effective in capturing more charges and assists in better collections.  And the federal government subsidizes the initial purchase an implementation of the system.

Practitioners are a little less enthusiastic.

Enormous amounts of time are required to fill out electronic templates, complete countless electronic forms and respond to automated questions not impacting patient care, while often negotiating frustrating electronic roadblocks. The time required for the process occupies the staff and diverts the practitioner’s focus from the patient to a computer process. As a result, practitioners are spending less time interacting with their patients and more time looking at the computer screen. Overall, patient’s best interests seem to have largely been lost in this conversation.

Our practitioners – James A. Simon, MD; Lucy D. Treene, MSHS, PA-C; Carol J. Mack, MSHS, PA-C, MPH – are not Luddites (people just down on technology). Quite the contrary!  We use many facets of the EMR systems, such as e-prescribing, e-scheduling, electronic billing to Medicare, all of which improve patient care, reduce medical errors, or, in the case of Medicare billing, are required by the government. But we are selective because we are, particularly in our field, first and foremost concerned with the privacy of our patients.

Consider the recent cyber attacks at the Department of Health and Human Services (DHS) and the successful electronic security breach at the Office of Personnel Management (OPM) affecting 22.1 million people (“Hackers stole vast amount of sensitive data” according to The Washington Post), which resulted in the resignation of OPM Director Katherine Archuleta. The Carefirst® BlueCross BlueShield family of companies was also recently and successfully hacked for personal information (including that of James A. Simon, MD, PC employees).

Being one of the foremost specialty medical practices in women’s sexual health in the world, the risk of our patients’ private records becoming public is simply not worth taking.  Our patients’ sexual problems, predilections and peccadillos are private and, unlike your FICO “credit” score which can be restored if your credit card is lost or stolen, once the details of your private sexual life are “out there,” that information can live forever on Google, Facebook or Twitter. And in case you should think, even for a minute, “who cares about MY sexual life,” don’t forget our offices are convenient to many in the public eye, five blocks from The White House, 2 ½ miles from The Capitol, and 3 miles from The Supreme Court.  Patients, many of them quite prominent, come to see us from all over the world as well.  No matter who you are, your health information is private at James A. Simon, MD, PC, and no one’s business but yours!

In our world of internet immediacy and electronic everything we agree with author Lisa Gardner’s comment, “There are things that once done can’t be undone, things that once said can’t be unsaid.”


Interested in women’s sexual health? Contact us for an appointment.

Approximately 1 in 10 women suffer from polycystic ovary syndrome (PCOS). And in my practice, I work with many women who are navigating the side effects, causes, and complications of PCOS. I thought I’d take a minute to discuss what exactly PCOS is, what complications it can create, and who may be at risk for it.

PCOS, Defined

A New York Times article recently pointed out that PCOS is a very misleading name. PCOS is a hormonal imbalance of female sex hormones that can cause irregular periods, elevated male hormones (androgens) or multiple cysts in the ovaries. It is important to note that not all women with PCOS have the characteristic cysts. Doctors diagnose PCOS if two symptoms are present and hormonal blood tests are confirmatory. Relying solely on the presence of ovarian cysts can lead to a missed diagnosis.


PCOS can lead to a variety of complications, from type 2 diabetes and infertility to sleep apnea and cardiovascular disease. Women with PCOS may experience one or more of the following:

  • High blood pressure
  • Metabolic syndrome
  • Infertility
  • Depression and anxiety
  • Abnormal uterine bleeding
  • Endometrial cancer
  • Balding or extra body hair
  • Others


The cause of PCOS is unknown. Some experts believe insulin resistance causes it; others believe it’s caused by hormone dysregulation. This uncertainty, however, is not cause for alarm or to abandon hope of managing and preventing possible complications. One thing that is certain is it tends to be hereditary.


Treating and managing PCOS is very much an individualized plan. Early diagnosis, weight loss, diet changes, hormone treatments – such as oral contraceptives – may reduce the long-term complications. And while PCOS may pose challenges with becoming pregnant, there are many effective fertility treatment options to help people with PCOS achieve their family goals.

If you have any questions about PCOS, or would like to speak to someone in our office, please do not hesitate to contact us. We will work together to understand your medical history and goals to create a customized, effective plan just for you.


Interested in women’s sexual health? Contact us for an appointment.

512693513It’s no secret that tracking, much less managing, symptoms of menopause can be a daunting challenge. Now, there’s an app that may help women get a handle on their most common symptoms and even help physicians map out a customized treatment plan.

MenoPro is an app developed by Brigham and Women’s Hospital researchers with the North American Menopause Society (NAMS). Designed to bring women and doctors together, MenoPro offers a place for women to record symptoms and receive advice on how to best manage things like hot flashes and night sweats.

Clinicians are also able to use the app to help create a personalized treatment plan for each woman. An algorithm takes into account your symptoms, preference, risk factors and medical history to make recommendations on treatment. While there is no substitute for a strong relationship with a knowledgeable, certified menopause practitioner (look for the NCMP after their name), this app does offer great promise in helping women take control of their symptoms.

With this app, women have the power to recognize patterns, identify triggers and begin to modify their behavior to help avoid and manage some of their symptoms. And one of the things I like best of all, is that if offers a place for woman to record what they are experiencing. It can be extremely difficult to recall symptoms and situations when meeting face-to-face with a doctor. This app puts it all, quite literally, at your fingertips.

If you’re experiencing uncomfortable symptoms of menopause, don’t hesitate to schedule an appointment with your physician. The right doctor can walk you through all your treatment plans to help you find the one that will work for you.


Interested in women’s sexual health? Contact us for an appointment.

185839148-2Woman transitioning through menopause may deal with a number of different symptoms, and all of varying severity. Menopause is unique to each woman – some experience mild symptoms, and others experience extreme ones. The only consistency is, indeed, how much it differs from woman to woman.

Those differences and experiences are key reasons to seek out a knowledgeable specialist in menopausal medicine. In fact, a study recently published in The Journal of Woman’s Health found that woman experiencing a wide-range of menopausal symptoms, from mood swings to vaginal dryness, sleep problems, weight gain and hot flashes are more likely to seek out a menopause and midlife practice specialist over their regular gynecologist.

Reasons for visiting a physician specializing in midlife practice included:

  • Sleep problems (80 percent)
  • Vaginal dryness or low sexual desire (60 percent)
  • Weight gain (34 percent)

This study should really drive two things home to every woman at any stage of menopause: 1) You are not alone in experiencing uncomfortable and sometimes embarrassing symptoms; and 2) A specialist can help you manage those symptoms so you can live your life to the fullest.

Menopausal women are often in the prime of their lives. Now is not the time to hide in the corner or at home because of symptoms. Find a physician with North American Menopause Society (NAMS) certification, and someone you feel comfortable with when discussing your symptoms and personal history. With the right medical team in your corner, you can feel like yourself again.


Interested in women’s sexual health? Contact us for an appointment.

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