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From the Townsend Letter
January 2010

briefed by Jule Klotter
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STD Linked to Prostate Cancer
Trichomonas vaginalis, the world's most common nonviral sexually transmitted disease, can infect the prostate and be a source of inflammation. Inflammation is a risk factor for prostate cancer. Jennifer R. Stark and colleagues affiliated with Harvard School of Public Health reported a positive association between antibodies against Trichomonas vaginalis and incidence of prostate cancer on September 9, 2009. The study compared blood samples from 673 men with prostate cancer to blood from 673 controls without cancer. The blood samples were collected in 1982, a decade (on average) before cancer diagnosis. The correlation between antibodies to the protozoan and overall prostate cancer risk was not statistically significant. However, the association between antibody presence and aggressive prostate cancer was significant: extraprostatic prostate cancer (OR = 2.17) and prostate cancer-specific death (OR = 2.69). The researchers are unsure whether Trichomonas, in itself, increases prostate cancer risk or if the protozoan is simply a marker for another sexually transmitted organism. They call for more research to confirm an association between Trichomonas and aggressive prostate cancer.

Harvard School of Public Health. Link found between common sexual infection and risk of aggressive prostate cancer [press release]. September 9, 2009. Available at: Accessed October 1, 2009.
Stark JR, Judson G, Alderete JF, Mundodi V, et al. Prospective study of Trichomonas vaginalis infection and prostate cancer incidence and mortality: Physicians' Health Study (abstract). J Natl Canc Inst. Epub September 9, 2009. Accessed October 13, 2009.

Hormone Therapy for Men Safer than Presumed
Total testosterone and bioavailable testosterone levels tend to decline as men age. For most men, however, testosterone levels stay within normal range. In addition to aging, illness, malnutrition, obesity, smoking, and some medications can reduce testosterone levels. A deficiency of male hormones is characterized by decreased bone density and increased risk of fracture and osteoporosis, decreased muscle mass, increased body fat, mild anemia, mood changes, and changes in sexual potency and libido. Hormone replacement therapy can help relieve androgen deficiency symptoms in men who have below-normal serum testosterone. Men with low-normal levels are less likely to benefit, according to Rebecca Z. Sokol, MD, MPH.

Until recently, doctors seldom prescribed testosterone replacement therapy because of worries that the hormone would promote prostate cancer. In an excerpt from his book Testosterone for Life, Abraham Morgentaler, MD, a specialist in male infertility and sexual problems, tells how he realized that this fear was unfounded. From the beginning of his practice in the 1980s, Morgentaler has observed definite clinical benefits from testosterone replacement therapy in men with low serum levels. A former mentor recommended that Morgentaler perform prostate biopsies, in addition to the PSA test that he already required, to screen for cancer before prescribing hormones – just to be on the safe side. So he did. Contrary to the widespread belief that high testosterone levels promote prostate cancer and low levels prevent cancer, Morgentaler discovered an unusually high number of prostate cancers in men with low testosterone – the exact opposite of what he had been taught. He and his colleagues reported the results in the Journal of the American Medical Association (1996;276:1904–1906). Fourteen percent of 77 men in this study had a cancer-positive biopsy. All of the men had normal PSA levels.

Curious about genesis of the belief that high testosterone causes prostate cancer, Morgentaler tracked down the original research by Charles B. Huggins and a later 1981 article by Willet Whitmore. Huggins won a Nobel prize in 1966 for his work on prostate cancer and testosterone, and Whitmore was a recognized prostate cancer expert. Morgentaler discovered, "All the reports of testosterone causing rapid growth of prostate cancer occurred in men who already had extremely low testosterone levels, due to castration or estrogen treatment. Once we get beyond the near-castrate range, it is hard to find any evidence that changes in T concentrations matter at all to prostate cancer." Men who receive treatments for metastatic prostate cancer that drop their serum testosterone levels to nearly zero might have an increased risk of cancer recurrence. Otherwise, no evidence supports the belief that testosterone increases prostate cancer risk. Morgentaler refers to a 2008 article in the Journal of the National Cancer Institute that "included more than 3,000 men with prostate cancer and more than 6,000 men without prostate cancer, who served as controls in the study. No relationship was found between prostate cancer and any of the hormones studied, including total testosterone, free testosterone, or other minor androgens."

Known side effects of testosterone replacement therapy include skin irritation from a skin patch that delivers the hormones, acne, decrease in testicular volume, suppression of spermatogenesis, breast tenderness (particularly with older men using injectible forms of testosterone replacement therapy), and increased hemotocrit (particularly in smokers and older men). In addition, edema, experienced by men with conditions like congestive heart failure or hepatic cirrhosis, can worsen. Long-term risks of androgen replacement therapy are still unknown, according to Sokol.

Morgentaler A. Destroying the myth about testosterone replacement and prostate cancer. Life Extension. December 2008; 49–62.
Sokol RZ. Is androgen therapy indicated for aging men? SRM. August 2009;7(3);27–30. Available at: Accessed August 17, 2009.

Technology Affects Brain and Social Relationships
Several years ago, I remember reading a Townsend Letter article by Tim Batchelder about a study that looked at the effects of television on society and health in Brazil. Instead of evening walks and stopping to chat with friends and neighbors, people became aware of time. They wanted to be home to see their favorite TV shows. Social interaction began to erode.

Now we have access to hundreds of television channels, the Internet, Blackberries, cell phones, text messaging, and more. If simply adding a television to the home changed social interactions and affected health, we'd be naive to think that widespread computer interaction does not have an effect – both on relationships and social interaction and on brain circuitry.

Neuroscientist Gary Small, MD, director of UCLA's Memory & Aging Research Center and coauthor of iBrain: Surviving the Technological Alteration of the Modern Mind, told Energy Times that the brain enters "a state of continuous partial attention" while surfing the net and rushing through messages. A type of stress that Small calls "techno-brain burnout" results. The adrenal glands respond by producing cortisol and adrenaline as if the person were encountering an emergency. These hormones tell the brain to become more alert and direct the body to prepare to fight or run. Prolonged secretion of these hormones, however, leads to fatigue, anxiety, depression, and chronic stress-related illness.

In addition to evoking a stress response, repeated interaction with technology – like any activity – targets and strengthens certain areas and neuropathways in the brain. Activities literally change the way a brain works. For example, both sides of the frontal cortex are more active in musicians – a sign of creative thinking – than nonmusicians. Right now, the effect of high-tech communication on brain pathways is largely unknown.

While the Internet is great for grassroots activism and spreading information, what about social interaction? As social networks spawned by Facebook, e-mails, and other Internet technologies increase, direct contact with other humans is decreasing. People report significantly fewer confidantes with whom they can discuss important matters, says Aric Sigman in his article for Biologist. In 1998 – before text messaging, Facebook, and Twitter – R. Kraut et al.wrote about the Internet Paradox: "greater use of the internet was associated with declines in communication between family members in the house, declines in the size of their social circle, and increases in their levels of depression and loneliness."

The need for meaningful social interaction is hardwired into our DNA. In 2007, researchers at UCLA School of Medicine reported finding "the first evidence that social isolation is actually linked to global alterations in human gene transcription in leukocytes." Feeling isolated correlated to more activity in gene transcription control pathways that promote inflammation and to impaired transcription in genes that govern anti-inflammatory reactions to illness and stress. Some social scientists say that technological networking can decrease the feeling of social isolation among people who are housebound. But does online communication have the same power as in-person communication that involves voice tone, body language, energetics, and sometimes touch? It would be interesting to see if high-tech interaction has the same biological effects as social interaction that have already been documented.

No one questions that high-tech communications give us access to information we would not have otherwise. The question becomes, how can we manage these new tools without becoming enslaved, addicted, or losing the heart of social relationship?

Batchelder T. Television watching and health in Brazil. Townsend Lett. 231:34–36.
DiSalvo D. Four authors respond to the social networking controversy. Neuronarrative [Internet]. March 12, 2009. Accessed October 26, 2009.
Richter A. Our rewired brains. Energy Times. April 2009:31–36.
Sigman A. Well connected? The biological implications of "social networking." Biologist. February 2009;56(1); 14–20. Available at: Accessed July 27, 2009. (Note: Access at bottom of this page:
Vanderbilt University. Musicians use both sides of their brains more frequently than average people [press release]. October 2, 2008. Available at: Accessed November 6, 2009.

Prostate Cancer Screening May Pose Risk
In recent years, questions about the benefit/risk of mammography have arisen. Now, some researchers are voicing similar concerns about the prostate specific antigen (PSA) test that screens for prostate cancer. PSA is a protein produced in low amounts by healthy prostate cells. Elevated PSA levels are viewed as a sign of prostate cancer but may also occur with noncancerous prostate disorders. Recent studies indicate that PSA testing cannot differentiate between aggressive cancer and slow-growing prostate cancer that does not require treatment.

Two large ongoing studies, published in the New England Journal of Medicine (March 18, 2009), have followed a total of nearly 259,000 men for at least ten years. The men were randomly assigned to receive PSA screening or no screening. Researchers affiliated with the US National Cancer Institute are performing the smaller study consisting of about 77,000 men at ten US medical centers. So far, they have found no significant difference in death rate between screened men and unscreened men.

The European Randomized Study of Screening for Prostate Cancer involves 182,000 European men, ages 55 to 69, who are taking part in prostate studies with different designs. A BBC News report on this study claims that prostate cancer deaths could decrease by 20% with routine PSA screening. In actual numbers, one life was saved for every 1,408 men screened. The BBC report is less forthcoming about the high number of men who undergo treatment they do not need – 48 for every life saved, according to the New York Times. Treatment has its own risks. Prostate surgery can produce impotence and incontinence. Radiation therapy side effects include chronic diarrhea and painful defecation. US Preventive Services Task Force says that one in 200 die from treatment itself.

A spokesman for the American Cancer Society recommends that men at high risk for aggressive prostate cancer undergo regular PSA screening. High risks include a family history of deaths from prostate cancer and medical issues such as urinary tract problems. Meanwhile, both of these large studies will continue to gather data as participants age.

BBC News. Prostate screening to be reviewed. March 18, 2009. Available at: Accessed March 18, 2009.
Kolata G. Prostate cancer screening found to save few lives. New York Times. March 19, 2009. Available at: Accessed March 18, 2009.
Szabo L. Q&A: Should men still get PSA screenings or not? USA Today. Marcy 18, 2009. Available at: Accessed March 18, 2009.

Osteoporosis Is Also a Male Health Issue
Although we tend to think of osteoporosis as a woman's disease, men account for about one-fifth of all cases in the US. Women are more susceptible to the condition because their bones tend to be smaller than men's. Also, hormone shifts during menopause affect bone mass. While men's hormones do not usually change as significantly as women's during midlife, hormones appear to have a role in male osteoporosis as well. Men over the age of 60 with low blood testosterone levels were significantly more likely to have a low-trauma hip or nonvertebral fracture, characteristic of osteoporosis, according to a January 2008 Swiss study. Smoking and alcohol abuse are other known risk factors.

Treatment for osteoporosis is similar for men and women: weight-bearing and resistance exercise, calcium, and vitamin D3. Oral bisphosphonates, which inhibit bone breakdown (and bone formation), are the usual prescribed treatment for men and women; but testosterone replacement therapy is another option for men with low serum testosterone.

The herb Vitex agnus castus may also prevent bone loss in men, according to a December 2008 German study. The study involved 60 three-month-old male rats, whose testes were removed. The rats were divided into five groups and received one of the following: soy-free food, estradiol, testosterone, a high concentration of Vitex agnus castus, or a low concentration of the herb for 12 weeks. The researchers then examined the tibia metaphysic. Testosterone supplementation showed positive effects on trabecular bone, but both the testosterone and estradiol groups showed cortical bone loss. A low concentration of Vitex agnus castus had no significant effects. The high concentration, however, had positive effects on cortical and trabecular bone. Its effect on trabecular bone was 88.4% of that achieved with estradiol supplementation. Vitex agnus castus has not yet been tested on men.

Meier C, Nguyen TV, Handelsman DJ, et al. Endogenous sex hormones and incident fracture risk in older men: the Dubbo Osteoporosis Epidemiology Study [abstract]. Arch Intern Med. January 14, 2008;168(1):47–53. Available at: Accessed November 5, 2009.
Not for women only; despite what those ads on TV suggest, men are at risk for osteoporosis, too. Albuquerque Journal. May 28, 2008. Available at Accessed June 9, 2008.
Sehmisch S, Boeckhoff J, Wille J, Seidlova-Wuttke D, et al. Vitex agnus castus as prophylaxis for osteopenia after orchidectomy in rats compared with estradiol and testosterone supplementation [abstract]. Available at: Accessed January 2, 2009.

Flu Vaccine Has Questionable Effectiveness for Elderly
"Researchers suggest influenza vaccine's effectiveness in elderly patients may have been exaggerated by earlier observational studies," reads the headline for AMA Morning Rounds' lead story on September 2, 2008. Earlier studies that show a vaccine benefit for elderly people have "substantial unadjusted selection bias," according to an October 2007 article by L. Simonsen and colleagues at the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (Bethesda, Maryland). The NIAID researchers say that failure to take frailty differences into account and the use of nonspecific endpoints, like all-cause mortality, "have led cohort studies to greatly exaggerate vaccine benefits." In 2008, two studies, highlighted by the AMA Morning Rounds' story, approached the vaccine effectiveness question in new ways.

Michael L. Jackson, PhD, and colleagues looked for a correlation between flu vaccination and pneumonia risk in elderly people in their study for the Lancet (August 2, 2008).Unlike other studies, this one adjusted for confounding factors, including smoking and health status, and looked at both outpatient and inpatient pneumonia cases. (Most cases of pneumonia are treated on outpatient basis.) Using Group Health medical files, the researchers randomly picked two age-and-sex-matched controls (n = 2346) for each person with pneumonia (age 65–94) during the 2000, 2001, and 2002 preinfluenza and influenza seasons (n = 1173). After adjusting for presence and severity of lung and heart disease and other confounders, the researchers determined that "influenza vaccination was not associated with a reduced risk of community-acquired pneumonia (odds ratio 0.92, 95% CI 0.77-1.10) during the influenza season." Group Health Center for Health Studies and a Group Health Community Foundation fellowship grant funded the study.

In the second study, Dean T. Eurich and colleagues at University of Alberta (Edmonton, Alberta, Canada) hypothesized that frailty bias (also called "healthy-user effect") would produce fewer pneumonia deaths in vaccinated elderly compared to unvaccinated elderly during noninfluenza months. The presence of pneumonia during these months would rarely (if at all) be due to complications from the flu. The researchers defined noninfluenza months as one month before and one month after influenza was known to be circulating in the community. The vaccine's power to prevent flu (and its complications) should have little or no effect, in itself, on death rate during this time. If vaccinated people still showed a survival benefit, something besides the vaccine must be in play.

The researchers collected clinical, laboratory, and functional data on 352 vaccinated adults and 352 matched controls. Eighty-five percent of the participants were 65 or older. Before adjusting for confounding factors, the researchers reported, "Patients receiving influenza vaccination were significantly less likely to die compared with nonvaccinated patients (28 [8%] vs. 53 [15%]; odds ratio, 0.49…P = .004)." When they adjusted for age, sex, and comorbidities, the odds ratio was 0.45. When adjusting for functional and socioeconomic status, however, the odds ratio rose to 0.81 – greatly lessening the benefit and statistical significance of being vaccinated. Eurich and colleagues state: "Studies that are able to better adjust for health and functional status or other measures of frailty demonstrate attenuation or abolition of mortality benefit, suggesting substantial residual confounding in most reported observational studies of vaccine effectiveness."

Eurich DT, Marrie TJ, Johnstone J, Majumdar SR. Mortality reduction with influenza vaccine in patients with pneumonia outside "flu" season. Am J Respir Crit Care Med. June 12, 2008:178;527–533. Available at:;178/5/527. Accessed October 14, 2009.
Goodman B. Doubts grow over flu vaccine in elderly. New York Times. September 2, 2008. Available at Accessed October 14, 2009.
Jackson ML, Nelson JC, Weiss, NS, Neuzil, KM, Barlow W, Jackson LA. Influenza vaccination and risk of community-acquired pneumonia in immunocompetent elderly people: a population-based, nested case-control study [abstract]. Lancet. August 2, 2008;372(9636):398-405. Available at: Accessed October 14, 2009.
Simonsen L, Taylor RJ, Viboud C, Miller MA, Jackson LA. Mortality benefits of influenza vaccination in elderly people: an ongoing controversy [abstract]. Lancet Infect Dis. October 2007:7(10):658-666. Available at: Accessed October 14, 2009.

Flu Pandemics Revisited
A pandemic is defined by its high mortality rate: "6 to 56 times the number of Americans that die in an average nonpandemic flu season, according to the CDC or 4 to 30 times more worldwide according to WHO,"writes Peter Doshi in his article for American Journal of Public Health. How can a flu season be labeled a pandemic before the numbers are gathered? As Doshi's article shows, it can't – at least not with accuracy.

Doshi reviewed influenza mortality trends in the US from 1900 to 2004. He found that, except for the notorious 1918–1919 pandemic, the number of deaths during the pandemics of 1957–1958 and 1968–1969 were actually similar to those for nonpandemic seasons. In reality, more deaths occurred in most flu seasons during the 1940s than during either of these "pandemics." During his research, Doshi found an historical decline in influenza mortality rates. He says the decline may be due to ecological factors and improved public health, including the use of antibiotics to fight bacterial pneumonia. (Pneumonia is the actual cause of many flu-related deaths).

No flu season has approached the death rates of the 1918–1919 Spanish flu pandemic, but the very word pandemic conjures up the scourge of that period. On November 1, 2009, Infectious Diseases Society of America (IDSA) published an article about a possible contributor to the high death rate. In it, Dr. Karen M. Starko hypothesizes that "aspirin contributed to the incidence and severity of viral pathology, bacterial infection, and death, because physicians of the day were unaware that the regimens (8.0–31.2 g per day) produce levels associated with hyperventilation and pulmonary edema. … Recently, pulmonary edema was found at autopsy in 46% of 26 salicylate-intoxicated adults." Aspirin overdose is 150 mg/kg of body weight per day. About 20 tablets of 325 mg (6.5 grams) for a small adult can be fatal, according to NIH's MedlinePlus Medical Encyclopedia. Starko says that the US Surgeon General, the US Navy, and the
Journal of the American Medical Association recommended using aspirin for flu just before a sharp rise in deaths during October 1918.

Doshi P. Trends in recorded influenza mortality: United States, 1900–2004.
Am J Public Health. May 2008;98(5):939-945. Available at: Accessed October 14, 2009.
Starko KM. Salicylates and pandemic influenza mortality, 1918–1919 pharmacology, pathology, and historic evidence [abstract].
Clin Infect Dis. November 1, 2009;49:1405–1410. Available at: Accessed October 27, 2009.

Mind Can Counteract Aging
Back in the 1970s, Ellen J. Langer, a Harvard University psychologist, and colleague Judith Rodin performed a small, pioneering study with nursing home residents. They divided the residents into two groups. Residents in the first group were encouraged to make decisions for themselves. Langer and Rodin also gave each person in the first group a houseplant to care for. Those in the control group also received houseplants, but they were told that staff would maintain the plants for them. This group received no encouragement to make decisions.

When Langer and Rodin reevaluated the residents 18 months later, they found that people in the first group were more cheerful, active, alert, and healthy than those in the second group. The researchers were also surprised to find that significantly fewer in the "engaged group" had died – less than half the number of deaths in the control group. Langer and Rodin attributed the results to "the power of making choices and the increased personal control it affords," a conclusion that was supported by subsequent research. With this study, Langer began to consider how one's mindset affects aging. In her latest book, Counterclockwise: Mindful Health and the Power of Possibility, Langer describes a second experiment that raises possibilities about the mind's effect on aging and function.

In 1979, Langer and her students conducted the "counterclockwise study." "If we put the mind back 20 years," they asked themselves, "would the body reflect this change?" The research team recruited 16 men in their late 70s and early 80s from the community to take part in a study on reminiscing for one week at a country retreat. Since geriatricians could not give Langer's team definitive age markers, the research team chose to measure an array of physiological and psychology functions before and after the week-long retreats, including weight, dexterity, flexibility, vision, sensitivity to taste, visual memory, psychological self-evaluation, and speed and accuracy in completing paper-and-pencil mazes. In addition, researchers took photos of each participant before and after the retreat.

Langer and her students retrofitted an old New Hampshire monastery to match life in 1959. They developed activities and discussions built around 1959 news events, television programs, and culture. Half of the men, acting as a control group, simply reminisced. They spent their week taking part in activities and discussions that recalled their lives in 1959. The other group was encouraged to live as if it were 1959. Men in this group were instructed to bring 1959 pictures of themselves and to write their autobiographies as if September 1959 were the present. The biographies were shared with other members of the group. Langer told this group, "‘No one can discuss anything that happened after September 1959. It is your job to help each other do this. It is a difficult task, since we are not asking you to "act as if it is 1959," but to let yourself be just who you were in 1959.'"

While recruiting participants, Langer had observed passivity in the men. Most of them had been brought to the initial interview by a family member, who did most of the talking. Behavior changes in both groups were noticed early in the week. "Despite their obvious and extreme dependence on relatives who initially drove them to Harvard … for interviews," Langer writes in her book, "they were all functioning independently almost immediately upon arrival at the retreat. … " By the second day, all participants took part in serving and clean-up at mealtime. Hearing, memory, and grip strength improved in both groups by week's end. Joint flexibility, finger length (fingers straightened as arthritis waned), and manual dexterity improved more in the experimental group. Moreover, 63% of the experimental group increased their intelligence test scores, compared to 44% of the control group. Outsiders who were ignorant of the study's purpose were shown before-retreat and after-retreat pictures of each participant. "These objective observers judged that all of the experimental participants looked noticeably younger at the end of the study," says Langer.

Langer does not claim that reminiscing will cause physical and psychological improvements in everyone. Her research does, however, show that "using a different word, offering a small choice, or making a subtle change in the physical environment can improve our health and well-being." She argues for a psychology of possibility: "The psychology of possibility first requires that we begin with the assumption that we do not know what we can do or become. Rather than starting from the status quo, it argues for a starting point of what we would like to be. From that beginning, we can ask how we might reach that goal or make progress toward it."

Jacobs T. Botox for the brain. Miller-McCune. Available at: Accessed September 3, 2009.
Langer EJ. Counterclockwise. Chap. 1 in Counterclockerwise. New York: Ballantine Books; 2009. Available at: Accessed September 3, 2009.

Colostrum Outperforms Flu Vaccine
Bovine colostrum supplementation prevents influenza more effectively than flu vaccination, according to a 2007 Italian study. Colostrum, a substance produced in mammary glands within 48 to 72 hours after a female mammal gives birth, abounds with nutrients, growth factors, and immune-supporting compounds, including antibodies. Bovine colostrum has a similar composition to human colostrum.

Researchers, led by M. R. Cesarone, at San Valentino-Spoltere Vascular Screening Project in Pescara, Italy, compared the effectiveness of an oral colostrum tablet (900 mg, once in the morning) with anti-influenza vaccine in healthy subjects, ages 30 to 80. They divided the subjects into four groups: those who received vaccination alone, those who received vaccination and colostrum supplements, those who received only colostrum, and those who received no flu-preventive treatment. The researchers looked at the number of influenza episodes during the two-month treatment period plus the month after (three months total) and the total days of illness. Both colostrum-receiving groups experienced significantly fewer cases of flu than either the untreated or the vaccination-only group: "The number of days with flu was 3 times higher in the non-colostrum subjects. The colostrum group had 13 episodes versus 14 in the colostrum + vaccination group, 41 in the group [with] prophylaxis, and 57 in nontreated subjects."

A second part of this study involved 65 very high-risk cardiovascular patients, all of whom received influenza vaccination. Again, the colostrum group had fewer cases of influenza and fewer complications that required hospital admission. Cesarone et al.conclude: "Colostrum, both in healthy subjects and high-risk cardiovascular patients, is at least 3 times more effective than vaccination to prevent flu and is very cost-effective."

Cesarone MR, Belcaro G, Di Renzo A, Dugall M et al. Prevention of influenza episodes with colostrum compared with vaccination in healthy and high-risk cardiovascular subjects: the epidemiologic study in San Valentino [abstract]. Clin Appl Thromb Hemost. April 2007;13(2):130–136. Available at: Accessed October 3, 2008.
Cornelli U. Use of colostrum for the prophylaxis of influenza syndromes (WO/2007/057748). Filed November 15, 2006 with World Intellectual Property Organization. Available at: Accessed October 3, 2008.
(Note: Use

Jule Klotter

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