By V. Julio. University of Wisconsin-Whitewater.

This method consisted of the generation of identical regions of interest over the zone exhibiting uptake and over an adjacent area considered of normal tissue buy cheap fucidin 10 gm line. The regions of interest were drawn on the transverse slice showing maximal uptake of the tracer in the lesion buy fucidin. A total count ratio between the regions of interest was then calculated (tumour/ normal (T/N)) effective fucidin 10 gm. Pathology examinations revealed various types of pituitary adenomas in 15 cases, 2 cases of craniopharyn­ gioma and 1 of dysgerminoma. All cases of pituitary adenoma had elevated hormonal serum levels, with high correlation with the radiotracer uptake ratio. In positive cases, visual inspection usually revealed intense uptake of the radio­ tracer in the mid-anterior aspect of the base of the skull, with high contrast with respect to adjacent structures (Figs 1-3). Moderate uptake on the projection of the choroid plexus was also observed, although not affecting the interpretation of the study because of the higher and lateral location. The tumour is clearly delineated (arrow) and there is no prominent uptake at the level of the choroid plexus. Since hormone secretion is a high energy demanding process, significant isonitrile uptake and retention in secreting adenomas could be anticipated, as is observed in parathyroid adenomas [8]. Further studies are warranted to establish the potential of this technique for research and routine clinical practice. Among them were 132 cases of cerebrovascular disease, 33 cases of Parkin­ son’s disease and 12 cases of dementia. Six cases of infarction of the basal ganglia accompanied by cerebral cortical hypoperfusion may be neurological functional communica­ tion disturbances (similar to diathesis). This find­ ing was not related to the Hoehn-Yahr stage and the laterality of motor symptoms. Li Ping Zhang, and Zhi Xu Gao reported that the incidence of dementia in the elderly was 3. It is thus very important to make a diagnosis and differential diagnosis of central nervous system diseases in elderly patients. After the occlusion of the middle cerebral artery, the ratio of lesion site to normal site activity in 11 rats was 0. Six cases of infarction of basal ganglia accompanied by cerebral cortical hypoperfusion were con­ sidered to be similar to the diaschiasis; this phenomenon was caused by the after­ effect of neurological functional communication disturbances. In the hemi- anopia group, as the visual function improved after light stimulation treatment, the blood perfusion increased in the occipital lobe. This finding was not related to the Hoehn-Yahr stage and the laterality of motor symptoms. In individual cases of Alzheimer’s disease, the prominent unilateral cortical hypoperfusion accompanied by unilateral basal ganglia, and contralateral regional cerebellum hypoperfusion, may also be due to diaschiasis, but cerebral vascular lesion cannot be ruled out. Multiple infarction dementia manifested multiple, irregular cortical hypoperfusion, mostly involved with basal ganglia or cerebellum lesions, which can be differentiated from Alzheimer’s disease. In the pre-surgical studies, all cases showed hypoperfusion in the bilateral temporal and parietal regions. Also, in two patients moderate striatal bilateral hypoperfusion was observed and in two other patients moderate hypoperfusion was found on the contralateral side most clinically affected. In the striatal region, no significant changes were observed in the study after one month, but there were differences after six months, when all patients showed a significant increase to the right side (per cent change of 16, 11,9 and 14, respectively). In the study 12 months after grafting, no significant changes were found compared with the six month study. These results suggest that the increase of perfusion at the implantation site may be related to the graft’s viability. Their final aim has been to develop an alternative treatment for this pathology [1-5]. This technique, by means of serial studies, provides a useful method to evaluate implant survival and development in grafted patients. Patients Four male patients with Parkinson’s disease (patients 1-4) diagnosed clinically (stage 4 according to Hoehn and Yahr) were studied. The ages ranged from 49 to 53 years and the evolution time varied from 7 to 13 years. All cases were under chronic L-dopa therapy before surgery and showed motor complications associated with this treatment, such as dyskinesias, freezing and complex fluctuations in the motor condition (a mean dose of 1000 mg/d and a mean period of treatment of nine years). In patients 1-3, three trajectories were performed, one in the caudate and two in the putamen; in patient 4, only one was performed in the putamen. In these structures, 20-50 fiL of cells were implanted with a cell concentration of over 200 000 cells//*L. The study included a control group of four age matched healthy volunteers (average age: 53 years) selected according to their clinical histories and after an exhaustive physical and neurological examination. A total of eight oblique slices parallel to the orbito-meatal plane were obtained after reorienting and summing up the original transverse slices (slice thick­ ness: 15 mm, spatial tomographic resolution: 16 mm). The four age matched healthy volunteers were evaluated twice; the second study was performed immediately after the first, using the same injection. Studies corresponding to the same patient or a healthy subject were previously corrected for comparison. This analysis consisted of the visual identification of asymmetries between homologous regions of both cerebral hemispheres performed by consensus between two trained observers. With that aim, 11 pairs of regions of interest, bilateral (left-right) and regular (4x4 pixels), were drawn on four obliqué slices. The regions of interest included cerebellar hemispheres, cortical regions (medial, lateral and superior frontal; anterior, posterior and superior temporal, parietal and posterior parietal), striatal region (caudate/putamen) and thalamus. These variations are mainly due to the random nature of radioactive decay and the tomographic non-uniformities of the system [10]. In the pre-surgical studies, at the cortical level, disseminated areas of varying degrees of hypoperfusion were observed in all patients, preferentially in the temporal and parietal bilateral regions. This was more marked on the contralateral side most clinically affected, except in patient 3, in whom it was ipsilateral. In the striatal region, there was a moderate bilateral hypoperfusion in patients 1 and 4; in the other two a moderate decrease in perfusion was found on the contralateral side. In the six month studies, the global cortical perfusion improved significantly in all patients. In the cerebellar hemispheres, no significant changes were observed in the studies one month after operation. In the six month studies, the asymmetries registered in the pre-surgical studies decreased (patient 3) or disappeared (patient 2). Note the significant increase of the right striatal perfusion (caudate/putamen) for the six month study in (d) (per cent change of 16). In this patient a progressive clinical improvement was also observed after grafting. In the studies 12 months after surgery, the results were similar to those observed in the six month studies. On the other hand, in all cases a progressive clinical improvement was observed post-transplantation [14].

It is highly effective in preventing cardiovascular events generic 10 gm fucidin visa, particularly stroke cheap 10gm fucidin amex, but at the cost of m ore adverse effects than aspirin and the inconvenience of m onitoring fucidin 10gm without a prescription. Evidence-based m edicine w ill lead to the prescription of 4 or m ore drugs, usually indefinitely. W e m ust be prepared to m ake a case for the patient to accept that it really is w orthw hile. At the m om ent, for w hatever reasons, m ost of these proven m easures are underused. Secondary prevention of m yocardial infarction: role of beta-adrenergic blockers and angiotensin converting enzym e inhibitors. Atherosclerosis 1999;147 (suppl 1): S39–44 66 100 Questions in Cardiology 31 W hat advice should I give patients about driving and flying after m yocardial infarction? John Cockcroft Com pared to other form s of international travel, flying presents few er dem ands on the invalid passenger than the alternative m odes of travel. Airlines have a duty of care to other passengers w ho m ay be inconvenienced by em ergency diversions, unscheduled stops and delays in the event of a m edical em ergency. Recertification of drivers and pilots follow ing m yocardial infarction depends upon their subsequent risk of incapacitation w hilst at the controls. All pilots and all professional drivers have a duty to inform the relevant licencing authority as soon as possible follow ing m yocardial infarction. There are no international regulations governing the prospective passenger w ho has recently suffered a m yocardial infarction and no statutory duty to inform the airline concerned. M ost w ill be guided in the decision w hether to fly or not by their cardiologist or fam ily doctor. M odern passenger aircraft have a cabin atm ospheric pressure equivalent to 5–8,000 feet, and alveolar oxygen tension falls by around 30%. This m ay exacerbate sym ptom s in any patient w ho experiences angina or shortness of breath w hilst w alking 50 m etres or clim bing 10 stairs. The enforced im m obility of the passenger on a long flight, airport transfers and the crossing of tim e zones should be considered. If few er than 10 days have elapsed since m yocardial infarction, or if there is significant cardiac failure, angina or arrhythm ia the patient m ay require oxygen or suitable accom panim ent. Private pilots are subject to the sam e regulations but m ay fly w ith a suitably qualified safety pilot in a dual control aircraft w ithout undergoing angiography. Sym ptom atic or treated angina, arrhythm ia or cardiac failure disqualifies any pilot from flying. Professional drivers m ay be relicenced 3 m onths after m yocardial infarction provided that there is no angina, peripheral vascular disease or heart failure. Arrhythm ia, if present, m ust not have caused sym ptom s w ithin the last 2 years. Treatm ent is allow ed provided that it causes no sym ptom s likely to im pair perform ance. Private drivers need not inform the licencing authority after m yocardial infarction, but should not drive for one m onth. If arrhythm ia causes sym ptom s likely to affect perform ance, or if angina occurs w hilst driving, the licencing authority m ust be inform ed, and driving m ust cease until sym ptom s are adequately controlled. How should such patients be m anaged to im prove outcom e and what are the results? Prithwish Banerjee and Michael S Norrell The advent of the throm bolytic era has not altered the incidence or m ortality rate for cardiogenic shock com plicating m yocardial infarction (M I). It still represents alm ost 10% of patients w ith M I, w ith alm ost 90% dying w ithin 30 days. Recently, a few random ised trials have attem pted to com pare such early (w ithin 48 hours) revascularisation w ith a strategy of initial m edical stabilisation. Thirty day m ortality w as reduced in the early intervention group (46% vs 56% ) w ith this benefit extending out to 6 m onths and particularly apparent in the younger (<75 years) age group. The low m ortality in the control group is striking, and explains the lack of a large difference betw een the tw o groups. Nevertheless, it suggests benefit even w ith a relatively aggressive conservative policy in these patients. Because of trial recruitm ent difficulties it is unlikely that further random ised data w ill em erge in the foreseeable future. M ean tim e to revascularisation w as under 1 hour in the trial, and quite how m uch later such benefit m ight extend is unclear. Em ergency cardiac procedures in patients in cardiogenic shock due to com plications of coronary artery disease. Early revascularisation in acute m yocardial infarction com plicated by cardiogenic shock. The figures given should ideally be those currently being achieved by the team to w hom the patient is referred. In general term s, registry data are m ore representative than published series, w hich inevitably include bias tow ards m ore successful figures. The data should be adjusted up or dow n to m atch the circum stances of the individual patient, w ho is helped tow ards a rational decision based on the anticipated risks and benefits. It therefore applies to the typical patients – m ale, elective, aged 60–70, w ith an adequate left ventricle. Patients w ith one or m ore risk factors for perioperative death, w hich are older age, fem ale sex, obesity, w orse ventricular function, diabetes, very unstable or em ergency status, or significant co-m orbidity of any type, should have the stated risk appropriately increased. The United Kingdom Heart Valve Registry provides very reliable thirty day m ortality figures w hich for the three years 1994–1996 inclusive w ere 5% for aortic valve replacem ent and 6% for m itral valve replacem ent. Lethal brain damage and permanently disabling hemiplegia are rare w ith a com bined risk of about 0. If every focal deficit discovered on brain im aging, or every transient neurological 100 Questions in Cardiology 71 sign is included the incidence w ould probably be nearer 5%. Air, left atrial throm bus and calcific valve debris are additional risk in valve surgery. Som e difficulty w ith concentration and m em ory affects about a quarter of patients – but very few are troubled by it to any extent. In good hands it rarely com plicates valve operations w ithout coronary artery disease. In coronary surgery incidence depends on definition but m yocardial dysfunction, local or global, is the com m onest cause of death. The incidence of infarction is entirely dependant on definition and any figure from 2% to 10% could be given, depending on the criteria used. London and Philadelphia: Current Science, 1994: 161–9 72 100 Questions in Cardiology 34 W hich patients with post-infarct septal rupture should be treated surgically, and what are the success rates? Tom Treasure M yocardial rupture is a m ore com m on cause of death after infarction than is generally appreciated. The hospital m ortality for surgical repair is probably 40% (w ithout reporting bias – but there is surgical selection and natural selection – m ost have had to survive transfer to a surgical centre). Favourable features are younger age, anterior rather than inferior infarcts, m ore surviving left and right ventricular m yocardium , and functioning kidneys. There w as a vogue for holding these patients on a balloon pum p to operate on them w hen the infarcted tissue is better able to take stitches.

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Loop diuretics such as furosemide cause hyponatremia far less often than do thiazide diuretics discount 10gm fucidin with visa. Spironolactone is a competitive antagonist of aldos- terone at the mineralocorticoid receptor purchase 10gm fucidin otc. A nephrogenic origin will be postulated if there is no increase in urine concentration after exogenous vaso- pressin effective 10gm fucidin. The only useful mode of therapy is a low-salt diet and the use of a thiazide or amiloride, a potassium-sparing distal diuretic agent. The resultant volume contraction presumably enhances proximal reabsorption and thereby reduces urine flow. Tumor lysis syndrome results from rapid cell death with resultant increases in serum potassium, phosphate, and uric acid levels. Renal failure de- velops due to acute uric acid nephropathy, and pathology demonstrates deposition of uric acid crystals in the kidneys and the collecting system. The clinical picture is one of rapidly progressive renal failure, with oliguria and rapidly rising creatinine. Markedly el- evated levels of serum uric acid would be expected in acute uric acid nephropathy, but hyperuricemia occurs in any cause of renal failure. A urine uric acid/creatinine ratio of >1 mg/mg confirms hyperuricemia and uric acid nephropathy as the cause of renal fail- ure. This complication can largely be prevented by institution of allopurinol, 200–800 mg daily, prior to chemotherapy. Once hyperuricemia develops, however, efforts should be focused on preventing deposition of uric acid in the kidney. These measures include forced diuresis with furosemide or mannitol and alkalination of the urine with sodium bicarbonate. Colchicine is used to treat the inflammation in acute gouty arthritis but has no effects on serum uric acid levels. Prednisone may be used in the chemotherapeutic regimens of some individuals with hematologic malignancies, but does not prevent de- velopment of hyperuricemia. This is an example of an anion-gap metabolic acidosis with appropriate respiratory compen- sation. The efficiency of dialysis depends on the counter-current flow rate of the dialysate. The number of hours/sessions prescribed for a patient are derived from the dialysis dose and is individualized. Sodium modeling is an adjustment of the dialysate sodium that may lessen the incidence of hypotension at the end of a dial- ysis session. Aldosterone defects, if present, are not likely to play a role in this patient since his kidneys are not being perfused. Similarly, since the patient is likely anuric, there is no efficacy in utilizing loop diuretics to effect kaluresis. The relative hypertonicity of the extracellular fluid without time for intracellular compensation or os- motic compensation causes osmotic shrinkage of brain cells and demyelination. This syndrome usually occurs in patients with chronic hyponatremia who have osmotically equilibrated the intracellular space. Increased platelet aggre- gration has been described, and hyperfibrinogenemia is thought to result from an inflam- matory response and increased liver synthetic activity caused by urinary protein losses. Additionally, IgG is lost in the urine, and occasionally these patients develop low serum levels with associated immunocompromise. Chronic disseminated intravascular coagula- tion is not a mechanism of hypercoagulability in patients with the nephrotic syndrome. In response to a reduction in perfusion pressures, stretch re- ceptors in afferent arterioles trigger a cascade of events that lead to afferent arteriolar di- latation and efferent arteriolar vasoconstriction, thereby preserving glomerular filtration fraction. These mechanisms are partly mediated by the vasodilators prostaglandin E2 and prostacyclin. It is common for patients receiving intravenous contrast to develop a transient increase in serum creatinine. These agents cause renal fail- ure by inducing intrarenal vasoconstriction and reducing renal blood flow, mimicking prerenal azotemia, and by directly causing tubular injury. The risk of contrast nephropa- thy may be reduced by initiating newer isoosmolar agents and minimizing the dose of contrast. When the reduction in renal blood flow is severe or prolonged, tubular injury develops, causing acute renal failure. Patients with intravascular volume depletion, diabe- tes, congestive heart failure, multiple myeloma, or chronic renal failure have an increased risk of contrast nephropathy. The urine sediment is bland in mild cases, but with acute tubular necrosis, muddy brown granular casts may be seen. Saline hydration plus N-ace- tylcysteine may decrease the risk and severity of contrast nephropathy. Red cell casts indi- cate glomerular disease, and white cell casts suggest upper urinary tract infection. Urinary eosinophils are seen in allergic interstitial disease caused by many drugs. The clinical manifestations can be variable but may be characterized by fever, lumbar tenderness, leukocytosis, and hematuria. Magnetic resonance venography is the most sensitive and specific noninvasive form of imaging to make the diagnosis of renal vein thrombosis. Ultrasound with Doppler is operator-dependent and therefore may be less sensitive. Contrast venography is the gold standard for diagnosis, but it exposes the patient to a more invasive procedure and contrast load. Also known as antidiuretic hormone, vasopressin is primarily released under conditions of hyperosmolarity and volume depletion. Although sodium is the main determinant of hy- perosmolarity, sodium is not the only stimulus that affects the secretion of vasopressin. Other, less potent stimuli of vasopressin release include pregnancy, nausea, pain, stress, and hypoglycemia. This hormone acts on the principal cell in the distal convoluted tubule of the kidney to cause resorption of water. This occurs through nuclear mecha- nisms encoded by the aquaporin-2 gene that cause water channels to be inserted into the luminal membrane. The net effect is to cause the passive resorption of water along the os- motic gradient in the distal convoluted tubule. Activation of β2-adrenergic receptors in- duces cellular uptake of potassium and promotes insulin secretion by pancreatic islet β cells. Severe hy- pokalemia leads to progressive weakness, hypoventilation and eventually complete paral- ysis.

Once the appropriate (and correct) data has been composed Department of Rehabilitation Medicine purchase fucidin amex, Tokyo order fucidin 10 gm online, Japan buy fucidin 10 gm free shipping, 3Kawakita and analyzed, the capabilities of the specialty are evaluated. The strengths and weaknesses of the feld are inter- Department of Rehabilitation Medicine, Kyoto, Japan nal factors, while opportunities and threats normally are a result of external factors playing their part. Once the appropriate (and correct) data has been composed core set might be a useful clinical assessment tool for measuring and analyzed, the capabilities of the specialty are evaluated. The strengths and weaknesses of the feld are in- at four medical institutions in Japan were enrolled. Results: During the period between May 1 and Oct 31, the data of 25 patients (11 men, 14 women). Mueller1 1University Clinic of Munich, Orthopedic Surgery- Physical Medi- Introduction/Background: Core strength training, which usually done on stable surfaces, is an effective way to enhance physical ft- cine and Rehabilitation, Munich, Germany ness in youth. Previous study revealed that core strength training Introduction/Background: Local anesthetics are frequently preferred on unstable surfaces could improve some components of physical for intraarticular pain Management and in arthroscopic surgery. Training period lasted for 6 weeks (2 ses- acaine necrosis-inducing effects on all cell lines, the cell toxicity ef- sions/week), including frontal, dorsal and lateral core strength train- fect increasing steadily with the concentrations. Conclusion: Our results advise to prefer ropivacaine jumping sideways, Y balance, 20-m sprint and standing long jump), over bupivacaine in clinical use, e. Inhabited with or with- graphicimage, and biochemical indices were detected in Isl1+ posi- out a wheel, the mice were divided into three groups: the seden- tive cells by X-Gal staining. Cell neurogenesis and nation, as depicted by blue cells, existed in heart sinoatrial node, proliferation were examined using Brdu and Ki67 immunofuores- cardiac ganglia, the aortic arch and pulmonary roots in adult mice. Astrocyte, microglia neuron and c-fos were detected using Isl1 expression profle was corresponding with previous research. Results: Firstly, compared with the sedentary group, aerobic exercise mice were signifcantly increased (p<0. The animal model provides a useful tool for the Brdu-positive cells and Ki67 expression were signifcantly tracing cardiac progenitor cells in the study of cardiac regeneration. There were more Brdu-positive cells co exercise training compared to the sedentary control mice. Notch signal pathway was a conservative signal pathway to 1 1 1 control proliferation and differentiation. But the expression of relative proteins mill running was performed to the Ex and Ex+tempol groups, and among Notch signal pathway was decreased. In control group, there are no signifcant increase of Digit Span, sub test Digit Backward and Forward, and the Digit Symbol Coding scores. Kuntari1 1 case), which were found with abnormality at the follow-up of age 1 8 months and then were treated with selective rehabilitation therapy University of Padjadjaran, Physical Medicine & Rehabilitation, and offered family-based rehabilitation guidance as level B case. Bandung, Indonesia At the follow-up of 1 year (corrected age), all cases with neurode- Introduction/Background: Short-term memory has a major role velopmental disorders were treated with rehabilitation therapy for in cognitive process, intelligence and academic performance of 4. Technological advancement, transportation and learning results of qualitative general movements assessment could be the activities make children less active. Regular physical activity in- basis of making super-early rehabilitation therapy scheme for pre- creases physical ftness. Classifed rehabilitation therapy schemes is practical respond quickly to memory span and problem solving. Cardiac 1Chi Mei medical center, Physical medicine and Rehabilitation, rehabilitation that evaluate patient from the beginning have to con- Tainan, Taiwan, 2Chi Mei medical center, Pediatrics, Tainan, Tai- sider physical activity of patient beside type of working before reha- 3 bilitation in attempt to set goals that can be tolerated and achieved wan, Chia Nan University of Pharmacy, Recreation and Health- by patients and they can return to work and social. Khaleghipanah1 pregnant women who were admitted to ChiMei medical center of 1Tehran, Iran Taiwan between 2013/01/01 and 2013/12/31. Data were collected including pregnancy and labor characteristics, maternal complica- Introduction/Background: The primary goal of rehabilitation after tions, and neonatal health. We used multivariable regression models anterior cruciate ligament rupture is to restore knee function. Results: studies have showed that to-in walking exercise may ameliorate co- 1,462 pregnant women and their newborns were recruited. Quadratic regression analysis showed of noncoper subjects with anterior cruciate ligament injury. As a result, both too high or too low tion Comitee form were assessed before and after exercise program. Public health programs should em- eral linear model with adjustment for pre-training scores for each phasize the importance of weight control among pregnant women test. Conclusion: Hop test are one of the most important guides of 1 subjects’performance following anterior cruciate ligament injury. It University of Padjadjaran, Physical Medicine and Rehabilitation, seems that the suggested exercise program has improved subjects’ Bandung, Indonesia performance. The results supports recommendation of presented ex- Introduction/Background: White-collar, as well blue-collar work- ercise program for rehabilitation of non-copers at home. Aim the 1 2 1 study to measured correlation between exercise capacity and physi- A. Material 1Zirve University, Physiotherapy and Rehabilitation, Gaziantep, and Methods: 16 healthy subjects working at Hasan sadikin Hospi- Turkey, 2Yıldız Technical University, Mathematics, İstanbul, Turkey tal (11 male and 5 female), age range 25–40 years, devided white and blue collar group, 8 subjects in each group. Results: The mean Material and Methods: In order to analyze, 30 data (10 basketball age of participants both group is 31. The mean of exer- player, 10 volleyball player and 10 football player) would be used cise capacity in white-collar group is 11+1. Conclusion: According to fndings of the study, in es), rhythmic massage, eurythmy movement exercises, counselling stark contrast to other groups there is signifcant difference on the and anthroposophic nursing. Many people with chronic disease use rate of weight and peak torque for basketball players. Anthroposophic 1University of Tsukuba Hospital, Department of Rehabilitation therapies were used to stimulate salutogenetic self-healing capacities Medicine, Tsukuba, Japan, 2Ibaraki Prefectural University of and strengthen autonomy both in children and adults. Therapy, Ami, Japan, 5Kowa gishi Laboratory, Department of Studies showed that adverse reactions to anthroposophic therapies Prosthesis and Orthosis, Tsukuba, Japan, 6Ibaraki Prefectural Uni- were rare. The majority of these reactions were reported to be of versity Hospital of Health Sciences, Department of Occupational mild to moderate intensity. The results also indicated that the level Therapy, Ami, Japan, 7University of Tsukuba Hospital, Department of patient satisfaction was high. Furthermore, as he could not use the dysphagia patients of impaired mentality, comparing to the conven- existent prosthetic socket because of unhealed stumps, he started tional approach. Satisfaction Questionnaire with Gastrostomy Feeding of very little friction between the sockets and stumps. Two-sample paired t- healed and to continue rehabilitation with existent prosthesis. However, 21 patients 164 were excluded, including 19 who could begin oral feeding and two with cricopharyngeal incoordination. The delay muscle repair model was established by 168 transecting the tibial nerve motor branches to the gastrocnemius muscle. Sun1 The same volume of saline was injected in the other half as a con- The Second Affliated Hospital of Chongqing Medical University, trol.

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