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1.
Taiwan J Obstet Gynecol ; 60(5): 942-944, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34507681

RESUMEN

OBJECTIVE: A real-Taiwan experience to deal with near-term pregnant woman infected by severe acute respiratory syndrome coronavirus 2, SARS-CoV-2 (coronavirus disease 2019, COVID-19) is extremely limited. We described the first case in Taiwan. CASE REPORT: A 30-year-old woman, primigravida had a laboratory-confirmed COVID-19 infection at 36 gestational weeks (GW). She was asymptomatic. Ten days later, she was hospitalized and receive a selective cesarean section with a term baby weighted 3142 gm (Apgar score 8 and 9 at 1st and 5th minute, respectively) at 38 GW. No evidence of in utero and direct transmission was found and newborn was free of COVID-19. CONCLUSION: It is still uncertain whether timing or mode of delivery is appropriate in SARS-CoV-2 infected pregnant woman in near term, but we suggested that a selective delivery time at 38 GW or later, regardless of which mode of delivery is finally decided, can be considered.


Asunto(s)
COVID-19 , Complicaciones Infecciosas del Embarazo , Adulto , Puntaje de Apgar , Enfermedades Asintomáticas , Cesárea , Femenino , Humanos , Recién Nacido , Embarazo , Taiwán
2.
J Chin Med Assoc ; 84(4): 418-422, 2021 04 01.
Artículo en Inglés | MEDLINE | ID: mdl-33784267

RESUMEN

BACKGROUND: Bladder instillation of hyaluronic acid (HA) is an acceptable treatment for bladder pain syndrome/interstitial cystitis (BPS/IC). The treatment is limited by a high proportion of non-responders (~30%-40%). Here, we aimed to evaluate predisposing factors associated with treatment outcomes. METHODS: This is a prospective multicenter study. We enrolled a total of 137 (out of 140) women with refractory IC. They all underwent a standard protocol of 6-month intravesical HA therapy (initial 4 weeks, once weekly, followed by once monthly). To assess the outcomes, we used the pain Visual Analog Scale (Pain-VAS), Interstitial Cystitis Symptom and Problem Index (ICSI & ICPI), and a scaled Global Response Assessment (GRA). RESULTS: The age of patients was 47.6 ± 27.5 (range 24-77) years. We found statistically significant improvement (p < 0.001) in the Pain-VAS and the ICSI & ICPI scores both after the initial 4-weekly instillations and at the end of 6-month treatment. Those who reported moderate/marked improvement on GRA at the 2 follow-up visits were considered responders: 39.4% (n = 54) at the first follow-up, and 59.9% (n = 82) at the second follow-up. No remarkable side effect was noted. After statistical analyses, treatment outcomes on GRA were positively associated with baseline functional bladder capacity and with Pain-VAS scores. The initial treatment responses optimally (p < 0.001) predicted final treatment outcomes (McNemar). CONCLUSION: Intravesical HA therapy is safe and effective for most (~60%) of our patients with refractory IC. Functional bladder capacity and Pain-VAS scores before treatment, and the early treatment responses are helpful predictors of treatment outcomes.


Asunto(s)
Cistitis Intersticial/tratamiento farmacológico , Ácido Hialurónico/administración & dosificación , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Adulto Joven
3.
Artículo en Inglés | MEDLINE | ID: mdl-33029904

RESUMEN

OBJECTIVES: The objective of the study is to evaluate the therapeutic effect of hyoscine N-butylbromide (HBB) in active phase of labor and its safety to mother and fetus. METHODS: A systematic literature search was conducted on Cochrane Library, Pubmed, EMBASE, CINAHL, ClinicalTrials.gov and three databases in Chinese up to March 31, 2020. Randomized controlled trials (RCTs) of HBB administration during the active phase for shortening of spontaneous labor at term compared with placebo were included. Two reviewers assessed the methodological quality and data extraction independently. We calculated pooled risk ratios (RRs), mean differences (MDs) and 95% confidence intervals (CIs) using Review Manager 5.3 software. Intention-to-treat principles and random-effects model were adopted for analysis and pool results. RESULTS: In total, 1448 women from 9 RCTs were included in the meta-analysis. The HBB group exhibited significantly decreased durations of active phase (MD -61.1 min; 95% CI: -87.7 to -34.4, I2 : 96%), the second stage (MD -2.0 min; 95% CI: -3.4 to -0.5, I2 : 62%), and third stage (MD -0.7 min; 95% CI: -1.1 to -0.3, I2 : 51%). Intravenous (IV) HBB group and intramuscularly (IM) HBB group were compared to the control group (MD -60.9 min; 95% CI -87.7 to -34.1, I2 : 96%). No significant differences were observed in Cesarean section, post-partum hemorrhage, instrumental labor, Apgar scores or any adverse effects. CONCLUSION: Hyoscine N-butylbromide had a significant effect of shortening the duration of the active phase of labor without adverse effects. We recommend a single dose of intravenous administrated HBB when a woman undergoes labor augmentation.

5.
Int Urogynecol J ; 25(12): 1683-91, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24973098

RESUMEN

INTRODUCTION AND HYPOTHESIS: The purpose of our study was to describe the surgical trends for female stress urinary incontinence (SUI) during 2006-2010, and a time-frame comparison with 1997-2005, based upon the National Health Insurance (NHI) claims data in Taiwan. METHODS: Women who underwent various primary surgeries for SUI during 2006-2010 were identified, with a total of 15,099 inpatients. The variables included surgical types, patient age, surgeon age and gender, specialty, and hospital accreditation levels. Chi-squared tests and SAS version 9.3.1 were used for statistical analysis. RESULTS: During the follow-up study, midurethral sling (MUS) application increased significantly from 53.09 % in 2006 to 78.74 % in 2010. It was associated concomitantly with a decrease in retropubic urethropexy (RPU) from 29.68 % to 12.99 %, and pubovaginal sling treatment (PVS) from 9.33 % to 3.46 %. MUS was most commonly used among all patients' and surgeons' age groups, and different accreditation hospital levels. MUS was more commonly used by gynecologists (71.38 %) than urologists (57.91 %); while PVS and periurethral injection were more commonly performed by urologists than gynecologists. Similar surgical trends were found during time-frame comparison, 2006-2010 vs 1997-2005. SUI surgeries increased in patients aged ≥60, surgeons aged ≥ 50, and in regional hospitals. CONCLUSION: This follow-up study depicts the increase in popularity of MUS and offers evidence of surgical trends and a paradigm shift for female SUI surgery. More older women were willing to seek healthcare and undergo surgery. The surgical skills and knowledge spread from medical centers into regional hospitals. The time-frame shift may have a profound impact on patients, as well as the healthcare providers.


Asunto(s)
Procedimientos Quirúrgicos Ginecológicos/tendencias , Cabestrillo Suburetral/tendencias , Incontinencia Urinaria de Esfuerzo/cirugía , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Procedimientos Quirúrgicos Ginecológicos/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Programas Nacionales de Salud/estadística & datos numéricos , Estudios Retrospectivos , Cabestrillo Suburetral/estadística & datos numéricos , Taiwán/epidemiología , Factores de Tiempo , Incontinencia Urinaria de Esfuerzo/epidemiología
6.
Acta Obstet Gynecol Scand ; 91(10): 1167-72, 2012 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22497305

RESUMEN

OBJECTIVE: To evaluate the contribution to glucose intolerance and metabolic syndrome of obesity combined with the diagnostic criteria of polycystic ovary syndrome (PCOS). DESIGN: Prospective study. SETTING: University teaching hospital from 31 August 2010 to 31 August 2011. POPULATION: Two hundred and twenty women with PCOS and seventy normal control women. METHODS: The clinical and biochemical characteristics of women with PCOS and control women were evaluated. Main outcome measures. The impact of obesity, hyperandrogenism, oligo-anovulation and polycystic ovary morphology on impaired glucose tolerance and metabolic disturbances. RESULTS: Obese women with PCOS had significantly higher insulin resistance than obese normal control women. Logistic regression analysis showed that obesity was the only factor that predicted impaired glucose tolerance and metabolic syndrome. Use of the area under the receiver operating characteristic curve (AUROC) for the body mass index to predict impaired glucose tolerance and metabolic syndrome was more accurate than AUROCs for serum total testosterone level and the average menstrual interval. CONCLUSIONS: Body weight status was the major factor determining the risk of impaired glucose tolerance and metabolic syndrome in women with PCOS. Obesity should be treated as the major factor determining long-term health consequences associated with PCOS.


Asunto(s)
Intolerancia a la Glucosa/etiología , Síndrome Metabólico/etiología , Obesidad/complicaciones , Síndrome del Ovario Poliquístico/complicaciones , Adulto , Biomarcadores/sangre , Glucemia/metabolismo , Índice de Masa Corporal , Estudios de Casos y Controles , Colesterol/sangre , Femenino , Intolerancia a la Glucosa/sangre , Prueba de Tolerancia a la Glucosa , Humanos , Modelos Logísticos , Síndrome Metabólico/sangre , Obesidad/sangre , Síndrome del Ovario Poliquístico/sangre , Estudios Prospectivos , Curva ROC , Triglicéridos/sangre
7.
Hum Reprod ; 26(12): 3443-9, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21926412

RESUMEN

BACKGROUND: The clinical features and metabolic complications of polycystic ovary syndrome (PCOS) may change with age. This study was designed to investigate the clinical and biochemical characteristics of PCOS patients between the ages of 20 and 40. METHODS: The study included 781 Taiwanese women, of whom 453 were diagnosed with PCOS and 328 were non-PCOS controls. Anthropometric components, androgens, endocrine, insulin resistance, and metabolic components were measured and correlated with age. Above parameters were compared between younger and elder women with PCOS. RESULTS: Age had significant negative correlations with androgens (total testosterone and dehydroepiandrosterone sulfate), the modified Ferriman-Gallwey score and the prevalence of acne and hirsutism. Age had significant positive correlations with fasting glucose, cholesterol, triglycerides and low-density lipoprotein. The 453 women who fulfilled diagnostic criteria for PCOS were classified by age into two groups: Group A (20-29 years old, n= 294) and Group B (30-40 years old, n= 159). Group A had significantly higher total testosterone levels than Group B. Group B had higher fasting insulin and glucose levels, triglycerides, body mass index and waist measurements and a higher incidence of obesity than Group A. The average ovarian volume was not significantly different among the two groups. CONCLUSIONS: Increased age is accompanied by a decrease in the prevalence of both clinical and biochemical hyperandrogenism in women. Hyperandrogenism is the important factor for young women with PCOS; however, abdominal obesity and certain metabolic disturbances became major concerns for older women with PCOS.


Asunto(s)
Síndrome del Ovario Poliquístico/diagnóstico , Adulto , Factores de Edad , Glucemia , Índice de Masa Corporal , Colesterol/sangre , Estudios Transversales , Sulfato de Deshidroepiandrosterona/sangre , Femenino , Humanos , Lipoproteínas LDL/sangre , Obesidad/epidemiología , Ovario/patología , Síndrome del Ovario Poliquístico/sangre , Taiwán/epidemiología , Testosterona/sangre , Triglicéridos/sangre
8.
Gynecol Endocrinol ; 27(1): 55-62, 2011 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-20504100

RESUMEN

Polycystic ovary syndrome (PCOS) and hyperprolactinaemia are both common causes of secondary amenorrhoea in reproductive women. The relationship between PCOS and hyperprolactinaemia has been reported with controversial results. To evaluate the clinical and laboratory features of women with mild hyperprolactinaemia and PCOS, we studied 474 Taiwan Chinese women: 101 had mild hyperprolactinaemia, 266 had PCOS and 107 were the control group. In this study, we found that 64% of the women with mild hyperprolactinaemia fulfilled the PCOS diagnostic criteria, regardless of their prolactin levels. Obese women with PCOS had significantly lower luteinising hormone (LH) and LH-to-FSH ratios than non-obese women with PCOS. Obese hyperprolactinaemic women had significantly lower follicle-stimulating hormone (FSH), but higher LH-to-FSH ratios than the non-obese hyperprolactinaemic women. For women with PCOS, the BMIs were significantly negative with LH (γ = -0.253, p < 0.001), but not with FSH (γ = -0.061, p = 0.319). For the hyperprolactinaemic women, the BMIs were significantly negative with FSH (γ = -0.353, p < 0.001), but not with LH (γ = -0.021, p = 0.837). Although PCOS-related syndrome was very prevalent in women with hyperprolactinaemia, the patterns of disturbance in gonadotropin secretion were different between the PCOS and the hyperprolactinaemia patients.


Asunto(s)
Hiperprolactinemia/diagnóstico , Síndrome del Ovario Poliquístico/diagnóstico , Adolescente , Adulto , Amenorrea/etiología , Índice de Masa Corporal , Diagnóstico Diferencial , Femenino , Hormona Folículo Estimulante/sangre , Humanos , Hiperprolactinemia/complicaciones , Hormona Luteinizante/sangre , Obesidad/complicaciones , Síndrome del Ovario Poliquístico/complicaciones , Prolactina/sangre
9.
Nutrition ; 26(7-8): 818-22, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20071141

RESUMEN

OBJECTIVES: This in vitro study investigated the effects of different arginine (Arg) concentrations on angiogenic protein expressions of HeLa cells and endothelial cells (ECs) after stimulation. In addition, an inducible nitric oxide (iNO) synthase inhibitor (1400W) was used to investigate the possible role of iNO in angiogenesis. METHODS: Endothelial cells and HeLa cells were treated with different concentrations of Arg and 1400W: Arg 0, 50, 100, and 1000 micromol/L; Arg 100 micromol/L+1400W 10 micromol/L; and Arg 1000 micromol/L+1400W 10 micromol/L for 24 h. Then, ECs and HeLa cells were cocultured for 2 h, and the supernatant in the transwell was collected for analysis of angiogenic protein secreted. The expression of CD51/CD61 by ECs was also analyzed. RESULTS: The productions of vascular endothelial growth factor, basic fibroblast growth factor, prostaglandin E(2), and matrix metalloproteinase-2 were higher with Arg 100 and 1000 micromol/L than with Arg 0 and 50 micromol/L Arg, and this was consistent with the expression of CD51/CD61 by ECs. Inhibition of iNO production resulted in lower angiogenic protein expressions comparable with groups with low Arg administration. CONCLUSION: The findings of this study suggest that Arg administration at levels similar to or higher than physiologic concentrations enhance the production of angiogenic protein and iNO may partly play a role in promoting angiogenesis in the presence of HeLa cells.


Asunto(s)
Proteínas Angiogénicas/biosíntesis , Arginina/farmacología , Dinoprostona/biosíntesis , Células Endoteliales/efectos de los fármacos , Factor 2 de Crecimiento de Fibroblastos/biosíntesis , Metaloproteinasa 2 de la Matriz/biosíntesis , Factor A de Crecimiento Endotelial Vascular/biosíntesis , Relación Dosis-Respuesta a Droga , Células HeLa , Humanos , Integrina alfaV/metabolismo , Integrina beta3/metabolismo , Óxido Nítrico Sintasa de Tipo II/metabolismo
10.
Fertil Steril ; 91(4): 1168-74, 2009 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-18325508

RESUMEN

OBJECTIVE: To evaluate inappropriate gonadotropin secretion in women with polycystic ovary syndrome (PCOS). DESIGN: Retrospective study. SETTING: Academic tertiary center. PATIENT(S): A total of 373 women were classified into three groups: [1] healthy control women (n = 48); [2] women who were positive for PCOS risk factor; and [3] women with PCOS (n = 251). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Gonadotropin levels, LH-FSH ratio, body mass index, and clinical and/or biochemical presentations of PCOS. RESULT(S): The area under the receiver operating characteristic curve, used to predict PCOS for the LH-FSH ratio, showed similar diagnostic performance to total T and average ovarian volume. The LH-FSH ratio exhibits greater observed accuracy than total T and average ovarian volume for evaluation of women with oligomenorrhea or anovulation. An LH-FSH ratio of >1 presented the best combination of sensitivity and specificity. Body mass index was positively correlated with total T in non-PCOS and PCOS groups; however, body mass index was negatively correlated with LH in PCOS but showed no correlation in non-PCOS subjects. CONCLUSION(S): The LH-FSH ratio is a valuable diagnostic tool in evaluating women with PCOS and oligomenorrhea or anovulation, and an LH-FSH ratio of >1 may be used as a decision threshold. The link between body mass index and LH may provide clues for further understanding the pathological milieu of PCOS.


Asunto(s)
Gonadotropinas/metabolismo , Síndrome del Ovario Poliquístico/metabolismo , Adolescente , Adulto , Índice de Masa Corporal , Estudios de Casos y Controles , Femenino , Hormona Folículo Estimulante/sangre , Gonadotropinas/sangre , Humanos , Hormona Luteinizante/sangre , Ciclo Menstrual/sangre , Ciclo Menstrual/metabolismo , Obesidad/sangre , Obesidad/epidemiología , Síndrome del Ovario Poliquístico/sangre , Síndrome del Ovario Poliquístico/diagnóstico , Síndrome del Ovario Poliquístico/epidemiología , Prolactina/sangre , Estudios Retrospectivos , Sensibilidad y Especificidad , Adulto Joven
12.
Taiwan J Obstet Gynecol ; 45(4): 346-9, 2006 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-17175497

RESUMEN

OBJECTIVE: Malignant transformations of adenomyosis in premenopausal women with normal endometrium are extremely rare. We report a case of adenocarcinoma arising from an adenomyotic focus in the uterus, which was found unexpectedly in a woman undergoing myomectomy for adenomyosis. CASE REPORT: A 47-year-old premenopausal woman presented with massive vaginal bleeding and anemia. She was admitted and underwent myomectomy under the initial diagnosis of uterine leiomyoma. Microscopic studies revealed endometrioid adenocarcinoma, which was a malignant transformation of a focus of adenomyosis in the surgical specimen. A total hysterectomy and bilateral salpingo-oophorectomy with pelvic and para-aortic lymphadenectomy was then performed. Pathologic studies showed no residual tumors in the entire resected specimen except for the previous lesion. The endometrium had normal thickness with mild proliferative activity throughout the cavity. There was no atrophic or hyperplastic change in the whole endometrium. The adenocarcinoma was present exclusively in the myometrium, and a transition between the carcinoma and the adenomyotic glands was observed. CONCLUSION: This case report presents evidence that adenocarcinoma may a rise de novo from an adenomyotic lesion in the uterus.


Asunto(s)
Adenocarcinoma/diagnóstico , Neoplasias Endometriales/diagnóstico , Endometriosis/cirugía , Enfermedades Uterinas/cirugía , Transformación Celular Neoplásica , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Miometrio/patología , Premenopausia
13.
J Reprod Med ; 51(3): 193-8, 2006 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-16674015

RESUMEN

OBJECTIVE: To investigate whether the plasma glutamine (GLN) concentration would be depleted in pregnant women with preeclampsia and whether administering GLN comparable to physiologic levels would decrease cellular adhesion molecule expression in human umbilical vein endothelial cells (HUVECs) induced by plasma in preeclamptic women. STUDY DESIGN: We assessed plasma GLN levels from blood samples collected from 20 women with preeclampsia and 10 normal pregnant women. HUVECs were cultured in medium-199, containing fetal calf serum, antibiotics and growth factor, at different concentrations (0, 300, 500 microM) of GLN for 24 hours. We stimulated those cells for 1.5-6.0 hours with sera from patients with preeclampsia and then determined the expression of intercellular cell adhesion molecules (ICAM)-1 and vascular cell adhesion molecules (VCAM)-1 on endothelial cells by flow cytometry. RESULTS: Women with preeclampsia had significantly lower plasma GLN concentrations as compared with normal pregnant women. There were no differences in VCAM-1 expression in HUVECs among various GLN concentrations at each time point. However, ICAM-1 expression in HUVECs was significantly lower in the 500-microM GLN group than in the 0- and 300-microM groups at 3, 4.5 and 6 hours. CONCLUSION: This study showed that plasma from women with preeclampsia had significantly lower GLN levels than that from normal pregnant women and that administering GLN at physiologic levels reduces HUVEC ICAM-1 expression induced by preeclamptic plasma.


Asunto(s)
Células Endoteliales/metabolismo , Glutamina/farmacología , Molécula 1 de Adhesión Intercelular/metabolismo , Preeclampsia/sangre , Molécula 1 de Adhesión Celular Vascular/metabolismo , Adhesión Celular/efectos de los fármacos , Células Cultivadas , Células Endoteliales/efectos de los fármacos , Endotelio Vascular/metabolismo , Femenino , Citometría de Flujo/métodos , Expresión Génica/efectos de los fármacos , Glutamina/sangre , Humanos , Embarazo , Venas Umbilicales/citología
14.
Nutrition ; 21(11-12): 1134-40, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-16308137

RESUMEN

OBJECTIVE: This study analyzed plasma glutamine (GLN) concentrations in women with preeclampsia. Also, in an in vitro study we evaluated whether GLN concentration was related to surface molecule expressions on endothelial cells (ECs) and polymorphonuclear neutrophils (PMNs) and the transendothelial migration of PMNs through ECs stimulated by preeclamptic plasma. METHODS: Blood samples were collected from 20 women with preeclampsia and 15 normal pregnant women for plasma GLN analysis. In the in vitro study, human umbilical vein endothelial cells and PMNs were treated with different concentrations (0, 300, 500, and 1000 microM) of GLN for 24 h. After that, we stimulated human umbilical vein endothelial cells for 3 h with plasma from patients with preeclampsia, and PMNs were allowed to transmigrate through ECs for 2 h. EC surface expressions of cellular adhesion molecules (CAMs) and integrin (CD11b) interleukin-8 (IL-8) receptor expressions on PMNs were measured by flow cytometry. The transendothelial migration of PMNs through ECs was also analyzed. RESULTS: Women with preeclampsia exhibited significantly lower plasma GLN concentrations than did normal pregnant women. The in vitro study showed that, compared with normal plasma, CAM expressions on human umbilical vein endothelial cells and PMNs were increased when preeclamptic plasma was stimulated. Among the groups with preeclamptic plasma stimulation, intracellular CAM-1 expression on ECs and CD11b and IL-8 receptor expressions on PMNs were lower with 500 and 1000 microM than with 300 microM of GLN. IL-8 production from ECs and PMNs was also lower with 500 and 1000 microM than with 300 microM of GLN. PMN transmigration was significantly higher with 300 microM of GLN than with the other GLN concentrations. CONCLUSIONS: Plasma GLN is depleted in women with preeclampsia. The result of this in vitro study showed that ECs and PMNs were activated after preeclamptic plasma stimulation. A low GLN concentration resulted in greater CAM expression and greater transendothelial migration of neutrophils. GLN administration at levels similar to or higher than physiologic concentrations decreased IL-8 and CAM expressions, and PMN transmigration decreased after stimulation with preeclamptic plasma.


Asunto(s)
Moléculas de Adhesión Celular/efectos de los fármacos , Movimiento Celular/efectos de los fármacos , Glutamina/farmacología , Leucocitos/fisiología , Preeclampsia/sangre , Embarazo/sangre , Antígeno CD11b/metabolismo , Adhesión Celular/efectos de los fármacos , Moléculas de Adhesión Celular/metabolismo , Movimiento Celular/fisiología , Células Cultivadas , Relación Dosis-Respuesta a Droga , Células Endoteliales/metabolismo , Femenino , Sangre Fetal/citología , Citometría de Flujo , Expresión Génica/efectos de los fármacos , Glutamina/sangre , Humanos , Técnicas In Vitro , Molécula 1 de Adhesión Intercelular/metabolismo , Interleucina-8/biosíntesis , Leucocitos/efectos de los fármacos , Neutrófilos/fisiología
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