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1.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48250

RESUMO

Ministério da Saúde oferece testagem e tratamento gratuitos nas unidades básicas de saúde; se não for tratada a tempo, a doença traz sérias consequências para a saúde, podendo, inclusive, ser fatal


Assuntos
Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sistema Único de Saúde , Doenças Sexualmente Transmissíveis
2.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48233

RESUMO

Pacientes com artrite psoríaca contam Protocolo Clínico e Diretrizes Terapêuticas (PCDT) atualizado. O documento foi revisado para que o tratamento ofertado no Sistema Único de Saúde seja baseado na melhor e mais atualizada evidência científica.


Assuntos
Artrite Psoriásica/tratamento farmacológico , Psoríase/tratamento farmacológico , Sistema Único de Saúde/organização & administração , Protocolos Clínicos
3.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48235

RESUMO

Quando foi a última vez que você foi ao oftalmologista para uma visita de rotina? Saiba que manter o acompanhamento médico pode prevenir vários problemas, inclusive uma doença silenciosa que atinge mais de 900 mil pessoas no Brasil: o glaucoma


Assuntos
Glaucoma/diagnóstico , Glaucoma/tratamento farmacológico , Saúde Ocular , Cegueira/diagnóstico
5.
Ugeskr Laeger ; 183(21)2021 05 24.
Artigo em Dinamarquês | MEDLINE | ID: mdl-34060464

RESUMO

Bite wounds are common in the emergency departments in Denmark. As a result of the Covid-19 pandemic, more people are adopting pets and the number of hours spent at home with pets are increasing. This will probably result in more bite wounds and therefore, it is as important as ever for emergency doctors to be able to treat bite wounds appropriately. In this review, we summarise the most common types of bite wounds, how to make a thorough physical examination, what to focus on in the anamnesis, and how to treat bite wounds including when to suture and the indications for prophylactic antibiotics.


Assuntos
Mordeduras e Picadas , Infecção dos Ferimentos , Animais , Antibacterianos/uso terapêutico , Mordeduras e Picadas/epidemiologia , Mordeduras e Picadas/terapia , Gatos , Cães , Humanos , Pandemias , Infecção dos Ferimentos/tratamento farmacológico
6.
Medicina (Kaunas) ; 57(5)2021 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-34063455

RESUMO

The incidence of ovarian cancer, which has had a poor prognosis, is increasing annually. Currently, the prognosis is expected to improve with the use of molecular-targeted drugs and immune checkpoint inhibitors as maintenance therapies after the first-line chemotherapy. The GOG218 and ICON7 studies reported the usefulness of bevacizumab and the SOLO-1 and PRIMA (A Phase 3, Randomized, Double-Blind, Placebo-Controlled, Multicenter Study of Niraparib Maintenance Treatment in Patients With Advanced Ovarian Cancer Following Response on Front-Line Platinum-Based Chemotherapy) studies have reported the usefulness of olaparib and niraparib, respectively. The ATHENA study investigating the usefulness of rucaparib is currently ongoing. Although clinical studies of immune checkpoint inhibitors are lagging in the field of gynecology, many clinical studies using programmed death cell-1 (PD-1) and PD-1 ligand 1 (PD-L1) antibodies are currently ongoing. Some biomarkers have been identified for molecular-targeted drugs, but none have been identified for immune checkpoint inhibitors, which is a challenge that should be addressed in the future.


Assuntos
Motivação , Neoplasias Ovarianas , Bevacizumab/uso terapêutico , Feminino , Humanos , Estudos Multicêntricos como Assunto , Neoplasias Ovarianas/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
7.
Medicina (Kaunas) ; 57(5)2021 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-34065046

RESUMO

Background and Objectives: This observational study aims to determine the correlation between glycemic control with the HbA1c value and adverse obstetric outcome in women affected by pre-gestational diabetes. Materials and Methods: A retrospective analysis has been performed at the University Hospital of Udine. Only patients with a singleton pregnancy, pre-gestational diabetes, and known level of Hb A1c throughout pregnancy were included in the study. Results: According to the HbA1c level, at the beginning of pregnancy, 49 patients with HbA1c ≤ 7.0% were compared with 45 patients with HbA1c > 7.0%. Maternal age at diagnosis of the disease was significantly higher in the group with HbA1c ≤ 7% than in the group with HbA1c > 7%, 26.00 (18.00-32.00) vs. 20.00 (12.50-27.00). Women with HbA1c ≤ 7.0% reached, at term of pregnancy, significantly lower levels of HbA1c, 5.8% (5.7-6.0) vs. 6.7% (6.3-7.3). Daily insulin units were statistically different between the two groups at the end of pregnancy (47.92 (39.00-67.30) vs. 64.00 (48.00-82.00)). Proteinuria was significantly higher in the group with HbA1c > 7.0%, who delivered at earlier gestational age (37.57 (35.57-38.00) vs. 38.14 (38.00-38.43). Moreover, women with HbA1c > 7.0% had a significantly higher prevalence of an adverse composite outcome. Of note, in multivariate logistic regression analysis, pregnancy complications were significantly correlated to pre-pregnancy HbA1c > 7.0% (OR 2.95 CI.95 1.16-7.48, p < 0.05) independently of age, insulin treatment, and type of diabetes. Conclusions: Our data, obtained from a single-center cohort study, suggest that starting pregnancy with poor glycemic control might predict more complex management of diabetes in the following trimesters.


Assuntos
Diabetes Gestacional , Resultado da Gravidez , Glicemia , Estudos de Coortes , Diabetes Gestacional/tratamento farmacológico , Diabetes Gestacional/epidemiologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos
8.
Sensors (Basel) ; 21(10)2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34065245

RESUMO

Parkinson's disease medication treatment planning is generally based on subjective data obtained through clinical, physician-patient interactions. The Personal KinetiGraph™ (PKG) and similar wearable sensors have shown promise in enabling objective, continuous remote health monitoring for Parkinson's patients. In this proof-of-concept study, we propose to use objective sensor data from the PKG and apply machine learning to cluster patients based on levodopa regimens and response. The resulting clusters are then used to enhance treatment planning by providing improved initial treatment estimates to supplement a physician's initial assessment. We apply k-means clustering to a dataset of within-subject Parkinson's medication changes-clinically assessed by the MDS-Unified Parkinson's Disease Rating Scale-III (MDS-UPDRS-III) and the PKG sensor for movement staging. A random forest classification model was then used to predict patients' cluster allocation based on their respective demographic information, MDS-UPDRS-III scores, and PKG time-series data. Clinically relevant clusters were partitioned by levodopa dose, medication administration frequency, and total levodopa equivalent daily dose-with the PKG providing similar symptomatic assessments to physician MDS-UPDRS-III scores. A random forest classifier trained on demographic information, MDS-UPDRS-III scores, and PKG time-series data was able to accurately classify subjects of the two most demographically similar clusters with an accuracy of 86.9%, an F1 score of 90.7%, and an AUC of 0.871. A model that relied solely on demographic information and PKG time-series data provided the next best performance with an accuracy of 83.8%, an F1 score of 88.5%, and an AUC of 0.831, hence further enabling fully remote assessments. These computational methods demonstrate the feasibility of using sensor-based data to cluster patients based on their medication responses with further potential to assist with medication recommendations.


Assuntos
Doença de Parkinson , Humanos , Levodopa/uso terapêutico , Testes de Estado Mental e Demência , Doença de Parkinson/diagnóstico , Doença de Parkinson/tratamento farmacológico , Tecnologia
9.
MAbs ; 13(1): 1919285, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34074219

RESUMO

The newly emerging variants of SARS-CoV-2 from South Africa (B.1.351/501Y.V2) and Brazil (P.1/501Y.V3) have led to a higher infection rate and reinfection of COVID-19 patients. We found that the mutations K417N, E484K, and N501Y within the receptor-binding domains (RBDs) of the virus could confer ~2-fold higher binding affinity to the human receptor, angiotensin converting enzyme 2 (ACE2), compared to the wildtype RBD. The mutated version of RBD also completely abolishes the binding of bamlanivimab, a therapeutic antibody, in vitro. Detailed analysis shows that the ~10-fold gain of binding affinity between ACE2 and Y501-RBD, which also exits in the high contagious variant B.1.1.7/501Y.V1 from the United Kingdom, is compromised by additional introduction of the K417/N/T mutation. Mutation of E484K leads to the loss of bamlanivimab binding to RBD, although this mutation does not affect the binding between RBD and ACE2.


Assuntos
Anticorpos Monoclonais Humanizados/metabolismo , Antivirais/metabolismo , COVID-19/virologia , Mutação , SARS-CoV-2/metabolismo , Enzima de Conversão de Angiotensina 2/metabolismo , Anticorpos Monoclonais Humanizados/uso terapêutico , Antivirais/uso terapêutico , Sítios de Ligação , COVID-19/diagnóstico , COVID-19/tratamento farmacológico , Interações Hospedeiro-Patógeno , Humanos , Simulação de Acoplamento Molecular , Ligação Proteica , Domínios e Motivos de Interação entre Proteínas , Receptores Virais/metabolismo , SARS-CoV-2/efeitos dos fármacos , SARS-CoV-2/genética
11.
World J Surg Oncol ; 19(1): 170, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116681

RESUMO

BACKGROUND: We retrospectively examined the relationship among skeletal muscle mass index (SMI), prognosis, and chemotherapy side effects in patients with recurrent gastric cancer (RGC). METHODS: Sixty-seven patients who developed recurrence after undergoing curative gastrectomy for gastric cancer at Tottori University Hospital and received palliative chemotherapy were included in this study. Pretreatment computed tomography was performed to measure the skeletal muscle mass (SMM) and cross-sectional SMM at the third lumbar vertebra. We focused on haematologic toxicity (neutropenia, thrombocytopenia, and anaemia), febrile neutropenia, and gastrointestinal toxicity (diarrhoea, vomiting, and stomatitis) as the side effects of chemotherapy. RESULTS: Median SMIs for males and females (43.9 and 34.7 cm2/m2, respectively) were used as cutoff values. The patients were classified into high (SMIHigh; n = 34) and low SMI groups (SMILow; n = 33). The SMILow group included more patients treated with monotherapy (P = 0.016) compared with the SMIHigh group, had a significantly lower number of chemotherapy lines (P = 0.049), and had a significantly higher incidence of grade 3 or 4 side effects (P = 0.010). The median survival rate was significantly higher in the SMIHigh group (17.8 vs 15.8 months; P = 0.034). In the univariate analysis, body mass index, SMI, histological type, and prognostic nutritional index were identified as prognostic indicators. The multivariate analysis identified SMI (P = 0.037) and histological type (P = 0.028) as independent prognostic factors. CONCLUSION: The incidence of grade 3 or 4 side effects was significantly higher in patients with SMILow RGC. SMI was a useful prognostic marker of RGC.


Assuntos
Sarcopenia , Neoplasias Gástricas , Estudos Transversais , Feminino , Humanos , Masculino , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/patologia , Prognóstico , Estudos Retrospectivos , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
12.
World J Surg Oncol ; 19(1): 169, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116698

RESUMO

BACKGROUND: Interstitial lung disease (ILD) is a rare adverse event in patients receiving adjuvant or neoadjuvant chemotherapy (NAC) for breast cancer. Few studies have reported the frequency of ILD in detail, and only small numbers of cases have been described in the literature. Given these previous findings concerning ILD, we retrospectively examined the clinicopathological characteristics of five cases of ILD who had received epirubicin and cyclophosphamide (EC) and compared their findings with non-ILD cases. METHODS: The present single-center retrospective study included breast cancer patients who underwent adjuvant chemotherapy or NAC at our hospital between January 2014 and January 2021. RESULTS: Thirty-nine patients who had received EC for operable breast cancer were enrolled in this study. ILD developed 5 out of 39 patients (12.8%). The incidence of ILD in patients with non-dose-dense (dd) or dd chemotherapy was statistically significantly different (p = 0.0149). ILD occurred in three patients during dd EC treatment and two during weekly paclitaxel (wPTX) after dd EC. ILD was detected in one patient with high Krebs von den Lungen-6 (KL-6) levels, in two patients with continuous pyrexia, and in two patients from computed tomography imaging, which was taken to estimate the efficacy of chemotherapy, in two patients. Three of the 5 ILD patients underwent bronchoalveolar lavage, and 2 of these patients were diagnosed with Pneumocystis jirovecii pneumonia (PCP). There were no cases of serious ILD that required steroid pulse therapy. CONCLUSIONS: Dd chemotherapy may be associated with an increased ILD frequency, which may reflect developing PCP. Careful monitoring and a timely diagnosis are useful for detecting early-stage ILD.


Assuntos
Neoplasias da Mama , Doenças Pulmonares Intersticiais , Neoplasias da Mama/tratamento farmacológico , Quimioterapia Adjuvante/efeitos adversos , Feminino , Humanos , Doenças Pulmonares Intersticiais/induzido quimicamente , Terapia Neoadjuvante/efeitos adversos , Prognóstico , Estudos Retrospectivos
13.
Endocr Pract ; 27(6): 505-537, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34116789

RESUMO

OBJECTIVE: To provide evidence-based recommendations regarding the use of advanced technology in the management of persons with diabetes mellitus to clinicians, diabetes-care teams, health care professionals, and other stakeholders. METHODS: The American Association of Clinical Endocrinology (AACE) conducted literature searches for relevant articles published from 2012 to 2021. A task force of medical experts developed evidence-based guideline recommendations based on a review of clinical evidence, expertise, and informal consensus, according to established AACE protocol for guideline development. MAIN OUTCOME MEASURES: Primary outcomes of interest included hemoglobin A1C, rates and severity of hypoglycemia, time in range, time above range, and time below range. RESULTS: This guideline includes 37 evidence-based clinical practice recommendations for advanced diabetes technology and contains 357 citations that inform the evidence base. RECOMMENDATIONS: Evidence-based recommendations were developed regarding the efficacy and safety of devices for the management of persons with diabetes mellitus, metrics used to aide with the assessment of advanced diabetes technology, and standards for the implementation of this technology. CONCLUSIONS: Advanced diabetes technology can assist persons with diabetes to safely and effectively achieve glycemic targets, improve quality of life, add greater convenience, potentially reduce burden of care, and offer a personalized approach to self-management. Furthermore, diabetes technology can improve the efficiency and effectiveness of clinical decision-making. Successful integration of these technologies into care requires knowledge about the functionality of devices in this rapidly changing field. This information will allow health care professionals to provide necessary education and training to persons accessing these treatments and have the required expertise to interpret data and make appropriate treatment adjustments.


Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Mellitus , Glicemia , Automonitorização da Glicemia , Diabetes Mellitus/terapia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Humanos , Insulina/uso terapêutico , Sistemas de Infusão de Insulina , Qualidade de Vida , Tecnologia , Estados Unidos
14.
BMJ Case Rep ; 14(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116987

RESUMO

Melkersson-Rosenthal syndrome (MRS) is a rare neurocutaneous syndrome characterised by the triad of recurrent orofacial swelling, facial nerve palsy and fissured tongue. This diagnosis is particularly rare in children. We aim to increase awareness of the syndromic association of these clinical features since most patients present with a monosymptomatic form, reiterating the importance of detailed history and thorough physical examination, for the timely identification of these patients. Not only the recurring of symptoms, but also the association of MRS with other medical conditions, make 'earlier' diagnosis of the Syndrome beneficial. The average delay in diagnosis is 4-9 years. Although most cases resolve without treatment, when treated,steroids are most commonly used. Variable options have been tried for refractory and frequently recurrent cases. We present a case of MRS in a 12-year-old girl, diagnosed 3 years after onset of symptoms. We reviewed updated literature for MRS and associated clinical conditions as well as published treatment options.


Assuntos
Paralisia Facial , Síndrome de Melkersson-Rosenthal , Síndromes Neurocutâneas , Língua Fissurada , Criança , Feminino , Humanos , Síndrome de Melkersson-Rosenthal/complicações , Síndrome de Melkersson-Rosenthal/diagnóstico , Síndrome de Melkersson-Rosenthal/tratamento farmacológico , Recidiva
15.
BMJ Case Rep ; 14(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116989

RESUMO

Streptococcus pneumoniae is a rare cause of infectious endocarditis. Most cases have an acute and aggressive evolution, with a high mortality rate. We report the case of a 36-year-old man, with a history of unrepaired ventricular septal defect, who came to the emergency department with fever, cough and asthenia with 3 months of evolution. Blood cultures were positive for Streptococcus pneumoniae Echocardiogram showed large vegetation on septum, free wall and outflow tract of the right ventricle. Thoracic CT revealed septic pulmonary embolism. Antimicrobial therapy and surgical treatment was performed and the patient presented a favourable evolution.


Assuntos
Endocardite Bacteriana , Endocardite , Comunicação Interventricular , Adulto , Antibacterianos/uso terapêutico , Endocardite/tratamento farmacológico , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/tratamento farmacológico , Comunicação Interventricular/tratamento farmacológico , Humanos , Masculino , Streptococcus pneumoniae
16.
BMJ Case Rep ; 14(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116990

RESUMO

Brainstem abscess is an uncommon occurrence in itself and an abscess in the medulla oblongata is even rarer. Although these abscesses have established association with head and neck infections, we report the first known case of medullary abscess that was found to be strongly associated with dental procedure. Important point to note is that a simple procedure like tooth extraction can predispose spread of infective seeding to distant sites. High clinical index of suspicion and early diagnosis are essential, as if left untreated, the brainstem abscess is almost always fatal otherwise.


Assuntos
Abscesso Encefálico , Infecções Estreptocócicas , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/etiologia , Humanos , Bulbo/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus intermedius , Extração Dentária/efeitos adversos
17.
BMJ Case Rep ; 14(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116997

RESUMO

We describe a unique case of a patient with acute myeloid leukaemia (AML), with recurring infections during chemotherapy from chronic nasal carriage of non-diphtherial Corynebacterium, who was eventually diagnosed as she presented with neutropaenic sepsis. Identifying (often multiple) sources of infection in immunocompromised patients is crucial but deciding whether multiple organisms, which in health are considered as commensals, are actually pathogenic during vulnerable states-can be clinically difficult. Our case highlights the efforts to correctly identify the actual source of this rare organism and the recognition of its pathogenic potential when other illnesses present. We also review the literature of Corynebacteria in patients with haematological malignancies but believe this is the first case of AML to be infected with Corynebacterium presenting during the COVID-19 pandemic with a probable incidental positive swab for SARS-CoV-2.


Assuntos
Bacteriemia , COVID-19 , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Corynebacterium , Feminino , Humanos , Hospedeiro Imunocomprometido , Recidiva Local de Neoplasia , Pandemias , SARS-CoV-2
18.
BMJ Case Rep ; 14(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116998

RESUMO

A 61-year-old obese man who had recently tested positive for COVID-19 presented to the emergency department following an unwitnessed collapse, with a brief period of unresponsiveness. CT pulmonary angiography confirmed the presence of extensive bilateral pulmonary embolism despite the patient reporting full compliance with long-term dabigatran. The patient was initially anticoagulated with low-molecular-weight heparin and was treated with non-invasive ventilation and dexamethasone for COVID-19 pneumonia. He made a full recovery and was discharged on oral rivaroxaban. His case highlighted some of the common problems encountered when selecting an anticoagulation strategy for obese patients, as well as the lack of definitive evidence to guide treatment decisions. These challenges were further complicated by our incomplete understanding of the underlying mechanisms of COVID-19 coagulopathy, with limited data available regarding the optimal management of thromboembolic complications.


Assuntos
COVID-19 , Embolia Pulmonar , Tromboembolia Venosa , Anticoagulantes/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Embolia Pulmonar/complicações , Embolia Pulmonar/tratamento farmacológico , SARS-CoV-2 , Tromboembolia Venosa/complicações , Tromboembolia Venosa/tratamento farmacológico
19.
BMJ Case Rep ; 14(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34116999

RESUMO

We report a case of a 30-year-old man who presented with altered mental status, fever, headache and vomiting for 3 days. An initial CT scan of the brain revealed the presence of pneumocephalus with a bony defect in the anterior cranial fossa. The pneumocephalus was not explained initially and the patient was re-examined for any signs of trauma to the face, and a review of the history revealed a series of three traumatic events months prior to this illness. Further laboratory studies revealed Streptococcus pneumoniae in the blood and bacterial meningitis. He was treated with antibiotics and was later taken up for endoscopic repair of the skull base defect. This case highlights the importance of recognising post-traumatic pneumocephalus with superimposed meningitis and sepsis months after a traumatic event to the skull base.


Assuntos
Meningites Bacterianas , Pneumocefalia , Adulto , Fossa Craniana Anterior , Humanos , Masculino , Meningites Bacterianas/complicações , Meningites Bacterianas/tratamento farmacológico , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/etiologia , Base do Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 50(1): 32-40, 2021 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-34117847

RESUMO

The metabolic reprogramming of tumor cells is characterized by increased uptake of various nutrients including glutamine. Glutamine metabolism provides the required substances for glycolysis and oxidative phosphorylation and affects the homeostasis of carbohydrate,fat and protein metabolism to induce the chemoresistance of tumor cells. Combination of chemotherapeutic agents with inhibitors specific to different components of glutamine metabolic pathway has obtained favorable clinical results on various tumors. Glutamine metabolic pathway plays a role in drug resistance of tumor cells in various ways. Firstly,the dynamic change of glutamine transporters can directly affect intracellular glutamine content thereby causing drug resistance; secondly,tumor stromal cells including adipocyte,fibroblast and metabolite from tumor microenvironment would give rise to immune-mediated drug resistance; thirdly,the expression and activity of key enzymes in glutamine metabolism also has a critical role in drug resistance of tumors. This article reviews the effects of glutamine metabolic pathway in the development of tumor chemoresistance,in terms of transporters,tumor microenvironment and metabolic enzymes,to provide insight for improving the therapeutic efficacy for drug-resistant tumors.


Assuntos
Glutamina , Neoplasias , Linhagem Celular Tumoral , Resistencia a Medicamentos Antineoplásicos , Glutamina/metabolismo , Glicólise , Humanos , Neoplasias/tratamento farmacológico , Fosforilação Oxidativa , Microambiente Tumoral
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