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1.
目的探讨改良单孔腹腔镜结直肠癌根治术的临床安全性及可行性。方法选取自2014年3月至2017年4月郴州市第一人民医院收治的92例接受直肠癌根治术患者为研究对象。将所有92例患者随机均分A组和B组,每组各46例。A组行传统单孔腹腔镜直肠癌根治术治疗,B组行改良单孔腹腔镜结直肠癌根治术治疗,比较两组患者的手术及术后基本情况、并发症发生率及术后满意度等相关指标,评估两种术式的安全性及可行性。结果两组患者手术切口长度、清扫的淋巴结个数比较,差异无统计学意义(P>0.05);A组患者手术时间、术中出血量均明显高于B组,差异有统计学意义(P<0.05)。两组患者术后首次排便时间比较,差异无统计学意义(P>0.05);B组住院时间、肠胃功能恢复时间、早期活动时间均显著短于A组,差异均有统计学意义(P<0.05);B组术后并发症的发生率为10.9%(5/46),显著低于A组的23.9%(11/46),两组间比较,差异有统计学意义(P<0.05)。B组术后总满意度为97.8%(45/46),显著高于A组的91.3%(42/46),差异有统计学意义(P<0.05)。结论改良单孔腹腔镜结直肠癌根治术与传统单孔腹腔镜直肠癌根治术治疗效果相似,但改良单孔腹腔镜结直肠癌根治术可降低患者术后并发症的发生率,患者术后恢复快,安全性高,值得临床推广应用。  相似文献   

2.
目的探讨腹腔镜下与经下腹部正中切口疝无张力修补术治疗成人腹股沟斜疝的临床疗效,旨在为成人腹股沟斜疝的微创治疗提供理论依据。方法选取如皋市人民医院自2015年3月至2017年8月收治的200例成人腹股沟斜疝患者为研究对象,采用随机数字表法将患者分为A、B两组,每组各100例患者。A组采用腹腔镜下疝修补术,B组患者采用经下腹部正中切口疝无张力修补术。比较两组患者手术及住院指标、综合临床疗效、切口愈合情况以及并发症发生情况。结果 A组患者术中出血量、首次活动时间、手术时间、住院时间均显著低于B组,且A组治疗总有效率高于B组(94.0%比85.0%),两组间比较,差异均有统计学意义(P<0.05)。A组切口甲级愈合率优于B组(P<0.05)。A组切口感染、阴囊水肿、尿潴留发生率均显著低于B组(P<0.05);而两组患者鞘膜积液、发热、复发情况比较,差异均无统计学意义(P>0.05)。结论与常规腹部正中切口手术比较,腹腔镜下疝修补术能显著降低手术创伤,加快创口愈合,减少住院时间,并降低并发症发生率。  相似文献   

3.
目的探讨配偶双方感染幽门螺杆菌(Hp)采用益生菌联合三联疗法进行同时治疗与单方治疗的疗效及对患者血清炎症因子水平的影响。方法选择自2016年1月至2017年1月核工业417医院收治的Hp感染且其配偶也均确认为Hp感染的患者86例为研究对象。将所有符合标准的患者根据患者自身及其配偶的意愿,分成仅患者本人治疗,其配偶不治疗组(A组,n=43)和患者本人与配偶共同治疗组(B组,n=43)。A组仅对入选患者给予益生菌联合三联疗法进行根除治疗,而其配偶未给予治疗;B组患者及其配偶均给予益生菌联合三联疗法进行根除治疗。观察并记录两组患者的临床疗效,治疗前后血清超敏C反应蛋白(hs-CRP)、白细胞介素-2(IL-2)、白细胞介素-6(IL-6)水平的变化情况,以及Hp根除及复发情况。结果 B组患者的Hp根除率为88.4%(38/43),显著高于A组的62.8%(27/43);B组患者的复发率为13.2%(5/38),明显低于A组的37.0%(10/27);两组比较,差异均有统计学意义(P<0.05)。两组患者治疗14 d后及治疗结束30 d后的血清hs-CRP、IL-2及IL-6水平均显著改善,与治疗前比较,差异有统计学意义(P<0.05);B组治疗14 d后的上述指标与A组比较,差异无统计学意义(P>0.05);B组治疗结束30 d后的上述指标水平均显著优于A组,两组比较,差异有统计学意义(P<0.05)。两组患者的不良反应发生率比较,差异无统计学意义(P>0.05)。结论配偶双方同时治疗相比于单方治疗,可以显著提高Hp的根除率,降低复发率,并能更有效改善患者血清炎症因子水平。  相似文献   

4.
目的比较腹腔镜下子宫肌瘤剔除术和子宫动脉栓塞术治疗子宫肌瘤的疗效。方法回顾性分析自2014年1月至2016年6月沈阳市第六人民医院收治的88例子宫肌瘤患者的临床资料,按照术式不同,分为腹腔镜下子宫肌瘤剔除术组(A组,n=42)和子宫动脉栓塞术组(B组,n=46)。比较两组患者围术期不良反应以及随访3、6、12个月的临床症状改善情况、子宫和肌瘤体积变化情况、生存质量情况。结果所有患者围术期均未发生明显不良反应。随访期间,B组月经量增多、痛经症状改善情况明显好于A组,差异有统计学意义(P<0.05),但两组经期延长、贫血、尿路和直肠压迫、盆腔疼痛症状改善情况比较,差异无统计学意义(P>0.05);A组子宫和肌瘤体积缩小比例明显高于B组,差异有统计学意义(P<0.05);B组生存质量改善情况明显好于A组,差异有统计学意义(P<0.05)。结论腹腔镜下子宫肌瘤剔除术和子宫动脉栓塞术治疗子宫肌瘤疗效均良好。  相似文献   

5.
目的探讨经皮微创钢板内固定在治疗胫骨平台骨折治疗中应用的方法及疗效。方法选取国家电网公司北京电力医院自2015年6月至2017年6月收治的胫骨平台骨折患者60例为研究对象。采用随机数字表法将所有患者分为A、B两组,每组各30例患者。A组患者采用传统切开复位钢板内固定技术,B组患者采用经皮微创钢板内固定技术。术后12个月,比较两组患者的手术指标、Lysholm评分、36项普适性生活质量量表(SF-36)评分及并发症发生情况。结果两组患者手术时间比较,差异无统计学意义(P>0.05)。B组患者术中出血量、切口长度、住院时间及骨折愈合时间均优于A组,两组间比较,差异均有统计学意义(P<0.05)。术后12个月,两组患者Lysholm评分均高于本组术前评分(P<0.05),且B组Lysholm评分高于A组(P<0.05);两组患者SF-36评分均高于本组术前评分(P<0.05),且B组SF-36评分高于A组(P<0.05)。B组患者术后并发症发生率为0,显著低于A组的13.3%(4/30),两组间比较,差异有统计学意义(P<0.05)。结论经皮微创钢板内固定是治疗胫骨平台骨折的有效方法,与传统切开复位钢板内固定比较,其具有术后恢复快、创伤小、膝关节功能恢复好及并发症低等优点,并有利于提高患者术后生活质量。  相似文献   

6.
目的探讨腹腔镜与开腹手术治疗糖尿病并发急性化脓性阑尾炎患者的临床效果及可行性。方法选取自2014年7月至2017年7月收治的200例糖尿病并发急性化脓性阑尾炎患者为研究对象。将所有患者随机均分为A组和B组,每组各100例。A组行开腹手术治疗,B组行腹腔镜阑尾切除术(LA)治疗,比较两组患者的治疗疗效及手术安全性。结果 B组患者的手术时间为(38.6±9.8)min,显著低于A组的(51.9±10.6)min,两组间比较,差异有统计学意义(P<0.05);B组患者的切口长度明显短于A组(P<0.05),B组患者的术中出血量肛门排气时间、住院时间、术后止痛次数均低于A组,两组间比较,差异均有统计学意义(P<0.05)。结论腹腔镜治疗糖尿病并发急性化脓性阑尾炎的治疗疗效明显优于开腹手术,可有效缩短手术时间,术后恢复快,且术后并发症的发生率更低。  相似文献   

7.
目的探讨冠状动脉内注射小剂量重组尿激酶原治疗急性ST段抬高型心肌梗死的临床效果。方法选取徐州医科大附属沭阳县人民医院自2018年1月至2019年2月收治的86例急性ST段抬高型心肌梗死患者为研究对象。根据治疗方法不同,将患者分入A组和B组,每组各43例。A组患者接受常规治疗,B组患者在常规治疗基础上联合冠状动脉内注射小剂量重组尿激酶原治疗。比较两组患者的治疗有效率,术后4、8、12、24 h和术后1、3个月6个时间点的心肌酶、心电图QT离散度、血浆B型脑钠肽、左室射血分数,心肌梗死溶栓(TIMI)血流分级,ST段回落和再通情况,以及主要不良心血管事件发生率。结果 B组治疗有效率为95.4%(41/43),高于A组的76.7%(33/43),差异有统计学意义(P<0.05)。治疗后,两组患者心肌酶、心电图QT离散度、血浆B型脑钠肽在术后4、8、12、24 h和术后1、3个月这6个时间点呈逐渐下降趋势,各时间点比较,差异均有统计学意义(P<0.05);且B组低于A组,差异有统计学意义(P<0.05)。治疗后,两组患者左室射血分数在术后4、8、12、24 h和术后1、3个月这6个时间点呈逐渐上升趋势,各时间点比较,差异均有统计学意义(P<0.05);且B组高于A组,差异有统计学意义(P<0.05)。B组TIMI血流分级2~3级所占比例为95.4%(41/43),高于A组的79.1%(34/43),差异有统计学意义(P<0.05)。B组患者ST段回落≥50%者所占比例为81.4%(35/43),高于A组的60.5%(26/43),差异有统计学意义(P<0.05);B组ST段完全回落者所占比例为55.8%(24/43),高于A组的34.9%(15/43),差异有统计学意义(P<0.05);B组再通者所占比例为76.7%(33/43),高于A组的55.8%(24/43),差异有统计学意义(P<0.05)。B组主要不良心血管事件发生率为7.0%(3/43),低于A组的18.6%(8/43),差异有统计学意义(P<0.05)。结论冠状动脉内注射小剂量重组尿激酶原治疗急性ST段抬高型心肌梗死的临床效果显著,可有效改善患者心功能和心肌灌注,减少出血风险,降低主要不良心血管事件发生率。  相似文献   

8.
目的观察去氧孕烯炔雌醇(妈富隆)与米非司酮对预防不孕症患者子宫内膜息肉术后复发的临床疗效。方法选取150例子宫内膜息肉的不孕症患者行宫腔镜下子宫内膜息肉电切术(TCRP),术后按区组随机化法分为对照组、妈富隆治疗组和米非司酮治疗组,每组50例。观察三组患者子宫内膜息肉复发情况。结果对照组的复发率为32.0%,妈富隆治疗组的复发率为6.0%,米非司酮治疗组的复发率为18.0%,后两组患者的复发率均明显低于对照组(P<0.01),且妈富隆治疗组的复发率低于米非司酮治疗组(P<0.01)。结论子宫内膜息肉术后加用妈富隆与米非司酮均能明显减少不孕症患者子宫内膜息肉的复发率,且妈富隆优于米非司酮。  相似文献   

9.
目的:探讨胸腔镜联合腹腔镜下食管癌切除临床应用价值。方法回顾性分析中国医科大学附属盛京医院胸外科收治的50例食管癌患者的临床资料。根据治疗方法不同,分为研究组(A组,n=25)和对照组(B组,n=25)。 A组采用全胸腔镜、腹腔镜下食管癌根治方案;B组采用传统开胸手术方案。对比两组患者手术时间、失血量、清扫淋巴结数、术后住院天数、围术期并发症发生例数等临床数据。结果与B组比较,A组手术时间缩短、术中出血较少、住院时间明显缩短、肺部感染率降低,差异均有统计学意义(P<0.05);两组患者在清扫淋巴结数、再次开胸止血、吻合口瘘等并发症发生率方面,差异无统计学意义(P>0.05)。结论对食管癌患者给予全胸腔镜、腹腔镜下食管癌根治术,疗效确切,可有效缩短治疗疗程,对降低术后肺部感染风险,值得临床推广。  相似文献   

10.
目的探讨传统切开复位术与关节镜下经皮微创钛缆内固定术在髌骨骨折中的临床应用价值。方法选取自2016年3月至2017年3月承德医学院附属医院南院区收治的83例髌骨骨折患者为研究对象。将所有患者随机分为A组(n=40)和B组(n=43)。A组行传统切开复位术,B组行经皮微创钛缆内固定术。比较两组患者的手术时间、术中出血量、愈合时间、住院时间、临床疗效与不良反应发生情况。结果 B组患者的手术时间、术中出血量、愈合时间及住院时间均显著低于A组,两组比较,差异有统计学意义(P<0.05)。B组优良率为97.7%(42/43),显著高于A组的82.5%(33/40),两组比较,差异有统计学意义(P<0.05)。B组不良反应发生率为20.9%(9/43),显著低于A组的42.5%(17/40),两组比较,差异有统计学意义(P<0.05)。结论与传统切开复位术相比,经皮微创钛缆内固定术治疗髌骨骨折者的疗效及安全性均更为突出。  相似文献   

11.
目的观察术后即时电子线放射治疗烧伤后瘢痕的疗效。方法将我院收治的98例烧伤后瘢痕患者,根据入院的先后顺序分为A、B两组,其中A组(对照组)患者49例,给予单纯手术治疗。B组(实验组)患者49例,给予术后即时电子线放射治疗,并对所有患者进行随访,随访时间为1年。结果 A组患者总有效率为67.35%,B组为95.92%,两组比较,差异有显著统计学意义(P<0.01)。A组患者复发率为34.69%,B组为4.08%,两组比较,差异也有显著统计学意义(P<0.01)。结论术后即时电子线放射治疗烧伤后瘢痕,治愈率高,复发率低,疗效较好。  相似文献   

12.
BackgroundSeventy percent of newly diagnosed colorectal cancer cases are potential candidates for curative surgery, but after resection, in 30%, the tumor will recur.Postoperative follow-up includes endoscopic colonoscopy (EC) and computed tomography (CT). There have been only a few publications on the use of contrast-enhanced CT colonography (CECTC) in the follow-up of these patients.MethodsTwenty-nine consecutive patients after resection of colorectal cancer underwent CECTC and EC on the same day. CECTC studies were reviewed for identification of strictures, recurrence, polyps and metastases.ResultsThe anastomosis was identified in 96% of patients on CECTC and in 82% on endoscopic colonoscopy. One stricture was identified by both techniques. One extraluminal recurrence was depicted only on CECTC. Sensitivity in detecting polyps was per polyp 93% and per patient 100%.ConclusionCECTC performed on a 64-slice multidetector CT is reliable in imaging the postoperative colon for the follow-up of patients after resection of colorectal cancer.  相似文献   

13.
OBJECTIVE: To investigate the diagnostic value of CT colonography for the detection of colorectal polyps. MATERIALS AND METHODS: From December 2004 to December 2005, 399 patients underwent CT colonography and follow-up conventional colonoscopy. We excluded cases of advanced colorectal cancer. We retrospectively analyzed the CT colonography findings and follow-up conventional colonoscopy findings of 113 patients who had polyps more than 6 mm in diameter. Radiologists using 3D and 2D computer generated displays interpreted the CT colonography images. The colonoscopists were aware of the CT colonography findings before the procedure. RESULTS: CT colonography detected 132 polyps in 107 of the 113 patients and conventional colonoscopy detected 114 colorectal polyps more than 6 mm in diameter in 87 of the 113 patients. The sensitivity of CT colonography analyzed per polyp was 91% (41/45) for polyps more than 10 mm in diameter and 89% (101/114) for polyps more than 6 mm in diameter. Thirteen polyps were missed by CT colonography and were detected on follow-up conventional colonoscopy. CONCLUSION: CT colonography is a sensitive diagnostic tool for the detection of colorectal polyps and adequate bowel preparation, optimal bowel distention and clinical experience are needed to reduce the rate of missing appropriate lesions.  相似文献   

14.
多层螺旋CT对于结肠镜检查失败病人的应用   总被引:10,自引:0,他引:10  
目的评估多层螺旋CT(MSCT)对临床上怀疑有结肠病变,但术前结肠镜检查又不成功病人的应用价值。方法对31例结肠镜检查失败的病人行MSCT检查,然后利用工作站的后处理软件获得CT仿真内窥镜(CTVC)、多层面重建(MPR)、表面遮盖显示(SSD)、透亮法显示(Raysum)4种后处理图像。将MSCT诊断结果与结肠镜、术中探查、术后病理结果逐一对照。结果31例结肠镜检查不完全的病人均成功完成了MSCT检查,术后病理证实有结肠癌22例(包括1例多原发癌,2例癌并发息肉),结肠良性病变9例。22例结肠癌病例(包括并发病灶)MSCT均正确诊断,9例良性病例中MSCT正确诊断6例,2例误诊为结肠癌,1处息肉病变漏诊。结论MSCT是全面评价梗阻性结肠病变的有效方法。  相似文献   

15.
PURPOSE: To prospectively investigate with computed tomographic (CT) colonography the prevalence and size distribution of nonadenomatous polyps in asymptomatic adults and to compare the detection rates of adenomatous and nonadenomatous polyps. MATERIALS AND METHODS: A total of 1233 asymptomatic adults (mean age, 57.8 years; 505 women, 728 men) underwent same-day CT colonography and optical colonoscopy procedures. CT colonoscopy studies were interpreted prospectively with a primary three-dimensional approach immediately before optical colonoscopy. Statistical analysis was performed with the chi(2) test. Size, prevalence, and by-polyp detection differences were compared between adenomatous and nonadenomatous polyps. RESULTS: Seven hundred fifty-six (57.7%) colorectal polyps identified at optical colonoscopy in 410 (33.3%) patients were nonadenomatous; of these lesions, 622 (82.3%) were diminutive (相似文献   

16.
PURPOSE: To evaluate our experience in the 1st year of computed tomographic (CT) colonography screening since the initiation of local third-party payer coverage. MATERIALS AND METHODS: This HIPAA-compliant study was approved by the institutional review board, and informed consent was waived. Over a 1-year period that ended on April 27, 2005, 1110 consecutive adults (585 women, 525 men; mean age, 58.1 years) underwent primary CT colonography screening. More than 99% were covered by managed care agreements. CT colonographic interpretation was performed with primary three-dimensional polyp detection, and the final results were issued within 2 hours. Patients with large (> or =10-mm) polyps were referred for same-day optical colonoscopy, and patients with medium-sized (6-9-mm) lesions had the option of immediate optical colonoscopy or short-term CT colonography surveillance. RESULTS: Large colorectal polyps were identified at CT colonography in 43 (3.9%) of 1110 patients. Medium-sized lesions were identified in 77 (6.9%) patients, 31 (40%) of whom chose optical colonoscopy and 46 (60%) of whom chose CT colonography surveillance. Concordant lesions were identified in 65 of 71 patients who underwent subsequent optical colonoscopy (positive predictive value, 91.5%). Sixty-one (86%) of 71 optical colonoscopic procedures were performed on the same day as CT colonography, thereby avoiding the need for repeat bowel preparation. The actual endoscopic referral rate for positive findings at CT colonography was 6.4% (71 of 1110 patients). The demand for CT colonography screening from primary care physicians and their patients increased throughout the study period. CONCLUSION: As a primary colorectal screening tool, CT colonography covered by third-party payers has an acceptably low endoscopic referral rate and a high concordance of positive findings at optical colonoscopy.  相似文献   

17.
目的 探讨不同能量氩离子激光防止翼状胬肉术后复发的效果.方法 将116例116只眼原发性翼状胬肉术后1周手术区结膜或角膜缘出现新生血管胚芽的患者分为3组:(1)低能量氩离子激光光凝组(A组)56例,功率0.1~0.15 W;(2)常规能量氩离子激光光凝组(B组)30例,功率0.2~0.3 W;(3)对照组(C组)30例,不行光凝.结果 随访1年,A、B、C组胬肉术后复发率分别为7.1%、10.0%、33.3%.激光治疗后A组患者结膜充血、结膜灼伤、结膜充血的发生率均低于B组(P<0.05).结论 低能量氩离子激光照射封闭胬肉术后1周新生血管胚芽,为防止翼状胬肉术后复发的一种有效方法,激光治疗后胬肉早期新生血管胚芽、结膜灼伤、结膜出血等局部反应较少.  相似文献   

18.
The aim of this study was to calculate pre- and postcontrast CT attenuation values of benign colorectal polyp and carcinoma lesions detected by virtual colonoscopy, and to investigate whether contrast enhancement of these lesions can be potentially used for differentiation from residual fluid in the colon. Fifteen benign polyps and 21 colorectal carcinoma lesions detected by virtual colonoscopy in 18 patients were included in our study. All of the polyps and carcinoma lesions were confirmed by colonoscopic biopsy. Measurement of CT attenuation values was performed in precontrast (supine) and postcontrast (prone) scans for each polyp and carcinoma. The CT attenuation values of residual fluid in the colon was also measured from the same location before and after intravenous contrast administration. On unenhanced CT scan mean attenuation values of benign polyps and colorectal carcinomas were 32.4 and 42.6 HU, respectively. Following contrast enhancement, mean attenuation value increased to 78.9 HU for polyps and 90.7 HU for carcinomas. Increase in the CT attenuation values of these lesions was significant ( p <0.0001). Mean CT attenuation value of residual fluid before and after administration of IV contrast were 14.6 and 13.8 HU, respectively. The difference between CT attenuation value of residual fluid in the colon before and after contrast material was not significant ( p =0.29). Colorectal benign polyps and carcinomas demonstrate significant enhancement following contrast administration and use of intravenous contrast material during virtual colonoscopy may help in some cases in differentiating these solid lesions from residual colonic fluid that does not enhance. This paper was presented at RSNA 2001 meeting.  相似文献   

19.
CT colonography: multiobserver diagnostic performance   总被引:9,自引:0,他引:9  
PURPOSE: To prospectively evaluate multiobserver diagnostic performance and reader agreement for colorectal polyp detection in a well-characterized cohort of patients with increased number of polyps, compared with an average-risk patient, with colonoscopy as the reference standard. MATERIALS AND METHODS: A cohort of 70 patients suspected of having polyps was examined with spiral computed tomographic (CT) colonography, with colonoscopy performed the same day. After air insufflation per rectum, supine and prone images were obtained with single-detector row CT (5-mm collimation, 8-mm table increment, 2-mm reconstruction interval). Images were analyzed independently by four experienced abdominal radiologists using two-dimensional multiplanar reformation followed by selective use of three-dimensional endoscopic volume-rendered images. Data were analyzed both per polyp and per patient. RESULTS: Analysis per polyp demonstrated a pooled sensitivity of 0.68 for lesions 10 mm or larger (n = 40), with 75% agreement among the four readers. Analysis per patient demonstrated improved detection and agreement, with a pooled sensitivity of 0.88 for patients with polyps or cancers 10 mm or larger (n = 28), with 94% agreement. When sensitivity and receiver operating characteristic analyses were analyzed per polyp size threshold, results among readers converged and peaked at polyp diameters of approximately 10 mm. CONCLUSION: In this patient cohort, diagnostic performance and interobserver agreement with single-detector row CT colonography was sufficient for detection of patients with lesions 10 mm or larger, with more variable results for smaller polyps.  相似文献   

20.
OBJECTIVE: We compared the findings of time-efficient CT colonography with complete two-dimensional (2D) and three-dimensional (3D) CT colonography and conventional colonoscopy in detecting colorectal polyps. SUBJECTS AND METHODS: Forty-two patients undergoing colonoscopy screening were examined with CT colonography before endoscopy. Data were examined following one of two methods. In method 1, axial 2D data sets were examined in a cine mode. If findings were suggestive of abnormality, focal areas were examined with 3D CT colonography. In method 2, data sets were examined exactly as in method 1, and subsequent to that review, data sets were examined with simultaneous 3D "fly-through" CT colonography (surface-rendered images) and multiplanar reformatted images. The time required to examine CT colonography using each technique was recorded and abnormal findings were documented. Results of methods 1 and 2 were compared with findings on colonoscopy. RESULTS: Colonoscopy detected 16 polyps in 13 patients (polyp size, 2-10 mm). Ten polyps measured 5 mm or less, five measured between 6 and 9 mm, and one measured 10 mm or more. Using method 1, two of 10 polyps measuring less than 5 mm, three of five polyps measuring between 6 and 9 mm, and one polyp measuring 10 mm were detected. We noted no false-positive polyps. Average evaluation time was 16 min. With method 2, the same polyps were seen as with method 1. No additional polyps were detected, and the average evaluation time was 40 min. CONCLUSION: Axial 2D CT colonography can be performed quickly and is comparable with complete 2D and 3D CT colonography in detecting colorectal polyps.  相似文献   

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