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1.
儿童泌尿道感染中膀胱输尿管反流发生率的临床研究   总被引:1,自引:0,他引:1  
目的回顾性分析儿童泌尿道感染中膀胱输尿管反流(VUR)的发生情况,以加强对VUR的认识,提高检出率。方法选择2000年1月到2006年11月因泌尿道感染收治入院的患儿106例,根据年龄分为≤2岁组、~5岁组、>5岁组三组,通过排泄性膀胱尿道造影(VCUG)和直接放射性核素造影诊断VUR;通过肾皮质静态显像(DMSA)检查,了解肾疤痕的形成情况。分析不同年龄组的VUR发病情况、不同等级VUR的程度和肾疤痕的形成分布情况。结果106例中VUR共40例,不同年龄组VUR的所占比例分别是77.78%、46.67%、27.90%(χ2=12.994,P=0.002),差异具有统计学意义。106例中有40例作了DMSA检查,14例形成肾疤痕,三组间肾疤痕的分布情况依次是66.7%、30.77%、28.57%,≤2岁组肾疤痕发生率高。另外,从VUR的等级分布和单、双侧VUR发生的情况来看,≤2岁组中VUR患儿主要是Ⅲ、Ⅳ、Ⅴ级,而~5岁组和>5岁组则随着年龄的逐渐增加Ⅰ、Ⅱ级的例数增加,Ⅲ、Ⅳ、Ⅴ级的例数减少;而且≤2岁组的VUR患儿双侧VUR的例数也较后两组多。结论≤2岁的泌尿道感染患儿最易形成肾疤痕,VUR的发病率高,且高级别、双侧VUR的发生率高,应及时行VCUG和DMSA,及早发现VUR和肾疤痕。  相似文献   

2.
目的 评价~(99m)Tc放射性核素肾静态扫描(DMSA)在婴幼儿发热性尿路感染急性期预测膀胱输尿管反流(VUR)的作用,探讨DMSA和排泄性膀胱尿路造影(MCU)在发热性尿路感染中应用的优先次序.方法 回顾性分析总结2000年1月到2009年12月间因发热性尿路感染就诊的年龄≤2岁婴幼儿的医疗记录和影像学资料.入组患儿均在就诊后1周内接受DMSA肾扫描、在感染控制后1周内行MCU检查.根据MCU检查结果分为无反流组、低级别VUR组和高级别VUR组.结果 共有370例患儿(男233例,女137例)纳入本研究,其中263例(71.1%)DMSA结果提示异常;126例经MCU证实患VUR(34.1%),其中高级别VUB(Ⅲ~Ⅴ级)为103例(占到所有VUR的81.7%).高级别VUR组DMSA结果异常率明显高于无反流组和低级别VUR组,其差异有统计学意义(P<0.01).DMSA检出高级别VUR(经MCU确诊)的敏感性为99.0%,阴性预测值为99.1%,阴性似然比(LR-)为0.03.结论 高级别VUR是婴幼儿发生肾损害的一个重要危险因素,DMSA检查为阴性的尿路感染患儿中高级别VUR的可能性较小.在婴幼儿发热性尿路感染急性期,DMSA在检出肾损害的同时对高级别VUR也有较好的预测能力,其应用次序可考虑优先于MCU.  相似文献   

3.
婴幼儿发热性尿路感染的影像学检查评价   总被引:1,自引:1,他引:0  
目的 探讨肾脏超声检查(US)、放射性核素肾静态扫描(DMSA)和排泄性膀胱尿道造影(VCUG)检查在婴幼儿发热性尿路感染(UTI)中的应用价值.方法 发热性UTI患儿人院1周内进行US及DMSA检查,2周后进行VCUG检查,急性期DMSA异常者6个月复查,并对US、DMSA和VCUG检查结果进行回顾性分析.结果 婴幼儿发热性UTI患儿160例,急性期接受US、DMSA和VCUG三项检查的共75例,VCUG检出VUR患儿23例(35个VUR肾输尿管单位),检出率为30.7%;35个VUR肾输尿管单位中,Ⅰ级反流0个,Ⅱ级8个(22.9%).Ⅲ级11个(31.4%),Ⅳ级14个(40.0%),V级2个(5.7%).35个反流肾输尿管单位中,US提示反流的有15个;无反流的114个肾输尿管单位中US提示反流的有12个,US筛查VUR的敏感性为42.9%,特异性为89.5%,阳性预测率为55.6%,阴性预测率为83.6%.35个反流的肾输尿管单位中,DMSA提示异常的有31个;无反流的114个肾输尿管单位中,DMSA提示异常的有61个,DMSA筛查VUR的敏感性为88.6%,特异性为46.5%,阳性预测率为33.7%,阴性预测率为93.0%.24例6个月后DMSA复查发现肾瘢痕形成15例,占62.5%,其中VUR患儿有10例,反流程度均为Ⅲ级或Ⅲ级以上.结论 发热性UTI婴幼儿中VUR的发生率高,以严重VUR多见,且容易形成肾瘢痕,US、VCUG和DMSA均应作为常规评估检查.  相似文献   

4.
加强对儿童尿路感染和膀胱输尿管反流的认识   总被引:2,自引:0,他引:2  
徐虹 《临床儿科杂志》2008,26(4):269-272
儿童尿路感染是婴儿和儿童中一种常见的细菌性感染,6岁以内儿童泌尿道感染(UTI)累计发病率女孩为6.6%,男孩为1.8%.UTI与膀胱输尿管反流(VUR)的关系复杂,共同存在是导致持续性的肾脏损害和疤痕化的重要因素.UTI诊断明确后最常应用的影像学检查有肾脏和尿路超声检查、排泄性膀胱尿道造影和核素肾静态显像(DMSA),其中DMSA为目前公认的诊断肾瘢痕的金标准.尽管对在不同年龄、性别和临床表现的患儿中如何正确选择相关的影像学检查有较大的争议,但多数推荐对所有2岁以下的儿童进行超声、VCUG和DMSA检查.研究还显示VUR有其一定的遗传基础,在同胞中的发病率显著高于健康儿童.随时间推移发育逐渐成熟,有部分反流可自行痊愈,大都不需要手术治疗.大多数VUR的病例,尤其是5岁以下的儿童建议使用低剂量持续性抗生素预防治疗.反流性肾病长期的并发症是发生终末期慢性肾功能衰竭.  相似文献   

5.
目的对可疑膀胱输尿管反流(vesicouretericreflux,VUR)患儿进行排尿性膀胱尿道超声造影检查(contrast—enhancedvoidingurosonography,VUS)和排尿性膀胱尿道造影检查(voidingcystoure.thrography,VCUG),对其结果进行分析,探讨超声造影对膀胱输尿管反流的诊断价值。方法将2010年7月至2011年12月本院泌尿外科收治的可疑VUR患儿54例作为研究对象,包括反复尿路感染6例,可疑后尿道瓣膜12例,单侧或双侧。肾积水并输尿管扩张36例,对比脉冲序列超声造影技术对患儿进行超声造影检查,经膀胱注入SonoVue造影剂后,实时观察造影剂微泡在反流病例尿路中的流动过程,分析评价反流程度,用五级法分析评价,并与VUCG对照。结果(1)54例患儿(108个。肾输尿管单位)中,VUS检出VUR48个肾输尿管单位,VCUG检出45个肾输尿管单位,VUS诊断VUR的敏感性为91.1%,特异性为88.9%,阳性预测值85.4%,阴性预测值93.3%,VUS和VCUG对VUR的检查有较好的一致性(Kappa值=0.792)。(2)在16例患儿中,VUS诊断VUR的分级高于VCUG1~2级。(3)在5例(6个肾输尿管单位)中,VUS可显示出肾内反流微泡,提示对肾功能造成极大影响的肾内反流的存在。相比,VCUG只能检出V级反流,无法显示肾内反流。结论VUS是一种准确可靠的检查手段,对VUR检测的敏感性及特异性均较高,在VUR检出率及分级上优于VCUG。同时无放射性,重复性好,可作为VUR的筛查或追踪观察的首选方法之一。  相似文献   

6.
目的探讨输尿管膀胱反流(VUR)的临床特征。方法回顾分析2012年1月至2017年12月期间因发热性尿路感染住院治疗并经排泄性尿路造影(MCU)确诊VUR的患儿的临床资料。结果 90例患儿中男41例、女49例,中位年龄0.90岁;双侧反流46例,其中神经源性膀胱4例。51例1岁以下患儿中,男性28例、女性23例;10例5岁以上患儿中,仅1例男性患儿。6例手术治疗,其余84例内科保守治疗,其中随访到48例。随访患儿中,15例尿路感染复发,5例因肾瘢痕、患侧肾小球滤过率下降转为手术治疗;25例于一年后复查MCU,1例反流级别加重、12例无变化、5例减轻、7例消失。8例患儿首次肾静态显像(DMSA)发现肾脏缩小、肾瘢痕形成,36例患儿半年后复查DMSA发现10例出现肾瘢痕。结论婴儿期发热性尿路感染患儿,尤其是男孩应注意是否存在VUR。DMSA、MCU等检查不能相互取代。双侧VUR患儿应排除神经源性膀胱及合并其他畸形。  相似文献   

7.
儿童膀胱输尿管反流的转归预后探讨   总被引:4,自引:0,他引:4  
Wu XC  Yi ZW  Tse KC  Liu CZ  Lai WM  Zhao MH 《中华儿科杂志》2003,41(11):854-855
膀胱输尿管反流 (vesicouretericreflux ,VUR)是指排尿时尿液从膀胱反流至输尿管和肾盂 ,是婴幼儿反复泌尿道感染的常见原因。部分VUR患儿可自行缓解 ,但是 ,也有部分VUR患儿可引起反流性肾病 (refluxnephropathy ,RN) ,表现为肾脏瘢痕形成、肾生长迟缓、肾功能不全。VUR患儿因反复泌尿道感染常常导致肾功能受损 ,估计 15岁以下儿童每年有 0 3~ 0 4人 / 10 0万人口因RN导致肾衰竭 ,每年有 5~ 10名女孩 / 10 0万人口因RN而进入终末期肾病[1] ,但也有研究认为无症状VURⅠ度及Ⅱ度可能为一生理现象[2 ] 。所以 ,很有必要进一步研…  相似文献   

8.
Ji LN  Cao L  Chen DK  Cui YC  Zhang YL  Ye H  Hao CS  Yuan XY 《中华儿科杂志》2011,49(4):282-286
目的 对膀胱输尿管反流(VUR)高危患儿的临床表现和排泄性膀胱尿道造影(VCUG)检查结果 进行分析,同时探讨应用无辐射的排泄性尿道超声检查(VUS)对VUR的诊断意义.方法 以2007年7月-2010年4月于首都儿科研究所住院的VUR高危患儿93例为研究对象,包括首次或反复尿路感染58例、无尿路感染但胎儿期或生后B超发现肾积水者35例,所有患儿均行VCUG检查,22例患儿同时接受VUS检查,反流分级采用五级法进行评价.结果 (1)58例尿路感染患儿中发现VUR 20例,检出率为34.5%.反复尿路感染患儿中VUR的检出率明显高于首次尿路感染患儿中VUR的检出率.VUR分布为:≤1岁13例,其中男10例,双侧反流6例,Ⅳ+Ⅴ级反流占57.9%;1~5岁4例,其中男2例,双侧反流1例,Ⅳ+Ⅴ级反流占40.0%;≥5岁3例,其中男1例,双侧反流1例,全部为Ⅲ级以下反流.35例无尿路感染的肾积水患儿中发现VUR 6例,检出率为17.1%.(2)22例患儿同时行VCUG和VUS两种检查,与VCUG相比,VUS诊断VUR的敏感度为100%,特异度为92.1%,阳性预测值66.7%,阴性预测值100%,VUS和VCUG的检出一致性为93.2%.结论 对儿童尤其是低年龄组男童的尿路感染、以及胎儿期或生后B超发现有肾积水的患儿应重视VUR的早期筛查.VUS是一种准确可靠的检查手段,且避免放射暴露,可作为儿童VUR的筛查或追踪观察的方法 之一.
Abstract:
Objective To analyze the clinical data and result of voiding cystourethrography (VCUG)in high-risk children with vesicoureteral reflux(VUR)for better awareness of VUR,and to assess the usefulness of non-radioactive voiding ultrasonography(VUS) in the diagnosis of VUR. Method Ninety-three high-risk children with VUR who were hospitalized from July 2007 to April 2010 were studied.The study included 58 cases of urinary tract infection(UTI)and 35 cases of fetal or postnatal hydronephrosis detected on a B ultrasound scan.The results of urinalysis,urine culture,renal function,B ultrasound and VCUG were evaluated.Part of patients underwent VUS followed by VCUG immediately.Result (1)Sixtytwo boys and 31 girls(aged 1 month to 11.5 years,mean age 2 years)were included.VUR was detected in 26 patients(28%)by VCUG.In terms of kidney-ureter units,VUR was detected in 36 of 186 kidney-ureter units,including 6 grade Ⅰ ,3 grade Ⅱ ,6 grade Ⅲ,15 grade Ⅳ and 6 grade Ⅴ.(2)VUR was detected in 20 of 58 UTI patients(34.5%)by VCUG.The proportion of VUR in recurrent UTI group was 61.1%,much higher than that in first UTI group(22.5%).Thirteen of 20 VUR(65%)occurred in UTI patients under 1 year of age(M/F 10/3),with more bilateral VUR and severe grades of VUR than the older group.VUR was detected in 6 of 35 fetal or postnatal hydronephrosis patients(17.1%)by VCUG.(3)Twentytwo patients underwent both VUS and VCUG.VUR was detected in 4 patients and 6 kidney-ureter units by VCUG,while in 6 patients and 9 kidney-ureter units by VUS.Taking VCUG as the reference standard,VUS  相似文献   

9.
儿童泌尿道感染影像学检查进展   总被引:1,自引:0,他引:1  
泌尿道感染 (UTI)为儿科常见病 ,据报道 11岁以下儿童发病率达 1%~ 3%。其中以急性肾盂肾炎 (APN )最受临床重视 ,反复肾实质感染所致的瘢痕形成远期会导致儿童高血压、蛋白尿及肾功能衰竭等严重后果 ,而且临床及实验室评价肾感染又常不可靠 ;此外 ,已知膀胱输尿管返流(VUR)是诱发UTI和UTI复发的主要危险因素。因此 ,对UTI患儿了解肾损害及检测有否VUR最为重要 ,而影像学检查对此有重要价值。现就儿童泌尿道感染影像学检查进展做一综述。1 肾实质损害评价———APN及肾瘢痕的检测APN患儿 ,尤其婴幼儿临床症状及体征缺乏特异性 …  相似文献   

10.
目的 评价腹腔镜Lich-Gregoir手术治疗儿童双侧原发性膀胱输尿管反流治疗效果.方法 对2007年9月至2009年9月4例腹腔镜Lich-Gregoir手术治疗双侧原发性膀胱输尿管反流患儿的临床资料进行回顾性分析.结果 4例患儿,均因反复尿路感染收治.平均年龄6.5岁(5~8岁).男1例,女3例,排尿行膀胱尿道造影(VCUG)均提示双侧VUR,其中Ⅴ级2侧,Ⅳ级3侧,Ⅲ级3侧.二巯丁二酸(DMSA)肾图均证实存在一侧或双侧肾瘢痕.所有病例均经腹腔路径成功于膀胱外完成腹腔镜Lich-Gregoir手术.平均手术时间为200min(140~300min),术中无明显出血,术后平均住院时间6 d(5~7 d).平均随访18.5个月(6~30个月),所有患儿术后6个月VCUG复查证实膀胱输尿管反流均完全消失,无发热性尿路感染及新的肾瘢痕形成.1例患儿术后出现短期尿潴留,留置导尿1周后症状消失.结论 我们的初步经验显示腹腔镜Lich-Gregoir手术安全、有效、创伤小、术后恢复快,有望成为治疗儿童原发性膀胱输尿管反流,尤其是双侧病变较理想的治疗方法.  相似文献   

11.
There is a common progression known as the allergic march from atopic dermatitis to allergic asthma. Cetirizine has several antiallergic properties that suggest a potential effect on the development of airway inflammation and asthma in infants with atopic dermatitis. Methods. Over a two year period, 817 infants aged one to two years who suffered from atopic dermatitis and with a history of atopic disease in a parent or sibling were included in the ETAC® (Early Treatment of the Atopic Child) trial, a multi-country, double-blind, randomised, placebo-controlled trial. The infants were treated for 18 months with either cetirizine (0.25mg/ kg b.i.d.) or placebo. The number of infants who developed asthma was compared between the two groups. Clinical and biological assessments including analysis of total and specific IgE antibodies were performed. Results. In the placebo group, the relative risk (RR) for developing asthma was elevated in patients with a raised level of total IgE (≥ 30 kU/I) or specific IgE (≥ 0.35 kUA/I) for grass pollen, house dust mite or cat dander (RR between 1.4 and 1.7). Compared to placebo, cetirizine significantly reduced the incidence of asthma for patients sensitised to grass pollen (RR = 0.5) or to house dust mite (RR = 0.6). However, in the population that included all infants with normal and elevated total or specific IgE (intention-to-treat - ITT), there was no difference between the numbers of infants developing asthma while receiving cetirizine or placebo. The adverse events profile was similar in the two treatment groups. Discussion. Raised total IgE level and raised specific IgE levels to grass pollen, house dust mite or cat dander were predictive of subsequent asthma. Cetirizine halved the number of patients developing asthma in the subgroups sensitised to grass pollen or house dust mite (i.e. 20% of the study population). In view of the proven safety of the drug, we propose this treatment as a primary pharmacological intervention strategy to prevent the development of asthma in specifically sensitised infants with atopic dermatitis.  相似文献   

12.
孤独症谱系障碍(autistic-spectrum disorders,ASDs)近年来患病率逐年攀升至1%左右,其症状往往伴随终生,成为严重威胁儿童健康和发展的神经发育性疾患;注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童期最常见的精神障碍,国内报道患病率为4.13%~5.83%,其症状可延续至青少年期,甚至到成年期[1]。这两类精神障碍在成年期的临床表现、共患病、治疗策略和预后与儿童期有哪些不同呢?本文通过回顾相  相似文献   

13.
During the past several decades, our understanding of the complex pathophysiology of vasoocclusion associated with sickle cell disease has improved greatly. Interaction of genes, hemoglobin molecules, red cell membrane and metabolic changes, cell-cell interactions and cell-plasma interactions, red cell adhesion to vascular endothelium, activation of coagulation, and vascular reactivity play a role in vaso occlusion. Penicillin prophylaxis of pneumococcal infections and appropriate use of blood transfusions and other supportive measures improved survival of sickle cell patients. Hydroxyurea made a major impact on sickle cell therapy when it was shown to decrease acute painful episodes, acute chest syndrome, and the need for blood transfusion in adults. Significant experience in the use of hydroxyurea has been accumulated in older children. The benefits and risks of hydroxyurea for younger children and long-term risks in all patients will be evaluated in future investigations. Other promising therapies include butyrate compounds, clotrimazole, magnesium supplementation, poloxamer 188, antiadhesion agents, anticoagulant approaches, and nitric oxide. Hemopoietic transplantation remains the only curative therapy. However, several transgenic mouse models are available for studies of gene therapy or other treatment approaches on biochemical, cellular, and pathologic effects of mutant genes.  相似文献   

14.
A 21-year-old man with granular lymphocyte-proliferative disorders (GLPD) associated with chronic active Epstein-Barr virus (EBV) infection is described. Chromosomal analyses revealed several clonal abnormalities and two of them were mainly repetitious. High copy numbers of monoclonal EBV genome were also detected in the proliferative large granular lymphocytes (LGLs), indicating the monoclonal expansion of EBV-infected LGLs. The patient had an indolent course for several years, and there was no evidence of infiltrations of his bone marrow until the end stage. At autopsy, microscopic studies revealed marked infiltrations of LGL in the liver and spleen, and the infiltrating cells were NK-cell immunophenotype. The infiltrated LGLs showed latency I.  相似文献   

15.
Human male sexual development is regulated by chorionic gonadotropin (CG) and luteinizing hormone (LH). Aberrant sexual development caused by both activating and inactivating mutations of the human luteinizing hormone receptor (LHR) have been described. All known activating mutations of the LHR are missense mutations caused by single base substitution. The most common activating mutation is the replacement of Asp-578 by Gly due to the substitution of A by G at nucleotide position 1733. All activating mutations are present in exon 11 which encodes the transmembrane domain of the receptor. Constitutive activity of the LHR causes LH releasing hormone-independent precocious puberty in boys and the autosomal dominant disorder familial male-limited precocious puberty (FMPP). Both germline and somatic activating mutations of the LHR have been found in patients with testicular tumors. Activating mutations have no effect on females. The molecular genetics of the inactivating mutations of the LHR are more variable and include single base substitution, partial gene deletion, and insertion. These mutations are not localized and are present in both the extracellular and transmembrane domain of the receptor. Inactivation of the LHR gives rise to the autosomal recessive disorder Leydig cell hypoplasia (LCH) and male hypogonadism or male pseudohermaphroditism. Severity of the clinical phenotype in LCH patients correlates with the amount of residual activity of the mutated receptor. Females are less affected by inactivating mutation of the LHR. Symptoms caused by homozygous inactivating mutation of the LHR include polycystic ovaries and primary amenorrhea.  相似文献   

16.
17.
OBJECTIVE: To ascertain the profile of cases of measles seen at a general hospital during a recent outbreak that occurred despite a measles vaccination program. METHODOLOGY: A retrospective study from January 1991 to March 1998. All patients with measles (ICD code 055. 9) seen at the emergency unit or as inpatients were included. RESULTS: There were 87 cases identified. The diagnosis was clinical in all and proven serologically in 71%. Eighty-five per cent of the cases occurred between January 1997 and March 1998. There was a bi-modal age distribution with peaks in the very young (相似文献   

18.
The aim of the study was to explore psychological factors and autonomic activity in children with recurrent abdominal pain and to compare them with those in a control group of healthy children. The Personality Inventory for Children was used for assessment of developmental, emotional and psychosocial factors in 25 children with recurrent abdominal pain (age, 7-15 y). Parasympathetic and sympathetic functions in these children and in 23 healthy control subjects (age, 7-13 y) were also investigated, non-invasively using a computerized polygraph. Vagal tone (parasympathetic function) was indexed by calculation of respiratory sinus arrhythmia in beats/min. Skin conductance (sympathetic function) was recorded by the constant current method. On the Personality Inventory for Children, 16 patients had high scores on somatic concern. Several patients had scores in the clinical range for depression, withdrawal and anxiety, but the mean scores for these personality profile scales were well within the normal range of healthy children. Interestingly, there was a spike on the L (Lie)-scale for most of the patients and 15 patients had scores above or close to the clinical cut-off value. As compared with the scores in healthy children, vagal tone and sympathetic tone were normal. Conclusion: Many children with recurrent abdominal pain have scores in the clinical range for depression, withdrawal, anxiety and L-scale indicating coping problems, denial and a trend towards somatic concern that may contribute to the evolution of abdominal pain. Autonomic nerve activity was not disturbed in these children.  相似文献   

19.
Inhibition of the function of pulmonary surfactant in the alveolar space is an important element of the pathophysiology of many lung diseases, including meconium aspiration syndrome, pneumonia and acute respiratory distress syndrome. The known mechanisms by which surfactant dysfunction occurs are (a) competitive inhibition of phospholipid entry into the surface monolayer (e.g. by plasma proteins), and (b) infiltration and destabilization of the surface film by extraneous lipids (e.g. meconium-derived free fatty acids). Recent data suggest that addition of non-ionic polymers such as dextran and polyethylene glycol to surfactant mixtures may significantly improve resistance to inhibition. Polymers have been found to neutralize the effects of several different inhibitors, and can produce near-complete restoration of surfactant function. The anti-inhibitory properties of polymers, and their possible role as an adjunct to surfactant therapy, deserve further exploration.  相似文献   

20.
The World Health organisation recommends breast feeding infants for the first six months of life. When this breast feeding does not occur either through parental choice or medical need, infant formulas will be required. There is a bewildering array of formulas on the UK market for many different requirements. When faced with an unsettled infant many parents (and healthcare professionals) will experiment with the infant formula available and then attend the paediatric clinic looking for help and advice. It is therefore essential that paediatricians understand what milks are available and what the key differences between different products are. This review attempts to provide a simple guide through many of the formulations currently available in the UK; and offers advice for the dietary management of the child with extra calorie requirements, infants with cow's milk protein allergy, gastro oesophageal reflux disease, apparent unresolved hunger and infantile colic. Whatever the underlying condition, there is likely to be an infant formula that is suitable in this generation of ever expanding formulations.  相似文献   

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