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1.
目的:观察青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者上、下端椎及顶椎凸、凹侧下关节突软骨组织学分级和软骨细胞的增殖与凋亡,探讨其软骨内成骨性生长在侧凸进展中的作用。方法:16例AIS患者,平均年龄13.5岁。取上、下端椎和顶椎凸、凹侧下关节突进行组织学观察及免疫组织化学测定其软骨细胞的增殖指数(proliferation cell nuclear antigen,PCNA)和凋亡指数(Poly ADP-ribose pdymerase,PARP)。采用PCN/PARP比值及组织学分级作为软骨内成骨活跃程度的指标,并对其进行比较。结果:AIS患者上、下端椎和顶椎凸、凹侧下关节突软骨组织学分级、软骨细胞的增殖指数(PCNA)、凋亡指数(PARP)和PCNA/PARP比值的比较均没有统计学差异(P〉0.05)。结论:AIS患者上、下端椎和顶椎凸、凹侧下关节突软骨内成骨活跃程度没有差异,关节突软骨内成骨性生长发育可能对脊柱侧凸进展没有明显的作用。  相似文献   

2.
Zhu F  Qiu Y  Meng K  Cheng JC 《中华外科杂志》2004,42(20):1221-1224
目的 通过对青少年特发性脊柱侧凸 (adolescentidiopathicscoliosis ,简称AIS)脊柱前后柱次发性生长骨骺的增殖和凋亡研究 ,发现AIS患者青春期脊柱前后柱生长活跃度的差异。方法AIS组患者 17例 (男性 4例 ,女性 13例 ) ,平均年龄 13 6岁 (10~ 17岁 ) ,均有累及胸段的脊柱侧弯 ,术前Cobb角 6 5°~ 115°,平均 89 3° ,Risser分级 0~ 3。取材部位为顶椎区终板软骨和棘突次发性生长骨骺。HE染色 ,光镜下观察生长板软骨细胞层结构变化。免疫组化增殖采用细胞增殖核抗原 (PCNA)指数 ,凋亡采用原位末端标记法 (TUNEL)指数 ,采用PCAN/TUNEL作为生长活跃度的指标。结果 AIS前柱 (终板软骨 )细胞增殖活跃 ,增生骨巢密集且厚度较大 ;后柱软骨增生程度一般 ,增殖层内骨巢散在分布呈团状 ,骨巢厚度较前柱低。前后柱骨骺软骨静止区、增殖区以及肥大区均有PCNA和TUNEL阳性细胞 ,PCNA指数前后柱大于后柱 (P <0 0 5 ) ,PCNA/TUNEL指数前柱大于后柱 (P <0 0 1)。静止层未见显著差异 (P >0 0 5 )。结论 特发性脊柱侧凸患者青春期脊柱前后柱软骨细胞生长活性存在明显差异  相似文献   

3.
目的:观察青少年特发性脊柱侧凸(adolescent idiopathic scoliosis;AIS)患者终板软骨的组织学形态;探讨其与AIS发生、发展的关系.方法:20例AIS患者;前路手术时分别获取20份顶椎及18份下端椎终板软骨;每份均包含凸侧与凹侧.切片行HE染色;光镜下观察终板软骨组织形态;采用病理图像分析系统测量终板软骨肥大区的厚度、细胞巢面积、巢内细胞数及增殖区细胞数(个/视野).参照Enileking法设定曲度因子(factor of curve;FC);将顶椎标本分为FC≤6组(11例)和FC>6组(9例).比较上述指标在不同部位、不同FC分组下的差异.结果:顶椎凸侧的上述指标均显著高于凹侧(P<0.05);下端椎仅凸侧肥大区细胞巢平均面积显著大于凹侧(P<0.05);顶椎与下端椎间同侧比较;仅下端椎凹侧肥大区的细胞数显著大于顶椎(P<0.05).FC>6组的顶椎凸侧和凹侧终板软骨肥大区的巢内细胞数显著小于FC≤6组(P<0.05);FC>6组的凸侧增殖区细胞数也显著小于FC≤6组(P<0.05).结论:AIS患者终板软骨的组织学变化特征更倾向于与脊柱不同部位、不同状态下机械应力差异有关的继发性改变;但组织学变化与机械应力变化之间不完全平行;AIS的发生、发展可能伴有生物力学以外的因素.  相似文献   

4.
[目的]探讨AIS患者椎体生长板凸、凹侧组织学及软骨细胞增殖与凋亡差异在AIS发生、发展中目的作用.[方法]本研究中取AIS患者椎体生长板,应用HE染色评估生长板凸、凹侧目的组织学分级差异,应用免疫组织化学方法及TUNEL方法评估生长板凸、凹侧软骨细胞增殖与凋亡指数,并对其进行比较.[结果]光镜下椎体生长板凸侧可见正常分层结构,生长板凹侧分层结构排列混乱.顶椎椎体牛长凸、凹侧组织学分级差异有统计学意义(<0.05).终椎凹侧生长板和顶椎凹侧生长板组织学分级有明显差异且有统计学意义(P<0.05).顶椎生长板凸侧软骨细胞增殖指数和凋亡指数明显高于凹侧,其差异有统计学意义(P<0.05).在上终椎椎体牛长板凸、凹侧软骨细胞PCNA增殖指数有明显差异且有统计学意义(P<0.05).上、下终椎椎体生长板和顶椎椎体生长板凹侧软骨细胞增殖和凋亡指数有差异且统计学意义(P<0.05).在上、下终椎和顶椎椎体生长板凸侧软骨细胞TUNEL凋亡指数有差异且有统计学意义(P<0.05).[结论]AIS患者上、下终椎和顶椎椎体生长板凸、凹侧组织学分级目的差异和软骨细胞目的增殖与凋亡指数差异可能表明椎体生长板凸、凹侧存在生长动力学差异,这可能影响侧凸[目的]进展.  相似文献   

5.
【摘要】 目的:检测褪黑素对青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者软骨细胞增殖的影响,并探讨其与AIS病因学的关系。方法:选取2009年1月~2010年12月在我院手术治疗的15例AIS患者(AIS组)和6例非脊柱侧凸患者(对照组)的软骨组织(髂软骨或棘突软骨)行软骨细胞培养。取P2代细胞分别用浓度为0M、10-11M、10-9M、10-7M、10-5M褪黑素连续刺激3d。加入Brdu 12h后用ELLSA法标记,显色后在酶标仪450nm波长下检测光密度(optical density,OD)值以评估软骨细胞的增殖情况。结果:不同浓度(10-11M、10-9M、10-7M、10-5M)褪黑素刺激以后,对照组软骨细胞的OD值分别增加了(5.7±6.7)%、(32.1±11.1)%、(57.5±11.9)%、(103.2±16.2)%(P<0.05)。AIS组软骨细胞的OD值相分别增加了(-0.3±22.3)%、(5.8±29.9)%、(12.7±36.1)%、(10.2±44.0)%(P>0.05)。结论:褪黑素可以有效促进正常软骨细胞增殖,但是却无法有效促进AIS患者软骨细胞的增殖,说明AIS患者中褪黑素信号通路调节软骨内成骨的过程可能存在异常。  相似文献   

6.
目的:检测转录因子Sox9在青少年特发性脊柱侧凸(AIS)患者软骨细胞中的表达,探讨其在AIS患者生长发育异常中的可能作用.方法:14例(男1例,女13例)年龄10~16岁(平均13.1岁)的AIS患者(AIS组),Cobb角41°~88°,平均51.4°;8例(男1例,女7例)非AIS患者(对照组),年龄10~15岁,平均12.9岁;腰椎骨折1例,脊髓室管膜瘤1例,腰椎间盘突出症1例,脊柱骨样骨瘤1例,先天性髋关节脱位4例.在行手术治疗时获取髂骨生长板软骨,采用酶消化法体外分离、培养、传代,并观察细胞形态;采用Ⅱ型胶原细胞免疫组织化学法对传至P2代的细胞行表型鉴定;采用逆转录-聚合酶链反应(RT-PCR)、蛋白免疫印迹(Western blotting)法检测两组软骨细胞中Sox9 mRNA及蛋白表达情况.结果:酶消化法体外单层培养软骨细胞成功;细胞传至P2代时具有软骨细胞的典型形态特征,呈多角状;Ⅱ型胶原细胞免疫组化染色呈阳性,细胞胞浆内可见棕褐色颗粒,很好地保持了软骨细胞的表型特征;AIS组患者软骨细胞中Sox9核酸表达强度为1.08±0.14,蛋白表达强度为0.38±0.14,均较对照组高(P<0.05).结论:转录因子SOx9在软骨细胞水平表达强度的异常可能与AIS患者生长发育异常有关.  相似文献   

7.
目的:观察青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者软骨细胞中褪黑素受体含量的变化,并探讨其与AIS病因学的关系.方法:随机选取2007年1月~2007年12月在我院手术治疗的22例AIS患者及8例非脊柱侧凸(肿瘤、外伤等)患者(对照组).AIS组患者年龄10~16岁,平均12.7岁,平均Cobb角60.1°,其中10例在术中取髂软骨,12例取棘突软骨.对照组患者年龄10~15岁,平均12.9岁,其中7例在术中取髂软骨,1例取棘突软骨.对髂软骨和棘突软骨标本进行细胞培养至二代,取二代细胞用Ⅱ型胶原免疫组化染色方法进行软骨细胞表型鉴定,并抽提总RNA,采用逆转录聚合酶链反应(RT-PCR)检测软骨细胞中褪黑素受体两种亚型MTNR1A、MTNR1B的mRNA表达量.结果:两组患者软骨细胞Ⅱ型胶原免疫组化染色均为阳性表达.AIS组软骨细胞中MTNR1A、MTNR1B mRNA的相对表达量分别为0.44±0.29和0.54±0.31,对照组分别为0.69±0.18和0.83±0.30,组间比较均有显著性差异(P<0.05).结论:AIS患者软骨细胞中MTNR1A、MTNR1B的mRNA表达均减少,这可能与AIS的发生、发展有关.  相似文献   

8.
青少年特发性脊柱侧凸患者骨密度变化的分析   总被引:8,自引:8,他引:8  
目的 :探 讨青 少年 特 发性 脊柱 侧 凸患 者的 骨 密度 变化 规 律。方 法:应用 双 能 X 线骨 密 度吸 收仪 测 定 101例特 发 性 脊 柱侧 凸 患 者 腰椎 (L2 ̄L4)和 股 骨 近 端 (股 骨 颈 、大 转 子 、W ard's 三 角 )的 骨 密 度 ,结 合 脊 柱 侧 凸 严 重程度 进行 分 析,并 与 62名 同 年龄 段正 常 青少 年骨 密 度进 行比 较 。结 果:特发 性脊 柱 侧凸 患者 所 测各 部位 的 骨密度均 明显 低 于正 常对 照 组(P<0.05),腰 椎 骨 密 度的 降 低 比 股骨 明 显 ,股 骨 近 端 的三 个 部 位 ,以 W ard's 三 角的 骨密度 降低 尤 为显 著。有 75.2% 的 特发 性脊 柱 侧凸 患者 发生 骨 密度 降低 ,其 中 26.7% 发 生骨 量 减少 , 48.5% 符 合骨质疏 松症 的 诊断 标准 ;但 其骨 密 度的 降低 程 度与 侧凸 严 重程 度无 明 显相 关性 。 结论 :青 少年 特 发性 脊 柱 侧凸 患者存 在着 骨 密度 的降 低 ,其与 侧 凸的 严重 程 度无 关,可能 与 特发 性脊 柱 侧凸 的发 病 机理 有关 。  相似文献   

9.
青少年特发性脊柱侧凸患者的中枢神经异常   总被引:3,自引:1,他引:2  
目的 :检查青少年特发性脊柱侧凸 (AIS)患者的后脑及脊髓的结构和功能异常 ,探讨两者间的相关性及与Cobb角的关系。方法 :用MRI探查AIS患者的后脑及脊髓的解剖结构 ,用体感诱发电位 (SEP)检查体感传导通路功能 ,并对两者结果作相关性检验。结果 :MRI见小脑扁桃体脱垂或脊髓空洞和SEP显示体感传导通路功能异常病例在Cobb角 >45°患者中依次占 31%和 2 7 6 % ,而 <45°患者中分别只占 3 7%和 11 9% ,结构异常和功能异常有显著相关性。结论 :对严重脊柱侧凸或合并SEP异常患者应常规行全脊髓MRI检查 ,以便及早发现后脑及脊髓病变  相似文献   

10.
青少年特发性脊柱侧凸(adolescent idiopathic scol-iosis,AIS)是发生于青春发育期前后的脊柱结构性侧凸畸形,是一种最常见的脊柱侧凸畸形,  相似文献   

11.
Summary The spinal growth in scoliotic segments (T4-L4) of 110 girls with untreated idiopathic scoliosis was measured from two successive radiographs taken at a mean interval of 1.1 years. At the first visit the mean age of the patients was 14 years (range 11–16 years), the mean magnitude of the major curves 24° (range 9°–38°) and that of the minor curves 14° (range 2°–38°). Spinal growth was most rapid at the age of 11–12 years. The progression of the curves (major plus minor) correlated with the spinal growth (r=0.384). The greater the initial curves were, the stronger the correlation was between the spinal growth and the progression of the curves (r=0.046–0.639), and the correlation was more significant in thoracic scoliosis (r=0.560) than in thoracolumbar and lumbar scoliosis (r=0.152).  相似文献   

12.
The aim of this study is to quantify the changes in the sagittal alignment of the cervical spine in patients with adolescent idiopathic scoliosis following posterior spinal fusion. Patients eligible for study inclusion included those with a diagnosis of mainly thoracic adolescent idiopathic scoliosis treated by means of posterior multisegmented hook and screw instrumentation. Pre and post-operative anterior–posterior and lateral radiographs of the entire spine were reviewed to assess the changes of cervical sagittal alignment. Thirty-two patients (3 boys, 29 girls) met the inclusion criteria for the study. The average pre-operative cervical sagittal alignment (CSA) was 4.0° ± 12.3° (range −30° to 40°) of lordosis. Postoperatively, the average CSA was 1.7° ± 11.4° (range −24° to 30°). After surgery, it was less than 20° in 27 patients (84.4%) and between 20° and 40° in 5 patients (15.6%). The results of the present study suggest that even if rod precontouring is performed and postoperative thoracic sagittal alignment is restored, improved or remains unchanged after significant correction of the deformity on the frontal plane, the inherent rigidity of the cervical spine limits changes in the CSA as the cervical spine becomes rigid over time.  相似文献   

13.
目的:探讨青少年特发性脊柱侧凸(AIS)手术患者胸廓成形术后肋骨再生情况,比较男女性患者间肋骨再生差异。方法:1999年至2004年我院共行脊柱矫形内固定融合术及胸廓成形术治疗66例AIS患者,其中女性患者43例,平均年龄15.62岁,平均Cobb角58.86°;男性患者23例,平均年龄16.83岁,平均Cobb角60.87°。术后3个月、6个月、1年、2年摄全脊柱正侧位片复诊时应用Philips等提出的肋骨再生分级标准对患者肋骨再生情况进行评估。结果:术后3个月复诊60例患者,225根部分切除的肋骨中31.6%处于再生4级,52.9%处于5级;术后6个月复诊29例患者,107根部分切除的肋骨中79.4%处于再生5~6级;术后1年复诊32例患者,121根部分切除的肋骨中90.1%处于再生5~6级;术后1年内未见肋骨再生达到7级;术后2年复诊22例患者,79根部分切除的肋骨中98.7%处于再生5~7级,其中有4根肋骨(5.1%)达到7级。男女患者间肋骨再生分级未见明显差异。结论:AIS患者胸廓成形术后肋骨再生可分为2期,即肋骨形成期和塑形改建期,肋骨形成期在术后6个月基本完成,塑形改建期则持续时间较长;肋骨再生没有性别差异。  相似文献   

14.
This is a prospective study comparing the short- and long-term three-dimensional (3D) changes in shape, length and balance of the spine after spinal instrumentation and fusion in a group of adolescents with idiopathic scoliosis. The objective of the study was to evaluate the stability over time of the postoperative changes of the spine after instrumentation with multi rod, hook and screw instrumentation systems. Thirty adolescents (average age: 14.5 ± 1.6 years) undergoing surgery by a posterior approach had computerized 3D reconstructions of the spine done at an average of 3 days preoperatively (stage I), and 2 months (stage II) and 2,5 years (stage III) after surgery, using a digital multi-planar radiographic technique. Stages I, II and III were compared using various geometrical parameters of spinal length, curve severity, and orientation. Significant improvement of curve magnitude between stages I and II was documented in the frontal plane for thoracic and lumbar curves, as well as in the orientation of the plane of maximum deformity, which was significantly shifted towards the sagittal plane in thoracic curves. However, there was a significant loss of this correction between stages II and III. Slight changes were noted in apical vertebral rotation, in thoracic kyphosis and in lumbar lordosis. Spinal length and height were significantly increased at stage II, but at long-term follow-up spinal length continued to increase while spinal height remained similar. These results indicate that although a significant 3D correction can be obtained after posterior instrumentation and fusion, a significant loss of correction and an increase in spinal length occur in the years following surgery, suggesting that a crankshaft phenomenon may be an important factor altering the long-term 3D correction after posterior instrumentation of the spine for idiopathic scoliosis. Received: 3 March 1998 Revised: 22 August 1998 Accepted: 15 September 1998  相似文献   

15.
目的:研究青少年特发性脊柱侧凸(adolescent idiopathic scoliosis,AIS)患者心脏异常的发生率,探讨可能影响AIS患者心脏异常发生的相关因素.方法:2008年6月~2011年6月收治AIS患者719例,其中男113例,女606例,年龄10~18岁,平均15.1±2.2岁.术前均行心脏超声多普勒检查,统计AIS患者心脏异常的发生率.将心脏异常患者分为先天性心脏病及其他心脏异常2组,分别按性别(男组与女组)、弯型(胸弯组与腰弯/胸腰弯组)分组比较先天性心脏病发生率;分别按弯型(胸弯组与腰弯/胸腰弯组)、Cobb角(≤70°组与>70°组)及胸椎后凸角(<10°、10°~40°与>40°组)分组比较其他心脏异常的发生率.利用二分类Logistic回归分析探讨AIS患者弯型(胸弯组与腰弯/胸腰弯组)、Cobb角(连续变量)及胸椎后凸角(连续变量)是否为其他心脏异常发生的显著相关因素.结果:AIS患者心脏异常发生率为6.68%(48/719),其中先天性心脏病发生率为4.59%(33/719),包括房间隔缺损2.50%(21/719)、室间隔缺损0.56%(4/719)、动脉导管未闭0.28%(2/719)、永存左上腔静脉0.28%(2/719)、法洛四联症0.14%(1/719)、二尖瓣狭窄0.14%(1/719)、单心房单心室0.14%(1/719)及房间隔膨出瘤0.14%(1/719);其他心脏异常的发生率为2.09%(15/719),其中二尖瓣脱垂1.11%(8/719)、肺动脉高压0.97%(7/719).48例存在心脏异常的AIS患者中,36例在入院前未获知存在心脏异常,其中3例(8.33%)入院后需先行心脏干预手术(2例行房间隔缺损修补术,1例行动脉导管未闭封堵术),二期行脊柱侧凸矫正手术:12例入院前已获知有心脏异常,其中10例为先天性心脏病,均在脊柱侧凸发现前已行心脏干预手术.AIS患者先天性心脏病的发生率,按性别、弯型分组组间比较均无显著性差异(P>0.05);二尖瓣脱垂、肺动脉高压的发生率,按弯型、Cobb角以及胸椎后凸角分组组间比较均无显著性差异(P>0.05).二分类Logistic回归分析显示,二尖瓣脱垂及肺动脉高压的发生与弯型、Cobb角及胸椎后凸角无显著相关性(P>0.05).结论:AIS患者有较高的心脏异常发生率,部分心脏异常可能严重影响脊柱手术安全性,需要在脊柱矫形术前先行心脏干预手术.AIS患者脊柱矫形术前应常规行心脏超声多普勒检查以评估心脏情况.  相似文献   

16.
This is a prospective observational study comparing cases with retrospective controls. The aim of the study is to compare rib regeneration with a scaffold placed intra-periosteally against no scaffold, after costectomy in adolescent idiopathic scoliosis. A prospective study was conducted at Amrita Institute of Medical Sciences on 16 consecutive patients (51 ribs) with adolescent idiopathic scoliosis who underwent costectomy and application of gel foam in the rib bed as a scaffold. These patients were compared with a retrospective group of 15 patients (33 ribs) who did not have the scaffold. All prospective and retrospective patients were followed up for a minimum period of 6 months and were analyzed radiographically for rib regeneration and morphology. A classification system was devised to include all possible morphologies of regenerate. The resulting data, when analyzed showed that majority of ribs re-grew to normal morphology in 3–6 months in the trial group. In comparison the regeneration in the retrospective controls was slower and poorer in quality. Ribs treated by placement of gel foam scaffold in the bed regenerate to a near normal radiological profile within 6 months of costectomy compared to a slower regeneration in those without gel foam scaffold.  相似文献   

17.
目的:探讨青少年特发性脊柱侧凸(AIS)患者后路矫形术后远端交界区(LIV+2)在冠状面、矢状面和轴位上的变化。方法:2005年6月~2007年6月手术治疗AIS患者32例,男6例,女26例,年龄10~19岁,平均14.4岁。按PUMC分型,Ⅰc1例,Ⅱa4例,Ⅱb19例,Ⅱb21例,Ⅱc11例,Ⅱc35例,Ⅱd15例,Ⅲa5例,Ⅲb1例。均采用后路全节段椎弓根螺钉系统矫形固定,其中远端融合椎(LIV)与稳定椎(SV)为同一椎体(A组)15例,LIV与SV非同一椎体(B组)17例。术前和末次随访时摄站立位全脊柱正侧位X线片,测量冠状面上躯干偏移(TS),LIV的倾斜度(LIVT),LIV尾侧椎间盘开角(LIVA),冠状面和矢状面上远端交界区的Cobb角和椎体的旋转度(LIV+1VR和LIV+2VR)。结果:随访24~36个月,平均29个月。两组末次随访时的TS与术前比较均无显著性差异(P0.05)。A组LIVT由术前20.2°±5.9°下降到末次随访时的4.7°±3.8°(P0.001),B组由17.2°±5.5°下降到4.4°±2.7°(P0.001);A组术前和末次随访时LIVA分别为7.5°±4.7°和3.9°±3.1°(P=0.056);B组分别为4.5°±3.4°和5.4°±3.2°(P=0.492);Pearson′s相关分析显示两组远端融合椎倾斜度变化和其尾侧椎间盘开角变化之间相关性不显著(A组r=-0.067,P=0.813;B组r=0.362,P=0.154)。A组远端交界区(LIV+2)冠状面上Cobb角由术前20.5°±9.6°矫正至末次随访时9.4°±7.3°(P0.001);B组由13.8°±6.7°矫正至8.1°±4.7°(P=0.013);A、B组末次随访时远端交界区矢状面上Cobb角与术前比较均无显著性差异(分别为P=0.464,P=0.598);Pearson′s相关分析显示A组末次随访时矢状面Cobb角和术前矢状面Cobb角之间相关性不显著(r=0.076,P=0.788),B组的相关性显著(r=0.803,P0.001)。两组末次随访时LIV+1VR和LIV+2VR与术前比较均无显著性差异(P0.05)。结论:AIS患者应用后路全节段椎弓根螺钉系统矫正后远端交界区在冠状面上矫形明显,矢状面和轴位上矫形不明显,且远端融合椎倾斜度减小。  相似文献   

18.
Height of girls with adolescent idiopathic scoliosis   总被引:13,自引:0,他引:13  
In a Finnish population, the standing height of 1500 consecutive female patients aged 9-24 years (mean 13.9 years) with untreated idiopathic scoliosis of at least 10 degrees in their lateral curves was compared with the standing height of average girls. The mean magnitude of the major curves was 29.4 degrees (range 10 degrees-80 degrees), and that of the minor curves 20.3 degrees (range 0 degrees-66 degrees). A formula for the height loss caused by the lateral curves, and that caused by thoracic kyphosis, was derived. The corrected height of the girls with idiopathic scoliosis was highly significantly (P<0.001) greater than the height of average girls at the age of 11-15, and this high level of significance was present at the age of 11-13, even without correcting for the height loss caused by scoliosis. After maturation, the girls with idiopathic scoliosis were not significantly taller than average girls. On average, the magnitude of thoracic kyphosis did not affect the height of patients with scoliosis as compared with the height of normal girls of the same age.  相似文献   

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