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Artificial Disc Replacement Surgery in India. Surgical procedure ,Recovery

Lumbar disc replacement surgery

A lumbar disc replacement is a type of back or spine surgery. The spine is made up of bones called vertebrae that are stacked on top of each other. Discs between the vertebrae act like cushions to allow the vertebrae to rotate and move without the bones rubbing against each other. The lumbar vertebrae and discs are at the bottom of the spine. Lumbar disc replacement involves replacing a worn or degenerated disc in the lower part of the spine with an artificial disc made of metal or a combination of metal and plastic. The goal of the procedure is to relieve back pain while maintaining more normal motion than is allowed with some other procedures, such as spinal fusion.

Lumbar fusion and artificial disc replacement

It is estimated that 70% to 80% of people will experience low back pain at some point in their lives, however most will not need surgery to improve their pain. Surgery is considered when low back pain does not improve with conservative treatment.

Lumbar fusion and artificial disc replacement

For patients who have exhausted nonsurgical options and are still in pain, lumbar fusion surgery remains the most common option for treating low back pain. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.

While many patients are helped by lumbar fusion, the results of the surgery can vary. In addition, some patients whose fusion surgeries heal perfectly still end up with no improvement of their back pain. Artificial disc replacement has emerged as an alternative treatment for low back pain with the aim to preserve normal motion unlike spinal fusion which prevents normal motion in the spine.

Indications of lumbar disc replacement surgery

In general, lumbar disk replacement surgery might be recommended if:

  • the back pain mostly comes from only 1 or 2 disks in the lower spine
  • there is no significant joint disease or compression on the nerves of the spine
  • body size is not excessively overweight
  • there has been no prior major surgery on the lumbar spine
  • there is no deformity of the spine (scoliosis)

Risk associated with lumbar disc replacement

Like all surgeries, lumbar disc replacement poses some risks. A disc replacement requires greater access to the spine than standard lumber fusion surgery. This also makes it a riskier procedure. Some of the potential risks of this surgery include:

  • ·        Infection of the artificial disk or the area around it
  • ·        Dislocation or dislodging of the artificial disc
  • ·        Implant failure or fracture (break)
  • ·        Implant loosening or wear
  • ·        Narrowing of the spine (stenosis) because of the breakdown of spinal bones
  • ·        Problems due to a poorly positioned implant
  • ·        Stiffness or rigidity of the spine
  • ·        Blood clots in the legs due to decreased activity

 

Surgical procedure

Generally artificial disk replacement surgeries take from 2 to 3 hours.

An incision will be made in the abdomen to approach the lower back. With this approach, the organs and blood vessels must be moved to the side. This allows access to the spine without moving the nerves.

The damaged disc will then be removed and the new artificial disc implant will be inserted into the disc space. The organs and blood vessels are put back in place and the incision will be closed.

Recovery

In most cases, the patient will stay in the hospital for 3 to 4 days following artificial disc replacement. The length of hospital stay will depends upon how well-controlled the pain is and return to function.

Patients are encouraged to stand and walk by the first day after surgery. Because bone healing is not required following artificial disc replacement, the typical patient is encouraged to move through the mid-section. Early motion in the trunk area may lead to quicker rehabilitation and recovery.

Patient is allowed to perform basic exercises, including routine walking and stretching, during the first several weeks after surgery. During this time, it is important to avoid any activities that cause hyperextension of the back.

Cost of surgery

The cost for lumbar artificial disc replacement is approx. USD 7500 with 4-5 days hospital stay. There are certain factors that determines the cost of treatment which include:

  •       Overall health of the patient
  •       Diagnosis, type of surgery, extent of the surgery, medications used
  •       Technology or approach used
  •       Expertise of the specialist
  •       Accreditation, brand value of the hospital

 

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Brain Tumor – Symptoms, Risk Factors, Diagnosis, Treatment Options

A brain tumor is a mass or growth of abnormal cells in the brain. Many different types of brain tumors exist. Some brain tumors are noncancerous (benign), and some brain tumors are cancerous (malignant).

What’s the Difference Between Benign and Malignant Brain Tumors?

A primary brain tumor is one that originates in the brain, and most primary brain tumors are benign. Benign brain tumors are noncancerous.

Malignant primary brain tumors are cancers that originate in the brain, typically grow faster than benign tumors, and aggressively invade surrounding tissue. Although brain cancer rarely spreads to other organs, it can spread to other parts of the brain and central nervous system.

Symptoms Of Brain Tumors

The signs and symptoms of a brain tumor vary greatly and depend on the brain tumor’s size, location and rate of growth.

General signs and symptoms caused by brain tumors may include:

  • New onset or change in pattern of headaches
  • Headaches that gradually become more frequent and more severe
  • Unexplained nausea or vomiting
  • Vision problems, such as blurred vision, double vision or loss of peripheral vision
  • Gradual loss of sensation or movement in an arm or a leg
  • Difficulty with balance
  • Speech difficulties
  • Personality or behavior changes
  • Seizures, especially in someone who doesn’t have a history of seizures
  • Hearing problems

Risk factors

In most people with primary brain tumors, the cause of the tumor is not clear. But here are some factors that may increase the risk of a brain tumor.

Risk factors include:

  • Exposure to radiation.People who have been exposed to a type of radiation called ionizing radiation have an increased risk of brain tumor. Examples of ionizing radiation include radiation therapy used to treat cancer and radiation exposure caused by atomic bombs.
  • Family history of brain tumors.A small portion of brain tumors occurs in people with a family history of brain tumors or a family history of genetic syndromes that increase the risk of brain tumors.

How Are Brain Tumors Diagnosed?

Sophisticated imaging techniques can pinpoint brain tumors. Diagnostic tools include:

  • Imaging studies such as a CT(CAT) scan or MRI to see detailed images of the brain
  • Angiogram MRA, which involve the use of dye and X-rays of blood vessels in the brain to look for signs of a tumor or abnormal blood vessels

Sometimes the only way to make a definitive diagnosis of a brain tumor is through a biopsy. A biopsy is required to determine whether or not the tumor is cancer. A biopsy is a sample of tissue removed from the brain either during surgery to remove the tumor or with a needle inserted through a small hole drilled into the skull before treatment is started. The sample is then sent to a lab for testing.

How Are Brain Tumors Treated?

Surgery

Surgery to remove the tumor is typically the first option once a brain tumor has been diagnosed. To remove a brain tumor, a small opening in made the skull. This operation is called a craniotomy to access the tumor and remove as much of it possible. A drain (EVD) may be left in the brain fluid cavities at the time of surgery to drain the normal brain fluid as the brain recovers from the surgery.

Partial removal helps to relieve symptoms by reducing pressure on the brain and reduces the amount of tumor to be treated by radiation therapy or chemotherapy.

Stereotactic biopsy is another procedure that is commonly performed before a craniotomy.  This smaller operation allows doctors to obtain tissue in order to make an accurate diagnosis.

Ventriculoperitoneal Shunting may be required for some patients with brain tumors. Everyone has cerebrospinal fluid (CSF) within the brain and spine that is slowly circulating all the time. If this flow becomes blocked, the sacs that contain the fluid (the ventricles) can become enlarged, creating increased pressure within the head, resulting in a condition called hydrocephalus. If left untreated, hydrocephalus can cause brain damage and even death. In this case, a shunt may be used to divert the spinal fluid away from the brain and, therefore, reduce the pressure.

The body cavity in which the CSF is diverted usually is the peritoneal cavity (the area surrounding the abdominal organs). The shunt usually is permanent. If it becomes blocked, the symptoms are similar to that of the original condition of hydrocephalus and may include headaches, vomiting, visual problems and/or confusion or lethargy, among others. Another method that may be used to control obstruction of the brain fluid pathways is called an Endoscopic Third Ventriculostomy. This helps the brain fluid be diverted around the obstruction without the need for a shunt.

Radiation Therapy

Radiation therapy, also called radiotherapy, is the use of high-powered rays to damage cancer cells and stop them from growing. It is often used to destroy tumor tissue that cannot be removed with surgery or to kill cancer cells that may remain after surgery. Radiation therapy also is used when surgery is not possible.

The Gamma Knife or stereotactic radiosurgery, is another way to treat brain tumors. The Gamma Knife isn’t actually a knife, but a radiation therapy technique that delivers a single, finely focused, high dose of radiation precisely to its target. Treatment is given in just one session. High-energy rays are aimed at the tumor from many angles. In this way, a high dose of radiation reaches the tumor without damaging other brain tissue.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. The doctor may use just one drug or a combination, usually giving the drugs orally or by injection into a blood vessel or muscle. Intrathecal chemotherapy involves injecting the drugs into the cerebrospinal fluid.

Chemotherapy is usually given in cycles. A treatment period is followed by a recovery period, then another treatment period and so on. Patients often don’t need to stay in the hospital for treatment and most drugs can be given in the doctor’s office or clinic. However, depending on the drugs used, the way they are given and the patient’s general health, a short hospital stay may be necessary.

Because treatment for cancer also can damage healthy tissue, it’s important to discuss possible side and long-term effects of whatever treatment is being used. The risk and the possibility of losing certain faculties needs to be explained along with the importance of planning for rehabilitation following treatment. Rehabilitation could involve working with several different therapists, such as:

  • Physical therapist to regain strength and balance
  • Speech therapist to address problems with speaking, expressing thoughts, or swallowing
  • Occupational therapist to help manage daily activities such as using the bathroom, bathing, and dressing
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Spinal Tumor – Types, Symptoms, Diagnosis And Treatment

A spinal tumor is an abnormal mass of tissue within or surrounding the spinal cord and/or spinal column. These cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells.

One way to describe a spine tumor is by whether it is primary or metastatic:

  • primary tumor is one that originated in the area in the area in which it is found.
  • metastatic tumor is one that develops as an extension of another cancer (such as lung, breast, colon, or kidney).

Another way to describe a tumor is by whether it is benign vs. malignant:

  • benign spinal tumor usually has definite borders and clean edges and does not infiltrate into healthy tissue. A benign tumor is not cancer, but it may need to be removed if it’s causing symptoms or creating pressure on the spine. Benign spine tumors include meningiomas, schwannomas, osteoid osteomas, and osteoblastomas.
  • malignant tumor is a cancerous growth that spreads and infiltrates into other tissue. Malignant spine tumors include chondrosarcomas, Ewing sarcomas, and osteosarcomas.

Spinal tumors may be referred to by the region of the spine in which they occur. These basic areas are cervical, thoracic, lumbar and sacrum. Additionally, they also are classified by their location in the spine into three major groups: intradural-extramedullary, intramedullary and extradural.

  • Intradural-extramedullary: These are tumors that occur outside the spinal cord but within its protective covering. These tumors are often meningiomas, Schwannomas, or neurofibromas. Like intramedullary tumors, these tumors are often benign, but they can be difficult to remove surgically and may recur after treatment.
  • Intramedullary: These tumors grow in the spinal cord itself, or in the nerves extending from the spinal cord, usually in the upper spine or neck (called the cervical spine). They are often astrocytomas, ependymomas, or hemangioblastomas. Intramedullary tumors are usually benign but can also be difficult to remove due to their location.
  • Extradural: These are the most common type of spinal tumors, forming outside the spinal cord and the dura in the bones and cartilage of the vertebrae. Some extradural tumors, such as osteosarcomas, osteoblastomas, and osteoid osteomas, arise from the vertebrae themselves (primary), but extradural tumors are more often metastatic tumors that spread from cancers of the lung, breast, prostate, and kidney.

Symptoms

Non-mechanical back pain, especially in the middle or lower back, is the most frequent symptom of both benign and malignant spinal tumors. This back pain is not specifically attributed to injury, stress or physical activity. However, the pain may increase with activity and is often worse at night. Pain may spread beyond the back to the hips, legs, feet or arms and may worsen over time — even when treated by conservative, nonsurgical methods that can often help alleviate back pain attributed to mechanical causes. Depending on the location and type of tumor, other signs and symptoms can develop, especially as a malignant tumor grows and compresses on the spinal cord, the nerve roots, blood vessels or bones of the spine. Impingement of the tumor on the spinal cord can be life-threatening in itself.

Additional symptoms can include the following:

  • Loss of sensation or muscle weakness in the legs, arms or chest
  • Difficulty walking, which may cause falls
  • Decreased sensitivity to pain, heat and cold
  • Loss of bowel or bladder function
  • Paralysis that may occur in varying degrees and in different parts of the body, depending on which nerves are compressed
  • Scoliosis or other spinal deformity resulting from a large, but benign tumor

Diagnosis

A thorough medical examination with emphasis on back pain and neurological deficits is the first step to diagnosing a spinal tumor. Radiological tests are required for an accurate and positive diagnosis which includes – X-ray, CT scan, MRI

After radiological confirmation of the tumor, the only way to determine whether the tumor is benign or malignant is to examine a small tissue sample (extracted through a biopsy procedure) under a microscope. If the tumor is malignant, a biopsy also helps determine the cancer’s type, which subsequently determines treatment options.

Treatment Options:

Treatment options include surgery, radiation, chemotherapy, or a combination of all three depending on the unique circumstances associated with each individual tumor.

Tumors that are asymptomtic or mildly symptomatic and do not appear to be changing or progressing may be observed and monitored with regular MRIs. Some tumors respond well to chemotherapy and others to radiation therapy. However, there are specific types of metastatic tumors that are inherently radioresistant (i.e. gastrointestinal tract and kidney): in those cases, surgery may be the only viable treatment option.

Multiple surgical treatment options are available ranging from surgery to correct spinal deformity or neural compression to interventional techniques where cement is injected into the bone to help strengthen the spine.

 

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Medical Travel To India

Accessibility to superlative medical treatment that is being provided by skilled doctors at internationally accredited hospitals has made India grow as a hub for the medical tourists every year. The prime reason being the cost of medical treatment in India being cheaper when compared to Western Europe, North America and some Southeast Asian countries.

Top Reasons Why India Is A Preferred Destination For Medical Travel:

Everybody can avail tertiary medical treatment in India which is either not available or people cannot afford it in their home country. Here are 7 major factors which make India an ideal medical tourism spot:

  1. Low Cost Of Treatment. India has one of the most affordable cost of treatment in the world. Some treatments can be provided for little as 10% of the cost that it would be available for in other countries like the US or UK. People can expect to save about 50-60% while receiving treatment in India compared to that in the West. Medical care in India is of supreme quality. It enables the patient to receive life-altering or life-saving treatment that may not otherwise be afforded.
  2. Easy to obtain medical visas. Visas are easily granted in a short period of time and the waiting period for most life-altering or life-saving procedures are almost non-existent. Government of India has introduced an e-visa program which enables citizens of more than 150 countries to get visa within 24-48 hours. Patients that need help in order to avoid more medical complications, permanent disabilities, or sometimes even death are given priority. The government of India has ensured that people who need critical, life-saving treatment should get their visas in a timely manner.
  3. No waiting period to get surgeries done. In the Western nations, sometimes people have to wait weeks or months for vital, life-saving treatments which can extend to years for elective procedures. Having procedures done so quickly helps avoid further complications and health problems in the future.  India provides this welcome change of pace to many patients from all around the world who desperately needs medical attention. Having procedures done in a timely manner has saved countless lives, and will save much more in the future.
  4. High skill level of doctors in India. Doctors are mostly always trained in the country’s top medical universities or in other Western-style schools. India has a strong base of qualified and skilled doctors. Another major factor that has made India succeed in inviting the medical tourists is the populace of good English speaking doctors, guides and medical staff which makes it easier for the foreign tourists to correlate well to Indian doctors. Language barriers are rarely an issue. These doctors also travel and conduct medical camps in different countries in Africa, Middle East, South East Asia, and the CIS region.
  5. World-class and standardized medical services and care with state of the art facilities and equipments. Indian hospitals are equipped with best in class technology and systems which compare very well with the top hospitals around the world. Despite being a “developing” nation, premium, Western-standardized care to their patients are being provided. Some of these services can include things like language translators or personal assistance for those who are disabled. Patients are provided with 24/7 access to the hospital facilities as a standard of excellent services.
  6. Offer therapies like Ayurveda, Naturopathy and Yoga. Availability of holistic, natural treatments like Ayurveda, Naturopathy, and Yoga which have originated in India itself. These are fabulous techniques to aid in post-retreatment recovery for many patients. The therapies provide a relaxing aspect to healing, which helps many patients feel better much sooner. The psychological benefits are oftentimes positive as well.
  7. Exotic destinations. Great sightseeing and opportunities to go see parts of the world and experience cultures that you may never otherwise experience can enhance the benefits of medical tourism. India provides an opportunity to the medical tourists to visit some of the most alluring and awe-inspiring places which can sometimes be the best part of medical tourist trip.
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Neck Pain – Symptoms, Causes, Diagnosis and Treatment Options

Best Neck Pain Treatment in Delhi And Gurugram – Dr. Arun Saroha

Pain located in the neck is a common medical condition. Neck pain is also referred to as cervical pain. The neck is made up of vertebrae that extend from the skull to the upper torso. Cervical discs absorb shock between the bones. The bones, ligaments, and muscles of the neck support the head and allow for motion. Any abnormalities, inflammation, or injury can cause neck pain or stiffness.

Many people experience neck pain or stiffness occasionally. In many cases, it’s due to poor posture or overuse. Sometimes, neck pain is caused by injury from a fall, contact sports, or whiplash.

Most of the time, neck pain isn’t a serious condition and can be relieved within a few days. But in some cases, neck pain can indicate serious injury or illness and require a doctor’s care. If the pain continues for more than a week, is severe, or is accompanied by other symptoms, seek medical attention immediately.

Common Symptoms Of Neck Pain:

  • Stiff neck. Soreness and difficulty moving the neck, especially when trying to turn the head from side to side.
  • General soreness. The pain is mostly in one spot or area on the neck, and it’s described as tender or achy, not sharp.
  • Sharp pain. This symptom can be pain localized to one spot and might feel like it’s stabbing or stinging. Often, this type of pain occurs in the lower levels of the neck.
  • Radiating pain. The pain can radiate along a nerve from the neck into the shoulders and arms. The intensity can vary and this nerve pain might feel like it’s burning or searing.
  • Tingling, numbness, or weakness. These sensations can go beyond the neck and radiate into the shoulder, arm or finger. There could be a “pins-and-needles” sensation. Typically, pain that radiates down the arm is felt in only one arm, not both.
  • Trouble with gripping or lifting objects. This can happen if tingling, numbness, or weakness in the fingers is present.
  • Headaches. Sometimes an irritation in the neck can also affect muscles and nerves connected to the head.

Common Causes Of Neck Pain

In order to effectively treat neck pain, it’s important to understand the underlying medical condition that’s causing the pain. This is especially true if the pain has lasted 4 or more weeks. Neck pain causes include:

  • Muscle strains. Overuse, such as too many hours hunched over computer or smartphone, often triggers muscle strains. Even minor things, such as reading in bed or gritting teeth, can strain neck muscles.
  • Worn joints. Just like the other joints in the body, neck joints tend to wear down with age. Osteoarthritis causes the cushions (cartilage) between the bones (vertebrae) to deteriorate. Bone spurs are then formed that affects joint motion and cause pain.
  • Nerve compression. Herniated disks or bone spurs in the vertebrae of the neck can press on the nerves branching out from the spinal cord.
  • Rear-end auto collisions often result in whiplash injury, which occurs when the head is jerked backward and then forward, straining the soft tissues of the neck.
  • Certain diseases, such as rheumatoid arthritis, meningitis or cancer, can cause neck pain.

Diagnosing Neck Pain:

As a first step to diagnosing the specific cause of neck pain, the doctor will take a thorough history of the patient in order to better understand the nature of the patient’s pain, such as if the pain is worse at certain times of day or exacerbated by certain activities. Physical examination will also be conducted to assess the neck movements.

Certain imaging tests are advised to get a better picture of the cause of the neck pain which includes:

  • X-rays.X-rays can reveal areas in your neck where your nerves or spinal cord might be pinched by bone spurs or other degenerative changes.
  • CT scan.CT scans combine X-ray images taken from many different directions to produce detailed cross-sectional views of the internal structures of your neck.
  • MRI uses radio waves and a strong magnetic field to create detailed images of bones and soft tissues, including the spinal cord and the nerves coming from the spinal cord.

It’s possible to have X-ray or MRI evidence of structural problems in the neck without having symptoms. Imaging studies are best used as an adjunct to a careful history and physical exam to determine the cause of pain.

Treatment:

The most common types of mild to moderate neck pain usually respond well to self-care within two or three weeks. If neck pain persists, other treatments might be recommended.

Medications: Many over-the-counter pain relievers are available to either reduce inflammation or hinder pain signals from reaching the brain. However, these drugs must be used with caution. Read the pain reliever’s entire label for directions and warnings, and be careful not to overdose. Consult a doctor who might prescribe stronger pain medicine than what you can get over-the-counter, as well as muscle relaxants and tricyclic antidepressants for pain relief.

Therapy:

  • Physical therapy.Correct posture, alignment and neck-strengthening exercises, use of heat, ice, electrical stimulation and other measures can help ease the pain and prevent a recurrence.
  • Transcutaneous electrical nerve stimulation (TENS).Electrodes placed on the skin near the painful areas deliver tiny electrical impulses that may relieve pain.
  • Traction uses weights, pulleys or an air bladder to gently stretch the neck. This therapy, under supervision of a medical professional and physical therapist, may provide relief of some neck pain, especially pain related to nerve root irritation.
  • Short-term immobilization.A soft collar that supports the neck may help relieve pain by taking pressure off the structures in the neck. However, if used for more than three hours at a time or for more than one to two weeks, a collar might do more harm than good.

Surgical and other procedures

  • Steroid injections.Your doctor might inject corticosteroid medications near the nerve roots, into the small facet joints in the bones of the cervical spine or into the muscles in the neck to help with pain. Numbing medications, such as lidocaine, also can be injected to relieve neck pain.
  • There are three common reasons to have surgery for a problem in the neck:
  1. To remove the damaged disc and/or other structures irritating a nerve root
  2. To stabilize the cervical spine
  3. To decompress the spinal cord

Common Types of Surgery for Neck Pain

  • Anterior cervical discectomy and fusion (ACDF): The most common surgery for neck pain symptoms involves a discectomy, which is the removal of a problematic disc in the cervical spine. Typically, the surgery is done through the front of the neck, called anterior cervical discectomy; this procedure is done in conjunction with a cervical spinal fusion to maintain spinal stability where the disc was removed, so the entire surgery is called an anterior cervical discectomy and fusion, or ACDF for short.
  • Posterior cervical decompression (Microdiscectomy) surgery: Another way to do a discectomy is through the back of the neck, where only part of the disc is removed and no spinal fusion is needed.
  • Cervical artificial disc replacement: somewhat newer option is discectomy with artificial disc replacement. This surgical procedure involves removal of the damaged disc and replacement with an artificial disc. This surgery is an alternative to ACDF. A potential benefit of this surgery is that it retains more neck flexibility.
  • Spinal decompression: There are a few different surgical options available to relieve symptoms of myelopathy and increase space in the spinal canal for the spinal cord:
    • Anterior cervical corpectomy. This surgery is similar to anterior cervical discectomy, except that it involves the removal of at least one vertebral body (the cylindrical bone at the front of a vertebra) along with the adjacent discs above and below that vertebra. After the removal, a bone graft and/or cage will be placed to fill the space and set up a favorable environment for the bones to fuse together into one solid segment of bone. This surgery may be done for someone who has spinal stenosis at more than one vertebra.
    • Posterior cervical laminectomy. This surgery is done through the back of the neck and involves the removal of a lamina, which is the back part of a vertebra. A potential advantage to this surgery is that more flexibility in the neck can be retained if a spinal fusion can be avoided. However, sometimes a spinal fusion is still done in conjunction with laminectomy.
    • Posterior cervical laminoplasty. This surgery is similar to the laminectomy, except the lamina isn’t completely removed. Rather the lamina is cut and restructured to make more space in the spinal canal.
    • Posterior cervical foraminotomy. This surgical procedure goes through the back of the neck and a small part of the foramen is removed. If a nerve is irritated by a herniated disc, then the surgeon might remove part of the disc. If a nerve is irritated by a bone spur, then the surgeon will chisel away that bone spur. No spinal fusion is needed.
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