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Enthesitis refers to hypertension 90 discount 5mg hytrin free shipping inflammation of the location where a bone has an insertion to prehypertension 23 years old hytrin 1 mg generic a tendon or a ligament arrhythmia etiology generic 1mg hytrin with visa. Although the disease often begins in middle age and occurs with increased frequency in older people arteria retinae hytrin 1 mg fast delivery, children and young adults also develop it. Scientists still do not know exactly what causes the immune system to turn against itself in rheumatoid 156 arthritis but several factors have been implicated. These include genetic (inherited) factors, environmental factors such as a viral or bacterial infection, and an interaction of many factors. To arrive at a diagnosis of rheumatoid arthritis, laboratory and imaging examinations are performed. One common laboratory examination is a test for rheumatoid factor, an antibody that is present eventually in the blood of most people with rheumatoid arthritis. Other common laboratory tests include a white blood cell count, a blood test for anemia, and a test of the erythrocyte sedimentation rate, which measures inflammation in the body. C-reactive protein is another common test that measures disease activity resulting from inflammatory processes. Radiography of the area under investigation is usually among the first imaging examinations requested when rheumatoid arthritis is suspected. Current treatment approaches include lifestyle/health behavior changes, medications, surgery, and routine monitoring and ongoing care. Seronegative spondylosteoarthritis Seronegative spondylosteoarthritis is a general term for a group of joint conditions that are not associated with rheumatoid factors or rheumatic nodules. Five subgroups of spondylosteoarthritis are distinguished: ankylosing spondylitis, reactive arthritis. The subtypes are generally distinguished on the basis of the patients history and clinical findings. Imaging does not play a major role in differentiating between the subtypes of spondylosteoarthritis because their imaging features are comparable, especially in early disease. Exceptions to this include undifferentiated spondylosteoarthritis and psoriatic arthritis, which is known to produce syndesmophytes. A syndesmophyte is a bony growth inside a ligament, similar to osteophytes, appearing in the intervertebral joints of the spine. Radiography images of the areas affected will demonstrate fine, confluent syndesmophytes. The condition affects men 3 9 to 10 times more often than women, with the age of onset between 15 and 35 years. As with other rheumatic conditions, early diagnosis and treatment are essential for avoiding structural damage and functional impairment. In many cases, rheumatologists referring patients for radiography evaluation request detailed images that demonstrate the inflammatory changes in specific area of the skeleton. Ankylosing spondylitis Ankylosing spondylitis is a progressive form of arthritis due to chronic inflammation of the joints, generally occurring in the spine. Ankylosing spondylitis belongs to a group of disorders called seronegative spondyloarthropathies. When a seronegative test result is confirmed it means that an individual has tested negative for a rheumatoid factor autoantibody. In some people, ankylosing spondylitis affects joints such as the shoulders, ribs, hips, knees, and feet can also be affected. Ankylosing spondylitis may also affect organs, such as the eyes, bowel, and more rarely, the heart and lungs. The presenting symptoms include pain and loss of flexibility in the affected area. Ankylosing spondylitis typically begins in adolescents and young adults, but has lifelong impacts. Approximately, 80% of people who have the disorder develop symptoms before age 10 30. The cause of ankylosing spondylitis is unknown, but it is likely that both genetic and environmental factors play a role. Factors such as infections or normal bacteria that live in the intestines may trigger the disease in people who are genetically susceptible. Long-term inflammation leads to calcification that causes two or more bones, especially in the spine, to fuse and may be demonstrated by radiography examinations of the affected structures. Conventional, non-contrast radiography may be able to 158 demonstrate changes in the spine and sacroiliac joints that indicate ankylosing spondylitis; however, it may take years of inflammation to cause damage that is visible on the images. African Americans and Asians are affected more often than people from other 11 races. Also the condition may affect one organ or body system first and others may become involved 11 later. The most frequently affected joints are in the fingers, hands, wrists, and 11 knees. Other common symptoms include: Chest pain when taking a deep breath; Fatigue; Fever with no other cause; Hair loss; Mouth sores; Sensitivity to sunlight; and, A butterfly rash over the cheeks and the bridge of the nose. Radiography indications of infection include cartilage loss, joint effusion, and progressive bone loss. Bone scintigraphy may be requested to illustrate the extent of bone 159 infections. Bone Infections Osteomyelitis is an infection of bone and bone marrow that may be caused by direct inoculation of an open traumatic wound or by blood-borne organisms. Bone and bone marrow infection caused by blood-borne organisms is common in children and occurs more frequently in boys than girls. In children, the infection is most common in the metaphysis or epiphysis of the long bones and more common in the lower extremity than the upper extremity. The most common organisms include Staphylococcus aureus, 13 gram-negative bacilli, and group B streptococcus. The four main routes through which osteomyelitis may be acquired include hematogenous spread of infection from the bloodstream, spread of infection from adjacent soft tissues, direct inoculation through 13 penetrating trauma, and postoperative infection. Radiographic changes of acute osteomyelitis include soft tissue swelling, bone 13 demineralization (10-14 days), and sequestra and involucrum later. Pain, loss of function of the involved extremity, and a soft tissue abscess may be present. Radiography evidence of osteomyelitic bone changes often take 7 to 14 days to 13 develop. Skeletal lesions appear as enlarging ill-defined radiolucent areas in the infected bone. Magnetic resonance imaging and 3-phase bone scan may be used to 13 diagnose acute osteomyelitis. Injection of gadolinium contrast is useful in differentiating an abscess from bone marrow edema in the marrow space or in differentiating a soft tissue abscess from 13 surrounding cellulitis. Image detection of sinus tracts and sequestra is also improved after gadolinium administration. A sequestrum is a fragment of necrotic bone that is separate from the living parent bone. A sequestrum may be absorbed, be discharged through a sinus tract, or persist as a focus of infection. It may merge with the parent bone or become perforated with tracts through which pus can escape. A choaca is an opening in the involucrum through which granulation tissue and the sequestra may be discharged. A sinus tract is a channel extending from the bone to the skin surface that is lined with granulation tissue. A Brodie abscess is a bone abscess found characteristically in subacute pyogenic osteomyelitis, but which also may be identified in chronic osteomyelitis. A Brodie abscess typically occurs near the ends of tubular bones and may present as single or multiple lesions, and is especially common in children. On radiography images, a Brodie abscess appears as a well-defined circular or elliptic radiolucency with adjacent 13 sclerosis. The type of surgery depends on which bone is infected and may include drainage of the infected area, removal of diseased bone and tissue, or bone and tissue grafting.

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Decreasedlibido 1-3 3-6 Decreasederections 1-3 3-6 Malesexualdysfunction Variable Variable Breastgrowth 3-6 2-3 Decreasedtesticular 3-6 2-3 volume Decreasedsperm In fact arteria latin purchase genuine hytrin, the Sex-related differences are present in almost every cell blood pressure medication without food purchase line hytrin, tissue and organ system of the body hypertension with cardiac involvement cheap hytrin online master card, including those associated with circu lation heart attack blues buy discount hytrin on-line, respiration, digestion, renal function, metabolism, and neural and endocrine activity [3]. Conditions associated with sex differences include blepha Eye-health disparities arise from a multitude of causes, some of rospasm, eyelid edema, conjunctivitis, keratitis, herpetic reac which are known and some of which remain to be determined. Therefore, in this stated in a 1888 monograph addressing clinical ophthalmology report, we consider both gender and sex d terms that are distin males are by no means as prone to diseases of the eye from sexual guishable but intertwined as they both have pronounced effects on causes as females. These this Subcommittee report is to review and critique the nature of hormone actions appear to be mediated through classical, and this role, as well as to recommend areas for future research to possibly membrane, receptors and impact multiple structural and advance our understanding of the interrelationships between sex, functional aspects of the eye. Sex-related differences are extremely impor junctivitis, corneal transplant rejection and corneal pathologies tant, as they directly or indirectly in uence numerous physiological [18e23]. In the past signi cant these sex-related differences in the eye are not due solely to attention has been focused on sex-based variations at the societal the effects of sex steroids. In addition, sex-related dif To address this lack of understanding, the Institute of Medicine ferences may arise from the sex chromosome complement, commissioned a six-volume report to address our knowledge of including differences in parent-of-origin effects, X chromosome biological sex differences and to identify barriers to the conduct of gene dosage. The conclusions and recommendations recombining region of the Y chromosome [24e30], as well as from this report, entitled Exploring the Biological Contributions to from sex-speci c autosomal factors and epigenetics. As stated the Institute of Medicine reported three conclusions: by the Institute of Medicine [3], sex refers to the classi cation of living things, generally as male or female, according to their Sex (male or female) matters. Sex is an important basic human reproductive organs and functions assigned by chromosomal variable. Gender is rooted in genetic and physiological constitutions, combined with an in biology and shaped by environment and experience. Gender, in turn, re ects socially con occurrence, frequency and severity of diseases vary between structed characteristics such as behaviors and expectations males and females. These sex differences appear to be due to the related to being a man, masculine, or being a woman, feminine. Furthermore, gender is dynamic, context-related and operates on the study of sex differences is evolving into a mature science. There is now suf cient knowledge of the biological basis of sex the correct and consistent usage of the terms sex and gender related differences to validate their scienti c study and to across scienti c disciplines promotes the accurate assessment, permit the generation of experimental hypotheses. In most studies of nonhuman animals the term sex should ences in health and illness exist and must be eliminated. The purposeful integration of considerations of sex and gender in health and disease throughout the scienti c community will facilitate uptake by policy makers and dissemination to the 2 the termhealth care disparities refersto differences in access tooravailability of general public. Item Barrier Terminology use in literature Inconsistent use of the terms sex and gender Research tools and resources Studies with more complex experimental designs, model systems and additional resources are lacking. Information on sex differences and sex of origin of cell and tissue culture material is lacking in the literature. Lack of data from longitudinal studies about different diseases, disorders, and conditions across the life span. Interdisciplinary and collaborative research Interpretation and application of federal regulations is not uniform. Interdisciplinary research, training and translational research is lacking in the study of sex differences. Non-health-related implications of research Lack of awareness that the consequences of genetics and physiology may be open to change. Recommendations for better understanding of sex differences trying to conduct research on the role of sex differences in in health and disease health and disease. These barriers, as summarized in Table 1 [3], the Institute of Medicine report made a number of recom encompass ethical, nancial, sociological, and scienti c con mendations to advance our understanding of sex differences in siderations, and should be eliminated. Several of these are as follows: Identify the roles of X and Y-chromosome linked genes in so 2. Every cell has a sex, sex begins in the womb, sex affects matic and germ-line cells, and determine with ethical research behavior and perception, and sex affects health the impact of genetic sex differences on biological organization the Institute of Medicine report highlighted several ndings: and disease susceptibility. Include sex as avariable in basic research, in order toreveal how Every cell has a sex. Advances in molecular biology have sex-related differences in uence health, disease and longevity. Genes on these chromosomes can be expressed Evaluate natural genetic variability, disorders of sex differenti differently between males and females because of the pres ation, reproductive status and environmental in uences to gain ence of either one or two copies of the gene and because of a better understanding of human health. There are multiple studied and elucidated, in order to advance our knowledge of their ubiquitous differences in the basic cellular biochemistries of biological contributions to human health and disease. Some originate in the intrauterineenvironment, others in the prenatal period, pre 2. Female sex is also persist through life and contribute to the variable onset and among the most widely studied and consistently identi ed risk progression of disease in males and females. It is best studied in important to research sex differences at all stages of the life population-based epidemiological studies, since differences in care cycle. A discrepant nding emerged from the Salisbury Eye Evalua treatment of diseases. This possibility of effect modi cation by age could be evalu as well as by the Symptom Assessment in Dry Eye questionnaire ated in existing data as well as future studies. However using blurred vision, poor vision, and uctuating/unstable vision, as well ade nition of at least one symptom plus one sign, the sex differ as on tasks requiring sustained visual attention such as reading, ence was diminished (11. Nonetheless, the prevalence of a tear breakup time of 10 s Sex-related differences also extended beyond visual activities to was also higher among women in this study (17. S100 calcium-binding pro Human [7, 10, 110e116] protein) tein, leptin) Higher expression of speci c polar lipids in meibum in both Higher expression of speci c polar lipids in meibum in both young and old men young and old women Higher expression of speci c neutral lipids in meibum in old Higher expression of speci c neutral lipids in meibum in old men women Higher expression of speci c fatty acid products, Higher expression of speci c fatty acid products, predominantly polar, in meibum than age-matched women predominantly polar, in meibum Higher casual level of meibum in young men Higher prevalence of meibomitis-related keratoconjunctivitis Higherincidenceofabnormallidmarginandglanddropoutin men! However, factors associated with worsening show higher survival rates than for male recipients [132]. Women also had a record of considered in nding the optimal transplant for the recipient. Conjunctiva, nasolacrimal duct and tear lm Signi cant sex-related differences have been identi ed for Signi cant sex-related differences have been identi ed in the example in the density of goblet cells and susceptibility to lacrimal gland, meibomian gland, cornea, conjunctiva, nasolacrimal in ammation (Table 3). These features, as well as the acute angle between the bony canal and nasal oor in women, may predispose to chronic 2. Lacrimal gland in ammation of the nasolacrimal drainage system and may explain Signi cant, sex-related differences exist in the anatomy, physi why primary nasolacrimal duct obstruction is more frequent in ology and pathophysiology of the lacrimal gland (Table 3). Signi cant sex-related differences exist in the tear vestigators have speculated that the increased diffuse atrophy, and lm (Table 3). Overall, many of these sex-related differences in the orbital lobe and periductal brosis, present in the lacrimal glands of ocular surface and adnexa are likely to be due to the in uence of elderly women may decrease aqueous out ow and contribute to hormones and genetics. Sex-related differences in immunity of the ocular surface and gene in female mouse lacrimal tissue is particularly intriguing adnexa [83, 89]. In general infections are more com autoantigenic target of both B and T-cells [212]. Examples of sex-speci c differences in the innate immune response include: males have a greater percentage of pro 2. Meibomian gland in ammatory cytokine producing monocytes than females [227]; Sex-related differences have been identi ed in the morpholog females have less natural killer cell activity than males [228]; pe ical appearance, gene expression, neutral and polar lipid pro les, ripheral blood monocytes and plasmacytoid dendritic cells from and secretory output of the meibomian gland (Table 3). Examples of sex-speci c differences in the adap species are not necessarily the same. As and sebaceous glands are known have sex-associated differences alluded to with the last example, the effects of steroid hormones [213]. Signi cant sex-related differences exist in corneal anatomy and In terms of genetic effects an obvious point of discussion is the physiology (Table 3). The X chromosome has some 1100 genes (versus the Y which these alterations include variations in thickness, hydration, cur harbors less than 100) including several that are involved in im vature and sensitivity, endothelial pigmentation, foreign body mune function such as certain cytokine receptor subunits and Toll sensation, contact lens tolerance and visual acuity (Table 3) like receptors, E26 transformation-speci c domain-containing [214e222]. While donor transplants from males have higher which is important for Treg development [225]. The tear lm is an affect the immune response can be minimized in females whereas essential component of the ocular immune response and contains in males the effects of the altered gene will be manifest. In humans many components with antimicrobial functions [248] and a small approximately 15% of the genes on the inactive X chromosome number of studies have compared the levels of some of these actually remain active thus it is also possible for females to have antimicrobial components in males and females. Secretory IgA at increased expression of some X-linked genes if both copies have the ocular surface binds and neutralizes pathogens and facilitates remained active [235]. Although females produce higher levels of antibody contribute to enhanced immune responses. Further they have a 14-fold increase in the prevalence of tears of adult male rats than females [100, 103]. In contrast, at least in rabbits, the concentration of humans with approximately 10% being located on the X chromo lipocalin was increased in adult male rabbits in lacrimal uid and some [238].

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We would like to hypertension meds cheap hytrin 2 mg with visa seek views on the proposed activities that cause pain blood pressure chart male buy cheapest hytrin, criteria in Appendix 2 as part of this consultation arteriovascular malformation buy hytrin 5 mg mastercard. Appendix: They have used a small splint Surgery should be only performed in specific cases to blood pressure 9058 buy hytrin 2 mg free shipping hold the finger or thumb where alternative measures have not been successful. The risks of injection are small (it very occasionally causes some thinning or colour change in the skin at the site of injection). If clinically appropriate, the patient may be offered a second injection at the discretion of the treating clinician. Treatments like historic restrictions and They are bleeding from a endothermal ablation or ultrasound-guided foam were agreed after a varicosity. Clinical Definitions-continued Liver failure-Failure of the liver to perform its biosynthetic functions. Abnormal Liver Tests True liver function tests are not widely used galactose clearance, aminopyrine clearance tests. Suggestions are: Although nonspecfic, consider alcohol Review risk factors for non-alcoholic fatty liver disease. Medical Director, Liver Transplant Associate Chief, Section of Hepatology Loyola University Medical Center jahn2@lumc. Physical Therapy Modalities this protocol is intended as a quick reference for the application of a variety of physical therapy modalities, including cryotherapy, thermotherapy, ultrasound and electrotherapy. Many physical therapy modalities are aimed at controlling pain and/or inflammation. As a general principle, these modalities should be used on a brief and limited basis as part of initial treatment of the acute patient or during acute flare-ups. The clinician should understand that certain patients especially those with more chronic problemsmay become inappropriately dependent on these passive modalities. The majority of modalities do not have well-controlled outcome studies for most conditions. Consult specific care pathways and protocols for additional information regarding efficacy and application to a particular condition. There is usually little evidence that one modality is more effective than another. In the case of electrotherapy and heat/cold applications, the patient should be alerted to the risks of burns. In cases of home care, patients need to be clear about duration of treatment and precautions, such as skin reaction and/or irritation. Contraindication a specific situation in which a procedure or modality should not be used because it may be harmful to the patient. In this protocol local contraindications are specifically indicated by a phrase such as contraindicationover the gravid uterus). Precaution a situation in which a patient is at some risk of experiencing an adverse event. Proactive measures should be taken to reduce the risk of harm; such measures might include adjusting treatment parameters (lower intensity) or treatment schedule (treatment duration or frequency of application) and/or closer monitoring of patient response to the treatment. Contraindications Confused or unreliable patients Cold-Induced Urticaria: raised patches (wheals), severe itching and/or systemic reactions such as sneezing and dysphasia. Contraindications Pacemaker Over the carotid sinus Within 20 feet of an operating diathermy Over the gravid uterus Through the heart Over areas of hemorrhage, infection, or malignancy, deep vein thrombosis or thrombophlebitis Over an active epiphysis/apophysis (generally 16 years old or younger, although the 1 plate may not close in some individuals until between ages 18 and 25). Precautions On patients with circulatory, sensory, or mental impairment 1 Although Houghton (2010) categorizes this only as a precaution, we recommend that the epiphysis be avoided in this age group (Bazin 2006, Robertson 2001). Contraindications Do not use packs over genitals, eyes, a pregnant abdomen/pelvis, or if the patient has decreased sensation or decreased arterial flow, acute inflammation or edema, malignancy, acute tuberculosis, multiple sclerosis, hemorrhage, infection, deep vein thrombosis or thrombophlebitis. In this circumstance, additional layers of insulating toweling should be added to compensate for compression of the towels and body tissues, and the patient should be monitored closely. Physical Therapy Modalities Page 5 of 31 Contrast Therapy Effect: Used in the subacute stage to aid in flushing inflammatory exudates from the injured area; used in the chronic stage to flush edema. Note: Active movement of the target area while receiving hot and cold is the best way to mobilize venous and lymph circulation to reduce edema. Physical Therapy Modalities Page 6 of 31 Cryotherapy this modality is used in the acute and inflammatory stages. Effect: Anesthesia; reduces inflammation; in acute stage decreases tissue destruction and edema. In the case of gel packs, however, a thin towel is placed between the treated area and the gel pack. Be aware that compression wraps should be used with caution and only on populations that can tolerate more aggressive cooling. Note: When the goal of the ice pack is to create numbness before an aggressive or painful procedure (such as deep soft tissue massage, transverse friction massage, trigger point therapy, exercise or stretching), the patient should be advised to indicate when numbness has been achieved, at which point the ice pack can be discontinued. The goal is to numb the inflamed area to the point of analgesia (20-30 minutes) and then work to achieve normal range of motion. This therapy aids in an early return to activity and simultaneously stimulates circulation through exercise. However, this type of therapy is not appropriate in all cases, for example, for injuries where analgesia may lead to joint injury or dysfunction. Contraindications: Raynauds disease/phenomenon; sensitivity or allergy to cold; over regenerating peripheral nerve, superficial nerves or areas with circulatory compromise. Precautions: When treating previously frostbitten areas, areas of decreased sensation, infants, young children, or the elderly who have diminished thermoregulatory abilities, it is not advisable to leave the patient unattended. Effect: Reduce pain Technique: Intensity: o Sensory level (acute pain) o Motor or Nociception level (chronic pain) Frequency: o 80 pps (acute pain) o 1-10 pps (chronic pain) Polarity: o Positive (+) for acute pain o Negative (-) for chronic pain Time: 20-30 minutes Effect: Reduce inflammation and edema Technique: Intensity: Sensory level Frequency: 100 pps Polarity: Negative (-) Time: 20-30 minutes Effect: Muscle strengthening/rehabilitation Technique: Intensity: Motor level Frequency: 50 pps Polarity: Negative (-) Time: 15-20 minutes (15-20 repetitions) Pads: Apply one pad to muscle motor point or muscle belly and the other pad either proximal or distal on the muscle belly. Physical Therapy Modalities Page 8 of 31 Effect: Reduce muscle hypertonicity, spasm or spasticity Technique #1: Pad placement: Apply one pad to muscle motor point or muscle belly and the other pad either proximal or distal on the muscle belly. Physical Therapy Modalities Page 9 of 31 Interferential Current: Quadrapolar Technique Effect: Reduce pain Technique: Intensity: o Gate Mechanism: Sensory level o Opiate Release: Mild motor level Frequency: Sweep o Gate Mechanism: 80 to 120 bps o Opiate Release: 1 to 10 bps Pads: (4) Crisscrossed. Treatment affects superficial tissue when pads are placed close together, the deeper tissue with pads farther apart. Pads may be secured with elastic bands, weights, weight bags, hot packs, ice packs, or may be individual use self-sticking pads. Technique: Intensity: Sensory level or to patient tolerance Frequency: Sweep, 80-120 bps Pads: (4) crisscrossed Vector scan: on Time: 20-30 minutes Contraindications: See contraindications for electrotherapy, p. Negative pole (-) Negative charge repels negative ions of medicinal substance, providing their therapeutic effect. Technique: Active pad: the smaller pad, which is the active one and the same charge as the ions in the solution being phoresed, is placed directly over the target tissue. Use several 4x4 gauze sponges with a total thickness of approximately inch and soak them in the medicinal solution and place them on the active pad. For ointments and creams, soak gauze in saline solution, rub cream/ointment into skin and place gauze over cream/ointment. Note: Treatment should be discontinued immediately if the patient experiences warmth or discomfort (this may indicate burning). Physical Therapy Modalities Page 11 of 31 Intensity: Increase to patient comfort or until limited by the milliamperage rule. If the patient experiences discomfort during the treatment, lower the amperage or discontinue the therapy. Check for patient tolerance to the low volt galvanism and to the substance being phoresed. After the initial treatment time of 3-4 minutes, the amount of milliamps delivered multiplied by the number of minutes of application should equal 40 mA min. Contraindications: Direct irradiation of the eyes Areas of hemorrhage Over the thyroid gland Over malignancy Over low back or abdomen during pregnancy or menstruation Along the cervical sympathetic ganglion. Not Contraindicated: Pacemakers Implants: metal, plastic, joints Over boney prominences Peripheral vascular disease with decreased sensation When heat is contraindicated. Technique #1: Pad placement: Apply one pad to muscle motor point or muscle belly and the other pad either proximal or distal on the muscle belly. Physical Therapy Modalities Page 15 of 31 Microcurrent Note: Treatment can be applied through 2-4 pads on either side of the lesion, 2 probes or 1 probe and 1 pad. Effect: To reduce pain Technique: Intensity: 25-100 amps Frequency: 3 or 80 or 130 pps Polarity: Early treatment (1-24 hours post-injury) positive (+). Physical Therapy Modalities Page 16 of 31 Russian Muscle Stimulation Effect: Muscle rehabilitation and strengthening Technique: Patient isometrically contracts the muscle against resistance during the on-cycle of stimulation; usually to 10-20 repetitions with 10-second isometric hold. Technique: Applicators: o Condenser plates or pads using co-planar or longitudinal placement; single layer of thick toweling on patient.

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