CN102495217B - Clinical case monitoring and managing system - Google Patents

Clinical case monitoring and managing system Download PDF

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Publication number
CN102495217B
CN102495217B CN201110399730.XA CN201110399730A CN102495217B CN 102495217 B CN102495217 B CN 102495217B CN 201110399730 A CN201110399730 A CN 201110399730A CN 102495217 B CN102495217 B CN 102495217B
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glycosylated hemoglobin
container
magnetic bead
solution
mentioned
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CN102495217A (en
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黄传峰
郭永成
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Shenzhen Huachuang Technology Co ltd
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Abstract

The invention discloses a clinical case monitoring and managing system, and particularly relates to a clinical case monitoring and managing system for the II-type diabetes. The monitoring and managing system comprises a blood collection device and a glycosylated hemoglobin detection device. The invention also discloses a method for preparing the monitoring and managing system. The clinical case monitoring and managing system for the II-type diabetes can be used for detecting a glycosylated hemoglobin index of a diabetes patient simply and effectively so as to monitor the recovery condition of the patient and adjust the medicine dosage.

Description

A kind of clinical case management system for monitoring
Technical field
The present invention relates to a kind of clinical case management system for monitoring, especially relate to a kind of type ii diabetes clinical case management system for monitoring.
Background technology
Diabetes (diabetes) are by inherent cause, immunologic function disorder, infected by microbes and toxin thereof, free radical toxin, the various virulence factors of mental element etc. act on body and cause hypoinsulinism, insulin resistance etc. and cause sugar, protein, fat, a series of metabolic disorder syndromes such as power and water Xie Zhi, clinically take hyperglycaemia as principal feature, can there is diuresis in model case, many drinks, many foods, the performance such as become thin, i.e. " three-many-one-little " symptom, diabetes (blood sugar) cause complication once control bad meeting, cause kidney, eye, the exhaustion pathology at the positions such as foot, and cannot cure.Clinical observation insulin resistance is prevalent in type ii diabetes, up to 90% left and right.Type ii diabetes can cause infection, heart change, cerebrovascular disease, renal failure, loses the sight of both eyes, lower limb gangrene etc. and become the lethal main cause disabling.Diabetes are high oozes the serious acute complication that syndrome is diabetes, starting stage can show as diuresis, many drinks, lassitude hypodynamia, slow in reacting etc., along with the increase state of an illness of body fluid loss sharply develops, occur that drowsiness, disorientation, epileptic twitch, the symptom of the similar cerebral apoplexy such as hemiplegia, even stupor.
Glycosylated hemoglobin is the product that in blood of human body, endoerythrocytic haemoglobin is combined with blood sugar.Glycosylated hemoglobin was used chromatography from the haemoglobin of other type, to separate first in 1958, and was classified as a kind of glycoprotein in nineteen sixty-eight.1969, it is found that the quantity of glycosylated hemoglobin in diabetic increases.Researchers in 1975 have obtained generating the reaction equation of glycosylated hemoglobin.The product that in blood of human body, endoerythrocytic haemoglobin is combined with blood sugar is glycosylated hemoglobin, it is non-reversible reaction that the combination of blood sugar and haemoglobin generates glycosylated hemoglobin, and be directly proportional to blood sugar concentration, glycosylated hemoglobin can more fully reflect type ii diabetes patient's glycemic control situation.In blood of human body, endoerythrocytic haemoglobin is easily combined with blood sugar, in conjunction with product be exactly glycosylated hemoglobin.This combination is an irreversible process substantially, once in conjunction with being just difficult to dissociate.Erythrocytic life cycle is 120 days, only has red blood cell decline by the time, and this combination just can stop.Certainly, red blood cell is constantly survived, also constantly dead.So the glycosylated hemoglobin value detecting has clinically reflected the blood sugar average level of the nearest 2-3 of patient month, is not subject to for a single second impact of blood glucose fluctuation, more objective, has more longer timeliness, is also still less subject to the interference of the factor such as diet, motion.
At present the index of reaction type ii diabetes blood sugar have multiple, as the fasting blood-glucose of direct reflection blood sugar level, 2 hours blood glucoses etc. after the meal.Although these indexs can reflect blood sugar level, clinical meaning or different.By fasting blood-glucose, we can understand the general status of patient's glycemic control.Fasting blood-glucose is high, means patient's Basal insulin secretion ability.Postprandial blood sugar is high, often points out the reserve capabillity of excreting insulin poor or have an insulin resistance.The monitoring of how carrying out type ii diabetes patient according to glycosylated hemoglobin index has become a medically difficult problem with standardization medication.
Summary of the invention
The technical issues that need to address of the present invention are the present invention relates to a kind of diabetes clinical case management system for monitoring, especially relate to a kind of type ii diabetes clinical case management system for monitoring, the kit that this system adopts the present invention to develop carries out glycosylated hemoglobin detection and has higher sensitivity and specificity, can be used for instructing clinical type ii diabetes clinical.
Type ii diabetes clinical case management system for monitoring provided by the invention, comprises blood sampling device and glycosylated hemoglobin pick-up unit, and described blood sampling device can be any conventional blood sampling device of field of medicaments, such as venous detaining needle, syringe and blood collecting pen etc.Described glycosylated hemoglobin pick-up unit is glycosylated hemoglobin detection kit, and its reagent comprising has glycosylated hemoglobin magnetic separation agent, enzyme labelled antibody, reinforcing agent, calibration object, control product, concentrate and substrate.
Described magnetic separation agent contains the magnetic microsphere that is marked with anti-glycosylated hemoglobin monoclonal antibody.
Described enzyme labelled antibody is the anti-glycosylated hemoglobin monoclonal antibody that contains horseradish peroxidase-labeled.
Described reinforcing agent is the damping fluid that contains Tris.
Described calibration object and control product are the solution that contains a certain amount of glycosylated hemoglobin antigen.
Described concentrate is the damping fluid that contains TWEEN-20 and Proclin-300.
Described substrate is enzyme-catalyzed chemical luminescence substrate.
The preparation method of the immue quantitative detection reagent box of glycosylated hemoglobin of the present invention, comprises the steps:
The first step: the preparation process of magnetic separation agent:
1,1.0mg disuccinimidyl suberate is dissolved in 50ul DMSO, get in the 0.1mol/L PB damping fluid that the anti-glycosylated hemoglobin monoclonal antibody of 2mg is dissolved in PH 9.5 to cumulative volume be 1ml;
2, join in the antibody-solutions of step 1 with the disuccinimidyl suberate that liquid-transfering gun is drawn in step 1, put room temperature 90min;
3, solution step 2 being obtained join in concentration tube, then put in high speed freezing centrifuge under 3000g concentrated 30min to volume be 0.5ml;
4, get 0.5ml magnetic bead, add in 5ml reaction cup, put into test tube rack special, after 2 minutes, draw supernatant through magnet adsorption;
5, add 1.5ml PH9.50.1mol/L PB at every turn, mix 30 seconds, added, remove supernatant, repetitive operation 3 times; The antibody-solutions that step 3 is obtained joins in above-mentioned magnetic bead, mixes rear room temperature reaction 4 hours;
6, add 37 ℃ of the TRIS solution 15 minutes of 0.3ml 1mol/L;
7, add 1.5ml PH 7.20.1mol/L PB to clean the magnetic bead of mark at every turn, mix 30 seconds, added, remove supernatant, repetitive operation 3 times;
8, preserve liquid with 100ml magnetic bead magnetic bead is proceeded to 125ml vial; It is 0.1%BSA that magnetic bead is preserved formula of liquid (mass volume ratio), 0.05% Tween-20,0.02%NaN3,20% ethanol, 4 ℃ of preservations.
9, magnetic separation agent magnetic bead buffer solution step 8 being obtained mixes according to the volume ratio of 1: 1, obtains magnetic separation agent in kit of the present invention; Described magnetic bead buffer solution is that concentration is the TRIS-HCl damping fluid of 1mol/L.
Second step: enzyme labelled antibody preparation process:
1,2.5mg glycosylated hemoglobin monoclonal antibody is dissolved in the N of 1.0ml, in dinethylformamide, add 10mg/ml horseradish peroxidase aqueous solution and the 1.3mg carbodiimides of 1ml, after 1 hour, the carbodiimides of 1.0ml 20mg/ml is added, potpourri constantly stirs, and 4 ℃ are spent the night;
2, the solution of step 1 is packed in bag filter, to the PH7.4PBS dialysis of 0.15M, 4 ℃ are spent the night, and collect and retain liquid; Then adding 10ml concentration is the BSA solution of 15mg/ml, and 4 ℃ store for future use; Finally the horseradish peroxidase of collecting is mixed with the volume ratio of 1: 1000 with enzyme labelled antibody dilution with the conjugate of glycosylated hemoglobin monoclonal antibody, obtain enzyme labelled antibody; Described enzyme labelled antibody dilution is that concentration is the TRIS-HCl damping fluid of 1mol/L.
The 3rd step: reinforcing agent preparation steps:
1, take TRIS1.56g and NaCl 4.23g in 1L container; With pipettor by Proclin-300 measure 0.2ml in the beaker of 10ml purified water completely dissolve after, pour in above-mentioned 1L container;
2, measure 800ml purified water in above-mentioned 1L container with graduated cylinder, fully stir, adjust PH until dissolve completely, control PH between 7.35-7.45;
3, take Mak330.9g in above-mentioned 1L container; Last constant volume 1000ml, after dissolving completely, with the filtration of 0.2um filter.
The 4th step:
The preparation of calibration object and the product of control:
Calibration object concentration is respectively 50,100,200,400,800ng/ml; Control product concentration is respectively 100,400ng/ml.
The 5th step:
Cleaning concentrate preparation steps, preparation 1L:
1, take TRIS 12.54g and NaCl 325.6g in 1L container;
2, after taking 5g Tween-20 and adding 20ml water in 100ml container it is dissolved completely, pour in above-mentioned 1L container;
3, with pipettor by Proclin-300 measure 0.2ml in the beaker that fills 10ml purified water completely dissolve after, pour in above-mentioned 1L container;
4, measure 800ml purified water in above-mentioned 1L container with graduated cylinder, fully stir, until dissolve completely;
5, adjust PH, control its scope between 7.35-7.45;
6, last constant volume 1000ml, filters and get final product with 0.2um filter after dissolving completely.
The 6th step:
Substrate preparation steps, preparation 1L:
1, take TRIS 2.35g, NaCl 6.41g, Na 2sO 30.002g and Proclin-3000.2ml are in 1L beaker;
2, measure 600ml purified water in 1L beaker with graduated cylinder, fully stir, until dissolve completely, adjust PH, control its scope between 7.95-8.05;
3, add after 250ml Lumi-Phos 530, filter and collect filtrate with 0.2um filter, be settled to 1000ml by purified water, after mixing and get final product.
Main innovation part of the present invention is:
Type ii diabetes clinical case management system for monitoring of the present invention can detect diabetic's glycosylated hemoglobin index simply and effectively, thus monitoring patient's recovery situation, and regulate medication.
Management system for monitoring of the present invention kit used combines chemiluminescence with immune magnetic particle, a kind of reaction system that approaches homogeneous phase is provided, compared with prior art, kit preparation technology simple possible of the present invention, there is higher detection sensitivity and specificity, experimental result is effectively stable, and has reached preferably performance parameter.
Embodiment
Embodiment 1,
One, the preparation process of magnetic separation agent:
1,1.0mg disuccinimidyl suberate is dissolved in 50ul DMSO, get in the 0.1mol/L PB damping fluid that 2mg glycosylated hemoglobin monoclonal antibody (Santa Cruz company product) is dissolved in PH 9.5 to cumulative volume be 1ml;
2, join in the antibody-solutions of step 1 with the disuccinimidyl suberate that liquid-transfering gun is drawn in step 1, put room temperature 90min;
3, the solution of step 2 is joined in Centricon-10 concentration tube, then put in high speed freezing centrifuge under 3000g concentrated 30min to volume be 0.5ml;
4, get 0.5ml magnetic bead, add in 5ml reaction cup, put into test tube rack special, after 2 minutes, draw supernatant through magnet adsorption;
Magnetic bead is the conventional magnetic bead in this area, preferred concentration 25mg/mL, and diameter is 800nm.
5, add 1.5ml PH9.50.1mol/L PB at every turn, mix 30 seconds, added, remove supernatant, repetitive operation 3 times; The antibody-solutions that step 3 is obtained joins in above-mentioned magnetic bead, mixes rear room temperature reaction 4 hours;
6, add 37 ℃ of the TRIS solution 15 minutes of 0.3ml 1mol/L;
7, add 1.5ml PH 7.20.1mol/L PB to clean the magnetic bead of mark at every turn, mix 30 seconds, added, remove supernatant, repetitive operation 3 times;
8, preserve liquid with 100ml magnetic bead magnetic bead is proceeded to 125ml vial; It is 0.1%BSA that magnetic bead is preserved formula of liquid (being mass volume ratio), 0.05% Tween-20,0.02%NaN3,20% ethanol, 4 ℃ of preservations.
9, solution step 8 being obtained mixes according to the volume ratio of 1: 1 by magnetic bead buffer solution, obtains magnetic separation agent in kit of the present invention; Described magnetic bead buffer solution is that concentration is the TRIS-HCl damping fluid of 1mol/L.
Embodiment 2
One, the preparation process of enzyme labelled antibody:
1,2.5mg glycosylated hemoglobin monoclonal antibody is dissolved in the N of 1.0ml, in dinethylformamide, add 10mg/ml horseradish peroxidase aqueous solution and the 1.3mg carbodiimides of 1ml, after 1 hour, the carbodiimides of 1.0ml 20mg/ml is added, potpourri constantly stirs, and 4 ℃ are spent the night;
2, the solution of step 1 is packed in bag filter, to the PH7.4PBS dialysis of 0.15M, 4 ℃ are spent the night, and collect and retain liquid; Then adding 10ml concentration is the BSA solution of 15mg/ml, and 4 ℃ store for future use; Finally the horseradish peroxidase of collecting is mixed with the volume ratio of 1: 1000 with enzyme labelled antibody dilution with the conjugate of glycosylated hemoglobin monoclonal antibody, obtain enzyme labelled antibody; Described enzyme labelled antibody dilution is that concentration is the TRIS-HCl damping fluid of 1mol/L.
Embodiment 3
Reinforcing agent preparation steps:
1, take TRIS1.56g and NaCl 4.23g in 1L container; With pipettor by Proclin-300 measure 0.2ml in the beaker of 10ml purified water completely dissolve after, pour in above-mentioned 1L container;
2, measure 800ml purified water in above-mentioned 1L container with graduated cylinder, fully stir, adjust PH until dissolve completely, control PH between 7.35-7.45;
3, take Mak330.9g in above-mentioned 1L container; Last constant volume 1000ml, after dissolving completely, with the filtration of 0.2um filter.Mak33 is the commercial reagent of Roche Holding Ag.
Embodiment 4
The preparation steps of calibration object and the product of control:
1, peak: maximum concentration point is X, impact point concentration is A, B, C, D, E, F, while preparing the solution of V volume, need add the volume of raw material for being respectively:
Concentration Add calibration object dilution volume Add X volume
A V-A*V/X A*V/X
B V-B*V/X B*V/X
C V-C*V/X C*V/X
D V-D*V/X D*V/X
E V-E*V/X E*V/X
F V-F*V/X F*V/X
2,, in glycosylated hemoglobin (glycosylated hemoglobin) immue quantitative detection reagent box, glycosylated hemoglobin antigen calibration object raw material (being purchased from Santa Cruz company) is mixed with by purified water that concentration point is 50,100,200,400,800ng/ml; Control product with the concentration point of purified water preparation be 100,400ng/ml.
3, after dissolving completely, post label in 2-8 ℃ of refrigeration house storage, the term of validity is 12 months.
Embodiment 5:
Concentrate preparation steps:
1, take TRIS 12.54g and NaCl 325.6g in 1L container;
2, after taking 5g Tween-20 and adding suitable quantity of water in 100ml container it is dissolved completely, pour in said vesse;
3, with pipettor by Proclin-300 measure 0.2ml in the beaker that fills 10ml purified water completely dissolve after, pour in above-mentioned 1L container;
4, measure 800ml purified water in above-mentioned 1L container with graduated cylinder, fully stir, until dissolve completely;
5, adjust PH with HCL or NaOH, measure its scope between 7.35-7.45;
6, last constant volume 1000ml, surveys pH value, and scope meets the requirements between 7.35-7.45, after dissolving completely, filters with 0.2um filter; After having filtered, post label in 2-8 ℃ of refrigeration house storage, the term of validity is 12 months;
Embodiment 6
Substrate formulation operations step:
1, take TRIS 2.35g, NaCl 6.41g, Na 2sO 30.002g and Proclin-3000.2ml are in 1L beaker;
2, measure 600ml purified water in 1L beaker with graduated cylinder, fully stir, until dissolve completely; With HCl or NaOH tune PH, measure its scope between 7.95-8.05;
3, add after 250ml Lumi-Phos 530, filter and collect filtrate with 0.2um filter, be settled to 1000ml by purified water, after mixing, post label in 2-8 ℃ of refrigeration house storage, the term of validity is 12 months.
The using method of Case monitoring management system of the present invention is as follows:
1, adopt blood sampling device to get blood to patient and obtain detection sample;
2, add 15 μ l glycosylated hemoglobin calibration objects, control product, detect sample to corresponding test tube bottom;
3, add 30 μ l enzyme labelled antibodies, 30 μ l reinforcing agents and 30 μ l magnetic separation agents to each test tube;
4, cover test tube with plastic sheeting, multitube vortex mixer after tube shaken frame 30s, is put 37 ℃ of water-baths 30 minutes gently.
5, test tube frame linking is put to magnetic separator, guarantees that every test tube all contacts with separator surface, precipitates 2 minutes, and the separation vessel that then reverses is slowly poured out supernatant.
6, concentrate is with after 20 times of purified water dilutions, adds concentrate after 200 μ l dilutions to each test tube, puts on multitube vortex mixer vibration gently and mixes 30s.When application of sample, should avoid application of sample dynamics excessive and cause magnetic bead to spill.Mix and want thoroughly.
7, add 200 μ l substrates and mix 3 seconds to test tube, detect with ready luminous detector rapidly.
Clinical testing:
Case: type ii diabetes patient 90 examples of the People's Hospital of city clinical definite, male 59 examples, female's 31 examples.Wherein, patient's fasting blood-glucose FPG >=7.0mmol/L, is defined as on an empty stomach empty calory at least 8 hours and takes in; 2h blood sugar >=11.1mmol/L when oral glucose tolerance test.
Testing result: as follows by the detection that utilizes type ii diabetes clinical case management system for monitoring provided by the invention to carry out glycosylated hemoglobin to above-mentioned 90 routine patients:
Figure BSA00000628965200071
Can determine patient's administering mode according to above-mentioned saccharification hemoglobin content ,≤6.5% patient can temporarily not take any medicine, adopts diet control, and check in each week once; >=6.5% and≤8.5% patient can adopt diet and oral antidiabetic drug to control, check is once week about; >=8.5% patient advises adopting the scheme of insulin injection treatment.It should be noted that physiological condition singularity and the otherness individual according to some, above-mentioned administering mode might not be suitable for all patients.
Although above the present invention is described in detail with a general description of the specific embodiments, on basis of the present invention, can make some modifications or improvements it, this will be apparent to those skilled in the art.Therefore, these modifications or improvements without departing from theon the basis of the spirit of the present invention, all belong to the scope of protection of present invention.

Claims (1)

1. a type ii diabetes clinical case management system for monitoring, is characterized in that, described management system for monitoring comprises blood sampling device and glycosylated hemoglobin pick-up unit; Described blood sampling device is venous detaining needle or blood collecting pen; Described glycosylated hemoglobin pick-up unit is glycosylated hemoglobin detection kit, and described kit comprises glycosylated hemoglobin magnetic separation agent, enzyme labelled antibody, reinforcing agent, calibration object, control product, concentrate and substrate;
Described kit is prepared in accordance with the following steps:
The first step: the preparation process of magnetic separation agent:
1) 1.0mg disuccinimidyl suberate is dissolved in 50 μ LDMSO, get in the 0.1mol/L PB damping fluid that the anti-glycosylated hemoglobin monoclonal antibody of 2mg is dissolved in pH9.5 to cumulative volume be 1mL;
2) join step 1 with the disuccinimidyl suberate that liquid-transfering gun is drawn in step 1) antibody-solutions in, put room temperature 90min;
3) by step 2) solution that obtains join in concentration tube, then put in high speed freezing centrifuge under 3000g concentrated 30min to volume be 0.5mL;
4) get 0.5mL magnetic bead, add in 5mL reaction cup, put into test tube rack, after 2 minutes, draw supernatant through magnet adsorption;
5) add step 3) obtain solution in above-mentioned magnetic bead, mix rear room temperature reaction 4 hours;
6) add 37 ℃ of the Tris solution 15 minutes of 0.3mL1mol/L;
7) add the PB of 1.5mL pH7.20.1mol/L to clean the magnetic bead of mark, mix 30 seconds, added, remove supernatant;
8) preserve liquid with 100mL magnetic bead magnetic bead is proceeded to 125mL vial; It is 0.1%BSA that magnetic bead is preserved formula of liquid, 0.05%Tween-20,0.02%NaN 3, 20% ethanol;
9) by step 8) obtain solution mix according to the volume ratio of 1: 1 by magnetic bead buffer solution, obtain magnetic separation agent; Described magnetic bead buffer solution is that concentration is the Tris-HCl damping fluid of 1mol/L;
Second step: enzyme labelled antibody preparation process:
1) 2.5mg glycosylated hemoglobin monoclonal antibody is dissolved in the N of 1.0mL, in dinethylformamide, add 10mg/mL horseradish peroxidase aqueous solution and the 1.3mg carbodiimides of 1mL, after 1 hour, the carbodiimides of 1.0ml20mg/mL is added, potpourri constantly stirs, and 4 ℃ are spent the night;
2) by step 1) solution pack in bag filter, to the pH7.4PBS dialysis of 0.15M, 4 ℃ are spent the night, and collect and retain liquid; Then adding 10mL concentration is the BSA solution of 15mg/mL, and 4 ℃ store for future use; Finally above-mentioned solution is mixed with the volume ratio of 1: 1000 with enzyme labelled antibody dilution, obtain enzyme labelled antibody; Described enzyme labelled antibody dilution is that concentration is the Tris-HCl damping fluid of 1mol/L;
The 3rd step: reinforcing agent preparation steps:
1) take Tris1.56g and NaCl4.23g in 1L container; With pipettor by Proclin-300 measure 0.2mL in the beaker of 10mL purified water completely dissolve after, pour in above-mentioned 1L container;
2) measure 800mL purified water in above-mentioned 1L container with graduated cylinder, fully stir, until dissolve completely, adjust pH between 7.35-7.45;
3) take Mak330.9g in above-mentioned 1L container; Last constant volume 1000mL, after dissolving completely, with 0.2 μ m filter filtration; The 4th step:
The preparation of calibration object and the product of control:
Glycosylated hemoglobin antigen is made into concentration is respectively 50,100,200,400, the calibration object of 800ng/mL; Glycosylated hemoglobin antigen is made into concentration is respectively 100, the control product of 400ng/mL;
The 5th step:
Concentrate preparation steps, preparation 1L:
1) take Tris12.54g and NaCl325.6g in 1L container;
2) after taking 5g Tween-20 and adding 20mL water in 100mL container it is dissolved completely, pour in above-mentioned 1L container;
3) with pipettor by Proclin-300 measure 0.2mL in the beaker that fills 10mL purified water completely dissolve after, pour in above-mentioned 1L container;
4) measure 800mL purified water in above-mentioned 1L container with graduated cylinder, fully stir, until dissolve completely;
5) adjust pH, control its scope between 7.35-7.45;
6) last constant volume 1000mL, filters and get final product with 0.2 μ m filter after dissolving completely.
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CN104897589B (en) * 2015-06-02 2017-05-31 中国农业科学院兰州畜牧与兽药研究所 A kind of qualitative assessment medicine hemolytic refers to calibration method
CN108226481A (en) * 2018-01-08 2018-06-29 宁波紫园医疗器械有限公司 A kind of magnetic bead reagent for chemiluminescence immunoassay detection reagent
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