CN113768587A - Intraspinal analgesia catheter implantation system for treating refractory cancer pain - Google Patents
Intraspinal analgesia catheter implantation system for treating refractory cancer pain Download PDFInfo
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Images
Classifications
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/34—Trocars; Puncturing needles
- A61B17/3401—Puncturing needles for the peridural or subarachnoid space or the plexus, e.g. for anaesthesia
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M19/00—Local anaesthesia; Hypothermia
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/06—Body-piercing guide needles or the like
- A61M25/0662—Guide tubes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/06—Body-piercing guide needles or the like
- A61M25/0662—Guide tubes
- A61M2025/0681—Systems with catheter and outer tubing, e.g. sheath, sleeve or guide tube
Abstract
The invention belongs to the technical field of medical treatment, and particularly relates to a vertebral canal analgesia catheter implantation system for treating refractory cancer pain. The implantation system comprises a puncture needle externally sleeved with a sleeve; a guidewire that can be placed within the cannula; a vascular sheath into which the guidewire can be placed; the dilating tube can be internally arranged inside the vascular sheath and internally provided with the guide wire; a PICC tube that can be built into the vascular sheath; the intrathecal analgesic and analgesic device adopts high-grade medical silica gel, has excellent biocompatibility, is suitable for medium and long-term retention, adopts a three-way valve design, prevents cerebrospinal fluid from flowing back, reduces the tube blocking rate, greatly lightens the economic burden of patients, has exact intrathecal analgesic and analgesic effects, takes effect quickly, has small side effect, and has the dosage of analgesic drug which is only 1/300 of oral dosage. The method has the advantages of convenient operation, definite curative effect and small adverse reaction, greatly reduces the economic burden of patients, and is suitable for patients with advanced cancer pain.
Description
Technical Field
The invention belongs to the technical field of medical treatment, and particularly relates to a vertebral canal analgesia catheter implantation system for treating refractory cancer pain.
Background
Pain is a painful experience of sensory, emotional, cognitive and social components associated with actual or potential tissue damage. Cancer is one of the first diseases threatening human survival, and cancer pain (hereinafter referred to as "cancer pain") is one of the most common cancer-related symptoms. Cancer pain is pain caused by the tumor itself or related diseases, including cancer-related pain, cancer treatment-related pain, and pain caused by other reasons. Statistically, about 25% of the first-diagnosed cancer patients, 55% of the cancer patients undergoing treatment, and 66% of the advanced cancer patients have symptoms of cancer pain. Cancer pain not only affects the quality of life of patients, but persistent and acute intractable pain often causes serious psychological trauma to patients and their families, and meanwhile, long-term pain stimulation can cause pathological reconstruction of the central nervous system, leading to the progression and increasingly difficult control of pain diseases. The drug therapy is the most basic therapy method for cancer pain patients, most of the cancer pain patients are obviously controlled after being treated according to the three-step therapy principle, but 10-30% of cancer pain can not be effectively controlled by adopting the drug therapy, or cannot be treated by the drug due to adverse drug reactions.
The intrathecal analgesia is to inject the analgesic drug into the subarachnoid space and directly act on the spinal cord and the brain through the circulation of cerebrospinal fluid to generate the analgesic effect. In 1979 Wang et al obtained satisfactory therapeutic effects on cancer pain by first using morphine via subarachnoid intracavitary injection. The long-term analgesia can be realized through intrathecal continuous administration.
Currently, intrathecal drug delivery and infusion systems commonly used in clinic are divided into full-implantation type and semi-implantation type intrathecal drugs. The fully-implanted system has the advantages of low infection rate, high patient comfort, convenient management and the like, but has larger trauma, small medicine storage capacity and higher price, and most patients cannot bear the expensive cost. The semi-implanted system has small wound, large drug storage capacity and low cost, and is suitable for patients with advanced cancer pain with short expected life cycle. The intrathecal implantation drug infusion system has good clinical effect in treating late cancer pain at home and abroad in recent years, and has ideal curative effect on pain which cannot be relieved by drugs and other analgesic methods. But the price is expensive and the patient is difficult to bear. Aiming at the technical problems, the invention provides an intraspinal analgesia catheter implantation system for treating refractory cancer pain, which brings good news to cancer pain patients.
Disclosure of Invention
The invention provides an intraspinal analgesia catheter implantation system for treating refractory cancer pain, which comprises a puncture needle, a puncture needle and a catheter, wherein the puncture needle is externally sleeved with the puncture needle and is used for skin or blood vessel puncture; a guidewire that can be placed inside the cannula for guiding other access devices; a vascular sheath into which the guidewire can be placed; the expanding tube can be internally arranged in the vascular sheath and internally provided with the guide wire, is used for expanding a passage and is convenient for inserting a PICC (peripherally inserted central catheter) tube; the PICC tube which can be internally arranged in the vascular sheath is remained in a blood vessel or a vertebral canal and is used for sampling or medication; the puncture needle comprises a needle seat and a needle tube which are fixedly connected, wherein the needle seat is hollow and is communicated with the needle tube, the needle tube part is made of a metal material, and the needle seat part is made of a polyethylene material; the sleeve is made of polyethylene material, the inner diameter of the sleeve is larger than the outer diameter of the needle tube, the sleeve is nested on the needle tube of the puncture needle, the needle head of the puncture needle is exposed, and the tail part of the sleeve is detachably connected with the needle seat; the head of the guide wire is bent, the length of the guide wire is 10-50cm, and the guide wire is stored in a storage tube; the vascular sheath comprises a sheath seat, the tail end of the sheath seat is connected with a connecting pipe, the head end of the sheath seat is fixedly connected with a sheath pipe, and the connecting pipe is communicated with the sheath pipe and the sheath seat; the expansion pipe comprises an expansion pipe seat and an expansion pipe body, the expansion pipe seat is fixedly connected with the expansion pipe body, the outer diameter of the expansion pipe body is smaller than the inner diameter of the vascular sheath pipe, and the length of the expansion pipe body is 5-10mm longer than that of the vascular sheath pipe; the PICC pipe form by silica gel preparation, the external diameter is less than the internal diameter of vascular sheath pipe, silica gel be senior medical silica gel, biocompatibility is splendid, is suitable for middle and long term to keep somewhere.
Preferably, the guide wire is a medical guide wire.
Preferably, the insertion system further comprises a tunnel puncture needle, a connecting piece and a fixing device; the fixing device is a STATCOMK fixing device, the tunnel puncture needle is a medical puncture needle, and the connecting pieces are medical connecting pieces and are all conventional medical instruments. Utilize above-mentioned device to establish subcutaneous tunnel, will PICC pipe along subcutaneous tissue to pierce to the flank portion to the left back outside of the back to reduce the infection.
Preferably, the length of the guide wire is 20-30 cm.
Preferably, the guide wire is 25cm in length.
Preferably, the PICC pipe be three-way valve PICC pipe, can prevent that cerebrospinal fluid from backflowing, reduce stifled tub of rate.
The invention has the beneficial effects that:
the invention adopts a method that a three-way valve PICC tube is adopted to carry out the connection of an intrathecal catheter and an electronic PCA pump, adopts high-grade medical silica gel, has excellent biocompatibility, is suitable for medium and long-term retention, adopts a three-way valve design, prevents the backflow of cerebrospinal fluid, reduces the tube blocking rate, is more convenient for a patient to take the catheter home, has the inner diameter of a PICC tube cavity of 0.033 and the gravity flow rate of 540ml/hr, is convenient to maintain, and completely meets the requirement of intrathecal administration.
Secondly, the method has convenient operation, definite curative effect and little adverse reaction, the cost is only 1/1000 of an imported full-implanted drug perfusion system, and the cost is 1/5 of an infusion port type semi-implanted infusion system, thereby greatly lightening the economic burden of patients and being suitable for being applied to patients with advanced cancer pain.
The intrathecal analgesia of the invention is to inject the analgesic drug into the subarachnoid space and directly act on the spinal cord and the brain through the cerebrospinal fluid circulation to generate the analgesic effect, and has the advantages of definite analgesic effect, quick effect taking, small side effect and the dosage of the analgesic drug which is 1/300 of the oral dosage.
The method has the advantages of convenient operation, definite curative effect, small adverse reaction, low cost of 1/1000 of an imported full-implanted drug perfusion system and 1/5 of an infusion port type semi-implanted infusion system, greatly lightens the economic burden of patients, and is suitable for patients suffering from late cancer pain.
Drawings
FIG. 1 is a schematic view of a puncture needle 1 with a cannula 2 fitted outside
FIG. 2 schematic representation of guidewire 3
FIG. 3 is a schematic view of the dilation tube 4
FIG. 4 schematic representation of vascular sheath 5
FIG. 5 schematic of a PICC tube 6
FIG. 6 schematic representation of the tunneling needle 7
FIG. 7 is a schematic view of a connection piece 8
Detailed Description
EXAMPLE one intraspinal analgesic catheter insertion System for treatment of refractory cancer pain
The invention provides an intraspinal analgesia catheter implantation system for treating refractory cancer pain, which comprises a puncture needle 1, a sleeve 2 and a catheter, wherein the puncture needle 1 is sleeved outside the puncture needle and is used for skin or blood vessel puncture; a guide wire 3 which can be built into the cannula for guiding other entering devices; a vascular sheath 5 into which the guidewire 3 can be placed; the expanding tube 4 can be internally arranged in the vascular sheath 5 and internally provided with the guide wire 3 and is used for expanding a passage so as to facilitate the insertion of a PICC (peripherally inserted central catheter) 6; the PICC tube 6 which can be internally arranged in the vascular sheath 5 is remained in a blood vessel or a vertebral canal and is used for sampling or medication; the puncture needle 1 comprises a needle seat and a needle tube which are fixedly connected, wherein the needle seat is hollow and is communicated with the needle tube, the needle tube is made of a metal material, and the needle seat is made of a polyethylene material; the sleeve 2 is made of polyethylene material, the inner diameter of the sleeve is larger than the outer diameter of the needle tube, the sleeve is nested on the needle tube of the puncture needle, the needle head of the puncture needle is exposed, and the tail part of the sleeve is detachably connected with the needle seat; the head of the guide wire 3 is bent, the length is 10-50cm, and the guide wire is stored in a storage tube; the vascular sheath 5 comprises a sheath seat, the tail end of the sheath seat is connected with a connecting pipe, the head end of the sheath seat is fixedly connected with a sheath pipe, and the connecting pipe is communicated with the sheath pipe and the sheath seat; the expansion pipe 4 comprises an expansion pipe seat and an expansion pipe body, the expansion pipe seat is fixedly connected with the expansion pipe body, the outer diameter of the expansion pipe body is smaller than the inner diameter of the vascular sheath pipe, and the length of the expansion pipe body is 5-10mm longer than that of the vascular sheath pipe; PICC pipe 6 form by silica gel preparation, the external diameter is less than the internal diameter of vascular sheath pipe, silica gel be senior medical silica gel, biocompatibility is splendid, is suitable for middle and long term to keep somewhere. The guide wire 3 is a medical guide wire. The implantation system also comprises a tunnel puncture needle 7, a connecting piece 8 and a fixing device; the fixing device is a STATCOMK fixing device, the tunnel puncture needle is a medical puncture needle, and the connecting pieces are medical connecting pieces and are all conventional medical instruments. A subcutaneous tunnel is established by using the device, and the PICC tube 6 is punctured into the flank along the subcutaneous tissue to the left back and the outer side of the back so as to reduce infection. The length of the guide wire 3 is 25 cm. PICC pipe 6 be three-dimensional valve PICC pipe, can prevent the cerebrospinal fluid reflux, reduce stifled tub rate.
EXAMPLE two methods of Using an intraspinal analgesic catheter insertion System for treatment of refractory cancer pain
(1) Selecting a puncture point, and conventionally disinfecting and paving a towel, wherein the puncture point is subjected to local infiltration anesthesia;
(2) cutting a 3mm incision by using a sharp blade, separating subcutaneous tissues in a blunt manner, successfully puncturing the puncture needle 1 sleeved with the sleeve 2 at the outer part to a subarachnoid cavity under the guidance of C-arm fluoroscopy, and leading cerebrospinal fluid to flow smoothly after the puncture needle 1 is pulled out;
(3) a guide wire 3 is placed in the sleeve 2, the sleeve 2 is withdrawn, the vascular sheath 5 and the expansion tube 4 are placed in the sleeve 3, the guide wire 3 and the expansion tube 4 are withdrawn, and 1ml of iodixanol is injected into the vascular sheath 5 to confirm that the head end of the vascular sheath 5 is positioned in the subarachnoid cavity;
(4) the PICC tube 6 is arranged at the tail end of the vascular sheath 5, the head end is arranged at the level of the thoracic 11 vertebral body, the PICC tube 6 is reserved, and the vascular sheath 5 is withdrawn;
(5) the method comprises the following steps of performing subcutaneous infiltration anesthesia along a puncture point by using 0.5% lidocaine, penetrating a tunnel puncture needle 7 into a flank part along the outer side of the left back part along subcutaneous tissues in a puncture point incision to penetrate out the skin, withdrawing a needle core, placing a guide wire 3 into a puncture needle sleeve, withdrawing the tunnel puncture needle 7, placing a vascular sheath 5 to an incision of the puncture point between spinous processes in a retrograde manner along the outer side of the guide wire, withdrawing the guide wire 3 and an expansion tube 4, leading a PICC (peripherally inserted central catheter) tube 6 to the outer side of the flank wall through the vascular sheath 5, reserving the PICC tube 6, withdrawing the vascular sheath 5, connecting a tail end connecting piece 8, locally pasting and suturing, and fixing a STATLOCK fixing device.
EXAMPLE III example of an intraspinal analgesic catheter insertion System for treatment of refractory cancer pain
The inventor utilizes the implantation system of the invention to continuously pump morphine into 1 case of patients with advanced cancer pain, the treatment effect is good, and the specific operation is as follows:
the patient female, 57 years old, has self-complaint of abdominal, pelvic and lumbosacral refractory pain for 6 months, aggravates for 2 months, receives, confirms diagnosis of cervical malignant tumor 1 year ago, and is given systemic chemotherapy and radiotherapy in the oncology department. The patient complains about intractable pain of the abdomen, the pelvic cavity and the lumbosacral part, the pain is continuous distending pain, the VAS score is 8-10, the sleep and diet are not good, and the imaging examination prompts: cervical occupancy is associated with multiple bone metastases. The oxycodone hydrochloride sustained release tablets are orally taken 320mg every day, the analgesic effect is poor, and mild nausea and severe constipation are caused after the oxycodone hydrochloride sustained release tablets are taken. Physical examination: the patients have haggard spirit, emaciation, irregular lumps in the small abdomen, poor mobility, obvious tenderness in the small abdomen, lumbosacral part and iliac part, and limited turning and movement.
1. Preoperative preparation: the routine examination before operation shows that the liver and kidney function, the blood routine and the blood coagulation have no obvious abnormality, and the MRI examination of the lumbar vertebra does not occupy space in the excluded vertebral canal.
2. Materials: the intraspinal analgesic catheter implantation system
3. The operation mode is as follows: the patient is fasted for 4 hours before operation, and the right side lying position is adopted in the operation to monitor blood pressure, pulse, respiration, dynamic electrocardiogram and oxygen saturation and establish a venous channel. Selecting L4-5 spinous process gap as a puncture point, conventionally disinfecting and paving the towel, wherein the puncture point uses 5% lidocaine as local infiltration anesthesia, a sharp blade is used for cutting an incision by 3mm, hypodermically separating, under the guidance of C-arm fluoroscopy, the puncture needle 1 with the outer sleeve 2 is successfully punctured to a subarachnoid cavity, after the puncture needle 1 is pulled out, cerebrospinal fluid backflow is smooth, the guide wire 3 is placed through the sleeve 2, the sleeve 2 is withdrawn, the 6F radial artery vascular sheath 5 and the expansion tube 4 are placed through the guide wire 3, the guide wire 3 and the expansion tube 4 are withdrawn, 1ml of iodixanol is injected through the vascular sheath 5 to confirm that the head end of the vascular sheath 5 is positioned in the subarachnoid cavity, the PICC tube 6 is placed through the tail end of the vascular sheath 5, the head end is placed at the level of the thoracic 11 vertebral body, the PICC tube 6 is reserved, and the vascular sheath 5 is withdrawn.
The method comprises the steps of performing subcutaneous infiltration anesthesia along a puncture point by using 0.5% lidocaine along the left back, penetrating into the lateral abdominal part along the left back outer side along subcutaneous tissues in a puncture point incision by using an 18G15cm tunnel puncture needle 7, penetrating out of the skin, establishing a subcutaneous tunnel, withdrawing a needle core, placing a guide wire 3 into a puncture needle sleeve through the tunnel, withdrawing the tunnel puncture needle sleeve, placing a 6F vascular sheath 5 to an interspinous puncture point incision along the guide wire 3 in a retrograde manner along the outer side, withdrawing the guide wire 3 and an expansion tube 4, leading a PICC (peripherally inserted catheter) 6 to the lateral abdominal wall outer side through the vascular sheath, reserving the PICC 6, withdrawing the vascular sheath 5, and locally sticking, suturing and fixing the tail end. And then carrying out drug titration, wherein the patient orally takes 320mg of oxycodone hydrochloride sustained release tablets per day, the converted morphine amount is 640mg, 1/300 is taken as intrathecal background infusion amount, the intrathecal morphine titration amount is not more than 2mg, and the injection is carried out in 5ml of subarachnoid cavity containing 0.5mg of morphine and physiological saline, the patient complaint pain can be relieved by 50% after 5 minutes, the patient has no uncomfortable symptoms after 15 minutes, then the injection is carried out in 5ml of morphine and physiological saline again in 0.5mg, and the patient complaint pain is completely relieved after 5 minutes of observation, and the intrathecal titration is completed.
4. The preparation of the medicine comprises the following steps: the morphine hydrochloride injection 100mg and bupivacaine 75mg are diluted to 250ml by 0.9% sodium chloride injection and injected into a micro electronic pump (electronic pump brand), the initial dose of the morphine is adopted according to the conversion dose (all the opium is converted into 24h oral morphine dose, 1/300 of the oral morphine dose is used as intrathecal background dose), the initial dose of the bupivacaine is 3-6 mg, 1/10 of single impact dose as background dose is set, and the locking time is 30 min. All opioid analgesics were discontinued after the start of intrathecal administration and intrathecal morphine and bupivacaine doses were adjusted for 24 hours depending on the patient's pain relief. The first 24 hours after intrathecal administration electrocardiographically monitoring vital signs.
5. The curative effect is as follows: pain of a patient receiving intrathecal administration is obviously relieved, the VAS score is 2-3, no respiratory depression, headache, nausea and vomiting, no urinary retention and skin itch are caused, lower limb sensation and dyskinesia are avoided, the pain is obviously relieved after the patient is discharged for 2 months, and the life quality is obviously improved.
Claims (7)
1. An intraspinal analgesic catheter implantation system for treating refractory cancer pain is characterized in that the implantation system comprises a puncture needle externally sleeved with a sleeve;
a guidewire that can be placed within the cannula;
a vascular sheath into which the guidewire can be placed;
the dilating tube can be internally arranged inside the vascular sheath and internally provided with the guide wire;
a PICC tube that can be built into the vascular sheath;
the puncture needle comprises a needle seat and a needle tube which are fixedly connected, wherein the needle seat is hollow and is communicated with the needle tube, the needle tube part is made of a metal material, and the needle seat part is made of a polyethylene material; the sleeve is made of polyethylene material, the inner diameter of the sleeve is larger than the outer diameter of the needle tube, the sleeve is nested on the needle tube of the puncture needle, the needle head of the puncture needle is exposed, and the tail part of the sleeve is detachably connected with the needle seat; the head of the guide wire is bent, the length of the guide wire is 10-50cm, and the guide wire is stored in a storage tube; the vascular sheath comprises a sheath seat, the tail end of the sheath seat is connected with a connecting pipe, the head end of the sheath seat is fixedly connected with a sheath pipe, and the connecting pipe is communicated with the sheath pipe and the sheath seat; the expansion pipe comprises an expansion pipe seat and an expansion pipe body, the expansion pipe seat is fixedly connected with the expansion pipe body, the outer diameter of the expansion pipe body is smaller than the inner diameter of the vascular sheath pipe, and the length of the expansion pipe body is 5-10mm longer than that of the vascular sheath pipe; the PICC pipe form by silica gel preparation, the external diameter is less than the internal diameter of vascular sheath pipe.
2. The intraspinal analgesic catheter insertion system as set forth in claim 1, wherein said guidewire is a medical guidewire.
3. The intraspinal analgesic catheter insertion system as set forth in claim 1, further including a tunneling needle, a connector, and a fixation device; the fixing device is a STATCOMK fixing device, the tunnel puncture needle is a medical puncture needle, and the connecting piece is a medical connecting piece.
4. The intraspinal analgesic catheter insertion system as set forth in claim 1, wherein said guidewire is 20-30cm in length.
5. The intraspinal analgesic catheter insertion system as claimed in claim 1, wherein said guidewire is 25cm in length.
6. The intravertebral analgesic catheter insertion system of claim 1, wherein the PICC tube is a three-way valve PICC tube.
7. The method of operating an intravertebral analgesic catheter insertion system of claim 1, wherein the method includes the steps of:
(1) selecting a puncture point, and conventionally disinfecting and paving a towel, wherein the puncture point is anesthetized;
(2) cutting an incision by using a sharp blade, separating subcutaneous tissues, successfully puncturing the puncture needle 1 externally sleeved with the sleeve 2 to a subarachnoid cavity under the guidance of C-arm fluoroscopy, and leading cerebrospinal fluid to flow smoothly after the puncture needle 1 is pulled out;
(3) a guide wire 3 is placed in the sleeve 2, the sleeve 2 is withdrawn, the vascular sheath 5 and the expansion tube 4 are placed in the sleeve 3, the guide wire 3 and the expansion tube 4 are withdrawn, and 1ml of iodixanol is injected into the vascular sheath 5 to confirm that the head end of the vascular sheath 5 is positioned in the subarachnoid cavity;
(4) the PICC tube 6 is arranged at the tail end of the vascular sheath 5, the head end is arranged at the level of the thoracic 11 vertebral body, the PICC tube 6 is reserved, and the vascular sheath 5 is withdrawn;
(5) the subcutaneous tunnel is established by the tunnel puncture needle 7, the guide wire 3 is placed in through the puncture needle sleeve, the tunnel puncture needle 7 is withdrawn, the vascular sheath 5 is placed in the incision of the puncture point between the spinous processes along the guide wire in the reverse direction through the outer side, the guide wire 3 and the expansion tube 4 are withdrawn, the PICC tube 6 is introduced to the outer side of the lateral abdominal wall through the vascular sheath 5, the PICC tube 6 is reserved, the vascular sheath 5 is withdrawn, the tail end is connected with the connecting piece 8, the local sticking suture is carried out, and the STATLOCK fixing device is fixed.
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