RU2548507C1 - Method of restoring muscular corset of cervical spine and device for its realisation - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: group of inventions relates to medicine, vertebrology, therapeutic exercise and rehabilitology. Vector traction of the cervical spine (CS) is carried out by means of a device which contains a set of loads, an armchair for a patient rotary with respect of the vertical axis with elements for the shoulder girdle fixation and skull traction tongs, connected with a load by means of a flexible pull, slung over a pulley. An initial weight is 0.5 kg, in a sitting position with fixation of the shoulder girdle, and simultaneously with traction performed are exercises, which include head movements to the side, opposite to the load action, and back, as well as the change of position relative to the applied loading, by turning the armchair with the patient around the vertical to a specified angle. Vector traction is carried out with the traction angle of 10-30° relative to the vertical. Movements of the head to the side, opposite to the load action, are performed to the straight line with the spine. All neck muscles are made work by performing the armchair rotation with a specified discreteness within the limits of its complete 360° turn, with the rigid fixation of the armchair position after each rotation. The device pulley is placed relative to the armchair in such a way that a section of the pull between the skull traction tongs, fixed on the head of the patient, sitting in the armchair, and the pulley forms a 10-30° angle with the vertical. The armchair is provided with a stop motion mechanism, providing the rigid fixation of an angular position of the armchair with the specified discreteness within the limits of its complete 360° turn, in any direction of rotation.EFFECT: group of inventions provides simple, effective and safe strengthening of the CS muscular corset, including cases of CS instability, protrusions and hernia of intervertebral discs, with the quality working out of all cervical muscles taking into account individual peculiarities of the patient's CS.12 cl, 3 dwg, 3 ex

Description

FIELD OF THE INVENTION

The invention relates to the field of medicine, vertebrology, physiotherapy and rehabilitation, and can be used to treat instability and osteochondrosis of the cervical spine, protrusions and hernias of the intervertebral discs, as well as to restore the muscular-ligamentous apparatus of the neck.

State of the art

The cervical spine is a complex anatomophysiological apparatus. In the neck there are many blood vessels and nerve endings. Improper mechanical action in this area can lead to serious consequences, which makes it difficult to use mechanical simulators in the treatment and restoration of the musculo-ligamentous apparatus of the neck. The use of simulators, on the one hand, should ensure the effectiveness of impact on a variety of muscle groups, including the deep muscles of the neck, and on the other hand, it should be safe and eliminate the risks of complications.

A known method of treating clinical forms of osteochondrosis (see patent RU 2122393, IPC: A61H 1/02, op. 11/27/1998), including the extension of the cervical spine, carried out using the Glisson loop, flexible traction and load, and simultaneously with the stretching exercise muscular -Ligament apparatus by alternating tension and relaxing the neck muscles, for which they use a special helmet with pillows, on which the patient presses his head, providing alternate workout of the muscles.

A known method of treating pathology of the spine, including the extension of the cervical spine using a head holder, flexible traction and load (patent RU 2249443, IPC: A61F 5/042, publ. 10.04.2005). Simultaneously with the traction, they train the muscles by turning the head left-right with muscle effort to the limit of mobility. After traction, the cervical region is fixed. The number of turns performed and the amount of cargo are increased weekly.

As in the previous analogue, performing exercises using your own deep muscles of the spine allows you to improve blood circulation to the working muscles and all affected tissues of the vertebral segment. At the same time, traction of the spine simultaneously with exercises allows you to remove compression from the intervertebral discs, increase the intervertebral foramen and release the most important compressed blood vessels and nerve pathways, thereby increasing the effectiveness of training, and relieving pain. However, performing only turns does not provide restoration of the entire muscle corset of the cervical spine.

Closest to the claimed is a method that is implemented when the device for the treatment and rehabilitation of the ligamentous-muscular apparatus of the neck, disclosed in patent RU 26413 U1, IPC: A61F 5/00, publ. 12/10/2002. The aforementioned method includes vector traction of the cervical spine, carried out using the Glisson loop, flexible traction and load in a sitting position with the fixation of the shoulder girdle, and simultaneously with stretching, performing exercises involving moving the head to the side opposite to the load and vice versa, as well as changing the position relative to the applied load by turning the chair with the patient around a vertical axis with repetition of exercises, which provides the opportunity to study the entire musculo-ligamentous apparatus (In a circle).

The known method cannot be used for the treatment of patients with serious pathology, such as instability of the cervical spine, which is caused by too large a traction angle exceeding the physiologically permissible, and uncontrolled execution of movements with too much amplitude. With spinal instability, such traction and exercises can lead to additional displacements in the hypermobile segment, provoke the appearance of transcendental displacements in adjacent segments, and also lead to other undesirable consequences.

Another significant disadvantage of this method is the lack of rigid fixation of the position of the chair, so that during exercise under the action of pulling loads, angular displacements of the chair are inevitable. As a result, it is impossible to clearly establish and distribute the load in relation to specific muscles. In such a "floating mode" the work is performed by those muscles that are stronger. Weak muscles are not involved, which means they are not strengthened during training.

The absence of strictly fixed positions of the chair makes it impossible to repeat exercises in the same positions, to repeat the biomechanics of movements, which does not allow for a quality study of the musculo-ligamentous apparatus.

A device is known for training neck muscles, comprising a seat, a Glisson loop and a cable block mechanism (see patent US 2003/0228955, IPC: A63B 23/025, publ. 12/11/2003). Simultaneously with performing exercises, for example, by tilting the head, the trainee exerts a traction effect on the spine, pulling with his hands a cable thrown over the block and secured with the second end to the Glisson loop worn on his head.

However, in this case it is impossible to accurately determine the angle of traction and to track the dose of the load applied to the spine, determined subjectively by the trainees themselves, which is possible only with a healthy spine. In the case of treatment of injuries of the cervical spine, accurate dosing of the load is required. In addition, with this training method, not only the muscles of the cervical spine are involved, but also the muscles of the shoulder girdle and back.

A device is known for treating the ligamentous-muscular apparatus of various parts of the body (see patent RU 2056815, IPC: A61F 5/01, publ. 03/27/1996), containing a base with a rack and an exhaust mechanism, including a Glisson loop connected sequentially by a flexible rod through the guide blocks , vibrator and counterweight with load.

The device allows you to accurately dose the applied load due to the selection of the weight of the cargo. Vibrational effect, which is exerted simultaneously with stretching, promotes muscle training, however, this is a passive training and it is not enough to obtain a strong muscle corset.

A device for dosed stretching of joints is known, comprising a chair for the patient and a head holder made according to the Glisson loop type and connected to the point of force application (load) by means of a flexible rod thrown over the block (see patent RU 2100987, IPC: A61F 5/01, publ. 10.01.1998). The block is mounted on a rack by means of a “hinged suspension”, which provides the ability to move the block in three coordinates relative to the head holder and fix the position along each of the coordinates. By moving the block, the angle of application of force (traction angle) is set, the position of the flexible rod is measured by means of goniometers. However, said device only provides traction of the cervical spine. The stand carrying the block is rigidly fixed to the back of the chair and the patient can perform head exercises only in one position relative to the load. In this case, it is impossible to work out the entire musculo-ligamentous apparatus of the neck.

As the closest analogue in the presence of signs similar to the essential features of the claimed technical solution, a device for the treatment and rehabilitation of the ligamentous-muscular apparatus of the neck is disclosed in the utility model patent RU 26413, IPC: A61F 5/00, publ. 12/10/2002. Said device comprises a rack, a set of weights, a chair for the patient swiveling relative to the vertical axis with elements of fixation of the shoulder girdle and a device like the Glisson loop made with the possibility of fastening on the patient’s head and connected to the load (the weight of which is adjustable) by means of a flexible rod thrown over the fixed on the rack block.

One significant drawback of the closest analogue is too large, despite the possibility of its regulation, the traction angle exceeding the physiologically permissible.

Another significant drawback is the lack of strictly fixed positions of the chair, which makes it impossible to repeat the biomechanics of movements, and the lack of rigid fixation of the chair during the exercise, which does not allow for a quality study of all the muscles of the musculo-ligamentous apparatus of the neck.

These shortcomings do not allow the use of the known device for the treatment of patients with serious pathology, for example, in case of instability of the cervical spine, hernias, protrusions.

Disclosure of invention

The technical problem to which the present invention is directed is to develop an effective and safe way to strengthen the muscular corset of the cervical spine, which could be effectively used to treat such complex diseases as instability of the cervical spine, hernia and protrusion of the intervertebral discs, as well as simple and easy to use simulator, on which this method can be implemented.

The mentioned technical problem is solved due to the fact that in the method of restoring the muscular corset of the cervical spine, including vector traction of the cervical spine, carried out using the Glisson loop, flexible traction and weight, in a sitting position with fixation of the patient’s shoulder girdle, and simultaneously with the exercise including head movements in the direction opposite to the action of the load and vice versa, as well as a change in position relative to the applied load by turning the chair with the patient g of the vertical axis at a predetermined angle, and the repetition of exercises according to the claimed invention, vector traction is carried out with a traction angle of 10-30 ° relative to the vertical, the head moves in the opposite direction to the load, is carried out to a straight line with the spinal column, work out all the muscles of the neck, performing rotations of the chair with a given discreteness within its full rotation of 360 °, while rigidly fixing the position of the chair after each turn.

The aforementioned method is carried out using a device for the restoration of a muscular corset of the cervical spine containing a set of weights, a chair for the patient swiveling relative to the vertical axis with elements of fixation of the shoulder girdle and a Glisson loop connected to the load by means of a flexible rod thrown through the block. According to the claimed invention, the block is placed relative to the chair so that the traction section between the Glisson loop fixed on the head of the patient sitting in the chair and the block forms an angle of 10-30 ° with the vertical, while the chair is equipped with a locking mechanism that provides rigid fixation of the angular position of the chair with given discreteness within its full rotation of 360 °, for any direction of rotation of the chair.

The term “Glisson loop”, originally designating a specific product, is currently used as a species name, covering a number of products having a different design, but united by a common purpose and performing the function of a fixed holding of a person’s head when performing traction or weight training.

In the formula, the term “Glisson loop” is used precisely as the specific name of the head holder, which can have any design that ensures its purpose.

A positive technical result achieved using the present invention is the high safety and efficiency of the proposed method and device, which allows them to be used to treat instability of the cervical spine, protrusions and hernias of the intervertebral discs and in other complex cases.

Another positive aspect of the present invention is the simplicity of the proposed method and device, accessibility for understanding, the ability to perform exercises by the patient himself under the supervision of a doctor.

In the proposed method, as in well-known analogues, traction (traction) of the cervical spine is carried out simultaneously with the exercises, which allows you to remove compression from the vertebrae before training, thereby facilitating, and for complex cases, providing the ability to perform exercises.

As in the closest analogue, the patient’s head under the influence of the load initially deviates by a predetermined angle, which is the angle of traction, and this position is the starting point for the exercises.

Unlike the closest analogue, in the proposed method of moving the head in the direction opposite to the action of the load, carry out only up to a straight line with the spinal column. By “straight line” is meant a line conditionally drawn through the spine. In other words, the exercise is performed until the cervical spine returns to its normal physiological state, in which it is located on the same conditional line with the rest of the spine.

Such a movement of the head, on the one hand, is enough for muscle training, and on the other hand, ensures the safety of exercises and avoids undesirable side effects that are possible in case of over-extension of the spine.

Thus, in the proposed solution, the angle of traction also sets the range of movements made by the head. The traction angle is 10-30 ° relative to the vertical, it is fixed and originally laid in the design of the simulator.

An angle of traction ranging from 10 to 30 ° is sufficient and optimal for training and strengthening the muscular corset of the cervical spine, which was revealed as a result of many years of experience and clinical studies.

An angle of traction of less than 10 ° will not provide a sufficient range of movements for muscle training; muscles will not be worked out along the entire length.

The maximum angle of 30 ° is established on the basis of the physiological capabilities of a person and taking into account the fact that in sick people with injuries in the cervical spine, the amount of free movement is reduced. The large range of movements obtained with a traction angle of more than 30 ° can lead to pain and impaired blood circulation with subsequent undesirable consequences.

Another significant distinguishing feature of the proposed solution is that the rotation of the chair with the patient is performed with a given discreteness, carrying out rigid fixation of the chair after the rotation. To do this, the chair is equipped with a special locking mechanism that blocks the chair from turning, providing stability of the chair relative to the load application vector in strictly specified positions.

Due to the rigid fixation of the patient in relation to the load (fixing the chair and fixing the patient in the chair), all necessary muscles of the neck are involved in the process of flexion and extension during the exercise. Moreover, in different, relative to the load, positions the same muscles work differently, each receiving its own share of the load. Changing the position of the chair relative to the load, provide for the study of all the muscles of the neck (in a circle).

Thus, the application of the proposed method and device allows to ensure high-quality recovery of the entire muscle corset of the cervical spine and at the same time ensure proper patient safety.

Discreteness of rotation is determined by the design of the locking mechanism of the chair and determines the number of fixed positions of the chair for one full revolution (360 °).

Discreteness of rotation, determined by the angle of rotation between two fixed positions of the chair, is selected taking into account the anatomical features of the musculo-ligamentous apparatus of the neck.

In the preferred case of the implementation of the proposed solution, the discreteness of rotation is 45 °, which additionally provides simplicity of the technological implementation of the proposed device.

Such discreteness of rotation is not absolute and may slightly differ from the mentioned value, for example, be 40 or 50 °.

However, the following should be considered. With a discreteness of rotation of 45 °, there are 8 positions per one full revolution of the chair. Reducing the discreteness of rotation increases the number of positions, which is tiring for the patient's musculo-ligamentous apparatus.

If the gap between neighboring positions increases significantly, this will not allow for a quality study of all muscle groups.

Previously, stretching and performing exercises carry out passive warm-up and stretching of the muscles of the cervical spine by tilting the head to the sides and slow rotational movements.

The restoration of the muscle corset of the cervical spine is carried out every other day, starting with a weight of 0.5 kg, and increase the weight every 6 days of classes, adding 0.5-1 kg. The load is selected and changed individually based on the assessment of the clinical condition of the patient at the moment, taking into account the initial data on magnetic resonance imaging, computed tomography, functional x-rays, depending on the age and degree of preparedness of the patient. The task of traction is to ensure the state of decompression, reduce the phenomenon of gravity, remove compression and infringement of the intervertebral discs and spinal nerves for the possibility of performing and painless movements. In this case, excessive stretching of the spine, which can cause additional hypermobility of the cervical spine, should be excluded. The maximum load does not exceed 15-20 kg.

Exercises perform 6-8 repetitions in each position, starting with movements in the sagittal plane "facing the load."

It is preferable to alternately change the direction of rotation of the chair, and not turn it strictly sequentially in one direction.

So, for example, first turn the chair to the right by 45 ° from the first position, and then to the left by 90 ° (i.e., past the previous position and to the left of it by 45 °).

Such a change of direction avoids the occurrence of unilateral muscle tension. The latter can be triggered by excessive tone and muscle strain in the case of prolonged work of the same muscle groups.

At the end of the set of exercises in the “back to load” position, rotate head movements to the right and left at a slow pace, and then traction the cervical spine for 5 minutes.

The elements of fixation of the shoulder girdle ensure the correct fit: the correct position of the body when performing exercises, and make it possible to exclude the involvement of other muscle groups in the work.

In a specific example of the implementation of the device, the fixation elements of the shoulder girdle are fixed on the back of the chair with the ability to adjust their height position. The chair can also be made with adjustable height.

The locking mechanism can be implemented as in the example below, similarly to known solutions (see patents RU 2419002, op. 20.05.2011 or RU 2350503, op. 27.03.2009) or performed by any method known from the prior art.

It is advisable to bring the control handle of the movable element (stopper, lock) of the locking mechanism to the armrest of the chair for the convenience of working on the simulator.

Brief Description of the Drawings

The proposed method for the restoration of muscle corset of the cervical spine is illustrated by the example of using the proposed device, illustrated by the drawings:

figure 1 - the proposed device, General view; figure 2 is a view A of figure 1;

figure 3 is a cross-section B-B of figure 2, schematically shows the locking mechanism.

The implementation of the invention

A device for restoring the muscular corset of the cervical spine (see FIGS. 1, 2) contains a stand 1, a set of weights 2, a chair 3 rotatable with respect to the vertical axis, 3 with fixation elements for the shoulder girdle 4 and a locking mechanism 5, a Glisson loop 6 connected to the load by flexible traction 7, passed through the block 8, mounted on the rack 1.

Block 8 is placed relative to the chair 3 so that the portion of the flexible rod 7 between the Glisson loop 6 fixed on the head of the patient sitting in the chair 3 and the block 8 forms an angle α = 10-30 ° with the vertical.

Thus, the traction angle is set by the design of the device itself: the distance between the chair 3 and the rack 1 and the height of placement on the last block 8. Chair 3 and the rack 1 can be fixed on one frame base 9.

The locking mechanism 5, in a specific embodiment of the device (see FIG. 3), includes a movable controllable latch 10 that interacts with holes 11 made on the periphery of the disk 12 mounted on the axis 13 and rotates together with the seat 3. Handle 14 ( the lever) for controlling the latch 10 is brought out to the armrest of the chair 3. The holes 11 are made through 45 °, which makes it possible to rigidly fix the chair 3 every 45 ° of rotation, as a result of which the chair has eight fixed positions (I-VIII).

As a set of 2 goods, free weights of 15 with a face value of 0.5 to 25 kg can be used. Before starting the exercises, a load of the required size is selected.

In another case, all goods can have one face value, for example, they can be made in the form of pancakes 16 or plates weighing 0.5 or 1 kg each. In this case, to increase the load on the rod 17 connected to the end of the flexible rod, add the required number of pancakes 16.

The package of plates can be placed in the racks of the rack 1, as in well-known sports simulators (not shown in the drawings). In this case, the plates have through holes for the passage of the rod connected to the flexible rod, and are held thereon by means of a latch. With this design of the loading mechanism, it will be necessary to use additional blocks through which the flexible rod 8 is additionally passed. In this case, the output load decreases, so the weight of the load connected to the rod is doubled.

The proposed method is carried out using the proposed simulator as follows.

The patient who performed the preliminary warm-up by tilting the head to the sides and slow rotational movements is seated in the chair 3 and fix his shoulder girdle by means of fixing elements 4, which are fixed on the back of the chair 3 with the possibility of adjusting their height position. Chair 3 can also be made with the possibility of adjusting the height.

Glisson loop 6 put on the patient's head. Flexible rod 7 is fixed at one end to the ring on the Glisson loop, and the other to the load.

The starting weight of the cargo is 0.5 kg. The minimum load was established on the basis of clinical trials and biomechanical calculations, while the author in practice found that such loads are physiological and do not cause unpleasant sensations.

In the initial position, under the weight of the cargo, the head is deviated from the vertical by an angle of 10-30 °. Perform head movements in the direction opposite to the load to a straight line with the spinal column, and return the head to its original position.

Exercises begin in the sagittal plane "face to the load" (the first fixed position), performing 6-8 repetitions in each position.

To move between positions (for turning the chair 3), press the handle 14 and release the latch 10 out of engagement with the hole 11 of the disk 12. After turning, releasing the handle 14, turn the chair until the latch 10 is aligned and engaged with the corresponding hole of the disk 12, which ensures a rigid fixing the position of the chair 3.

Chair 3 is rotated alternately left and right, placing each time in a new position (I-VIII), for example, in such a sequence as shown in figure 3, to prevent the occurrence of unilateral muscle tension.

In conclusion, the complex, in the "back to load" position (see figure 1), perform rotational movements of the head to the right and left for 6-8 repetitions at a slow pace, and then traction of the cervical spine for 5 minutes. Then they remove the Glisson loop and offer the patient to rest lying on their back for 5-10 minutes with a roller under the cervical spine with a diameter of 10 cm.

The restoration of the muscular corset of the cervical spine is carried out every other day, adding 0.5-1 kg of weight every 6 days of classes, without exceeding the load of 15-20 kg. The weight is increased by the doctor based on the clinical condition of the patient at the moment, taking into account the initial data of magnetic resonance and / or computed tomography, functional x-rays, depending on the age and degree of preparedness of the patient.

The effectiveness of the method and the safety of the simulator have been repeatedly confirmed by clinical trials.

Example 1. Patient Inna L., 43 years old. Received treatment with a diagnosis of osteochondrosis of the cervical spine (SHOP), persistent pain and restriction of movements in the SHOP, headaches, dizziness. Multiple protrusions of the intervertebral discs up to 3 mm, sclerosis of the end plates, a decrease in the height of the discs, osteophytes on the MRI SHOP. A course of physiotherapy exercises was prescribed using the aforementioned device, No. 12, every other day. Traction and strengthening exercises were assigned according to the proposed method described above. The initial weight was 1 kg. After six sessions, headaches decreased, the range of movements in the SHOP increased, and, according to the patient, it was easy to perform the exercises. In the seventh lesson, the weight was increased to 2 kg. By the last lesson, the pain symptoms were gone, but the restriction of movements continued. A second course was offered.

Example 2. Patient Igor P., 49 years old. He was admitted for rehabilitation with a diagnosis of widespread osteochondrosis of the spine, S-shaped scoliosis of the second degree, lumbar, PMD L-4 L-5, L-5 S-1 up to 4.5 mm, instability of SHOP, headaches. A course was appointed with the inclusion of the proposed simulator in the complex according to the established scheme. The starting weight of the weight was 1.5 kg. After six classes, the weight was increased to 2 kg. She felt better, headaches decreased. A second course with a weight of 2.5 kg was prescribed. In the sixth lesson, the weight was 3 kg. Headaches are gone.

Example 3. Danil, 9 years old. He was admitted for treatment with a diagnosis of cerebral palsy, right-sided hemiparesis, a syndrome of a shortened neck, stoop, instability of the SHOP. Flexion contractures in the right elbow joint and in the right knee joint. After three cycles according to this treatment regimen, I felt a decrease in headaches, and mobility in the SHOP improved. The weight of the load was 1 kg at the beginning of treatment, subsequently it was increased to 3 kg. Continues treatment.

Claims (12)

1. A method of restoring the muscular corset of the cervical spine, including vector traction of the cervical spine, carried out using the Glisson loop, flexible traction and weight, in a sitting position with fixation of the shoulder girdle, and simultaneously with stretching, performing exercises involving head movements in the opposite direction the action of the load and vice versa, as well as changing the position relative to the applied load, by turning the chair with the patient around the vertical axis by a predetermined angle, and repeating the exercises, excellent In that the vector traction is carried out with a traction angle of 10-30 ° relative to the vertical, the head moves in the direction opposite to the action of the load, it is carried out up to a straight line with the spinal column, all the muscles of the neck are worked out, turning the chair with a given discreteness within its full revolution 360 °, while rigidly fixing the position of the chair after each turn. 2. The method according to p. 1, characterized in that the chair is rotated by an angle multiple of 45 °. 3. The method according to p. 1, characterized in that the restoration of the muscular corset of the cervical spine is carried out every other day, starting with a weight of 0.5 kg, increasing the weight every 6 days of training by 0.5-1 kg, depending on the clinical condition the patient at the moment, taking into account age, degree of preparedness, initial data of magnetic resonance and computed tomography, functional x-ray images, but not more than 15-20 kg. 4. The method according to p. 1, characterized in that pre-stretching and performing exercises carry out warm-up and stretching of the muscles of the cervical spine by tilting the head to the sides and slow rotational movements. 5. The method according to p. 1, characterized in that the exercises perform 6-8 repetitions in each position, starting with movements in the sagittal plane "facing the load." 6. The method according to p. 1, characterized in that the change of position is made by alternately turning the chair left and right. 7. The method according to p. 1, characterized in that in conclusion of the set of exercises in the "back to load" position, rotate the head to the left and to the left at a slow pace, and then traction the cervical spine for up to 5 minutes. 8. A device for restoring the muscular corset of the cervical spine, containing a set of weights, a chair swivel relative to the vertical axis for the patient with elements of fixation of the shoulder girdle and a Glisson loop connected to the load by means of a flexible rod thrown over the block, characterized in that the block is placed relative to the chair so that the section of traction between the Glisson loop fixed on the head of the patient sitting in the chair and the block forms an angle of 10-30 ° with the vertical, while the chair is equipped with a locking mechanism, ensuring ayuschim rigid fixation of the angular position of the chair with a predetermined increments within its full rotation of 360 °, in either direction of rotation of the chair. 9. The device according to p. 8, characterized in that the locking mechanism is made with the possibility of fixing the chair every 45 ° rotation. 10. The device according to p. 8, characterized in that the control knob of the locking mechanism is brought out to the arm of the chair. 11. The device according to p. 8, characterized in that the fixing elements of the shoulder girdle are fixed on the back of the chair with the ability to adjust their position in height. 12. The device according to p. 8, characterized in that the chair is made with the possibility of adjusting the height.

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