Editorial
Deep brain stimulation in Parkinson’s disease: Looking back, looking forward
Patients with Parkinson’s disease (PD) may present with prodromal (e.g. hyposmia, sleep disorders, constipation), motor (e.g. tremors, rigidity, bradykinesia, postural dysfunction) and non-motor (e.g. cognitive dysfunction, depression) symptoms.1 Treatment is symptomatic, targeting motor and non-motor manifestations, but there is presently no effective disease modifying treatment.1 Although PD therapies have...
Editorial
Shock index: Easy to use, but can it predict outcomes following major abdominal emergency surgery?
Major abdominal emergency surgery (MAES) is commonly performed for various potentially life-threatening intra-abdominal surgical conditions with high perioperative mortality of up to 45%.1 Certain patient factors (e.g. advanced age, frailty, and presence of multiple comorbidities) and disease factors (e.g. perforated viscus and intra-abdominal sepsis) have been shown to predict...
Letter to the Editor
Minimal monitoring is a safe but underutilised strategy for hepatitis C virus management in Singapore
Dear Editor,
Chronic hepatitis C virus (HCV) infection is estimated to affect 57 million people globally.1 Despite the availability of safe and effective pan-genotypic direct acting antivirals,2-5 many countries have yet to achieve the WHO goal of HCV elimination by 2030.1 To facilitate HCV elimination, current guidelines recommend using a...
Editorial
Different strokes for different folks
Atrial fibrillation (AF) remains the most common arrhythmia since William Harvey’s observation of fibrillating auricles in open chest animal models in 1628. Willem Einthoven first documented ECG tracing of AF in 1906. Fast forward several hundred years since its first observation, AF remains a mystery from its pathogenesis and...
Review Article
Barriers to breast cancer screening in Singapore: A literature review
Breast cancer is a major public health concern and a leading cause of cancer death among women worldwide, including Singapore.1 According to the 2018 Singapore Cancer Registry report, breast cancer has been consistently ranked as a leading cancer (29.3% of all cancers in Singapore) among women in Singapore for...
Original Article
Interaction of sex and diabetes in Asian patients with heart failure with mildly reduced left ventricular ejection fraction
Diabetes mellitus (DM) is a common comorbidity worldwide with global prevalence among adults above 18 years of age increasing from 4.7% in 1980 to 8.5% in 2014.1 DM has been shown to be a common comorbidity in heart failure (HF) patients ranging from 4.3–28%2 and when present, portends a...
Original Article
Prevalence, risk factors and parental perceptions of gastroesophageal reflux disease in Asian infants in Singapore
Functional gastrointestinal (GI) disorders, such as colic, gastroesophageal reflux (GER) and constipation, are common in infants under 1 year. They are a frequent cause of concern for parents and result in a significant healthcare burden1,2 due to their negative impact on feeding behaviours, caregivers’ mental wellbeing and quality of...
Editorial
Gastroesophageal reflux disease in Asian infants: Similar condition, different perceptions
Gastroesophageal reflux disease (GERD), a common problem in infancy, may lead to troublesome symptoms or complications such as oesophagitis or oesophageal stricturing in a small minority of infants.1 In the majority of cases, however, frequent regurgitations, the commonest symptoms of GERD, resolves with age spontaneously without any medical intervention.2,3...
Commentary
Invasive Cancer after Treatment of Cervical Intraepithelial Neoplasia
The objective of a cervical screening programme is to prevent invasive cancer of the cervix by detecting and treating pre-invasive disease of the cervix. The impact of the programme depends both on the detection of women with cervical intraepithelial neoplasia (CIN) and upon their being treated effectively.
This article is...
Review Article
Use of Atypical Neuroleptics in a State Mental Institute
Schizophrenia is the most severe of all mental disorders and affects about 1% of the population. The main disturbances of schizophrenia comprise positive symptoms, negative symptoms and disorganisation.
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Others
Subclavian-oesophageal Fistula as a Complication of Foreign Body Ingestion: A Case Report
Ingested foreign bodies are a common condition in the practice of Otolaryngology. In particular, there is no doubt a greater tendency in the local community to consume fish without it being de-boned.
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Review Article
Osteoporosis—The Need for a Paradigm Shift
Osteoporosis is becoming an increasing public health problem in most countries. Osteoporosis literally means “porous bones” and involves skeletal fragility leading to an increased risk of fracture.
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Review Article
Managing Problem Gout
Gout occurs in 3 overlapping phases: a long phase of asymptomatic hyperuricaemia, a period of recurrent acute gouty attacks separated by asymptomatic intervals (interval gout), followed in about 10% of patients by chronic tophaceous gouty arthritis. Gout is one of the better understood of the arthritic disorders, and certainly...
Review Article
Systemic Lupus Erythematosus in Singapore
Systemic lupus erythematosus (SLE) or lupus (“wolf” in Latin) in short, is an autoimmune disorder of unknown aetiology(ies) and characterised by diverse clinical manifestations as well as a plethora of autoantibodies in the sera of patients. The clinical features of SLE vary in different population groups. Ethnic and genetic...
Original Article
Aetiology and Distribution of Mandibular Fractures in the National University Hospital, Singapore
Apart from the nasal bone, the mandible is the most commonly fractured bone in the face. It is also the 10th most often broken bone in the body.
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Others
Bilateral Caudate Infarct—A Case Report
The head of caudate nucleus forms a prominent bulge in the lateral wall of the anterior horn of the lateral ventricle. Its blood supply is from the deep penetrators from the middle cerebral and anterior cerebral arteries.
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Review Article
Under-diagnosed Psychiatric Syndrome II: Pathologic Skin Picking
Pathologic skin picking may be defined as the habitual picking of skin lesions, which when chronic and extensive, can lead to significant distress, dysfunction and disfigurement. The underlying skin lesions may range from benign ones, e.g. barely noticeable irregularities of the skin, to more severe ones, e.g. acne, eczema,...
Review Article
Under-diagnosed Psychiatric Syndrome I: Trichotillomania
Trichotillomania (TTM) is a chronic psychiatric condition characterised by uncontrollable, self-inflicted, hair pulling, resulting in noticeable hair loss. First described by Hallopeau a century ago, it was previously regarded as an obscure condition.
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Review Article
Current Therapeutic Strategies in Glomerulonephritis
Twenty years ago, the therapy of glomerulonephritis (GN) was relatively simple as it was believed that treatment with prednisolone should be confined to patients with minimal change nephrotic syndrome and lupus nephritis. For those patients who failed to respond, they were treated with oral cyclophosphamide.
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Others
Case Reports of Low Dose Cyclosporine A Therapy in Adult Minimal Change Nephrotic Syndrome
There have been many reports on the use of conventional doses of cyclosporine A (CsA) in inducing remission among adults with minimal change nephrotic syndrome (MCNS), including those who fail steroids and cyclophosphamide therapy or who are steroid dependent and frequent relapsers. We report 3 cases which demonstrate the...
Review Article
Quality of Life in Long-Term Survivors of Intensive Care
Intensive care has undergone rapid technological advancement in recent years enabling complex treatment of patients of advanced age and/or with advanced chronic diseases underlying their acute medical problems. New interventions have been introduced with success determined by their ability to save lives.
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Review Article
Limitation of Life Support in the Critically Ill: The Hong Kong Perspective
Technological advances over the last 30 years have had an enormous impact on the way in which medicine is delivered today. This is particularly so in the specialty of intensive care where intensivists possess the necessary knowledge and tools to prolong life in many situations where patients would previously...
Original Article
The Views of Mental Health Professionals Towards Psychotherapy—A Singapore Survey
There is a trend in Asia towards a greater application of psychotherapeutic approaches in multidisciplinary settings to emotional and behavioural disturbances. The inaugural issue of Asian Psychologist announced landmarks in the education and training of clinical psychology in two major Asian communities.
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Others
Update in the Management of Stroke
Stroke is the fourth leading cause of death and a leading cause of morbidity in Singapore. The number of hospital admissions for cerebrovascular disorders has been rising dramatically over the last few years, exceeding 10,400 in 2001.
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Others
Clinical Update on Osteoporosis
Fractures, the most serious complication of osteoporosis, are increasing and constitute an evolving public health problem in terms of disability, mortality and cost. A paradigm shift in the management of osteoporosis has resulted from the development of techniques which can diagnose osteoporosis before fractures occur, and effective medications which...
Review Article
An Asian Perspective to the Problem of Osteoporosis
Osteoporosis is regarded as an important public health problem in many Caucasian populations. Much of the research on epidemiology, diagnosis, treatment, genetic and molecular aspects has been carried out in the West.
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Others
Contemporary Management of Fibroids
Fibroids are the most common, solid benign pelvic tumours occurring in about 30% of women beyond the age of 30. They are asymptomatic in most women.
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Others
Surgical Management of Colorectal Metastases to the Liver
Colorectal carcinoma is the second commonest cancer in both males and females in Singapore, accounting for about 15% of all cancer cases. The liver is the most common site of distant metastases from colorectal cancer.
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Others
The Diagnosis and Management of Hypercalcaemia
Hypercalcaemia is a relatively common clinical problem with the widespread use of routine biochemical screening. Population studies have suggested a prevalence of 3% in women and <1% in men above the age of 60 years.
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Review Article
Nipah Encephalitis Outbreak in Malaysia
From September 1998 to June 1999, there was an outbreak of viral encephalitis in several pig farming villages in Malaysia. The outbreak, which started in Ulu Piah, Tambun and Ampang near Ipoh in the state of Perak, later involved Sikamat, Sungai Nipah, Kampong Sawah and Bukit Pelanduk areas in...
Original Article
Clinico-pathological Analysis of Myelodysplastic Syndromes According to French-American-British Classification and International Prognostic Scoring System
Myelodysplastic syndromes (MDS) are a heterogeneous group of acquired clonal haemopoietic stem cell disorders characterised by ineffective haematopoiesis and peripheral cytopenia. The natural history ranges from the indolent forms spanning years to those with rapid evolution to blast transformation.
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Original Article
Patients who Talk and Deteriorate: A New Look at an Old Problem
Patients who talk after traumatic brain injury (TBI) and then subsequently deteriorate into a coma are defined as those with an initial Glasgow Coma Score (GCS) verbal score of 3 or greater, and then deteriorate to a GCS of 8 or less. Less than 10% of patients with minor...
Original Article
High-sensitivity C-reactive Protein is Predictive of Medium-term Cardiac Outcome in High-risk Asian Patients Presenting With Chest Pain Syndrome Without Myocardial Infarction
Patients with chest pain often pose a diagnostic conundrum to the attending physician especially when symptoms are not typical of angina and the electrocardiogram nondiagnostic. Troponin levels are frequently measured at presentation to prognosticate the patient.
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Others
A Case Report of Occupational Asthma due to Gluteraldehyde Exposure
Worldwide, asthma is estimated to affect between 5% and 10% of the population and, among adults, 4% to 9% of these cases have been attributed to an occupational cause. Yet, only 3 cases were reported and confirmed in Singapore in the year 2000 – an incidence of only 0.14/100,000...
Others
Bile Duct Perforation in Children: Is it Truly Spontaneous?
Bile duct perforation (BDP) and biliary ascites in children is a rare clinical entity. The aetiopathogenesis is still elusive.
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Original Article
SARS in Singapore – Predictors of Disease Severity
Severe acute respiratory syndrome (SARS) is a recently defined illness caused by a novel coronavirus. The outbreak in Singapore originated from Hong Kong via mainland China.
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Others
Swallowed Foreign Bodies in Children: Report of Four Unusual Cases
Foreign body (FB) ingestion in children is a frequent and frightening experience to the patients and caregivers. It is a common paediatric problem necessitating occasional immediate intervention to avoid serious complications.
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Others
Newborn Screening for all Identifiable Disorders with Tandem Mass Spectrometry is Cost Effective: The Negative Case
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Original Article
The NORSE (New-onset Refractory Status Epilepticus) Syndrome: Defining a Disease Entity
Status epilepticus (SE) describes a clinical condition characterised by an epileptic seizure or a series of seizures that lasts for at least 30 minutes without consciousness being regained.1 Some authors have added a time line of 60 minutes. The incidence of generalised convulsive status epilepticus (GCSE) is between 40...
Review Article
Obesity and Obstructive Sleep Apnoea Hypopnoea Syndrome in Singapore Children
Obesity is becoming a problem of epidemic proportions and is perhaps, the most pervasive medical problem faced by medical providers today. It is a problem affecting about 10% to 15% of our school-going population in Singapore, affecting disease burden in virtually every medical subspecialty.
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Review Article
Diagnosis and Evaluation of Obstructive Sleep Apnoea in Children
Children with obstructive sleep apnoea (OSA) may present with nocturnal and/or diurnal symptoms. The history is best obtained from parents, or siblings who share a bedroom, since the child is often unaware of what happens when he or she is asleep.
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Original Article
Concurrent Chemoradiotherapy followed by Surgery in Locally Advanced Squamous Cell Carcinoma of the Oesophagus: A Single Centre Experience
Carcinoma of the oesophagus is a relatively uncommon malignancy in Singapore and incidence rates have been declining since 1968. A total of 506 cases were diagnosed from 1993 to 1997. The age-standardised rate for the same period was 5.8 per 100,000.1 The predominant histologic type is squamous cell carcinoma,...
Review Article
A Walk Through the Management of Parkinson’s Disease
The management of idiopathic Parkinson’s disease is deceptively simple. Current practice, which consists of replacing dopamine on a twice or thrice daily regime may actually be responsible for causing the involuntary movements (dyskinesias) which were formerly thought to be inevitable in the disease and which occur in association with...
Others
Clinical Characteristics of Renal Infarction in an Asian Population
Renal infarction is a rare disease. Domanovits et al reported an incidence rate of 0.007% (17/248,842) during a study period of 45 months.
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Original Article
Review of the Management Outcome of Slipped Capital Femoral Epiphysis and the Role of Prophylactic Contra-lateral Pinning Re-examined
Slipped capital femoral epiphysis is the commonest hip problem in the adolescent age group. The goals of treatment are aimed at avoiding the complications of osteonecrosis and chondrolysis, preventing further slips, and promoting physeal closure.
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Original Article
Application of the McDonald MRI Criteria in Multiple Sclerosis
Since its advent in 1982, magnetic resonance imaging (MRI) has become an important component in the evaluation of multiple sclerosis (MS). MRI is a highly sensitive tool for MS, with 95% patients with clinically definite MS (CDMS) demonstrating brain abnormalities.1 However, MRI is also known to be low in...
Original Article
Perforated Appendicitis in Children: Benefits of Early Laparoscopic Surgery
Despite perforated appendicitis (PA) being a common surgical emergency in childhood, controversy still exists with regard to its management in this era of minimal access surgery. Open appendicectomy (OA) has been accepted as the standard procedure for PA. However, OA has been associated with prolonged hospitalisation and significant complications...
Original Article
Extracranial Non-vestibular Head and Neck Schwannomas: A Ten-year Experience
Schwannomas, also known as neurilemmomas, neuromas, or neurinomas, are uncommon nerve sheath neoplasms that may originate from any peripheral, cranial or autonomic nerve of the body with the exception of the olfactory and optic nerve. Malignant change is unusual. Some 25% to 45%1 of schwannomas are located in the...
Review Article
Recovery and Regeneration after Spinal Cord Injury: A Review and Summary of Recent Literature
Spinal cord injury (SCI), whether of traumatic or non-traumatic aetiology, often results in significant and catastrophic dysfunction and disability. It physically and psychologically affects not only the individual, but also the family and society. Early rehabilitation in an organised multidisciplinary SCI care system has been shown to be beneficial,...
Original Article
Factors Predictive of Outcome in Childhood Stroke in an Asian Population
Strokes in childhood are generally considered to be rare with an incidence of about 2.7 per 100 000 children per year.1 The aetiologies of stroke in children differ considerably from adults and multiple risk factors commonly co-exist. A large stroke registry in North America reported that a large proportion...
Original Article
Surgical Metastasectomy in AJCC Stage IV M1c Melanoma Patients with Gastrointestinal and Liver Metastases
The prognosis of patients with stage IV melanoma or recurrent melanoma is poor with an estimated median survival period of 6 months. The recent revised version of the American Joint Committee on Cancer (AJCC) staging system for cutaneous melanoma has further sub-divided melanoma metastatic sites to 3 specific categories;...
Original Article
Acceptability of Medical Students by Patients from Private and Public Family Practices and Specialist Outpatient Clinics
In recent decades, medical advances and economic pressures have shifted medical student training from hospital inpatient to ambulatory settings such as hospital outpatient and primary care clinics. Most studies have found that patients are agreeable to seeing medical students and value the opportunity to interact with them.
This article is...
Original Article
The Need for a System of Prognostication in Skeletal Metastasis to Decide Best End-of-life Care – A Call to Arms
Decisions regarding potential surgery for metastatic disease are influenced by estimates of patient survival. For example, patients with long life expectancy may be appropriately treated with extensive resection and durable reconstruction to provide long lasting function and mobility; in contrast, a patient with a very short life expectancy may...
Original Article
Socio-demographic Profile and Psychiatric Comorbidity of Subjects with Pathological Gambling
Gambling has been defined as a wager of any type of item or possession of value upon a game or event of uncertain outcome in which chance, of a variable degree, determines the outcome. The failure to resist the impulse to gamble despite disruption to personal, family and vocational...
Original Article
rTSβ as a Novel 5-fluorouracil Resistance Marker of Colorectal Cancer: A Preliminary Study
Although colorectal cancer is common in Western countries, in the past, it has been uncommon in Asian countries. However, its prevalence has gradually been increasing. Since 1982, malignant cancers have been the leading cause of death in Taiwan.
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Original Article
Presentation and Outcome Amongst Older Singaporeans Living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS): Does Age Alone Drive Excess Mortality?
Singapore is a country of high income with a low level human immunodeficiency virus (HIV) epidemic, the yearly incidence of disease currently standing at 121.7 new infections per million population per year. Certain features of Singapore’s HIV epidemic are notable. Firstly, despite active screening programmes amongst high-risk populations and...
Original Article
Supplementary Breast Ultrasound Screening in Asian Women with Negative But Dense Mammograms—A Pilot Study
Mammogram has been the gold standard for breast cancer screening and Magnetic Resonance Imaging (MRI) has been advocated for screening of high- risk individuals. However, there is currently no recommendation for supplementary ultrasound scan in breast cancer screening. Moreover, it is known that dense breasts, which are common in...
Original Article
Assessment of the American Joint Committee on Cancer 7th Edition Staging for Localised Prostate Cancer in Asia Treated with External Beam Radiotherapy
Prostate cancer (PCa) is the second most frequently diagnosed cancer in men, with a worldwide incidence of approximately 900,000 in 2008. Internationally, there is marked variation in incidence, ranging from 104.2 per 100,000 in some Western populations, to 4.1 per 100,000 in South and Central Asia. However, there has...
Commentary
Internet Addiction in Young People
The Internet has in recent years become ubiquitous in the lives of young persons and children due to rapid information technology (IT) development, high speed wire connection, easy accessibility and increasing affordability. Its growth has also been fuelled by a huge customer demand created by social and print media,...
Original Article
Singapore Rhabdomyosarcoma (RMS) Experience: Shall We Change Our Practice?
Rhabdomyosarcoma (RMS) constitutes nearly 4% of all children diagnosed with cancer in the ethnically diverse small island city of Singapore. It is the most common primary soft tissue malignancy of childhood and one which is highly sensitive to chemotherapy and radiation therapy leading to excellent overall survivals. In KK...
Original Article
Epidemiology and Clinical Evolution of Liver Cirrhosis in Singapore
Cirrhosis is the common end result of chronic damage to liver parenchyma caused by a variety of liver diseases. It results in replacement of liver tissue by fibrotic scar tissue and regenerating nodules, leading to progressive liver dysfunction and clinical complications such as portal hypertension, hepatocellular carcinoma (HCC), liver...
Original Article
Accuracy of self-reported height, weight and BMI in a multiethnic Asian population
Overweight and obesity continue to be one of the most critical public health issues worldwide. Body mass index (BMI) derived from height and weight has been directly linked to a number of debilitating diseases, including diabetes, heart disease and cancer, and has gained increased popularity as a measure of...
Letter to the Editor
Carbamazepine-induced toxic epidermal necrolysis in a patient despite testing negative for HLA B*15:02 allele
Carbamazepine (CBZ) has been used in Singapore since 19881 as an effective drug for the treatment of conditions such as epilepsy, neuropathy, neuralgia and psychiatric conditions. However, it is a high-risk drug for Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), particularly in Asians, and in 2004, a genetic marker human leukocyte...
Review Article
Endovenous cyanoacrylate ablation for chronic venous insufficiency and varicose veins among Asians
In the past 2 decades, the management of chronic venous insufficiency (CVI) has been revolutionised by the introduction of minimally invasive endovenous techniques, which have replaced open surgical high tie and stripping as the treatment of choice. CVI is common in the Western population and is reported to affect...
Original Article
Assessing the Content Validity of the EQ-5D Questionnaire Among Asians in Singapore: A Qualitative Study
EQ-5D is a tool to measure and value health status. It is a standardised questionnaire that comprises 2 components: a Descriptive System (DS) on the first page and a hash-marked visual analogue scale (EQ-VAS) on the second page. Importantly, responses to the DS can be converted into a utility...
Original Article
Long-term outcomes of ischaemic stroke patients with diabetes in a multi-ethnic cohort in Singapore
Asia faces an epidemic of diabetes. The prevalence of diabetes in Asia is projected to grow from 114 million in 2007 to 180 million by 2025, driven in part by marked economic and epidemiologic transition in recent decades.1 In China, the prevalence of diabetes rose from 1% in 1980...
Review Article
Obesity in COVID-19: A Systematic Review and Meta-analysis
Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is established that increasing age and comorbidities such as cardiovascular diseases are associated with risk of infection, more severe disease and adverse outcomes. Obesity is an epidemic globally, causing...
Original Article
Clinical Presentation and Disease Associations of Gout: A Hospital-based Study of 100 Patients in Singapore
Gout is a common metabolic disease that causes arthritis which is often painful and sometimes disabling. It results from the deposition of monosodium urate monohydrate crystals in the joints and soft tissue giving rise to an acute inflammatory response.
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