Lecture #7 - DIsc Pathologies
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Questions and Answers

What is the primary imaging technique used first in assessing suspected disc pathology?

X-ray

List two differential diagnoses for a suspected disc pathology.

Stenosis, Spondylolisthesis

What clinical tests are used to evaluate for disc pathologies?

Cervical compression, Spurling’s

In which case would the tests for disc pathologies yield negative results?

<p>In the absence of spinal nerve or nerve root compression.</p> Signup and view all the answers

Who is the appropriate medical professional to refer a patient to for imaging if disc pathology is suspected?

<p>Family physician.</p> Signup and view all the answers

What is the inner portion of the intervertebral disc called?

<p>Nucleus pulposus.</p> Signup and view all the answers

Describe the primary difference between a disc extrusion and sequestration.

<p>In extrusion, nuclear material has broken through the outer wall but remains in contact, while in sequestration, the nuclear material is free-floating.</p> Signup and view all the answers

Identify the preferred outcome of disc pathology assessment between centralization and peripheralization.

<p>Centralization is generally preferred.</p> Signup and view all the answers

What should be established during initial assessment before performing the McKenzie technique?

<p>A baseline of the patient's pain and symptoms.</p> Signup and view all the answers

What is the significance of Schmorl's nodes in spinal health?

<p>Schmorl's nodes represent herniation of the nucleus pulposus into the vertebral end plate, indicating potential spinal issues.</p> Signup and view all the answers

Which four types of pain or symptoms should be evaluated after performing movements?

<p>Worse/better, not worse/better, centralized/peripheralized, and no effect.</p> Signup and view all the answers

What anatomical structures should be palpated when assessing a disc pathology?

<p>Occiput, spinous processes, transverse processes, facet joints, temporomandibular joint, and scalenes.</p> Signup and view all the answers

What guiding factors determine which PPIVMs to perform?

<p>Findings from history, active, and passive range of motion.</p> Signup and view all the answers

What is the most specific imaging technique for diagnosing disc pathology?

<p>Discography.</p> Signup and view all the answers

Name two conditions that could be considered differential diagnoses for disc pathology.

<p>Spondylolisthesis and sacroiliac pathology.</p> Signup and view all the answers

Which two special tests are used to assess compression in the cervical spine?

<p>Cervical compression and Spurling’s test.</p> Signup and view all the answers

Under what circumstances might cervical distraction test yield a negative result?

<p>In the absence of spinal nerve or nerve root compression.</p> Signup and view all the answers

Who is typically the first medical professional to refer a patient for imaging studies of suspected disc pathology?

<p>Family physician.</p> Signup and view all the answers

Explain the difference between disc protrusion and disc prolapse.

<p>Disc protrusion involves a small amount of nucleus pulposus reaching the inner wall of the annulus fibrosus without breaking through, while disc prolapse has moved to the outer margins but hasn't yet reached the outer wall.</p> Signup and view all the answers

What is the main characteristic of sequestration in disc pathology?

<p>Sequestration is characterized by free-floating nuclear material that has broken off, making it an unstable disc pathology.</p> Signup and view all the answers

Describe how centralization is preferred during the assessment of disc pathologies.

<p>Centralization is preferred because it indicates that symptoms are moving from the periphery towards the spine, suggesting improvement in the patient's condition.</p> Signup and view all the answers

What are the four categories of disc pathologies referenced by the acronym PPE?

<p>The four categories are Protrusion, Prolapse, Extrusion, and Sequestration.</p> Signup and view all the answers

What assessment must be established during the initial evaluation before applying the McKenzie technique?

<p>A baseline must be established, including quantifying pain and identifying its location and severity through specific questioning.</p> Signup and view all the answers

List two significant symptoms to assess during movements according to the McKenzie technique.

<p>Symptoms to assess include whether the pain diminishes or worsens and if the symptoms are centralizing or peripheralizing.</p> Signup and view all the answers

Why are important bony and muscular structures palpated during an evaluation of disc pathology?

<p>Palpation of these structures helps locate pain sources and assess the overall condition of the surrounding anatomy related to the disc.</p> Signup and view all the answers

What are the implications of a patient's symptoms being described as radicular during an assessment?

<p>Radicular symptoms indicate that the pain is radiating along the nerve pathway, suggesting nerve involvement and potential compression.</p> Signup and view all the answers

What imaging technique is considered the least specific for diagnosing disc pathology?

<p>X-ray</p> Signup and view all the answers

What is a common clinical test that may indicate disc pathology by applying compression to the cervical spine?

<p>Cervical compression test</p> Signup and view all the answers

Name one condition that could mimic symptoms of disc pathology, often leading to a misdiagnosis.

<p>Spondylolisthesis</p> Signup and view all the answers

In which circumstance would special tests for disc pathologies likely yield negative outcomes?

<p>In the absence of spinal nerve or nerve root compression.</p> Signup and view all the answers

Who is the appropriate medical professional to refer to for further imaging when disc pathology is suspected?

<p>Family physician</p> Signup and view all the answers

What is the critical distinction between disc protrusion and disc prolapse?

<p>Disc protrusion has the nucleus pulposus reaching the inner wall of the annulus fibrosus without breaking through, while disc prolapse has it moved to the outer margins but still not penetrating the wall.</p> Signup and view all the answers

Explain the phenomenon of centralization in the context of disc pathology assessment.

<p>Centralization refers to the reduction of symptoms that move from the periphery towards the spine, indicating an improvement in the patient's condition.</p> Signup and view all the answers

Describe the implications of a herniated nucleus pulposus exhibiting sequestration.

<p>Sequestration involves free-floating nuclear material, which is considered unstable and may lead to more severe symptoms and complications.</p> Signup and view all the answers

What are the main factors to consider when determining which PPIVMs to perform?

<p>The main factors include findings from the patient's history, as well as active and passive range of motion assessments.</p> Signup and view all the answers

When assessing the presence of radicular symptoms during movements, what key question should be asked?

<p>It is essential to ask if the symptoms are radicular and identify if they increase or decrease during specific movements.</p> Signup and view all the answers

What role does the assessment of the four types of pain/symptoms after movements play in managing disc pathology?

<p>Assessing these types determines the effectiveness of movements in improving the patient's condition and guides further treatment.</p> Signup and view all the answers

How do Schmorl’s nodes relate to the pathology of the nucleus pulposus?

<p>Schmorl's nodes occur when the nucleus pulposus herniates into the vertebral end plate, which can impact spinal health and stability.</p> Signup and view all the answers

What are the core components to establish during the initial assessment prior to the McKenzie technique?

<p>The core components include obtaining a baseline of the patient’s pain levels, locations, and quantifying their symptoms.</p> Signup and view all the answers

Name three diagnostic imaging techniques used for suspected disc pathology in order of increasing specificity.

<p>X-ray, CT scan, Myelogram.</p> Signup and view all the answers

List four differential diagnoses for disc pathology that involve joint-related conditions.

<p>Spondylolisthesis, Facet joint pathology, Sacroiliac pathology, Hip joint pathology.</p> Signup and view all the answers

Identify two special tests that can help confirm cervical disc pathology in a patient.

<p>Cervical compression, Spurling’s.</p> Signup and view all the answers

Explain a scenario in which cervical distraction might not indicate a disc-related issue.

<p>When there is no spinal nerve or nerve root compression by the disc pathology.</p> Signup and view all the answers

What is the primary role of a family physician in the process of imaging for suspected disc pathology?

<p>To refer the patient for appropriate imaging studies.</p> Signup and view all the answers

What characterizes the disc protrusion in relation to the annulus fibrosus?

<p>In disc protrusion, a small amount of nucleus pulposus reaches the inner wall of the annulus fibrosus without pushing through it.</p> Signup and view all the answers

What differentiates disc extrusion from disc sequestration?

<p>Disc extrusion involves nuclear material breaking through the outer wall of the annulus fibrosus, while sequestration has free-floating nuclear material separate from the disc.</p> Signup and view all the answers

Explain the significance of centralization in the assessment of disc pathology.

<p>Centralization refers to the movement of symptoms from the periphery towards the spine, which is generally preferred as it indicates a favorable response to treatment.</p> Signup and view all the answers

What are the implications of identifying Schmorl's nodes during spinal evaluation?

<p>Schmorl's nodes indicate herniation of the nucleus pulposus into the vertebral end plate, which can contribute to back pain and potential complications.</p> Signup and view all the answers

How do repeated movements affect symptom patterns during the McKenzie technique?

<p>Repeated movements are assessed to determine whether symptoms diminish, worsen, centralize, or peripheralize, guiding further treatment.</p> Signup and view all the answers

What key factors guide the choice of PPIVMs during a physical assessment?

<p>The choice of PPIVMs is guided by findings in the patient's history as well as active and passive range of motion assessments.</p> Signup and view all the answers

Describe the four categories of disc pathology represented by the acronym PPE.

<p>The four categories are Protrusion, Prolapse, Extrusion, and Sequestration, which describe varying degrees of disc herniation.</p> Signup and view all the answers

What should be established regarding pain symptoms during the initial evaluation before utilizing the McKenzie technique?

<p>A baseline of the patient's pain symptoms should be established, including its location, severity, and response to movements.</p> Signup and view all the answers

Which imaging technique is considered the most specific for diagnosing disc pathology?

<p>Discography (C)</p> Signup and view all the answers

Myelogram is less specific than CT scan for diagnosing disc pathology.

<p>True (A)</p> Signup and view all the answers

Name one condition that could be a differential diagnosis for disc pathology.

<p>Spondylolisthesis</p> Signup and view all the answers

The special test that involves applying pressure to the cervical region is called __________.

<p>Cervical compression</p> Signup and view all the answers

Match the following special tests to their purpose:

<p>Spurling’s = Tests for nerve root irritation Cervical distraction = Relieves nerve root tension Valsalva = Increases intrathecal pressure Shoulder abduction = Assesses symptom relief</p> Signup and view all the answers

Which of the following is considered an unstable disc pathology?

<p>Extrusion (B)</p> Signup and view all the answers

Centralization of symptoms is preferred during the assessment of disc pathologies.

<p>True (A)</p> Signup and view all the answers

What is the term for herniation of the nucleus pulposus into the vertebral end plate?

<p>Schmorl's nodes</p> Signup and view all the answers

Disc __________ occurs when the nuclear material reaches but does not break through the wall of the annulus fibrosus.

<p>prolapse</p> Signup and view all the answers

Match the types of disc pathologies with their characteristics:

<p>Prolapse = Nuclear material moves to outer margins Disc protrusion = Nucleus pulposus reaching the inner wall of annulus fibrosus Extrusion = Nuclear material makes direct contact with annulus fibrosus Sequestration = Free-floating nuclear material outside disc</p> Signup and view all the answers

During a McKenzie assessment, which of the following is NOT one of the five questions you should ask the patient?

<p>What is your occupation? (B)</p> Signup and view all the answers

What term describes symptoms moving from the periphery towards the spine?

<p>Centralization</p> Signup and view all the answers

Peripheralization is an outcome that indicates improvement in disc pathology assessment.

<p>False (B)</p> Signup and view all the answers

Which imaging method is considered the most specific for diagnosing disc pathology?

<p>Discography (A)</p> Signup and view all the answers

Stenosis is a differential diagnosis for disc pathology.

<p>True (A)</p> Signup and view all the answers

Name one special test that is used to assess disc pathologies.

<p>Cervical compression</p> Signup and view all the answers

The ______ is the least specific imaging technique for assessing disc pathology.

<p>X-ray</p> Signup and view all the answers

Match the following differential diagnoses with their characteristics:

<p>Spondylolisthesis = Forward slippage of a vertebra over another Piriformis syndrome = Compression of the sciatic nerve by the piriformis muscle Facet joint pathology = Pain arising from the joints at the back of the spine Sacroiliac pathology = Discomfort originating from the joint between the sacrum and pelvis</p> Signup and view all the answers

Which of the following correctly describes disc extrusion?

<p>Nucleus pulposus has broken through the outer wall of annulus fibrosus. (C)</p> Signup and view all the answers

Peripheralization refers to symptoms moving toward the spine.

<p>False (B)</p> Signup and view all the answers

What is the outcome that is generally preferred during the assessment of disc pathology?

<p>Centralization</p> Signup and view all the answers

The herniation of the nucleus pulposus into the vertebral end plate is known as __________.

<p>Schmorl's nodes</p> Signup and view all the answers

Match the type of disc pathology with its description:

<p>Disc Protrusion = Small amount of nucleus pulposus reaching the inner wall Prolapse = Nucleus pulposus moved to the outer margins Extrusion = Nuclear material contacts the wall of annulus fibrosus Sequestration = Free-floating nuclear material outside the disc</p> Signup and view all the answers

What is the primary action to take before performing the McKenzie technique?

<p>Establish a baseline of symptoms. (A)</p> Signup and view all the answers

What symptom pattern should be examined after performing movements?

<p>Worse/Better, Centralized/Peripheralized, No effect</p> Signup and view all the answers

There are four types of disc pathologies represented by the acronym PPE.

<p>True (A)</p> Signup and view all the answers

Flashcards

Disc Protrusion

A small portion of the nucleus pulposus (inner disc material) pushes slightly against the inner wall of the annulus fibrosus (outer disc layer).

Disc Prolapse

The inner disc material has moved to the outer edges of the intervertebral disc, but hasn't yet broken through the outer wall of the annulus fibrosus.

Disc Extrusion

The nucleus pulposus has ruptured through the outer wall of the annulus fibrosus and is touching the outer wall of the annulus fibrosus.

Disc Sequestration

A type of disc extrusion where a part of the nucleus pulposus breaks off and floats freely in the area of the disc.

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Schmorl's nodes

Herniation of the nucleus pulposus into the vertebral end plate.

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Centralization

A desirable outcome in pain assessment where symptoms move from the periphery (e.g., buttock) in toward the spine (e.g., the low back).

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Peripheralization

Symptom progression from the spine towards the periphery during assessment, such as pain moving from the lower back to the glutes.

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McKenzie Technique

A method of assessing and treating musculoskeletal pain, primarily spinal pain, using repeated movements to observe how symptoms change in response.

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Disc Pathology Imaging (Least to Most Specific)

X-ray, CT scan, MRI, Myelogram, Discography. These imaging techniques are used to diagnose disc problems, starting with a less-detailed X-ray and progressing to the more specialized tests (such as discography) if needed.

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Differential Diagnoses for Disc Pathology

Conditions that might have similar symptoms to a disc problem, and need to be ruled out. Examples include stenosis, neurodynamic issues, spondylolisthesis, and more.

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Referrals for Imaging

If a patient is suspected of having a disc problem, a family physician should refer them for appropriate imaging tests.

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Tests for Disc Pathology (Negative Result)

Tests like cervical compression, Spurling's, and cervical distraction are used to assess disc-related nerve compression. A negative result means no nerve root compression is present based on these tests.

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Disc Pathology Differential Diagnoses

A list of possible conditions that could have similar symptoms to a disc issue. Examples include stenosis, neurodynamic issues, and spondylolisthesis.

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SternoCleidoMastoid (SCM)

A large, prominent muscle in the neck that helps with head rotation and flexion. It originates from the sternum and clavicle and inserts into the mastoid process of the temporal bone.

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Erector Spinae

A group of muscles that run along the length of the spine, primarily responsible for back extension and maintaining posture.

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Lumbosacral Junction

The area where the lumbar spine (lower back) meets the sacrum (triangular bone at the base of the spine).

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What's the most specific imaging for a disc pathology?

Discography is the most specific imaging technique for diagnosing disc pathologies. It involves injecting a contrast agent into the disc and observing its spread.

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When are disc pathology tests negative?

Tests for disc pathology, like cervical compression, Spurling's, and cervical distraction, will be negative in the absence of spinal nerve or nerve root compression.

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Types of Disc Pathology

There are 4 main types of disc pathology: protrusion, prolapse, extrusion, and sequestration. These describe the severity of the disc herniation and the location of the nucleus pulposus.

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McKenzie Technique Baseline

Before starting a McKenzie technique assessment, a baseline is established by asking 5 questions to assess pain and symptoms, including location, severity, and the effect of a specific movement.

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McKenzie Technique Questions During

During the McKenzie technique, 5 additional questions are asked to assess the effect of the movement on the patient's pain. It helps track if the movement causes centralization or peripheralization.

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McKenzie Technique Questions After

After performing McKenzie movements, 4 questions are used to assess how the pain has changed, focusing on improvement, worsening, centralization, and any lasting effects.

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Palpation for Disc Pathology

During an examination for a potential disc issue, you should palpate several specific areas, including the occiput, spinous processes, transverse processes, facet joints, temporomandibular joint, and scalene muscles.

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X-ray for Disc Pathology

An initial imaging technique used to assess the overall structure of the spine, looking for any gross abnormalities. Can be used to rule out or potentially suggest a disc issue.

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MRI for Disc Pathology

A highly detailed imaging technique that provides clear visualization of soft tissues, like intervertebral discs, nerves, and surrounding structures. Can identify herniations, tears, and other disc problems.

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Cervical Distraction Test

A test that assesses for potential nerve compression in the neck by gently pulling the head upwards. A positive result indicates a possible disc issue.

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Spurling's Test

A test that involves gently rotating and extending the neck to simulate pressure on the nerves. Used to assess for a potential disc issue.

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Imaging for Disc Pathology (Least to Most Specific)

X-ray, CT scan, MRI, Myelogram, Discography. These imaging techniques are used to diagnose disc problems, starting with a less-detailed X-ray and progressing to the more specialized tests (such as discography) if needed.

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Tests for Disc Pathology

Tests like cervical compression, Spurling's, and cervical distraction are used to assess disc-related nerve compression. A positive result suggests nerve root compression, indicating a possible disc issue.

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Special Tests for Disc Pathology (Negative)

Tests like cervical compression, Spurling's, and cervical distraction are used to assess disc-related nerve compression. A negative result means no nerve root compression is present based on these tests.

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Who to Refer for Imaging?

If a patient is suspected of having a disc problem, a family physician should refer them for appropriate imaging tests.

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Who Refers to Imaging for Disc Pathology?

A family physician should refer patients suspected of having a disc problem for appropriate imaging tests.

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Disc Pathology Categories

Disc pathologies are categorized into 4 types: protrusion, prolapse, extrusion, and sequestration. These describe the severity and location of the nucleus pulposus herniation.

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Study Notes

Intervertebral Disc Pathology

  • Nucleus pulposus: Inner portion of the intervertebral disc.
  • Vertebral end plate: Part of the intervertebral disc structure.
  • Disc pathology: Localized herniation of the nucleus pulposus against or through the intervertebral disc wall.
  • Disc pathology categories (PPE):
    • Protrusion: Small amount of nucleus pulposus reaching the inner annulus fibrosus wall, but without material penetrating through.
    • Prolapse: Nuclear material moved to the outer margins, but still within the annulus fibrosus.
    • Extrusion: Nuclear material has broken through the outer annulus fibrosus wall and contacted the surrounding structures.
    • Sequestration: Similar to extrusion, but with free-floating nuclear material; considered unstable.
  • Schmorl's nodes: Herniation of the nucleus pulposus into the vertebral end plate.
  • Centralization: Symptoms moving from the periphery towards the spinal column (preferred outcome).
  • Peripheralization: Symptoms moving from the spinal column to the periphery (e.g., from low back to glutes).

Assessing Disc Pathology

  • McKenzie Technique:
  • Baseline assessment: Before applying the McKenzie technique, gather a baseline assessment of the patient's symptoms using 5 questions. These questions are for gathering information about baseline pain and movement ability.
  • Pain quantification, location, severity: Patients need to quantify the pain intensity, describe the location of pain, and rate the severity.
  • Movement assessment: Patients need to repeat the movement 10 times, and the examiner reassesses the patient.
  • Pain/symptom assessment during movement: During the repeated movement, evaluate:
  • Diminishment or worsening of pain?
  • Abolition or cessation of pain?
  • Radicular symptoms?
  • Localized pain?
  • Does the pain increase/decrease?
  • Does the pain produce/abolish symptoms?
  • Are symptoms centralizing/peripheralizing?
  • Is the pain during movement (which part/when), or at end-range only?
  • Pain/symptom assessment after movement: Observe how pain and symptoms respond to movement:
  • Worsening / improvement
  • No change
  • Centralization
  • Peripheralization
  • No effect on pain or symptoms
  • Palpation in disc pathology: Focus on specific structures, such as the occiput, spinous processes, transverse processes, facet joints, temporomandibular joint, scalenes, sternocleidomastoid, erector spinae, upper trapezius fibers, suboccipitals, lumbosacral junction, sacrum, and gluteals.

Imaging and Diagnostics

  • Imaging order of specific diagnosis of disc pathology (least specific to most):
  • X-rays
  • MRI
  • CT scan
  • Myelogram
  • Discography

Differential Diagnoses

  • 14 differential diagnoses:
  • Spinal stenosis
  • Adverse neurodynamics
  • Spondylolisthesis
  • Facet joint pathology
  • Sacroiliac pathology
  • Piriformis syndrome
  • Hip joint pathology
  • Lumbar stress fracture
  • Muscle strain
  • Spondylosis
  • Myelopathy/upper motor neuron lesion
  • Meralgia paresthetica
  • Intermittent claudication
  • Neoplasm

Special Tests for Disc Pathologies

  • Possible negative results of special tests: Indicate the absence of spinal nerve or nerve root compression by the disc pathology.
  • Special tests for disc pathologies:
  • Cervical compression
  • Spurling's
  • Cervical distraction
  • Shoulder abduction
  • Valsalva

Referral

  • Referral for imaging: Family physician is the appropriate reference to consult for imaging recommendations for a suspected disc pathology.

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Description

This quiz explores the pathology of intervertebral discs, focusing on the nucleus pulposus and the vertebral end plate. Key topics include various types of disc pathology such as protrusion, prolapse, extrusion, and sequestration, along with concepts like Schmorl's nodes and symptom centralization. Test your understanding of these important spinal conditions.

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