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激光,飞秒

激光,飞秒的相关文献在2009年到2021年内共计60篇,主要集中在眼科学 等领域,其中期刊论文58篇、专利文献236058篇;相关期刊3种,包括中华眼外伤职业眼病杂志、中华眼科杂志、滨州医学院学报等; 激光,飞秒的相关文献由191位作者贡献,包括王雁、左彤、李华等。

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激光,飞秒

-研究学者

  • 王雁
  • 左彤
  • 李华
  • 窦瑞
  • 张佳媚
  • 武志清
  • 耿维莉
  • 金颖
  • 危平辉
  • 张丰菊
  • 期刊论文
  • 专利文献

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    • 刘晶; 王雁; 邹昊翰; 李梦迪
    • 摘要: 目的 探讨飞秒激光小切口角膜基质透镜取出术(SMILE)后角膜生物力学特性变化量随残余基质厚度(RST)、组织去除厚度百分比(PTA)的变化规律,并分析SMILE后角膜生物力学特性的影响因素.方法 回顾性系列病例研究.选取2019年1月至2020年1月于天津市眼科医院屈光手术中心行SMILE者184例(184只右眼),其中男性83例,女性101例,年龄(24.6±5.8)岁.于术前和术后3个月用CorvisST角膜生物力学分析仪测量术眼的角膜生物力学参数,包括形变幅度比值(DA ratio)、角膜硬度参数(SPA1)和综合半径(IR).对RST、PAT与DAratio、SPA1、1R的变化量的关系进行线性和非线性回归分析.纳入年龄、性别、角膜前表面平均曲率(Km)、术前等效球镜度数(SE)、术后角膜中央厚度(CCT)和术前角膜生物力学参数为自变量,采用步进法多元线性回归模型分析术后DAratio、SPA1和IR的影响因素.对手术前后数据比较采用配对t检验;相关性检验采用Pearson或Spearman相关性分析.结果 SMILE术后DA ratio、SPA1和IR的变化量(变化率)分别为1.33(30.0%)、28.05(26.0%)和2.56(34.0%),手术前后差异均具有统计学意义(t=35.52,-28.00,36.95;P<0.01).最优拟合曲线显示,随着RST减少或者PTA的增加,DA ratio、SPA1和IR的变化量逐渐升高.其中,当RST<280μm或者PTA>28%时,DAratio变化量曲线斜率明显增加.多因素回归模型显示,对SMILE术后DAratio、SPA1和IR根据标准化回归系数(Sβ值)排序,影响权重前3位的因素分别为术前DA ratio(Sβ=0.489)、术前SPA1(Sβ=0.483)和术前IR(Sβ=0.471);CCT是术后DA ratio和SPA1的第二大影响因素(Sβ=-0.238,0.326).结论 SMILE术后DA ratio、SPA1和1R的改变随RST的减少或者PTA的增加而增加,当RST<280 μm或PTA>28%时,DA ratio的改变速度明显加快;术前角膜生物力学特性和术后CCT是影响术后角膜生物力学稳定性的主要因素.
    • 孙蕊; 刘文韬; 吕勇; 何欣琰
    • 摘要: 目的 分析有晶状体眼后房型人工晶状体(ICL)植入术及飞秒激光小切口角膜基质透镜取出术(SMILE)矫正高度近视术后早期干眼发生情况.方法 回顾性研究.郑州大学第一附属医院2019年3月至2020年5月高度近视172例(344只眼)按手术方式分成两组:ICL组73例(146只眼)及SMILE组99例(198只眼).随访3个月,比较两组眼表疾病指数(OSDI)评分、无创性泪膜破裂时间(NIBUT)、基础泪液分泌试验(SⅠT)、角膜荧光素染色及细胞因子(TNF-α,IL-1α)表达水平.结果 术后1个月,两组OSDI评分均较术前增高(P0.05);与术前相比差异亦无统计学意义(P>0.05).结论 两种手术方式早期均有术后干眼并发症,ICL组干眼程度均较SMILE组重,但二者干眼情况均可在短期内改善.
    • 徐新花; 张雪梅; 刘勤; 杨君; 金庸
    • 摘要: 目的 分析中度及高度近视小切口角膜基质透镜取出术(SMILE)角膜实际切削深度与预计切削深度的关系.方法 回顾性系列病例研究.收集2019年2月至2019年10月甘肃省人民医院SMILE手术的中度近视31例(62只眼)及高度近视22例(44只眼)的临床资料.比较术后1 d、1周、1个月及3个月实际切削深度与预计切削深度的关系.结果 中度及高度近视术后各时间点实际切削深度均低于预计切削深度(中度近视组,t=5.900、2.121、3.693及12.107,均P<0.05;高度近视组,t=-2.851、-2.095、-3.261及-5.244,均P<0.05);术后不同时间点高度近视组切削偏差均大于中度近视组,差异有统计学意义(P<0.05).中度及高度近视实际切削深度与预计切削深度在各时间点均成线性相关(中度近视,r=0.834、0.638、0.712及0.887,均P<0.001;高度近视,r=0.464、0.326、0.412及0.449,均P<0.05).结论 中度及高度近视SMILE术后不同时间中央角膜实际切削深度均低于预计切削深度,高度近视切削偏差更大.对于高度近视,SMILE术后中央角膜切削偏差具有较好的可预测性.
    • 徐艳雪; 王勇; 孙明; 鲍先议; 雷荣; 李黄恩; 李雪婷
    • 摘要: 目的 评价LenSx和LenSAR两种不同飞秒激光辅助白内障摘除手术操作平台的临床应用效果.方法 前瞻性随机对照研究.选择2018年4至11月在武汉爱尔眼科医院行飞秒激光辅助白内障摘除手术患者86例(90只眼),采用随机信封法分为LenSx组44例(45只眼),LenSAR组42例(45只眼).手术过程中获得下列观察指标结果并进行组间比较.操作性指标包括尝试对接次数、飞秒激光前囊膜切开时间、预劈核时间、飞秒激光发射总时间、负压吸引眼球的总时长;临床效果指标包括飞秒激光前后的眼压变化、结膜下出血率、晶状体前囊膜是否切开完整、前囊膜切口圆度、前囊膜切口居中性(前囊膜切口是否全周包裹人工晶状体光学部)、前囊膜切口撕裂率、晶状体后囊膜破裂率.采用t检验、秩和检验及x2检验进行统计学分析.结果 两组年龄、晶状体核硬度差异均无统计学意义(均P>0.05).LenSx组和LenSAR组尝试对接次数分别为1(1~4)、1(1~2)次,飞秒激光前囊膜切开时间分别为13.00(10.00~22.00)、3.00(1.00~3.00)s,飞秒激光预劈核时间分别为(16.67±3.36)、(12.38±4.36)s,飞秒激光发射总时间分别为(30.49±3.53)、(15.36±4.29)s,负压吸引固定眼球的总时长分别为(97.23±19.96)、(123.76±16.81)s,两组间差异均有统计学意义(Z=-2.23,-8.71;t=-5.23,-18.26,6.82;均P<0.05).两组患眼飞秒激光术后眼压平均值均较术前升高,LenSx组和LenSAR组术后与术前眼压差值分别为(2.99±4.66)、(5.64±5.42)mmHg(1 mmHg=0.133 kPa);结膜下出血率分别为33.3%(15/45)、8.9%(4/45),两组间差异均有统计学意义(t=-2.49,x2=6.67;均P<0.05).两组晶状体前囊膜完整切开率、前囊膜切口圆度、前囊膜切口全周包裹人工晶状体光学部、前囊膜切口撕裂率、晶状体后囊膜破裂率差异均无统计学意义(均P>0.05).结论 LenSAR对接过程便捷,结膜下出血少;LenSx总负压吸引时间短,眼压升高较低.
    • 王媛; 陈跃国
    • 摘要: 目的 比较飞秒激光原位角膜磨镶术(FS-LASIK)与准分子激光上皮下角膜磨镶术(LASEK)术后的眼表损伤情况.方法 回顾性分析北京大学第三医院2017年2月至5月近视及散光102例(102只眼)的临床资料,所有患者根据手术方式分为FS-LASIK组51例(51只眼),及LASEK组51例(51只眼).比较两组术前、术后的眼表情况.随访时间6个月.结果 两组患者术后早期不完全瞬目比例、泪膜脂质层厚度、泪膜破裂时间和泪液分泌量均较术前降低,而干眼患者标准评分问卷评分较术前升高,且随时间推移逐渐恢复;术后1周LASEK组的泪膜破裂时间短于FS-LASIK组(P=0.008);术后1个月LASEK组的泪膜脂质层厚度、泪膜破裂时间和泪液分泌试验均低于FS-LASIK组(P=0.039、0.001、0.037);术后3个月LASEK组的泪膜脂质层厚度低于FS-LASIK组(P=0.044).结论 FS-LASIK与LASEK术后早期可加重干眼的不适症状;LASEK对眼表的影响更为显著.
    • 马刚; 付梦军; 张浩润
    • 摘要: 目的 研究飞秒激光小切口角膜基质透镜取出术(SMILE)联合角膜胶原交联术(CXL)矫正近视的角膜生物力学参数的变化.方法 前瞻性研究,选取SMILE手术的患者32例(64眼),按照眼科检查结果 ,将患者分为SMILE组和SMILE+CXL组,其中SMILE组18例(36眼),SMILE+CXL组14例(28眼).SMILE组行常规SMILE手术.SMILE+CXL组先行SMILE手术,分离并取出角膜基质透镜后,再用Vibex Xtra核黄素溶液均匀反复注入角膜基质囊袋内,持续45 s,应用Avedro交联系统行跨上皮快速交联,选择波长365 nm,采用连续照射模式,照度30 mW/cm2的紫外线照射45 s,照射总能量为1.35 J/cm2.术后随访1、3个月,比较两组患者术前基本资料及术后眼科检查参数,手术前后角膜生物力学参数,角膜内皮细胞计数.结果 所有手术均顺利完成,术后均达到或超过术前最佳矫正视力,SMILE+CXL组患者术后早期有畏光,流泪等症状.SMILE组与SMILE+CXL组术后1天、术后1月和术后3月术前最佳矫正视力(Log-MAR)比较,差异有统计学意义,P<0.05;SMILE组与SMILE+CXL组术后1天、术后1月和术后3月等效球镜(SE)比较,差异有统计学意义,P<0.05;SMILE组与SMILE+CXL组术后1月和术后3月眼压(IOP)比较,差异有统计学意义,P<0.05.和术后1天相比,两组术后1月和术后3月LogMAR差异有统计学意义,P<0.05;和术后1天相比,两组术后1月和术后3月SE差异有统计学意义,P<0.05.和术后1月相比,SMILE+CXL组术后3月LogMAR差异有统计学意义,P<0.05;和术后1月相比,两组术后3月IOP增加,P<0.05.所有患者手术前后AT1、AT2、AL1、AL2、V1、V2、HCR、DA比较差异有统计学意义,P<0.05.SMILE组与SMILE+CXL组两组比较,术后3个月AT1、HCT、AL1、AL2、V1、V2、PD比较差异有统计学意义,P<0.05.结论 SMILE术后角膜生物力学降低,SMILE联合CXL矫正近视早期安全、有效.CXL术后角膜硬度增加,形变速度减慢,长期效果仍需进一步观察.
    • Ma Jiaonan; Wang Yan; Song Yi; Shao Ting; Cai Yong
    • 摘要: 目的 探讨飞秒激光小切口角膜基质透镜取出术(SMILE)术中不透明气泡层(OBL)的产生及其可能的生物力学影响因素进行分析.方法 巢式病例对照研究.入选2017年6至8月行SMILE的患者,术中出现OBL者为OBL组,与其同日行SMILE但无其他术中并发症者为无OBL组.通过术前Pentacam眼前节分析系统及CorvisST检查获取分析参数.独立样本t检验及多元Logistics回归模型分别用于分析两组之间生物力学参数的差异及与OBL发生可能相关的生物力学影响因素.结果 本研究共纳入71例(129只眼)患者,年龄为(22.50±5.18)岁,男性30例,女性41例,其中OBL组20例(31只眼),无OBL组51例(98只眼).结果 显示OBL组与无OBL组的等效球镜度数(SE)[(-4.64±1.33)和(-5.78±1.61)D]、中央角膜厚度(CCT)[(572±29)和(550±32) μm]、残余基质厚度(RST)[(356±31)和(325±36)μ m]及透镜厚度(LT)[(96±23)和(115±25) μm]差异均有统计学意义(t=3.58,-3.43,-5.68,3.64;P<0.05);两组之间的第一次压平时的偏移幅度(A1 DefA)、最大压陷时的偏移幅度(HC DefA)、最大压陷时的偏移面积(HC DefArea)、最大形变幅度(DAmax)、最大偏移幅度(DefAmax)、角膜刚性参数(SP)(108.85±13.77和100.19±14.13)差异均有统计学意义(t=-2.75,2.41,3.62,4.09,2.22,-2.99;P<0.05).Logistics回归基本模型和调整模型中,SP的OR值为1.04(95%可信区间1.01~ 1.07)(P=0.005)、1.01(95%可信区间1.00~1.05)(P=0.426).结论 影响OBL发生的角膜生物力学因素是多方面的,角膜厚度及残余基质床厚度较厚,SP较大均可能增加OBL发生的可能性.充分了解角膜生物力学特性对于手术效果的影响,同时评估术中OBL的发生,对于提高SMILE的安全性和预测性具有重要意义.%Objective To investigate the influence of corneal biomechanical properties on opaque bubble layer (OBL) in small incision lenticule extraction (SMILE).Methods In this nested case control study,20 patients (31 eyes) were enrolled in OBL group,while 51 patients (98 eyes) were included in non-OBL group.The parameters were obtained by Pentacam HR and Corvis ST examinations.Independent t test was used to analyze the difference of corneal biomechanical parameters between the two groups and multivariable logistics regression was applied to analysis the influence of corneal biomechanical properties on OBL.Results This study enrolled 129 eyes in 71 cases including 30 males and 41 females,with a mean age of (22.50±5.18) years old.It has shown that the spherical equivalent (SE) [(-4.64± 1.33) and (-5.78± 1.61) D],central corneal thickness (CCT) [(572±29) and (550t32)μm],residual stromal thickness (RST) [(356 ± 31) and (325± 36 μm)],and lenticule thickness (LT) [(96 ± 23) and (115± 25) μm] were significantly different between OBL group and non-OBL group (t=3.58,-3.43,-5.68 and 3.64,respectively,P<0.05).There were significant differences in deflection amplitude at the first applanation and highest concavity (A1 DefA and HC DefA),deflection area at the highest concavity (HC DefArea),maximum deformation amplitude (DAmax),maximum deflection amplitude (DefAmax) and stiff parameter (SP) (108.85± 13.77 and 100.19± 14.13) between the two groups (t=-2.75,2.41,3.62,4.09,2.22 and-2.99,respectively,P<0.05).The OR and 95% confidence interval of SP in crude and adjusted logistics models were 1.04,(1.01-1.07) (P=0.005),and 1.01,(1.00-1.05) (P=0.426),respectively.Conclusions The occurrence of OBL could be influenced by various corneal biomechanical factors.The thicker CCT,thicker RST and the stiffer comea may increase the risk for the occurrence of OBL.Fully acknowledgement on the relationship between corneal biomechanics and surgical outcomes and evaluation of the occurrence of OBL in SMILE surgery is of great importance for improving the safety and predictability of SMILE.
    • 王金铎; 曹向荣
    • 摘要: 飞秒激光辅助晶状体超声乳化手术以其精确性和安全性逐渐被眼科医生们所认可.在切口制作、撕囊、劈核及角膜松解切口制作上也积累了许多经验.其应用于常规白内障手术的优越性已经逐渐得以体现,在复杂白内障病例中也日益发挥着重要作用.本文就其在膨胀期、硬核、晶状体不全脱位等情况下的应用及临床价值做一综述.%The accuracy and safety of femtosecond laser assisted phacoemulsification is approved by ophthalmologist.They have accumulated experience of making incision, continuous curvilinear capsulorhexis, nucleus fragmentation and relaxing corneal incision.The benefit gradually are seen not only in general cataract operation ,but also complex cataract. This article summerizes the application and clinical value of femtosecond laser assisted phacoemulsification in cases of immature stage,hard nucleus,subluxation of lens and so on.
    • 李华; 陈敏; 田乐; 李德卫; 彭予苏; 张飞飞
    • 摘要: 目的 探讨飞秒激光辅助准分子激光原位角膜磨镶术(FS-LASIK)术后光学区的变化及Pentacam角膜地形图各模式测量值的特点.方法 回顾性病例研究.选取于青岛眼科医院角膜屈光科行FS-LASIK且术后随访≥6个月资料完整的近视眼及近视散光患者24例(41只眼),其中男性7例,女性17例,年龄18~ 42岁.应用Pentacam眼前节分析系统角膜地形图6种不同模式(单纯角膜轴向曲率图、单纯角膜切线曲率图、角膜轴向曲率差异图、角膜切线曲率差异图、角膜前表面高度图及角膜厚度差异图)联合自主研制的透明同心圆软件对患者术后光学区进行测量.手术后1、3、6个月不同角膜地形图模式测量的光学区直径比较采用重复测量方差分析,光学区实际测量值与理论设计值的比较采用两样本t检验.FS-LASIK术后光学区测量值与可能影响因素的相关性分析采用Spearman秩相关分析.结果 FS-LASIK术后1、3、6个月,单纯角膜轴向曲率图光学区测量值分别为(6.55±0.50)、(6.50±0.53)、(6.48±0.53) mm,差异无统计学意义(F=1.60,P>0.05);单纯角膜切线曲率图测量值分别为(5.44±0.46)、(5.46±0.52)、(5.44±0.50)mm,差异无统计学意义(F=0.17,P>0.05);角膜前表面高度图光学区测量值分别为(5.06±0.28)、(5.12±0.32)、(5.17±0.28)mm,仅术后3、6个月相比差异无统计学意义(F=6.14,P>0.05);角膜轴向曲率差异图光学区测量值分别为(6.51±0.37)、(6.45±0.41)、(6.41±0.40) mm,仅术后3、6个月相比差异无统计学意义(F=7.25,P>0.05);角膜切线曲率差异图光学区测量值分别为(5.21±0.23)、(5.16±0.19)、(5.17±0.20)mm,仅术后1、3个月差异有统计学意义(F=1.75,P<0.05);角膜厚度差异图光学区测量值分别为(6.53±0.40)、(6.39±0.43)、(6.41±0.47)mm,仅术后1、3个月差异有统计学意义(F=1.67,P<0.05).6种模式角膜地形图的光学区测量值与理论值(7.75 mm)相比均明显减小,差异均有统计学意义(t=16.79,31.91,66.44,22.76,69.98,20.09;P<0.01).结论 FS-LASIK术后光学区直径测量值在术后3个月趋于稳定.角膜地形图6种不同模式测量结果显示实际激光切削区与手术设计理论值相比均下降,其中单纯角膜切线曲率图、角膜切线曲率差异图、角膜前表面高度图测量值与理论设计值相差较大且边界清晰,对于偏心评估更有优势;而单纯角膜轴向曲率图、角膜轴向曲率差异图及角膜厚度差异图与理论设计值相对接近,此外角膜轴向曲率差异图边界更清晰更有利于光学区的测量.%Objective To explore the change of optical zone after femtosecond laser assisted laser in sitn keratomileusis(FS-LASIK) so as to provide the reference for measurement and design of clinical optical zone.Methods This retrospective case series study covers 41 eyes of 24 patients (7 males and 17 females,aged from 18 to 42 years old) with myopia and myopic astigmatism who have received FS-LASIK surgery at Corneal Refractive Department of Qingdao Eye Hospital and completed over 6 months of clinical follow-up.Pentacam system (with the application of 6 corneal topographic map modes including:the pure axial curvature topographic map,the pure tangential curvature topographic map,the axial curvature difference topographic map,the tangential curvature difference topographic map,the postoperative front elevation map and the corneal thickness difference topographic map),combined with transparent concentric software (a system independently developed by Qingdao Eye Hospital) was used to measure the optical zone at 1,3 and 6 months postoperatively,the optical zone diameters measurement results among different follow-up times in group were analyzed with the repeated measures analysis of variance,and the actual measured values and the theoretical design values of the optical zone were analyzed with independent-samples t-testing.Spearman correlation coefficient (rs) have been applied to evaluate the relationship between postoperative optical zone measurement values and the potential influencing factors.Results The optical zone diameters measured by pure axial curvature topographic map at 1,3 and 6 months after FS-LASIK showed (6.55± 0.50)mm,(6.50 ± 0.53)mm and (6.48 ± 0.53)mm respectively.The differences between values are of no statistical significance (F=1.60,P=0.21),the optical zone diameter measured by pure tangential curvature topographic map at 1,3 and 6 months after FS-LASIK showed (5.44±0.46)mm,(5.46 ± 0.52)mm and (5.44 ± 0.50)mm respectively,the differences between values are of no statistical significance (F=0.17,P=0.85).The optical zone diameters measured by postoperative front elevation map at 1,3 and 6 months after FS-LASIK showed (5.06±0.28)mm,(5.12±0.32)mm and (5.17±0.28)mm respectively.The differences between the values of 3 and 6 months postoperatively are of no statistical significance (F=6.14,P=0.15),the optical zone diameters measured by axial curvature difference topographic map at 1,3 and 6 months after FS-LASIK showed (6.51±0.37)mm,(6.45±0.41)mm and (6.41 ±0.40)mm respectively,and the differences between the values of 3 and 6 months postoperatively are of no statistical significance (F=7.25,P=0.05).The optical zone diameters measured by tangential curvature difference topographic map at 1,3 and 6 months after FS-LASIK showed (5.21 ± 0.23)mm,(5.16 ± 0.19)mm and (5.17 ±0.20) mm respectively,and the differences between the values of 1 and 3 months postoperatively are of statistical significance (F=1.75,P=0.04).The optical zone diameters measured by corneal thickness difference topographic map at 1,3 and 6 months after FS-LASIK showed (6.53±0.40)mm,(6.39±0.43)mm and (6.41± 0.47)mm respectively,and the differences between the values of 1 and 3 months postoperatively are of statistical significance (F=1.67,P=0.032).The actual measured optical zone values from the 6 different modes of Pentacam system are less than the theoretical design values (7.75 mm),and the differences were statistical significance (t=-15.42,-29.39,-59.27,-21.47,-81.69,-18.22,P<0.01).Conclusions The optical zone measurement values tend to be stable at 3 months after FS-LASIK.The actual measured values from all the 6 different modes of Pentacam system were less than the theoretical design values.The results from pure tangential curvature topographic map,the tangential curvature difference topographic map and the postoperative front elevation map showed greater variation with clear border,which was beneficial for eccentric research.The results from pure axial curvature topographic map,the axial curvature difference topographic map and the corneal thickness difference topographic map were close to the theoretically designed values.Furthermore,the axial curvature difference topographic map showed clearer border and less variation thus maybe more favorable for measuring optical zone in clinical application.
    • 王雁; 李晶
    • 摘要: 角膜屈光手术作为视觉矫正方式之一,已被越来越多屈光不正患者接受.近视眼在我国的发病率较高,使得接受角膜屈光手术的患者数量庞大.面对相对健康的角膜等眼部组织,需要选择最为安全而有效的手术方式.近年来角膜屈光手术新技术不断涌现,但仍存在许多未知.本文在介绍各类新技术的同时,指出角膜屈光手术面临的问题,强调需要进行大量的临床和基础研究,包括组织病理学、分子生物学等结合数学、物理学、计算机学、化学以及角膜生物力学等,通过多学科相互交叉、渗透,才能更加深入了解新技术的内涵及本质,正确掌握和选择手术方式,使角膜屈光手术达到组织损伤最小,从而获得最佳的临床视觉矫正效果.%Corneal refractive surgery,as one of the common visual correction methods,has been increasingly accepted in China.There are a large number of people in China who undergo the corneal refractive surgery due to the high incidence of myopia in the country.It is essential that the safest and most effective surgery should be used to correct refractive errors in the cases involved with relatively normal eyes and corneas.In recent years,corneal refractive surgery has been rapidly developing with new technologies and techniques emerging all the time,such as SMILE (small incision lenticule extraction) surgery,which has been extensively applied in China since five years ago when it was approved by FDA.However,little known are these new technologies and techniques,and the clinical and basic researches need further investigations by various approaches including histopathology and molecular biology,combined with mathematics,computer science,physics,chemistry and corneal biomechanics.To achieve minimal tissue damage and optimal clinical outcomes on visual quality by corneal refractive surgery requires the multidisciplinary partnerships of medical practitioners and researchers.
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