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Şenyuva İ, Acar DB, Demirel HH, Tunç E. Effects of testosterone treatment on anal sphincter damage repair in ovariectomized rats. Turk J Med Sci 2023; 53:475-485. [PMID: 37476872 PMCID: PMC10388087 DOI: 10.55730/1300-0144.5607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/20/2022] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Fecal incontinence (FI) generally occurs with anal sphincter damage caused by vaginal delivery in women, obvious FI can develop in the postmenopausal stage. This pelvic floor dysfunction has no rational medical therapeutic options. We investigated the effect of testosterone treatment on the anal sphincter structure, serum thiol/disulfide levels, uterine tissue, and body composition in female rats in an experimental menopause-FI model. METHODS The animal experiments were performed between September and November 2020 at Experimental Animal Application and Research Center, Afyon Kocatepe University, Afyonkarahisar, Turkey. Thirty-two female rats were divided into four groups: sham, saline, 10 mg/kg testosterone undecanoate, 100 mg/kg testosterone undecanoate. Except for the sham group, all the other groups underwent ovariectomy (OVE) to create a menopause model. Two weeks after this procedure, the FI model was created under general anesthesia in all rat groups. At the end of the experiment, the rats were placed under general anesthesia, weighed, and euthanized after recording the data. The anal sphincter region and uterine tissue samples were collected for histopathological examinations, and blood samples were collected for total testosterone and thiol/disulfide homeostasis analyses. RESULTS An increase in anal sphincter muscles and connective tissue thickness was observed in the testosterone-administered groups (p = 0.001). No difference was detected between the groups in the total thiol, native thiol, and disulfide balance (p = 0.087, p = 0.604, p = 0.092). The testosterone-treated groups did not have severe uterine epithelial degradation, hyperemia, or increased endometrial thickness (p = 0.186, p = 0.222, p = 0.630). The body weight of all rats increased (p < 0.05), but the omental weight did not increase (p = 0.061). DISCUSSION Testosterone treatment increased the anal sphincter muscle and connective tissue thickness without causing any oxidative stress and did not result in a pathological change in the uterine tissue and body fat composition.
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Affiliation(s)
- İrem Şenyuva
- Department of Obstetrics and Gynecology, Faculty of Medicine, Uşak University, Uşak, Turkey
| | - Duygu Baki Acar
- Department of Obstetrics and Gynecology, Veterinary Faculty, Afyon Kocatepe University, Afyon, Turkey
| | | | - Ece Tunç
- Department of Obstetrics and Gynecology, Veterinary Faculty, Afyon Kocatepe University, Afyon, Turkey
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Hambisa HD, Birku Z, Gedamu S. Magnitude of Symptomatic Pelvic Floor Dysfunction and Associated Factors Amongst Women in Western Ethiopia: A Cross-Sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231171309. [PMID: 37203183 PMCID: PMC10201172 DOI: 10.1177/00469580231171309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/25/2023] [Accepted: 04/05/2023] [Indexed: 05/20/2023]
Abstract
The goal of this research was to determine the extent of pelvic floor dysfunction and the factors that contribute to it. The study design was community-focused and cross-sectional, and participants were chosen using a systematic random sampling technique. For data entry and cleansing, we used EPI data version 3.1 software, and for analysis, we used Statistical Package for the Social Sciences version 26. The 95% confidence interval was predicted, and the factor with a significant level less than 0.05 was chosen for multivariate logistic regression analysis. The overall Magnitude of pelvic floor dysfunction was 37.7% [(95% confidence interval (31.7-42.5)]. The most common type of pelvic floor dysfunction is overactive bladder, which was reported by 135 of all participants. Pelvic organ prolapse accounted for 92 (30.4%) of all cases, and 4 factors were found to be significantly associated with pelvic floor dysfunction. In this study, age 55 years [(AOR = 2.1; 95% CI: (1.52-6.42)], heavy labor work for more than 10 years [(AOR = 3.21; 95% CI: (1.86-5.72) grand-multipara, and being menopause [(AOR = 4.03; 95% CI: (2.20-8.27)] were linked to symptoms of pelvic floor dysfunction. The magnitude of pelvic floor dysfunction in this study was slightly higher than in Ethiopian studies. Pelvic floor dysfunction has been linked to heavy load lifting, low socioeconomic status, recurrent vaginal deliveries, chronic cough, and menopause. Screening and treatment of pelvic floor disorders should be prioritized in collaboration with regional and zonal health departments.
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Affiliation(s)
- Hunduma Dina Hambisa
- College of Health Science, Department
of Midwifery, Assosa University, Asosa, Ethiopia
| | - Zelalem Birku
- College of Health Science, Department
of Midwifery, Assosa University, Asosa, Ethiopia
| | - Samuel Gedamu
- College of Health Science, Department
of Midwifery, Assosa University, Asosa, Ethiopia
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Freitas MM, Moura LEF, Saquetto D, Rodrigues IC, Carvalho VCPD, Uchôa SMM. Physiotherapeutic Approaches to Treat Anal Incontinence in Women after Obstetric Trauma. JOURNAL OF COLOPROCTOLOGY 2022. [DOI: 10.1055/s-0042-1742621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Introduction Anal incontinence is defined as the loss of voluntary control of fecal matter or gases with a recurrence period longer than 3 months in individuals aged ≥ 4 years; it has a female predominance. Among the treatment modalities is pelvic physiotherapy, the second line of treatment, which promotes the reeducation, coordination, and strengthening of the muscles of the pelvic floor to enable patients to return to their regular activities of daily living.
Objective To perform a systematic review on the physiotherapeutic treatments used in women between the ages of 18 and 65 years with a diagnosis of anal incontinence.
Material and methods Clinical studies written in Portuguese, Spanish and English were searched on the the following databases: Science Direct, Medical Literature Analysis and Retrieval System Online (Medline) via PubMed, Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (SciELO), and Scopus.
Results Of the 998 articles found, only 4 studies met the inclusion criteria of the present systematic review. The physiotherapeutic approaches to treat women with anal incontinence are biofeedback, Kegel exercises, electrostimulation, and training of the pelvic floor muscles. The average score on the PEDro scale was of 6.25, which indicates that the methodological quality was good.
Conclusion Although pelvic physiotherapy is effective to treat anal incontinence, it must be promoted through the performance of evidence-based scientific research.
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Affiliation(s)
- Mayanna Machado Freitas
- Evidence-Based Physiotherapy Research Group, Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil
| | - Lara Elma Franco Moura
- Evidence-Based Physiotherapy Research Group, Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil
| | - Denise Saquetto
- Evidence-Based Physiotherapy Research Group, Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil
- Centro Universitário Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | - Iane Castro Rodrigues
- Evidence-Based Physiotherapy Research Group, Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil
| | - Valéria Conceição Passos de Carvalho
- Evidence-Based Physiotherapy Research Group, Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil
- Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil
| | - Silvana Maria Macedo Uchôa
- Evidence-Based Physiotherapy Research Group, Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil
- Universidade Católica de Pernambuco (UNICAP), Recife, Pernambuco, Brazil
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Lakshmanan S, Kane S, Dibble C, Roland B. Need for Awareness and Training in Women's Gastrointestinal Health: A Call to Action. J Womens Health (Larchmt) 2021; 31:125-129. [PMID: 33887148 DOI: 10.1089/jwh.2020.8826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Women's gastrointestinal (GI) health is a topic that is not well understood nor taught in most training programs. In this article, we highlight the importance of proper training in women's GI health among gastroenterologists and fellows, and identify some common conditions to provide the best possible treatment for their female patients.
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Affiliation(s)
- Seetha Lakshmanan
- Department of Medicine, Roger Williams Medical Center, Providence, Rhode Island, USA
| | - Sunanda Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christy Dibble
- Department of Gastroenterology, Women & Infants Hospital/Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Bani Roland
- Department of Gastroenterology, Women & Infants Hospital/Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
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Physiotherapy for Prevention and Treatment of Fecal Incontinence in Women-Systematic Review of Methods. J Clin Med 2020; 9:jcm9103255. [PMID: 33053702 PMCID: PMC7600070 DOI: 10.3390/jcm9103255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 12/12/2022] Open
Abstract
Fecal incontinence (FI) affects approximately 0.25-6% of the population, both men and women. The most common causes of FI are damage to/weakness of the anal sphincter muscle and/or pelvic floor muscles, as well as neurological changes in the central or peripheral nervous system. The purpose of this study is to report the results of a systematic review of the possibilities and effectiveness of physiotherapy techniques for the prevention and treatment of FI in women. For this purpose, the PubMed, Embase, and Web of Science databases were searched for 2000-2020. A total of 22 publications qualified for detailed analysis. The studies showed that biofeedback (BF), anal sphincter muscle exercises, pelvic floor muscle training (PFMT), and electrostimulation (ES) are effective in relieving FI symptoms, as reflected in the International Continence Society recommendations (BF: level A; PFMT and ES: level B). Research has confirmed that physiotherapy, by improving muscle strength, endurance, and anal sensation, is beneficial in the prevention of FI, both as an independent method of conservative treatment or in pre/post-surgery treatment. Moreover, it can significantly improve the quality of life of patients. In conclusion, physiotherapy (in particular, BF, PFMT, or ES, as effective methods) should be one of the key elements in the comprehensive therapy of patients with FI.
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Rueb JJ, Goldman HB. Optimizing Neuromodulation Testing—Who, When, and How? CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00583-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Affiliation(s)
- Jo Booth
- Department of Nursing & Community Health, School of Health & Life SciencesGlasgow Caledonian University Glasgow UK
| | - Donna Bliss
- School of NursingUniversity of MinnesotaMinneapolis Minnesota
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Ribeiro DC, Souza JRN, Zatti RA, Dini TR, Moraes JRD, Faria CA. Double incontinence: associated factors and impact on the quality of life of women attended at a health referral service. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2019. [DOI: 10.1590/1981-22562019022.190216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract Objective: To evaluate the prevalence, associated factors, and impact on quality of life of double incontinence in a group of women with urinary incontinence. Method: A cross-sectional study was performed, including female patients with urinary or double incontinence (urinary and fecal incontinence) treated at a tertiary hospital from the public healthcare system. Information about sociodemographic and clinical characteristics was collected, and quality of life was assessed using validated questionnaires. The Mann-Whitney, Chi-square, and Fisher tests were used to evaluate the association between the variables and the types of dysfunction (urinary or double incontinence) and a worse general health perception. Results: Of 227 incontinent women included in the study, 120 (52,9%) were older individuals. The prevalence of double incontinence was 14.1% (32 patients). Double incontinence was associated with a higher number of comorbidities (p-value=0.04), polypharmacy (p-value=0.04), and rectocele (p-valor=0.02). Higher BMI (p-value=0.02) and number of comorbidities (p-value=0.05), but not double incontinence (p-value=0.36), were associated with low general health perception scores. Conclusion: the prevalence of double incontinence was different from other studies conducted in similar scenarios. The group of women included in the study presented low general health perception scores, but this was not associated with the presence of double incontinence. A higher number of comorbidities was associated with both double incontinence and a lower general health perception.
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Zhang L, Luo X. Clinical Significance of Neuropeptide Y Expression in Pelvic Tissue in Patients with Pelvic Floor Dysfunction. Open Life Sci 2019; 14:126-132. [PMID: 33817144 PMCID: PMC7874799 DOI: 10.1515/biol-2019-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/01/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To investigate the neuropeptide Y (NPY) expression in the tissue of pelvic floor ligament and anterior vaginal wall in female patients with pelvic organ prolapse (POP) and stress urinary incontinence (SUI). METHOD Seventeen patients with POP, 6 with SUI, 13 with POP and SUI (POP&SUI), and 10 controls were included in this study from First Affiliated Hospital of JiNan University. Immunohistochemical assay was used to examine NPY expression in the tissue of round ligament, cardinal ligament of uterus, uterosacral ligament, and anterior vaginal wall. NPY expression were compared between POP, SUI, POP&SUI and controls. RESULTS NPY was positive expressed in the round ligament, cardinal ligament of uterus, uterosacral ligament, and anterior vaginal subepithelial connective tissue. Compared with the control group, NPY expression in the round, cardinal, and uterosacral ligaments in patients with POP&SUI group was decreased with significant statistical difference (p<0.05). NPY expression in anterior vaginal wall was significantly decreased in POP, SUI, and POP&SUI groups compared to normal group (p<0.05). Compared to POP group, NPY expression in SUI and POP&SUI groups were significantly decreased (p<0.05), however the difference was not statistical different between SUI and POP&SUI groups (p>0.05). In POP and POP&SUI groups, the NPY expression in the cardinal ligament of uterus, uterosacral ligament, and anterior vaginal wall were negatively correlated with age (p<0.05), however, was not correlated with number of pregnancy, number of delivery, and BMI (p>0.05). CONCLUSIONS NPY expression was reduced in the round ligament, cardinal ligament of uterus, Uterosacral ligament, and vaginal anterior wall of the patients with POP and SUI. The decreased NPY expression may play an important role in the development of pelvic floordysfunction.
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Affiliation(s)
- Limin Zhang
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Fujian Medical University, Fuzhou350005 PRChina
| | - Xin Luo
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Jinan University, Jinan510632 PRChina
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Joh HK, Seong MK, Ahn HJ. Fecal incontinence knowledge, attitudes, and help-seeking behaviors among community-dwelling adults in Korea. Neurourol Urodyn 2018; 37:1474-1484. [PMID: 29331051 DOI: 10.1002/nau.23480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/05/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Fecal incontinence (FI) is a common debilitating disorder that tends to be underreported. Although low health literacy likely contributes to the underreporting, studies on FI knowledge among the general population remain scarce. We investigated how FI knowledge is associated with attitudes and help-seeking behaviors. METHODS We conducted a cross-sectional survey among community-dwelling adults undergoing national health screening in Korea. A structured, self-administered questionnaire was used to assess FI knowledge, attitudes, and help-seeking behaviors. Odds ratios (ORs; 95% confidence intervals, CIs) were estimated using logistic regression with adjustment for covariables. RESULTS Of the 601 participants completing the survey, only 29.8% were aware of the term FI, and their knowledge levels were insufficient. As for FI-related attitudes, 24.6% considered FI to be very rare, and 22.3% considered it to be moderately or less distressing. Individuals who knew the term FI tended to consider FI more common (OR: 2.45; 95%CI: 1.49-4.02) and distressing (OR: 1.68; 95%CI: 1.07-2.63) than those without knowledge. Assuming future FI occurrence, those considering FI to be distressing were less willing to ignore or self-manage the condition (OR: 0.25; 95%CI: 0.11-0.58). Among patients with FI (n = 83), only 30.1% had sought help and 8.4% had consulted doctors. Knowing the term FI was significantly associated with overall help-seeking behavior (OR: 9.23; 95%CI: 2.09-40.77). CONCLUSIONS FI knowledge levels and help-seeking rates were low among community-dwelling adults. FI knowledge was significantly associated with attitudes and help-seeking behaviors. Future public education programs are warranted to improve FI knowledge, attitudes, and help-seeking behaviors.
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Affiliation(s)
- Hee-Kyung Joh
- Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea.,Department of Family Medicine, Seoul National University Health Service Center, Seoul, South Korea.,Department of Family Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Moo-Kyung Seong
- Department of Colorectal Surgery, Konkuk University Medical Center, Seoul, South Korea.,Department of Surgery, Konkuk University School of Medicine, Seoul, South Korea
| | - Hyun-Jun Ahn
- Department of Colorectal Surgery, Konkuk University Medical Center, Seoul, South Korea
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Rajasekaran MR, Kanoo S, Fu J, Nguyen MUL, Bhargava V, Mittal RK. Age-related external anal sphincter muscle dysfunction and fibrosis: possible role of Wnt/β-catenin signaling pathways. Am J Physiol Gastrointest Liver Physiol 2017; 313:G581-G588. [PMID: 28838987 DOI: 10.1152/ajpgi.00209.2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/02/2017] [Accepted: 08/15/2017] [Indexed: 01/31/2023]
Abstract
Studies show an age-related increase in the prevalence of anal incontinence and sphincter muscle atrophy. The Wnt/β-catenin signaling pathway has been recently recognized as the major molecular pathway involved in age-related skeletal muscle atrophy and fibrosis. The goals of our study were to 1) evaluate the impact of normal aging on external anal sphincter (EAS) muscle length-tension (L-T) function and morphology and 2) specifically examine the role of Wnt signaling pathways in anal sphincter muscle fibrosis. New Zealand White female rabbits [6 young (6 mo of age) and 6 old (36 mo of age)] were anesthetized, and anal canal pressure was measured to determine the L-T function of EAS. Animals were killed at the end of the study, and the anal canal was harvested and processed for histochemical studies (Masson trichrome stain for muscle/connective tissue) as well as for molecular markers for fibrosis and atrophy [collagen I, β-catenin, transforming growth factor-β (TGF-β), atrogin-1, and muscle-specific RING finger protein-1 (MuRF-1)]. The L-T was significantly impaired in older animals compared with young animals. Anal canal sections stained with trichrome showed a significant decrease in the muscle content (52% in old compared with 70% in young) and an increase in the connective tissue/collagen content in the old animals. An increased protein and mRNA expression of all the fibrosis markers was seen in the older animals. Aging EAS muscle exhibits impairment of function and increase in connective tissue. Upregulation of atrophy and profibrogenic proteins with aging may be the reason for the age-related decrease in anal sphincter muscle thickness and function.NEW & NOTEWORTHY Our studies using a female rabbit model show age-related alterations in the structure and function of the external anal sphincter (EAS) muscle. We used endoluminal ultrasound to measure age-related changes in EAS muscle thickness. We employed Western blot and quantitative PCR to demonstrate age-related changes in the levels of important fibrogenic as well as atrophy markers. Our findings may have significant clinical implications, i.e., use of specific antagonists to prevent age-related EAS muscle dysfunction.
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Affiliation(s)
- M Raj Rajasekaran
- Division of Gastroenterology, Department of Medicine, Veterans Affairs San Diego Healthcare System and University of California, San Diego, California; .,Department of Urology, Veterans Affairs San Diego Healthcare System and University of California, San Diego, California; and
| | - Sadhana Kanoo
- Division of Gastroenterology, Department of Medicine, Veterans Affairs San Diego Healthcare System and University of California, San Diego, California
| | - Johnny Fu
- Division of Gastroenterology, Department of Medicine, Veterans Affairs San Diego Healthcare System and University of California, San Diego, California
| | - My-Uyen Lilly Nguyen
- Division of Gastroenterology, Department of Medicine, Veterans Affairs San Diego Healthcare System and University of California, San Diego, California
| | - Valmik Bhargava
- Division of Cardiology, Veterans Affairs San Diego Healthcare System and University of California, San Diego, California
| | - Ravinder K Mittal
- Division of Gastroenterology, Department of Medicine, Veterans Affairs San Diego Healthcare System and University of California, San Diego, California
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