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da Silva TN, Ribeiro VF, Apaza MCC, Romana LG, de Moraes ÍAP, Dias ED, Roizenblatt SS, Martinez JP, Magalhães FH, Massa M, Ré AHN, de Araújo LV, da Silva-Magalhães TD, de Mello Monteiro CB. Effectiveness of Transcranial Direct Current Stimulation (tDCS) during a Virtual Reality Task in Women with Fibromyalgia-A Randomized Clinical Study. Brain Sci 2024; 14:928. [PMID: 39335423 PMCID: PMC11430377 DOI: 10.3390/brainsci14090928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 09/09/2024] [Accepted: 09/14/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND/OBJECTIVES Fibromyalgia (FM) is a chronic condition characterized by widespread musculoskeletal pain, fatigue, and impaired motor performance. This study aimed to investigate the effects of transcranial direct current stimulation (tDCS) during virtual reality (VR) tasks on the motor performance of women with FM. METHODS Participants were divided into two groups: Group A received active tDCS for 10 days followed by sham tDCS for 10 days, while Group B received the opposite sequence. Both groups performed VR tasks using MoveHero software (v. 2.4) during the tDCS sessions. Motor performance was assessed by the number of hits (movement with correct timing to reach the targets) and absolute (accuracy measure) and variable (precision measure) errors during VR tasks. Participants were 21 women, aged 30-50 years, and diagnosed with FM. RESULTS Group A, which received active tDCS first, presented significant improvements in motor performance (number of hits and absolute and variable errors). The benefits of active tDCS persisted into the sham phase, suggesting a lasting neuroplastic effect. CONCLUSIONS tDCS during VR tasks significantly improved motor performance in women with FM, particularly in complex, extensive movements. These findings indicate that tDCS enhances neuroplasticity, leading to sustained motor improvements, making it a promising therapeutic tool in FM rehabilitation.
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Affiliation(s)
- Thaís Nogueira da Silva
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Vivian Finotti Ribeiro
- Graduate Program in Medicine (Cardiology), Escola Paulista de Medicina, Federal University of São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Margot Carol Condori Apaza
- Graduate Program in Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo, Brazil
| | - Lívia Gallerani Romana
- Graduate Program in Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo, Brazil
| | - Íbis Ariana Peña de Moraes
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
- Department of Medicine, University of City of São Paulo (UNICID), São Paulo, Brazil
| | - Eduardo Dati Dias
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
| | - Suely Steinschreiber Roizenblatt
- Graduate Program in Medicine (Cardiology), Escola Paulista de Medicina, Federal University of São Paulo (EPM/UNIFESP), São Paulo, Brazil
| | - Juliana Perez Martinez
- Graduate Program in Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo, Brazil
| | - Fernando Henrique Magalhães
- Graduate Program in Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo, Brazil
- Department of Physical Therapy, Faculty of Sciences and Technology (FCT/UNESP), State University of São Paulo, São Paulo, Brazil
| | - Marcelo Massa
- Graduate Program in Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo, Brazil
| | - Alessandro Hervaldo Nicolai Ré
- Graduate Program in Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo, Brazil
| | - Luciano Vieira de Araújo
- Graduate Program in Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo, Brazil
| | - Talita Dias da Silva-Magalhães
- Graduate Program in Medicine (Cardiology), Escola Paulista de Medicina, Federal University of São Paulo (EPM/UNIFESP), São Paulo, Brazil
- Graduate Program in Bioengineering, University Brazil, São Paulo, Brazil
| | - Carlos Bandeira de Mello Monteiro
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, Brazil
- Graduate Program in Physical Activity Sciences, School of Arts, Science and Humanities, University of São Paulo (EACH-USP), São Paulo, Brazil
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Augière T, Simoneau M, Brun C, Pinard AM, Blouin J, Mouchnino L, Mercier C. Behavioral and Electrocortical Response to a Sensorimotor Conflict in Individuals with Fibromyalgia. Brain Sci 2023; 13:931. [PMID: 37371409 DOI: 10.3390/brainsci13060931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/01/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
People with fibromyalgia have been shown to experience more somatosensory disturbances than pain-free controls during sensorimotor conflicts (i.e., incongruence between visual and somatosensory feedback). Sensorimotor conflicts are known to disturb the integration of sensory information. This study aimed to assess the cerebral response and motor performance during a sensorimotor conflict in people with fibromyalgia. Twenty participants with fibromyalgia and twenty-three pain-free controls performed a drawing task including visual feedback that was either congruent with actual movement (and thus with somatosensory information) or incongruent with actual movement (i.e., conflict). Motor performance was measured according to tracing error, and electrocortical activity was recorded using electroencephalography. Motor performance was degraded during conflict for all participants but did not differ between groups. Time-frequency analysis showed that the conflict was associated with an increase in theta power (4-8 Hz) at conflict onset over the left posterior parietal cortex in participants with fibromyalgia but not in controls. This increase in theta suggests a stronger detection of conflict in participants with fibromyalgia, which was not accompanied by differences in motor performance in comparison to controls. This points to dissociation in individuals with fibromyalgia between an altered perception of action and a seemingly unaltered control of action.
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Affiliation(s)
- Tania Augière
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC G1M 2S8, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Martin Simoneau
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC G1M 2S8, Canada
- Department of Kinesiology, Faculty of Medicine, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Clémentine Brun
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC G1M 2S8, Canada
| | - Anne Marie Pinard
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC G1M 2S8, Canada
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Laval University, Quebec City, QC G1V 0A6, Canada
| | - Jean Blouin
- Laboratoire de Neurosciences Cognitives, Aix-Marseille University, National Center for Scientific Research (CNRS), 13331 Marseille, France
| | - Laurence Mouchnino
- Laboratoire de Neurosciences Cognitives, Aix-Marseille University, National Center for Scientific Research (CNRS), 13331 Marseille, France
- Institut Universitaire de France, 75005 Paris, France
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC G1M 2S8, Canada
- Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC G1V 0A6, Canada
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Pujol J, Blanco-Hinojo L, Doreste A, Ojeda F, Martínez-Vilavella G, Pérez-Sola V, Deus J, Monfort J. Distinctive alterations in the functional anatomy of the cerebral cortex in pain-sensitized osteoarthritis and fibromyalgia patients. Arthritis Res Ther 2022; 24:252. [DOI: 10.1186/s13075-022-02942-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/01/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pain-sensitized osteoarthritis and fibromyalgia patients characteristically show nociceptive system augmented responsiveness as a common feature. However, sensitization can be originally related to the peripheral injury in osteoarthritis patients, whereas pain and bodily discomfort spontaneously occur in fibromyalgia with no apparent origin. We investigated the distinct functional repercussion of pain sensitization in the cerebral cortex in both conditions.
Methods
Thirty-one pain-sensitized knee osteoarthritis patients and 38 fibromyalgia patients were compared with matched control groups. And new samples of 34 sensitized knee osteoarthritis and 63 fibromyalgia patients were used to directly compare each condition. A combined measure of local functional connectivity was estimated to map functional alterations in the cerebral cortex at rest.
Results
In osteoarthritis, weaker local connectivity was identified in the insula, which is a cortical area processing important aspects of the brain response to painful stimulation. In contrast, fibromyalgia patients showed weaker connectivity in the sensorimotor cortex extensively affecting the cortical representation of the body.
Conclusions
In osteoarthritis, weaker insular cortex connectivity is compatible with reduced neural activity during metabolic recovery after repeated activation. In the fibromyalgia neurophysiological context, weaker connectivity may better express both reduced neural activity and increased excitability, particularly affecting the sensorimotor cortex in patients with spontaneous body pain. Such a combination is compatible with a central gain enhancement mechanism, where low sensory tolerance results from the over-amplification of central sensory reception to compensate a presumably weak sensory input. We propose that deficient proprioception could be a factor contributing to weak sensory input.
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Interoceptive accuracy and bias in somatic symptom disorder, illness anxiety disorder, and functional syndromes: A systematic review and meta-analysis. PLoS One 2022; 17:e0271717. [PMID: 35980959 PMCID: PMC9387777 DOI: 10.1371/journal.pone.0271717] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 07/06/2022] [Indexed: 12/03/2022] Open
Abstract
Somatic symptom disorder, illness anxiety disorder, and functional syndromes are characterized by burdensome preoccupation with somatic symptoms. Etiological models propose either increased interoceptive accuracy through hypervigilance to the body, or decreased and biased interoception through top-down predictions about sensory events. This systematic review and meta-analysis summarizes findings of 68 studies examining interoceptive accuracy and 8 studies examining response biases in clinical or non-clinical groups. Analyses yielded a medium population effect size for decreased interoceptive accuracy in functional syndromes, but no observable effect in somatic symptom disorder and illness anxiety disorder. The overall effect size was highly heterogeneous. Regarding response bias, there was a small significant effect in somatic symptom disorder and illness anxiety disorder. Our findings strengthen the notion of top-down factors that result in biased rather than accurate perception of body signals in somatic symptom disorder and illness anxiety disorder.
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Horváth Á, Vig L, Ferentzi E, Köteles F. Cardiac and Proprioceptive Accuracy Are Not Related to Body Awareness, Perceived Body Competence, and Affect. Front Psychol 2021; 11:575574. [PMID: 33519590 PMCID: PMC7840531 DOI: 10.3389/fpsyg.2020.575574] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/22/2020] [Indexed: 11/25/2022] Open
Abstract
Interoception in the broader sense refers to the perception of internal states, including the perception of the actual state of the internal organs (visceroception) and the motor system (proprioception). Dimensions of interoception include (1) interoceptive accuracy, i.e., the ability to sense internal changes assessed with behavioral tests, (2) confidence rating with respect to perceived performance in an actual behavioral test, and (3) interoceptive sensibility, i.e., the self-reported generalized ability to perceive body changes. The relationship between dimension of cardioceptive and proprioceptive modalities and their association with affect are scarcely studied. In the present study, undergraduate students (N = 105, 53 males, age: 21.0 ± 1.87 years) filled out questionnaires assessing positive and negative affect (Positive and Negative Affect Schedule), interoceptive sensibility (Body Awareness Questionnaire), and body competence (Body Competence Scale of the Body Consciousness Questionnaire). Following this, they completed a behavioral task assessing cardioceptive accuracy (the mental heartbeat tracking task by Schandry) and two tasks assessing proprioceptive accuracy with respect to the tension of arm flexor muscles (weight discrimination task) and the angular position of the elbow joint (joint position reproduction task). Confidence ratings were measured with visual analog scales after the tasks. With the exception of a weak association between cardioceptive accuracy and the respective confidence rating, no associations between and within modalities were found with respect to various dimensions of interoception. Further, the interoceptive dimensions were not associated with state and trait positive and negative affect and perceived body competence. In summary, interoceptive accuracy scores do not substantially contribute to conscious representations of cardioceptive and proprioceptive ability. Within our data, non-pathological affective states (PANAS) are not associated with the major dimensions of interoception for the cardiac and proprioceptive modalities.
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Affiliation(s)
- Áron Horváth
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Luca Vig
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Eszter Ferentzi
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
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Horváth Á, Ferentzi E, Köteles F. Proprioceptive accuracy is not associated with self-reported body awareness, body competence, and affect. Physiol Int 2019. [PMID: 31896267 DOI: 10.1556/2060.106.2019.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE Proprioception plays an essential role in motor control and in psychological functioning: it is the basis of body schema and the feeling of body ownership. There are individual differences in the processing accuracy of proprioceptive stimuli. Although proprioceptive acuity plays an important role in physical competence, there are contradictory findings concerning the role it plays in healthy psychological functioning. This study aims to shed more light on this association. MATERIAL AND METHODS Sixty-eight young adults participated in this study. We estimated proprioceptive acuity by the reposition accuracy of elbow joint positions. We tested both dominant and non-dominant hands with two different versions of Joint Position Reproduction Test. Perceived physical competence, body awareness, and affectivity were assessed using questionnaires (Physical Competence scale of Body Consciousness Questionnaire, Somatic Absorption Scale, and Positive and Negative Affectivity Schedule, respectively). RESULTS No significant association between proprioceptive acuity and body awareness, perceived body competence, and positive and negative affect was found. CONCLUSION Proprioceptive acuity, measured in the elbow joint, does not play a substantial role in body awareness, perceived body competence, and affect.
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Affiliation(s)
- Á Horváth
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - E Ferentzi
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - F Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
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Cescon C, Barbero M, Conti M, Bozzetti F, Lewis J. Helical axis analysis to quantify humeral kinematics during shoulder rotation. Int Biomech 2019; 6:1-8. [PMID: 34042003 PMCID: PMC7857310 DOI: 10.1080/23335432.2019.1597642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 02/04/2019] [Indexed: 11/18/2022] Open
Abstract
Information pertaining to the helical axis during humeral kinematics during shoulder rotation may be of benefit to better understand conditions such as shoulder instability. The aim of this study is to quantify the behavior of humeral rotations using helical axis (HA) parameters in three different conditions. A total of 19 people without shoulder symptoms participated in the experiment. Shoulder kinematics was measured with an optoelectric motion capture system. The subjects performed three different full range rotations of the shoulder. The shoulder movements were analyzed with the HA technique. Four parameters were extracted from the HA of the shoulder during three different full-range rotations: range of movement (RoM), mean angle (MA), axis dispersion (MDD), and distance of their center from the shoulder (D). No significant differences were observed in the RoM for each condition between left and right side. The MA of the axis was significantly lower on the right side compared to the left in each of the three conditions. The MDD was also lower for the right side compared to the left side in each of the three conditions.The four parameters proposed for the analysis of shoulder kinematics showed to be promising indicators of shoulder instability.
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Affiliation(s)
- Corrado Cescon
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Marco Barbero
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | | | - Francesco Bozzetti
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
| | - Jeremy Lewis
- Department of Allied Health Professions, School of Health and Social Work, University of Hertfordshire, College Lane, Hatfield, UK
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Ferentzi E, Horváth Á, Köteles F. Do body-related sensations make feel us better? Subjective well-being is associated only with the subjective aspect of interoception. Psychophysiology 2019; 56:e13319. [PMID: 30629298 DOI: 10.1111/psyp.13319] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 11/21/2018] [Accepted: 11/24/2018] [Indexed: 01/06/2023]
Abstract
According to the proposition of several theoretical accounts, the perception of the bodily cues, interoceptive accuracy and interoceptive sensibility, has a significant positive impact on subjective well-being. Others assume a negative association; however, empirical evidence is scarce. In this study, 142 young adults completed questionnaires assessing subjective well-being, interoceptive sensibility, and subjective somatic symptoms and participated in measurements of proprioceptive accuracy (reproduction of the angle of the elbow joint), gastric sensitivity (water load test), and heartbeat tracking ability (Schandry task). Subjective well-being showed weak to medium positive associations with interoceptive sensibility and weak negative associations with symptom reports. No associations with measures of interoceptive accuracy were found. Gastric sensitivity as opposed to heartbeat perception and proprioceptive accuracy moderated the association between interoceptive sensibility and well-being. Thus, subjective well-being is associated only with the self-reported (perceived) aspect of interoception but not related to the sensory measures of interoceptive accuracy.
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Affiliation(s)
- Eszter Ferentzi
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Áron Horváth
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.,Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
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Lower regulatory frequency for postural control in patients with fibromyalgia and chronic fatigue syndrome. PLoS One 2018; 13:e0195111. [PMID: 29617424 PMCID: PMC5884530 DOI: 10.1371/journal.pone.0195111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 03/16/2018] [Indexed: 11/20/2022] Open
Abstract
As many similar symptoms are reported in fibromyalgia (FM) and chronic fatigue syndrome (CFS), underlying defcits may potentially also be similar. Postural disequilibrium reported in both conditions may thus be explained by similar deviations in postural control strategies. 75 females (25/group FM, CFS and control, age 19-49 years) performed 60 s of quiet standing on a force platform in each of three conditions: 1) firm surface with vision, 2) firm surface without vision and, 3) compliant surface with vision. Migration of center of pressure was decomposed into a slow and a fast component denoting postural sway and lateral forces controlling postural sway, analyzed in the time and frequency domains. Main effects of group for the antero-posterior (AP) and medio-lateral (ML) directions showed that patients displayed larger amplitudes (AP, p = 0.002; ML, p = 0.021) and lower frequencies (AP, p < 0.001; ML, p < 0.001) for the slow component, as well as for the fast component (amplitudes: AP, p = 0.010; ML, p = 0.001 and frequencies: AP, p = 0.001; ML, p = 0.029) compared to controls. Post hoc analyses showed no significant differences between patient groups. In conclusion, both the CFS- and the FM-group differed from the control group. Larger postural sway and insufficient control was found in patients compared to controls, with no significant differences between the two patient groups.
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