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Ouyang Y, Chen H, Gong F, Lin G, Li X. Septum Resection Prior to In Vitro Fertilization-Embryo Transfer: A Retrospective Controlled Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1129-1137. [PMID: 36394304 DOI: 10.1002/jum.16128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/29/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To investigate the effectiveness of surgery for septate uterus in infertile patients before in vitro fertilization-embryo transfer (IVF-ET). METHODS The data of 937 infertile patients with septate uterus and achieved singleton pregnancy after IVF-ET from January 2014 to December 2015 were retrospectively analyzed. Thousand five hundred seventy-eight infertile patients with a normal uterus who achieved singleton pregnancy during the same period were selected as the control group. Patients with septate uterus were divided into two groups according to whether the septum was resected. The pregnancy and perinatal outcomes of the surgical group and the nonsurgical group were compared with the control group. The secondary infertility patients who were surgically corrected septa were also chosen as self-controls and an analysis was performed on their fertility outcomes pre- and post-surgery. RESULTS Compared with the control group, the surgical group had increased rates of early miscarriage, preterm delivery, and low birthweight and a significantly reduced live birth rate (P < .05). The outcomes of the nonsurgical and control groups were similar. Using secondary infertility patients who were surgically corrected septa as self-controls, after surgery, the rates of miscarriage and ectopic pregnancy were significantly lower and the live birth rate was significantly higher (P ≤ .001); however, perinatal mortality was not significantly different before and after surgery. CONCLUSIONS Patients with a septum depth greater than 10 mm or 5-10 mm associated with a history of unexplained recurrent miscarriage, IVF failure, or infertility might benefit from resection of the uterine septum with hysteroscopic metroplasty.
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Affiliation(s)
- Yan Ouyang
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center or Reproduction and Genetics in Hunan Province, Changsha, China
| | - Hui Chen
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center or Reproduction and Genetics in Hunan Province, Changsha, China
| | - Fei Gong
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center or Reproduction and Genetics in Hunan Province, Changsha, China
| | - Ge Lin
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center or Reproduction and Genetics in Hunan Province, Changsha, China
| | - Xihong Li
- Reproductive and Genetic Hospital of CITIC-Xiangya, Changsha, China
- Clinical Research Center or Reproduction and Genetics in Hunan Province, Changsha, China
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Sık BA, Ozdamar O, Ozolcay O, Sismanoglu A, Aba YA, Oral S, Koc M. Second look hysteroscopy following hysteroscopic septum resection improves reproductive outcomes in patients undergoing ICSI. J OBSTET GYNAECOL 2022; 42:2265-2271. [PMID: 35275047 DOI: 10.1080/01443615.2022.2038105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The aim of this study was to compare the reproductive outcomes between infertile women who underwent hysteroscopic uterine septum resection and those who required a second look hysteroscopy due to residual septum prior to intracytoplasmic sperm injection (ICSI) cycles with selective single 'Grade A' embryo transfer (ET). All second look hysteroscopies were performed due to partial remnant septum in a control three dimensional transvaginal ultrasonography (3D TVUSG) after the first hysteroscopic resection. Miscarriage and biochemical pregnancy rates were not different between the groups while clinical pregnancy and live birth rates were significantly higher in Group 2 than in Group 1. Second look hysteroscopic metroplasty performed to restore remnant septum significantly improves live birth rate as well as clinical pregnancy rates while it appears not to alleviate abortion and biochemical pregnancy rates in women undergoing ICSI-ET.IMPACT STATEMENTWhat is already known on this subject? The effect of hysteroscopic septum resection on reproductive outcomes in IVF treatment in infertile patients with uterine septum is not clearly known.What do the results of this study add? With the selective single ET strategy, complete or partial hysteroscopic correction of the uterine septum before ICSI and subsequent resection of the residual septum with control hysteroscopy significantly increases the live birth rates in the infertile population.What are the implications of these findings for clinical practice and/or further research? In the group of infertile patients with uterine septum, second control hysteroscopy should be performed 1 month later for residual septum or adhesions after hysteroscopic septum resection performed once.
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Affiliation(s)
- Bulat Aytek Sık
- Department of Reproductive Endocrinology and Infertility, Sisli Kolan International Hospital, Istanbul, Turkey
| | - Ozkan Ozdamar
- Department of Reproductive Endocrinology and Infertility, Memorial Bahcelievler Hospital, Istanbul, Turkey
| | - Ozan Ozolcay
- Department of Reproductive Endocrinology and Infertility, Istanbul IVF Centre, Istanbul, Turkey
| | - Alper Sismanoglu
- Department of Reproductive Endocrinology and Infertility, Sisli Kolan International Hospital, Istanbul, Turkey
| | - Yilda Arzu Aba
- Health Sciences Faculty, Bandirma Onyedi Eylul University, Balikesir, Turkey
| | - Serkan Oral
- Department of Reproductive Endocrinology and Infertility, Sisli Kolan International Hospital, Istanbul, Turkey
| | - Mehmet Koc
- Department of Reproductive Endocrinology and Infertility, Sisli Kolan International Hospital, Istanbul, Turkey
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Diagnosis of Congenital Uterine Abnormalities: Practical Considerations. J Clin Med 2022; 11:jcm11051251. [PMID: 35268343 PMCID: PMC8911320 DOI: 10.3390/jcm11051251] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/03/2022] [Accepted: 02/23/2022] [Indexed: 11/17/2022] Open
Abstract
As most congenital uterine abnormalities are asymptomatic, the majority of them are detected incidentally. While most women with uterine anomalies have a normal reproductive outcome, some may experience adverse reproductive outcomes. Accurate diagnosis and correct classification help in the appropriate counselling of women about their potential reproductive prognosis and risks and for planning any intervention. Evaluation of the internal and external contours of the uterus is the key in making a diagnosis and correctly classifying a uterine anomaly. Considering this, the gold standard test has been the combined laparoscopy and hysteroscopy historically, albeit invasive. However, 3D ultrasound has now become the diagnostic modality of choice for uterine anomalies due to its high degree of diagnostic accuracy, less invasive nature and it being comparatively less expensive. While 2D ultrasound and HSG are adequate for screening for uterine anomalies, MRI and combined laparoscopy and hysteroscopy are reserved for diagnosing complex Mullerian anomalies. Imaging for renal anomalies is recommended if a uterine anomaly is diagnosed.
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Nagshabandi ZK, Isaac B, Begum I. Unicornuate Uterus with Rudimentary Horn as a Rare Etiology of Secondary Dysmenorrhea: A Case Report. DUBAI MEDICAL JOURNAL 2021. [DOI: 10.1159/000519872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Congenital uterine anomalies are an uncommon type of female genital malformations caused by abnormal development of müllerian ducts during embryogenesis. Patients with an obstructive uterine anomaly have a higher risk of developing gynecological and obstetric complications that may present at menarche or later in life. We present a case of severe dysmenorrhea in a young teenager caused by obstructive hematometra in a noncommunicating horn of the unicornuate uterus. A differential diagnosis of a possible anomaly was made using 2-dimensional pelvic ultrasonography, which was later confirmed using MRI that revealed an anomalous uterine cavity with a single left-sided cornua communicating with the cervix and a distended right-sided rudimentary horn. She underwent a right salpingectomy with rudimentary horn excision, which was successfully managed laparoscopically. This case emphasizes the importance of physicians being cognizant in identifying patients with uterine anomaly to provide appropriate treatment and prevent adverse reproductive outcomes.
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Ezeike AC, Liman IM, Babandi RM, Austin-Amadi EO, Dantata HA, Ubani FU. Incidental intra-operative finding of a rare uterine fusion abnormality in a primigravida with breech presentation at term: A case report. Niger Postgrad Med J 2021; 28:145-147. [PMID: 34494602 DOI: 10.4103/npmj.npmj_561_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Uterine malformations are often asymptomatic but can be associated with a wide range of reproductive problems. We report a case of uterine fusion defect diagnosed intra-operatively in a 20-year-old primigravida who had elective caesarean section at term on account of breech presentation at term. Intraoperative findings included a cone-shaped uterus with narrowed fundus and the appendages emerging at the fundus and lower uterine segment on the right and left respectively. This is a rare fusion defect and makes a case for review of the existing uterine malformation classification systems, to make it all encompassing.
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Affiliation(s)
| | | | | | | | | | - Felix Ugo Ubani
- Department of Obstetrics and Gynaecology, National Hospital, Abuja, Nigeria
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Determinants of Infertility among Married Women Attending Dessie Referral Hospital and Dr. Misganaw Gynecology and Obstetrics Clinic, Dessie, Ethiopia. Int J Reprod Med 2020; 2020:1540318. [PMID: 32280671 PMCID: PMC7139857 DOI: 10.1155/2020/1540318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/22/2020] [Accepted: 02/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Infertility is the inability to become pregnant after one year of sexual intercourse without the use of contraception. Epidemiological data suggest that 10 to 15% of couples around the world are suffering from infertility. The exact meaning of marriage is mainly fulfilled if the couple conceives and bears children. Failure of this often leads to unhappy married lives, divorces, and high levels of psychiatric morbidity. There is scarcity of data about determinants of infertility in Ethiopia. Therefore, the aim of this study is to identify the determinants of infertility among married women attending Dessie Referral Hospital and Dr. Misganaw gynecology and obstetrics specialty clinic, Dessie, Ethiopia, 2019. Methods An institution-based case-control study was conducted on 281 participants. The participants were selected by a systematic random sampling technique. Data were collected using a structured interviewer-administered questionnaire. Data were entered into EpiData version 3.1 and exported to SPSS version 23 for analyses. Variables with p < 0.25 in bivariable logistic regression were entered into multivariable logistic regression. Odds ratio with its 95% confidence interval was estimated to measure the direction and strength of the association. The level of statistical significance was set at p < 0.05. Results The determinants of women's infertility were age at the first pregnancy (AOR = 2.89; 95% CI: 1.105, 7.564), age at menarche (AOR = 3.2; 95% CI: 1.278, 7.975), menstruation flow in days (AOR = 4.17; 95% CI: 0.062, 0.929), multiple sexual partners (AOR = 5.33; 95% CI: 2.124, 13.397), and history of STI (AOR = 2.79; 95% CI: 1.088, 7.159). Conclusion Age at the first pregnancy, age at menarche, multiple sexual partners, number of days of menstruation flow, and history of STI were determinants of women's infertility. Infertility may bring about unhappy married lives, divorces, and high levels of psychiatric morbidity. Therefore, couples need to have heath education about risk factors for infertility.
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Di Spiezio Sardo A, Campo R, Zizolfi B, Santangelo F, Meier Furst R, Di Cesare C, Bettocchi S, Vitagliano A, Ombelet W. Long-Term Reproductive Outcomes after Hysteroscopic Treatment of Dysmorphic Uteri in Women with Reproductive Failure: An European Multicenter Study. J Minim Invasive Gynecol 2020; 27:755-762. [DOI: 10.1016/j.jmig.2019.05.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 04/18/2019] [Accepted: 05/17/2019] [Indexed: 01/09/2023]
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The incidence of post-operative adhesion following transection of uterine septum: a cohort study comparing three different adjuvant therapies. Eur J Obstet Gynecol Reprod Biol 2016; 201:61-4. [PMID: 27062103 DOI: 10.1016/j.ejogrb.2016.01.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 01/21/2016] [Accepted: 01/29/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To investigate the clinical efficacy of postoperative estrogen therapy, intrauterine device (IUD) and intrauterine balloon in preventing intrauterine adhesions after transcervical resection of septum (TCRS). STUDY DESIGN 238 patients who underwent TCRS in our hospital from March 2012 to December 2013 were allocated into one of four groups. In Group 1 (50 patients), women received postoperative estrogen therapy. In Group 2 (59 patients), an intrauterine contraceptive device (IUD) was placed into the uterine cavity at the end of the operation. In Group 3 (75 patients), a Foley catheter with the balloon inflated with 4ml of normal saline solution was placed into the uterine cavity at the end of the operation for five days. In Group 4 (54 patients), women did not receive any of the above treatment (comparison group). All subjects underwent two further hysteroscopy, one and three months after the initial surgery. RESULTS The intrauterine adhesion rates among the four groups at one month were 22.0%, 28.81, 26.7% and 24.1% (p>0.05); and at the third month were 0%, 1.7%, 1.3% and 3.4%, respectively (p>0.05). CONCLUSIONS The use of postoperative estrogen therapy, IUD or intrauterine balloon did not appear to have any benefit in reducing the incidence of postoperative intrauterine adhesion formation.
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Nazzaro G, Locci M, Marilena M, Salzano E, Palmieri T, De Placido G. Differentiating Between Septate and Bicornuate Uterus: Bi-dimensional and 3-Dimensional power Doppler Findings. J Minim Invasive Gynecol 2014; 21:870-6. [DOI: 10.1016/j.jmig.2014.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 03/26/2014] [Accepted: 03/28/2014] [Indexed: 10/25/2022]
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Galliano D, Bellver J, Díaz-García C, Simón C, Pellicer A. ART and uterine pathology: how relevant is the maternal side for implantation? Hum Reprod Update 2014; 21:13-38. [PMID: 25155826 DOI: 10.1093/humupd/dmu047] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Assisted reproduction technology (ART) has become a standard treatment for infertile couples. Increased success rates obtained over the years have resulted primarily from improved embryo quality, but implantation rates still remain lower than expected. The uterus, an important player in implantation, has been frequently neglected. While a number of uterine pathologies have been associated with decreased natural fertility, less information exists regarding the impact of these pathologies in ART. This report reviews the evidence to help clinicians advise ART patients. METHODS An electronic search of PubMed and EMBASE was performed to identify articles in the English, French or Spanish language published until May 2014 which addressed uterine pathology and ART. Data from natural conception were used only in the absence of data from ART. Studies were classified in decreasing categories: RCTs, prospective controlled trials, prospective non-controlled trials, retrospective studies and experimental studies. Studies included in lower categories were only used if insufficient evidence was available. Pooled data were obtained from systematic reviews with meta-analyses when available. The summary of the evidence for the different outcomes and the degree of the recommendation for interventions were based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) statement recommendations. RESULTS There is strong evidence that surrogacy is effective for uterine agenesia. For the remaining pathologies, however, there is very little evidence that the established treatments improve outcomes, or that these pathologies have a negative effect on ART. In the presence of an apparently normal uterus, assessing endometrial receptivity (ER) is the goal; however diagnostic tests are still under development. CONCLUSIONS The real effect of different uterine/endometrial integrity pathologies on ART is not known. Moreover, currently proposed treatments are not based on solid evidence, and little can be done to assess ER in normal or abnormal conditions. No strong recommendations can be given based on the published experience, bringing an urgent need for well-designed studies. In this context, we propose algorithms to study the uterus in ART.
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Affiliation(s)
- Daniela Galliano
- Department of Reproduction, Instituto Valenciano de Infertilidad, Barcelona 08017, Spain
| | - José Bellver
- Department of Reproduction, Instituto Valenciano de Infertilidad (IVI), Valencia 46015, Spain
| | - César Díaz-García
- Woman's Health Department, Hospital Politécnico y Universitario La Fe, Valencia 46026, Spain
| | - Carlos Simón
- Department of Reproduction, Instituto Valenciano de Infertilidad (IVI), Valencia 46015, Spain IVI Foundation, Valencia 46015, Spain
| | - Antonio Pellicer
- Department of Reproduction, Instituto Valenciano de Infertilidad (IVI), Valencia 46015, Spain Woman's Health Department, Hospital Politécnico y Universitario La Fe, Valencia 46026, Spain IVI Foundation, Valencia 46015, Spain
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Application of detergents or high hydrostatic pressure as decellularization processes in uterine tissues and their subsequent effects on in vivo uterine regeneration in murine models. PLoS One 2014; 9:e103201. [PMID: 25057942 PMCID: PMC4109986 DOI: 10.1371/journal.pone.0103201] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/27/2014] [Indexed: 12/24/2022] Open
Abstract
Infertility caused by ovarian or tubal problems can be treated using In Vitro Fertilization and Embryo Transfer (IVF-ET); however, this is not possible for women with uterine loss and malformations that require uterine reconstruction for the treatment of their infertility. In this study, we are the first to report the usefulness of decellularized matrices as a scaffold for uterine reconstruction. Uterine tissues were extracted from Sprague Dawley (SD) rats and decellularized using either sodium dodecyl sulfate (SDS) or high hydrostatic pressure (HHP) at optimized conditions. Histological staining and quantitative analysis showed that both SDS and HHP methods effectively removed cells from the tissues with, specifically, a significant reduction of DNA contents for HHP constructs. HHP constructs highly retained the collagen content, the main component of extracellular matrices in uterine tissue, compared to SDS constructs and had similar content levels of collagen to the native tissue. The mechanical strength of the HHP constructs was similar to that of the native tissue, while that of the SDS constructs was significantly elevated. Transmission electron microscopy (TEM) revealed no apparent denaturation of collagen fibers in the HHP constructs compared to the SDS constructs. Transplantation of the decellularized tissues into rat uteri revealed the successful regeneration of the uterine tissues with a 3-layer structure 30 days after the transplantation. Moreover, a lot of epithelial gland tissue and Ki67 positive cells were detected. Immunohistochemical analyses showed that the regenerated tissues have a normal response to ovarian hormone for pregnancy. The subsequent pregnancy test after 30 days transplantation revealed successful pregnancy for both the SDS and HHP groups. These findings indicate that the decellularized matrix from the uterine tissue can be a potential scaffold for uterine regeneration.
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What is the role of hysteroscopic surgery in the management of female infertility? A review of the literature. Surg Res Pract 2014; 2014:105412. [PMID: 25374944 PMCID: PMC4208506 DOI: 10.1155/2014/105412] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/27/2014] [Indexed: 11/17/2022] Open
Abstract
The position of hysteroscopy in current fertility practice is under debate. There are many randomized controlled trials on technical feasibility and patient compliance demonstrating that the procedure is well tolerated and effective in the treatment of intrauterine pathologies. However, no consensus on the effectiveness of hysteroscopic surgery in improving the prognosis of subfertile women is available. A literature review was performed to explore the available information regarding the role of hysteroscopy in the evaluation and management of female infertility as well as to ascertain evidence that treatment of these uterine abnormalities improves fertility. The debate regarding the role of hysteroscopic surgery in the management of female infertility remains as the published studies did not reach a consensus on the benefit of such an intervention in this setting. The randomized trials do not clearly demonstrate that surgical correction of all intrauterine abnormalities improves IVF outcome. However, published observational studies suggest a benefit for resection of submucosal leiomyomas, adhesions, and endometrial polyps in increasing pregnancy rates. More randomised controlled studies are needed to substantiate the effectiveness of the hysteroscopic removal of suspected intrauterine pathology in women with unexplained subfertility or prior to assisted reproductive technology.
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Smit JG, Kasius JC, Eijkemans MJ, Veersema S, Fatemi HM, Santbrink van EJ, Campo R, Broekmans FJ. The international agreement study on the diagnosis of the septate uterus at office hysteroscopy in infertile patients. Fertil Steril 2013; 99:2108-13.e2. [DOI: 10.1016/j.fertnstert.2013.02.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/30/2013] [Accepted: 02/14/2013] [Indexed: 11/26/2022]
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