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1.
目的评价自身免疫性抗体对乳糜泻诊断的价值和意义。方法对2005年起.来我院就诊的长期慢性腹胀腹泻、具有乳糜泻症状的147例病人进行7种自身免疫性抗体检测:抗麦胶蛋白IgA和IgG抗体、抗肌内膜IgA和IgG抗体、抗网硬蛋白IgG和IgA抗体、抗组织转谷氨酰胺酶IgA抗体。结果有一项抗体阳性38例,二或三项抗体阳性14例。抗麦胶蛋白IgA和IgG抗体、抗肌内膜IgA抗体阳性率分别为53.6%、6413%、32.1%,网硬蛋白IgG及IgA抗体阳性率为0。在部分抗体检查结果阳性并进行小肠黏膜活检的10名患者中,检测到不同程度的黏膜绒毛萎缩变化。结论麦胶蛋白IgA和IgG抗体、肌内膜IgA抗体用于乳糜泻检测有较高的阳性率。  相似文献   

2.
Abstract

Introduction. Although the prevalence of celiac disease (CD) has been extensively investigated in recent years, an accurate estimate of CD frequency in the European population is still lacking. The aims of this study were: 1) to establish accurately the prevalence of CD in a large sample of the European population (Finland, Germany, Italy, and UK), including both children and adults; and 2) to investigate whether the prevalence of CD significantly varies between different areas of the European continent.

Materials and methods. Samples were drawn from the four populations. All 29,212 participants were tested for CD by tissue transglutaminase (tTG) antibody test. Positive and border-line findings were further tested for serum endomysial antibodies (EMA). All serological determinations were centrally performed. Small-bowel biopsies were recommended to autoantibody-positive individuals. Previously diagnosed cases were identified.

Results. The overall CD prevalence (previously diagnosed plus anti-tTG and EMA positives) was 1.0% (95% CI 0.9–1.1). In subjects aged 30–64 years CD prevalence was 2.4% in Finland (2.0–2.8), 0.3% in Germany (0.1–0.4), and 0.7% in Italy (0.4–1.0). Sixty-eight percent of antibody-positive individuals showed small-bowel mucosal changes typical for CD (Marsh II/III lesion).

Conclusions. CD is common in Europe. CD prevalence shows large unexplained differences in adult age across different European countries.  相似文献   

3.
PURPOSE: To heighten the awareness of primary care clinicians regarding the prevalence, clinical manifestations, diagnosis, and treatment of celiac disease (CD) in the primary care setting. DATA SOURCES: Selected research, clinical guidelines, research and clinically based articles from current scientific literature, and current medical textbooks. CONCLUSIONS: Celiac disease is commonly under diagnosed or misdiagnosed. Until recently, it was considered rare in the United States. New data indicate that 1:150 Americans are affected and demonstrate the protective effects of early diagnosis and treatment. IMPLICATIONS FOR PRACTICE: Delays in the diagnosis and treatment of CD increase the risk of early mortality, associated autoimmune disease, neurologic complications, gastrointestinal malignancy, and fetal growth retardation, where pregnancy precedes diagnosis. Primary care clinicians must cultivate a high index of suspicion for CD in the primary care setting and bear it in mind as a differential diagnosis in many clinical situations.  相似文献   

4.
Objective: To do a serological screening for celiac disease in patients with unexplained liver cytolysis.

Materials and methods: Fifty-six patients with liver cytolysis without known aetiology were studied. Endomysial antibodies were determined by indirect immunofluorescence on human umbilical cord. Two thousand and five hundred blood donors served as control group. For statistical analysis, we used Chi-square or Fisher’s exact test.

Results: The frequency of IgA endomysial antibodies in our patients was significantly higher than in the control group (8.92% vs. 0.28%, p?p?p?=?.006). The frequency of positive EMA in female patients was higher than in male, but the difference was not statistically significant (12.12% vs. 4.43%; p?=?.6). Two patients were non-compliant with the gluten-free diet. One patient was out of touch. For the two other patients, transaminase levels reverted to normal level within six months of strict gluten withdrawal.

Conclusions: A screening for celiac disease should be included within the diagnosis protocol of liver cytolysis.  相似文献   

5.
BACKGROUND Celiac crisis(CC), a potentially life-threatening condition, is one of the rare clinical presentations of celiac disease(CD). Several cases have been documented in the literature, mostly in children.AIM To perform a review of CC cases reported in adult CD patients.METHODS A systematic search of the literature was conducted in two databases,PubMed/MEDLINE and EMBASE, using the term "celiac crisis" and its variant"coeliac crisis", from January 1970 onwards. Altogether, 29 articles reporting 42 biopsy-proven cases were found in the search. Here, we summarized the demographic, clinical characteristics, laboratory and diagnostic work-ups, and therapeutic management in these patients.RESULTS Among the 42 CD cases, the median age was 50 years(range 23-83), with a 2:1 female to male ratio. The majority of patients(88.1%) developed CC prior to CDdiagnosis, while the remaining were previously diagnosed CD cases reporting low adherence to a gluten-free diet(GFD). Clinically, patients presented with severe diarrhea(all cases), weight loss(about two thirds) and, in particular situations, with neurologic(6 cases) or cardiovascular(1 case) manifestations or bleeding diathesis(4 cases). One in four patients had a precipitating factor that could have triggered the CC(e.g. trauma, surgery, infections). Laboratory workup of patients revealed a severe malabsorptive state with metabolic acidosis,dehydration, hypoalbuminemia and anemia. The evolution of GFD was favorable in all cases except one, in whom death was reported due to refeeding syndrome.CONCLUSION Celiac crisis is a rare but severe and potentially fatal clinical feature of CD. A high index of suspicion is needed to recognize this clinical entity and to deliver proper therapy consisting of supportive care and, subsequently, GFD.  相似文献   

6.
目的构建抗星形细胞上调基因1(AEG-1)单链可变区抗体(V23)的原核表达载体,并对表达蛋白进行纯化及免疫活性检测。方法应用Primer5软件设计针对抗AEG-1单链可变区抗体基因序列的引物,构建PRsetC/V23原核表达质粒,经限制性内切酶Pst1酶切以及DNA测序鉴定正确后,将原核表达质粒导入大肠杆菌BL21中,构建含V23基因的原核表达工程茵。经IPTG诱导后,用带His标签的磁珠纯化目的蛋白,SDS-PAGE电泳检测目的蛋白含量,Western blot及ELISA检测抗AEG-1单链可变区抗体的免疫活性。结果构建的原核表达质粒PRsetC/V23经单酶切和测序分析显示,构建的V23基因与设计序列100%一致。IPTG诱导后,SDS-PAGE电泳显示在31×103处出现一条明显蛋白条带,Western blot检测在80×103处出现AEG-1特异反应条带,ELISA检测显示阳性结果。结论成功构建了PRsetC/V23原核表达质粒及V23原核表达工程茵,该工程茵可表达抗AEG-1单链可变区抗体蛋白,且该蛋白具有良好的免疫活性。  相似文献   

7.
Against the grain: an overview of celiac disease   总被引:1,自引:0,他引:1  
PURPOSE: To review the epidemiology, pathophysiology, clinical presentation, diagnosis, and management of celiac disease (CD). DATA SOURCES: Review of literature using Pub Med and Access Medicine. The following search terms were used: celiac disease, malabsorption syndromes, diarrhea, and gluten-free diet (GFD). There was no limitation placed on publication year. Only articles written in English were included. CONCLUSIONS: CD is a chronic systemic autoimmune disorder triggered in genetically susceptible individuals by the ingestion of gluten proteins (wheat, barley, and rye). CD often presents atypically, and diagnosis delays are common. Currently, the only effective treatment for CD is strict adherence to a GFD. This is a difficult diet to comprehend and follow. Adherence to a GFD requires ongoing education and support from a multidisciplinary healthcare team, support groups, family, and friends. IMPLICATIONS FOR PRACTICE: Once considered a rare disease of childhood, CD is now recognized as a common disorder that can occur at any age. Clinicians need to be cognizant of risk factors, clinical manifestations, conditions, and complications associated with CD in order to make a timely diagnosis, ameliorate symptoms, and minimize disease complications.  相似文献   

8.
《Annals of medicine》2013,45(8):522-531
Abstract

Reduced levels of iron, folate, vitamin B12, vitamin D, zinc, and magnesium are common in untreated celiac disease (CD) patients probably due to loss of brush border proteins and enzymes needed for the absorption of these nutrients. In the majority of patients, removal of gluten from the diet leads to histological recovery and normalization of iron, vitamin, and mineral levels. Iron deficiency anemia is the most common extra-intestinal sign of CD and usually resolves with adherence to a gluten-free diet. However, deficiencies of both folate and vitamin B12 may persist in some patients on a gluten-free diet, thus requiring vitamin supplementation to improve subjective health status. Similarly, exclusion of gluten from the diet does not always normalize bone mineral density; in these cases, supplementation of vitamin D and calcium is recommended. Resolution of mucosal inflammation may not be sufficient to abrogate magnesium deficiency. Since gluten-free cereal products have a lower magnesium content as compared with gluten-containing counterparts, a magnesium-enriched diet should be encouraged in CD patients. In this article we discuss the frequency and clinical relevance of nutrient deficiency in CD and whether and when nutrient supplementation is needed.  相似文献   

9.
Background Celiac disease (CD) is a chronic intolerance to gluten, which induces intestinal mucosal lesions in genetically predisposed individuals. Transabdominal bowel sonography (TABS) is a safe and noninvasive procedure that allows to detect intestinal abnormalities in many conditions, but actually is not routinely part of the diagnostic management of CD. Aim To evaluate the diagnostic accuracy of TABS in CD patients. Patients and methods Fifty CD patients and 50 dyspeptic subjects (control group) underwent TABS. The presence of fluid-distended small bowel loops with thickened valvulae conniventes and increased peristalsis was considered a TABS sign of CD. All clinical, biochemical, and TABS features were assessed at the diagnosis and revaluated after 1 year of gluten-free diet. Results TABS signs were present in 66% of CD patients. Sensitivity, specificity, positive and negative predictive value were 66%, 96%, 94%, and 74%, respectively. TABS findings were recorded in 82% of patients with endoscopical markers of CD, in 87.5% of symptomatic patients, and in 61% of patients without symptoms. After 1 year of gluten-free diet TABS was still abnormal in 20% patients, with no correlation with laboratory tests e/o symptoms. Conclusions Patients with CD frequently present TABS signs of the disease and operators performing sonography every day have to consider the possibility to suggest CD diagnosis and aTTG determination in these subjects.  相似文献   

10.
Celiac disease, or gluten-sensitive enteropathy, is defined as a state of heightened immunologic responsiveness to ingested gluten (from wheat, barley, or rye) in genetically susceptible individuals. Ingestion of the offending proteins leads to inflammation and intestinal mucosal damage, which may result in a spectrum of gastrointestinal symptoms, nutritional abnormalities, and systemic complications ranging from anemia and osteoporosis to secondary autoimmunity and malignancy. The genetic influence in the pathogenesis of celiac disease is indicated by its familial occurrence. Celiac disease does not develop unless a person has alleles that encode for human leukocyte antigen DQ2 or DQ8 proteins. The clinical picture of celiac disease has changed considerably during the past 30 years. Diarrhea, which was the presenting symptom in > 90% of celiac disease patients before 1981, is now the chief complaint in < 40%. In contrast, the increased frequency of atypical celiac disease presentations, including anemia and bone disease, is revealed by the widespread availability of serologic testing. An association between celiac disease and autoimmune disorders, such as type 1 diabetes, autoimmune thyroid disease, and Sjögren’s syndrome, has been well documented. The tissue transglutaminase immunoglobulin antibody and the endomysial immunoglobulin antibody are the most sensitive and specific serologic tests, respectively, for identifying individuals who need to undergo an intestinal biopsy. If the suspicion of celiac disease is high, intestinal biopsy should be pursued even if serologic tests are negative. The gold standard for the diagnosis of celiac disease is a small bowel biopsy showing villous atrophy. The treatment for celiac disease is lifelong adherence to a gluten-free diet (GFD). Despite the proven benefits of the GFD, it can be exceedingly difficult to completely avoid gluten-containing foods, and adherence to a GFD is estimated to be only 45% to 80%.  相似文献   

11.
Introduction: Celiac disease is a common autoimmune condition induced by dietary gluten in genetically susceptible individuals. So far, the only available treatment for the disorder is a lifelong strict gluten-free diet, because of which small intestinal histological changes recover and symptoms disappear. However, gluten-free dieting is restrictive, and nutritionally less than optimal, and gluten is difficult to avoid.

Areas covered: With improving insight into the pathogenesis of celiac disease, several possible drug targets have been suggested. The new strategies include degradation of gluten intraluminally, reduction of mucosal permeability, inhibition of the transglutaminase 2 enzyme, blocking antigen presentation by HLA-DQ2 or HLA-DQ8, modulation of the immune responses of many cytokines, and vaccination.

Expert opinion: Non-dietary treatment options are warranted either as adjunctive therapy together with dieting or to replace the gluten-free diet. The key question is whether the envisaged novel drug is able to prevent gluten-induced small intestinal mucosal injury as efficiently as a strict gluten-free diet, alleviating symptoms and signs of the disease. Furthermore, the gluten dose that can be detoxified, if at all, must be established. The new drug should also be as safe as dietary treatment. Several novel treatment options are under development.  相似文献   

12.
BackgroundTest utilization for the diagnosis of celiac disease may affect the prevalence and incidence of the disease in Korea. We aimed to investigate the test utilization of serological biomarkers for celiac disease in Korea.MethodsWe retrospectively investigated the test utilization of tissue transglutaminase IgA, gliadin IgA and IgG, and endomysial IgA antibody (Ab) assays between January 2011 and June 2020.ResultsDuring a nine‐year‐and‐six‐month study period, overall 307,322,606 clinical tests were requested from different clinical settings, such as local clinics, hospitals, university hospitals, and tertiary medical centers. Among them, only 58 tissue transglutaminase IgA, 22 gliadin IgA, 12 gliadin IgG, and 16 endomysial IgA Ab tests were performed on 79 Korean patients. Among them, one patient had positive transglutaminase IgA Ab result (1.3%).ConclusionLow prevalence and incidence of celiac disease in Korea may be due to an underutilization of diagnostic assays.  相似文献   

13.
Celiac disease (CD) is an autoimmune intestinal disease caused by the intake of gluten-containing cereals and their products by individuals with genetic susceptibility genes. Vitiligo is a commonly acquired depigmentation of the skin; its clinical manifestation are skin patches caused by localized or generalized melanin deficiency. Both diseases have similar global incidence rates (approximately 1%) and are associated to similar diseases, including autoimmune bullous disease, inflammatory bowel disease, autoimmune thyroiditis, autoimmune gastritis, and type 1 diabetes. The relationship between CD and vitiligo has been reported in several studies, but their conclusions are inconsistent. Further, it has also been reported that a gluten-free diet (GFD) can improve the symptoms of immune-related skin diseases such as vitiligo. In this mini-review, we summarize and review the literature on the relationship between CD and vitiligo, assess the therapeutic significance of GFD for patients with vitiligo, and explore their possible physiopathology. We are hopeful that the information summarized here will assist physicians who treat patients with CD or vitiligo, thereby improving the prognosis.  相似文献   

14.
BACKGROUND: The membrane bound receptor OX40 (CD134) - a member of the TNF-R/NGF-R superfamily - is expressed on activated CD4+-T cells in humans and rodents. The interaction of OX40 with its ligand (OX40L) has been shown to be important in T-cell dependent B cell-stimulation and T-cell costimulation in vitro and in vivo. Several studies in experimental animal models for immunologically mediated GI-diseases have stressed the important role of the OX40-OX40L interaction for their manifestations. To assess if the OX40-OX40L interaction is also crucial in the pathogenesis of immunologically mediated diseases of the human gastrointestinal tract (e.g. celiac disease, Crohn's disease, ulcerative colitis) we investigated, in a first line of experiments, the expression of OX40 in biopsy specimens of patients suffering from these diseases. METHODS: The biopsies were formalin fixed and paraffin-embedded and cut into 5 microm slides. To demask the antigen, the slides were consecutively cooked in citrate buffer for 20 min. Binding of anti-OX40 antibody was detected using the alkaline phosphatase-anti-alkaline phosphatase (APAAP) method. RESULTS: Nine of 11 biopsy specimens of patients with celiac disease were OX40-positive; none of the 20 control duodenal biopsies demonstrated OX40-positivity; and all biopsies of patients with ulcerative colitis (n = 11) or Crohn's disease (n = 11), respectively, stained positively for OX40. One of the 20 control biopsies showed OX40 staining. DISCUSSION: OX40 is highly expressed in the gastrointestinal tissue of patients with immunologically mediated bowel diseases. Together with previous studies in animal models for these diseases, the present results point to a potential role of OX40 in their pathogenesis.  相似文献   

15.
Summary Study of the reaction of celiac disease-related antibodies with human substrates has been hampered by the immunological cross-reactivity between fluorescein isothiocyanate-conjugated anti-human immunoglobulins and immunoglobulins normally present in human tissues. In order to overcome this problem we extracted IgG from 2 celiac disease sera (positive for specific IgG and IgA antibodies) using a genetically engineered recombinant form of streptococcal protein G covalently immobilized on 4% agarose beads. The separated IgG and IgA was conjugated with fluorescein isothiocyanate and used in direct immunofluorescence on 0 blood group human duodenum, liver, and myocardium. Staining of the lamina propria beneath the villous epithelium, the endomysium of smooth muscle layers in the duodenum, and the liver sinusoidal and pericellular myocardial matrix was observed. The reactivity of celiac disease-related antibodies with various human tissues indicates that these antibodies are the result of a systemic immune response directed against all tissues containing matrix proteins.  相似文献   

16.
Celiac disease (CD) is a chronic immune-mediated intestinal disease that is characterized by production of autoantibodies directed against the small intestine. The main clinical manifestations of CD are typically defined as those related to indigestion and malabsorption. These manifestations include unexplained diarrhea or constipation, abdominal pain, bloating, weight loss, anemia, failure-to-thrive in children, and decreased bone density. Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by heterogeneous clinical manifestations, which may also involve the gastrointestinal tract. Comorbidity of CD and SLE is rare, and the overlapping symptoms and nonspecific clinical presentation may pose a diagnostic challenge to clinicians. We report here a case of SLE with CD, which mainly manifested as recurrent diarrhea, uncorrectable electrolyte disorders, and severe malnutrition. Through review, we hope to further improve our understanding and diagnostic level of this combination of diseases.  相似文献   

17.
Celiac disease (CD) may be found in association with other autoimmune diseases. We investigated the relation between autoimmune hepatitis (AIH) and CD by assessing the prevalence of IgA and IgG anti-tissue transglutaminase (tTG) antibodies in AIH, and by verifying whether the findings were associated with clinical and histological features of CD. Forty-seven consecutive patients with AIH (type I: n = 39; type II: n = 8) were studied. One hundred patients with chronic hepatitis C, and 120 healthy blood donors were also studied as controls. We analyzed sera for the presence of IgA and IgG anti-tTG antibodies using a specific human recombinant tTG immunoenzymatic assay. Anti-tTG positive patients and controls were further tested for anti-endomysium antibodies (EMA) and HLA typing, and those found positive by either of these tests underwent duodenal biopsy to confirm a possible diagnosis of CD. Three of the 47 AIH patients (6.4%) were positive for IgA anti-tTG and EMA antibodies, and were subsequently confirmed to be affected with CD by small-bowel biopsy findings. No IgG anti-tTG positivity was found in the AIH patients. None of the controls were positive for IgA anti-tTG, and only one with chronic hepatitis C had a low positive reaction for IgG anti-tTG, which resulted as a false positive. The crude prevalence rate of CD in AIH was 63.8 per 1,000 (95% CI, 13.2-186.1), and it was significantly higher than that found in the general population in Italy (4.9 per 1,000; 95% CI, 2.8-7.8). The results of this study showed a high prevalence of CD in patients with AIH. For this reason, early serological screening testing for CD is strongly recommended for all AIH patients.  相似文献   

18.
Objectives IgA antibodies against tissue transglutaminase (anti-TG2) is a reliable marker of celiac disease (CD). However, IgA-deficient patients are not identified and young children may lack IgA anti-TG2. Combined detection of IgA and IgG (IgA/IgG) against deamidated gliadin peptides (DGP) has shown a high diagnostic performance for untreated CD. Here we examined the utility of IgA/IgG anti-TG2, IgA/IgG anti-DGP and IgA/IgG against a mix of TG2 and DGP (anti-TG2/DGP) in finding CD among children. Methods Serum antibodies against TG2, DGP, and TG2/DGP were determined with ELISA in 242 children referred to a paediatric gastroenterologist. Fifty had untreated CD verified by an intestinal biopsy and 192/242 children had other diseases than CD. Results Forty-eight untreated CD children had increased IgA/IgG anti-TG2, 47/50 had increased IgA/IgG anti-DGP and 46/50 had increased IgA/IgG anti-TG2/DGP. One control subject had increased IgA/IgG anti-TG2 and IgA/IgG anti-TG2/DGP, whereas 7/192 control subjects had increased IgA/IgG anti-DGP. The IgA/IgG anti-TG2 assay had the best performance with a sensitivity of 96%, a specificity of 99.5% and the area under the ROC-curve was 0.996 (95% CI 0.992–1, p?Conclusions Detection of one antibody is not sufficient when screening for untreated CD among children due to cases of IgA deficiency. The inclusion of DGP antigens in the IgA/IgG combination assays seems to affect the sensitivity and specificity negatively, whereas detection of IgA/IgG anti-TG2 has the potential of finding most untreated CD patients, including those with IgA deficiency.  相似文献   

19.

Objectives

To compare cardiac troponin I (cTnI) values measured from 32 normal plasma specimens with a two-site cTnI research assay exploiting different molecular forms of a capture antibody.

Design and methods

The current research assay consists of two capture antibodies immobilized on streptavidin-well surface and one detection antibody attached to highly fluorescent europium(III)-chelate-doped nanoparticles. Four different molecular forms of one of the capture antibodies (intact monoclonal (Mab), F(ab′)2 fragment, Fab fragment and chimeric Fab fragment (cFab)) were tested. The developed immunoassays were evaluated in terms of their analytical sensitivities and assay kinetics. Furthermore, cTnI concentrations were measured from 32 heparin plasma samples from apparently healthy donors (mean age 32; range 24–60 years).

Results

The differences in the measured cTnI concentrations (corrected for the buffer-based zero calibrator) between the Mab and the three fragmented forms were highly significant (P < 0.0001). Replacing the intact Mab with the antibody fragments also reduced the required antibody amount from 100 ng to 66 ng (F(ab′)2) and 16.5 ng (Fab and cFab). Furthermore, the limit of detection was improved when Fab fragments were employed (Mab: 0.90 ng/L, Fab: 0.69 ng/L and cFab: 0.41 ng/L). The apparent normal range median (minimum/maximum) of the 32 healthy subjects was reduced from 7.28 ng/L (2.64/116 ng/L) with Mab to 1.80 ng/L (0.746/10.6 ng/L) for the cFab.

Conclusions

Eliminating the Fc-part from one of the two capture antibodies in an immunofluorometric cTnI assay substantially reduced the measured cTnI concentrations, simultaneously improving the assay sensitivity and reducing the reagent consumption.  相似文献   

20.
目的探讨血清甲状腺球蛋白抗体(TGAb)、甲状腺微粒体抗体(TMAb)、甲状腺过氧化物酶抗体(TPOAb)对自身免疫性甲状腺疾病(AITD)的诊断价值。方法100例甲状腺功能异常患者根据血清中三碘甲状腺原氨酸(B)、甲状腺素(Td)、促甲状腺激素(TSH)水平分为甲亢组和甲减组,每组50例;另选择50例甲状腺功能正常人群作为对照组。各组患者均采集静脉血5mL,分离血清,放射免疫法测定患者血清中TGAb、TMAb、TPOAb、L、T4、TSH水平。观察各组患者血清中TGAb、TMAb、TPOAb阳性率;比较各组TGAb、TMAb、TPOAb阳性患者血清水平。结果甲亢组和甲减组血清TPOAb阳性率均明显高于血清TGAb、TMAb阳性率;甲亢组、甲减组患者血清TGAb、TMAb、TPOAb阳性率均明显高于对照组;甲减组患者血清TGAb、TMAb、TPOAb阳性率均明显高于甲亢组。甲亢组和甲减组患者血清TGAb、TMAb、TPOAb水平均明显高于对照组。甲减组患者血清中TGAb、TMAb、TPOAb水平均明显高于甲亢组。结论TPOAb在AITD的诊断中具有重要意义,为AITD的诊断、治疗及预后评估提供了重要依据。  相似文献   

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