Vol 34, No 5 (2017)

Cover Page
Articles
PREDICTORS OF INTRAOPERATIVE AND EARLY COMPLICATIONS DEVELOPMENT IN PLANNED CORONARY ARTERY STENTING
Plechev V.V., Risberg R.Y., Buzaev I.V., Oleinik B.A., Nigmatullin M.R.
Abstract
Aim. To reveal the predictors of the development of intraoperative and early complications in planned coronary stenting on the basis of complex ultrasonic instrumental and laboratory studies. Materials and methods. To reach the above aim, treatment of 2610 patients with stable forms of stenocardia (functional class 2), hospitalized to Republican Cardiological Center of Ufa from 2003 to 2015 and underwent stenting of coronary arteries, was analyzed. Results. Intraoperative complications were observed in 200 (7.7 %) patients out of 2610 operated persons. Among complications the leading place belonged to development of “no-reflow” syndrome (41 %), the second place - dissection of coronary artery (35.5 %), the third - cardiac rhythm disturbance (23.5 %). Conclusions. Intraoperative complications in patients, undergoing planned coronary stenting, prevail over the postoperative ones. Instrumental and laboratory studies permit to determine direct correlations with complications, observed in planned transcutaneous coronary intervention. Using the method of binary logistic regression, we managed to develop a model for prognosis of risk for development of “no-flow” syndrome on the basis of CPK-MB parameters, fibrinolytic activity and final diastolic volume, which provides prognostic accuracy in 86.2 % of cases.
Perm Medical Journal. 2017;34(5):5-12
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PECULIARITIES OF ADAPTIVE REMODELING OF CARDIOVASCULAR SYSTEM UNDER PHYSICAL ACTIVITY IN YOUNG WOMEN WITH IDIOPATHIC ARTERIAL HYPERTENSION
Agafonova T.Y., Dusakova R.S., Samsonova O.A.
Abstract
Aim. To study the parameters of cardiovascular system under physical activity among women with idiopathic arterial hypertension. Materials and methods. The systemic hemodynamics, echographic and sonographic parameters of extracranial, peripheral arteries and veins under physical activity (by J. Ruffier) was analyzed among 73 women diagnosed idiopathic arterial hypertension with SAP 96 (91-98) mm Hg and 37 women having normal arterial pressure with SAP 124 (121-126) mm Hg. Women’s age ranged 18 to 25 years. Results. The results demonstrated that physical activity in case of hypertension causes a reliable increase in SAP, DAP and changes in vascular blood flow (blood velocity and vascular diameter) in a greater number of arteries and veins than in women with normal arterial pressure. Cardial hemodynamics under loading in both groups was identical. Conclusions. The changed response of cardiovascular system in young women with hypertension can be considered as a pathogenetic mechanism of adaptation, so as to preserve an adequate blood flow in the organs and systems.
Perm Medical Journal. 2017;34(5):13-19
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FIVE-YEAR CONSERVATIVE THERAPY RESULTS IN PATIENTS WITH LOWER EXTREMITY ARTERIAL ATHEROSCLEROSIS AT CRITICAL ISCHEMIA STAGE
Chervyakov Y.V., Vlasenko O.N., Kha K.N.
Abstract
Aim.To estimate the remote results of conservative treatment and 5-year follow-up observation in 34 patients with stage III chronic ischemia against the background of atherosclerosis. Materials and methods. The group of comparison included 21 men and 13 women with a mean age of 68.1 ± 4.8 years, who were treated from 2010 to 2015. All the patients were studied using 3 km/h speed treadmill-test up to occurrence of pain in the lower extremities, as well as ultrasonic scintiangiography and Doppler investigation of leg arteries. A mean ± standard deviations with confidence interval of 90 and 95 % was determined. For repeated measurements Wilcoxon test was used. To analyze dependencies, Spearman’s rank correlation coefficient with significance level of 0,05 was applied. Results. Survival rate in the group of the examined patients was 88 %, extremity was preserved in 82 % of patients observed. Painless walking distance increased by 15 meters ( p = 0.05). Significant changes in linear blood flow velocity and malleolar-shoulder index were detected. Conclusions. The obtained data were considered as a moderate improvement in 24 % of observations. Satisfactory result was reached in 44 % of patients, deterioration - 6 % of cases, unsatisfactory result of treatment - 26 %.
Perm Medical Journal. 2017;34(5):20-27
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INFLUENCE OF BRAIN-SPECIFIC PROTEIN S-100 AND ENDOTHELIAL NO-SYNTHASE ANTIBODIES-CONTAINING DRUG ON DEGREE OF ANXIOUS-DEPRESSIVE DISORDERS IN PATIENTS WITH ISCHEMIC STROKE IN EARLY REHABILITATION PERIOD
Golovina O.S., Kalinsky P.P., Eliseeva E.V., Kalinsky D.P.
Abstract
Aim. To estimate the dynamics of asthenic and anxious-depressive disorders in the early rehabilitation period of ischemic stroke against the background of taking a drug, containing antibodies to brain-specific protein S-100 and endothelial NO-synthase. Materials and methods. Sixty five patients (45 men and 20 women) with a mean age of 63.5 ± 5.3 years were examined in the early rehabilitation period of ischemic stroke. Neuropsychological examination inclu-ded the following tests: subjective multidimentional fatigue inventory (MFI-20), hospital anxiety and depression scale (HADS), National Institute of Health Stroke Scale (NIHSS). Results. After a course of taking a drug, containing antibodies to brain-specific protein S-100 and endothelial NO-synthase, manifestation of asthenia reduced in the main group by 35.48 %, p < 0.05, in the group of compari-son - by 9.57 %; anxious-depressive symptomatology decreased by 26.91 %, p < 0.05 and 5.16 %, respectively. Conclusions. Against the background of taking a brain-specific protein S-100 and endothelial NO-synthase antibodies-containing drug in the dose of 0.036 g, patients of the main group demonstrated faster regression of asthenic, anxious-depressive symptomatology and reduction of neurological deficiency manifestation.
Perm Medical Journal. 2017;34(5):28-34
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ROLE OF PATHOLOGICAL STRESS INCREASE IN ARTERIAL PRESSURE AS RISK FACTOR FOR LEFT VENTRICULAR HYPERTONIC REMODELING IN YOUNG PERSONS WITH DIFFERENT INITIAL ARTERIAL PRESSURE LEVELS
Sklyannaya E.V.
Abstract
Aim. To estimate the role of pathological stress increase in arterial pressure as a risk factor for hypertonic remodeling of the left ventricle (LV) in young persons with different levels of initial arterial pressure (AP). Materials and methods. Examination of 981 persons aged 20-29 was conducted. Arterial pressure was measured in all persons one day before stress and during stress; transthoracal EchoCG was also performed. Results. Hypertonic LV remodeling was revealed in 199 (32.10 %) examined persons. Pathological stress reaction of AP was observed in 66 (10.64 %) examined persons. Pathological stress reaction was associated with growing probability of hypertonic LV remodeling (odds ratio 8.45, 95%CI 4.97-14.36). Conclusions. Pathological stress reaction of AP is a risk factor for the development of hypertonic remodeling of LV in non-hypertonic patients when carrying out a standard office measurement.
Perm Medical Journal. 2017;34(5):35-40
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POSTINFECTIOUS ASTHENIA IN TICK-BORNE ENCEPHALITIS RECONVALESCENTS AND WAYS OF ITS ARRESTING
Sumlivaya O.N., Vorobyeva N.N., Karakulova Y.V.
Abstract
Aim. To study the influence of adamantilbromphenylamine on the degree of postinfectious somatogenic asthenia in tick-borne encephalitis reconvalescents. Materials and methods. Clinical examination of 64 tick-borne encephalitis reconvalescents with postinfectious somatogenic asthenia was performed. Group I - 34 persons received adamantilbromphenylamine in the dose of 100 mg during 25 days. Group II - 30 persons under observation without drug therapy. Before and after treatment all reconvalescents were examined using the following methods: visual analogous asthenia scale, hospital anxiety and depression scale in general somatic practice, questionnaire for revealing vegetative changes, questionnaire for score subjective sleep disturbance estimation. Results. After adamantilbromphenylamine therapy, a reliable fall in scores by visual analogous scale was detected: in group I this index decreased by 2.5 times, in group II - only 1,4 times. Against the background of drug intake there was observed a significant decrease in indices of emotional-personal disorders, reduction in manifestation of vegetative disorders, normalization of sleep indices. Conclusions. Adamantilbromphenylamine can be recommended to patients in rehabilitation period after tick-borne encephalitis with residual effects in the form of postinfectious somatogenic asthenia.
Perm Medical Journal. 2017;34(5):41-48
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SIGNIFICANCE OF MATRIX METALLOPROTEINASE-9 IN DEVELOPMENT OF COGNITIVE DISORDERS DURING ACUTE PERIOD OF ISCHEMIC STROKE
Kalinsky D.P., Khlystov Y.V., Kalinsky P.P., Golovina O.S.
Abstract
Aim. To study the correlation between matrix metalloproteinase-9 (MMP-9) serum concentration and manifestation of cognitive disorders in patients with ischemic stroke (IS) in its acute period. Materials and methods. Ninety four patients with IS in the pool of the left medial cerebral artery were examined; MMP-9 concentration was determined within the days 1-2 of the disease. Neuropsychological testing to assess the degree of manifestation of cognitive disorders was carried out within the days 7 and 18-21. Results. In the group of patients with high MMP-9 content compared to the control (353.7 ± 17.4 and 96.29 ± 11.37 ng/ml) ( p < 0.05), significantly more marked cognitive disorders were diagnosed. Conclusions. A direct correlation between the level of MMP-9 content and the degree of manifestation of cognitive disorders was stated, allowing to consider MMP-9 as a prognostic marker of the development of postinsult cognitive disorders.
Perm Medical Journal. 2017;34(5):49-54
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PECULIARITIES OF NEUROPSYCHOLOGICAL STATUS AND STRUCTURE OF NIGHT SLEEP IN CHILDREN WITH OBSTRUCTIVE APNEA SYNDROME
Kalashnikova T.P., Yastrebova A.V., Anisimov G.V.
Abstract
Aim. To study the clinical peculiar features of sleep and its structure by the data of night polysomnographic study and peculiarities of development of higher cortical functions (HCF) in children with obstructive sleep apnea/hypopnea syndrome (OSAHS). Materials and methods. Clinical, neuropsychological and polysomnographic examination of 25 preschool-age children with OSAHS was carried out. The group of сomparison included 10 healthy children. Clinical study of sleep was assessed, using specially developed by the author sleep questionnaire; HCF status was estimated by means of neuropsychological study, adapted for child age (E.G. Simernitskaya). Results. Some peculiar features of organizing sleep in children with obstructive night apnea were detected. There was demonstrated a reduced duration of drowsiness, decreased duration of fast sleep phase, reduced number of sleep cycles and vegetative disorders in the form more frequent episodes of tachycardia, confirming sympathicotonia during night sleep. Kinesthetic dyspraxia was registered in 76 % of observations among apnea children. Differences in anxiety level were registered in extreme values of anxiety index (AI); AI > 50 %, considered as high, was revealed in 72 % of patients with OSAHS. High productivity and stability of attention ( S = 1.00-1.25) was noted in 35 % of control children, in OSAHS group this index was 4 %. Conclusions. Reduced duration of fast sleep phase in children with apnea is a matter of principle. Not only snore is a marker of OSAHS, apnea can occur without marked concomitant snoring. The role of connective tissue dysplasia in OSAHS formation is to be discussed. Muscular hypotonia formed can increase constriction of the upper airways, especially within the fast sleep phase and provoke apnea/hypopnea episodes.
Perm Medical Journal. 2017;34(5):55-62
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ON AGE PECULIARITIES OF INFECTIOUS MONONUCLEOSIS
Permyakova A.V., Lvova I.I., Deryusheva A.Y.
Abstract
Aim. To determine the age peculiarities of infectious mononucleosis (IM), caused by Epstein-Barr virus, in hospitalized children. Materials and methods. On the basis of case histories of 50 children with infectious mononucleosis, caused by Epstein-Barr virus, who were hospitalized to children’s unit of Perm Regional Clinical Infectious Hospital in 2015, retrospective clinicostatistical analysis was carried out. Results. By means of mathematical prognostic modeling of age peculiarities of infectious mononucleosis, induced by Epstein-Barr virus, direct correlation dependence between children’ age and development of hepatitis with cytolysis syndrome was stated. To assess the probability of risk, a logistic classification model was developed. It was indicated that children over 3, despite moderately severe disease, are usually hospitalized reliably later, than younger children that can have unfavorable consequences due to late therapy of hepatitis. Conclusions. The created logistic classification model for assessment of age-dependent probability of risk for the development of hepatitis with cytolysis syndrome in Epstein-Barr infection indicated its growth by 1.5 times in children, reaching the age of 5.5 years.
Perm Medical Journal. 2017;34(5):63-68
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INFLUENCE OF PRENATAL INTRODUCTION OF VITAMIN COMPLEX ON MANIFESTATION OF ALLERGIC REACTIONS IN POSTERITY OF EXPERIMENTAL ANIMALS
Zenkova E.A., Kulesh P.A., Bagaeva A.A.
Abstract
Aim. To estimate the influence of prenatal introduction of polyvitamin complexes to experimental animals on the development of allergic reactions in their posterity. Materials and methods. Sexually mature female rats were placed with males 1:3 and during all the period of pregnancy they received vitamin complexes in the therapeutic dose (1TD) ( n = 8) and a five-fold greater dose (5TD) ( n = 8). The control female rats received treated water. By the age of 1 month, the posterity underwent blood sampling and allergic tests. For this purpose, the group of posterity from females, receiving therapeutic dose of vitamins was divided into 2 groups: the group, sensitized with vitamins during 7 days and the group without vitamins. Similarly was divided the posterity from females, receiving a five-fold dose of vitamins, and the posterity from control animals. Manifestation of allergic reactions was assessed in hypersensibility test of delayed type using a full Freund’s adjuvant and mast cell degranulation test. Besides, leukogram in peripheral blood smears was calculated and mass coefficients of immunocompetent organs after euthanasia of a part of animals from all the groups were estimated. Results. In the posterity from female rats, receiving a five-fold dose of vitamins during pregnancy, strengthening of a delayed type allergic reaction by 1.7-3 times compared to the control groups was stated. At the same time, peroral sensibilization of this posterity with vitamins during 7 days reduced the manifestation of this reaction, though, statistically significantly exceeding the indices of control groups and animal groups from females, taking during pregnancy therapeutic doses of vitamins, with practically comparable manifestations of delayed type hypersensibility reactions. In the reaction of immediate type, a statistically significant 2-2.5 times excess of mast cell degranulation index in all experimental groups compared to the control groups was established. At the same time, mast cell degranulation indices in the animal groups, perorally sensibilized during 7 days,was reliably higher (by 1.4 times) than in the groups of posterity without vitamin intake. In both groups of nonsensibilized posterity decrease in mass coefficient of the spleen was noted. No influence on the posterity peripheral blood leukogram in all experimental groups was detected. Conclusions. Prenatal introduction of vitamin complexes to female rats alters manifestations of allergic reactions of both immediate and delayed type in the posterity; introduction of vitamins to the posterity from the above mentioned female rats during 7 days also ambiguously influences the course of allergic reactions.
Perm Medical Journal. 2017;34(5):69-75
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PECULIARITIES OF NORMATIVE REGULATION OF PLASTIC SURGEONS’ TRAINING AND UNINTERRUPTED PROGRESS IN THE RUSSIAN FEDERATION
Kochubei V.V.
Abstract
Normative documents, regulating training and uninterrupted professional progress of plastic surgeons are presented in the paper. Absence of succession regarding educational programs of specialty and residency, failure of federal state educational standards, aimed at provision of high and universal quality of residency training, absence of professional standard of physician, specializing in plastic surgery, was revealed.
Perm Medical Journal. 2017;34(5):76-82
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PROBLEMS OF MODERN PUBLIC HEALTH SYSTEM AND WAYS OF THEIR SOLUTION AT THE EXAMPLE OF PERM KRAI
Lukin P.S., Nevostruev N.A.
Abstract
Aim. To analyze the modern system of public health in the Russian Federation and Perm Krai, to determine the problems of this system and ways of their solution. Materials and methods. The results of literature analysis on the problems, revealed in public health system, history of medicine, normative legal documents, regulating medical activity, programs, determining development of health care service at the modern stage are presented in the paper. Results. Health care service remains an object of experiments in the country and Perm Krai. Reforms of public health system are directed to solution of three basic problems: overcoming of problems inherited from the USSR, optimization of legislative base of health care service, growth of professional level and quality of training of medical and pharmaceutical staff, as the main resource of public health service. Conclusions. Public health system is now at the stage of its formation and there is still no universal way for its development. Health care reforms are not supported by material and normative-legal basis. A negative balance in dynamics of the quantity of medical workers is being preserved.
Perm Medical Journal. 2017;34(5):83-94
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REPEATED ARVI AND NUTRITION IN PRESCHOOL CHILDREN- ARE THEY INTERCONNECTED?
Startseva S.E., Krasavina N.A.
Abstract
Aim. To assess the sickness rate in preschool children, depending on their nutrition. Materials and methods. The investigation of preschool children is presented as a cohort, retrospective, open, randomized study. Children were divided into 2 groups by resistance index and ARVI: group 1 - RI 0.32 (330 children), group 2 - RI > 0.33 (350 children). Cohort inclusion criteria: mature infants from full families; naturally born; repeated ARVI at the age of 5-6; absence of ENT and allergic pathology; children regularly attending infant school for not less than 2 years and living nearby. Exclusion criteria: infants, born as a result of operative delivery; premature infants from incomplete families; sickness rate - ARVI 3 times and more, presence of ENT and allergic pathology; parents and children, refusing from study. Odds ratio (OR) and relative risk (RR) of different factors was calculated using the program “OpenEpi” with determination of 95 % confidence interval (95% CI). Prognostic coefficient (PC), determined by Wald method, was calculated for each of factor gradations. Results. More irrational nutrition was observed in children with resistance index (RI) > 0.33. The maximum share of healthy two-year-old children, correctly fed (RI < 0.32) was 65.2 % (95%CI 251.3-178.7), incorrectly fed (RI > 0.33) - 43.1 % (95%CI 185.5-116.5). Three-year- old children, attending infant school, had growth of ARVI sickness rate. The maximum share of children, who had correct nutrition with RI < 0.32 and fell ill with ARVI twice a year was 21.5 % (95%CI 178.1-111.9) and incorrect nutrition with RI > 0.33 - 54.2 % (95%CI 1301.3-78.7). When calculating odds and risks for ARVI morbidity development, correlation between correct and incorrect nutrition was stated. When estimating odds and risks ratio as >1, risk for ARVI morbidity development in children with incorrect nutrition during the days off was established to be higher. The following groups of children were distinguished depending on nutrition and resistance index using Wald method: risk groups, favorable and unfavorable. In case of prolonged incorrect nutrition of children during the days off, risk can change to unfavorable zone (frequent ARVI). Conclusions. Among children with incorrect nutrition during the days off, the risk to fall ill with ARVI is higher, than in children from all age groups with correct nutrition. At the age of two, 43.1% of children with incorrect nutrition can form a risk group, which includes children with poor health. When using prognostic coefficient by Wald method, one can assume the group and give necessary recommendations on nutrition.
Perm Medical Journal. 2017;34(5):95-101
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SICKNESS RATE OF ADULT POPULATION IN CONDITIONS OF DISPENSARY OBSERVATION
Sandakov Y.P.
Abstract
Aim. To analyze the organization of dispensary observation on the basis of detected tendencies and structure of noninfectious diseases sickness rate over the period from 2012 to 2016. Materials and methods. A comparative analysis of chronic diseases sickness rate among dispensary patients and registered adult population was conducted; statistical processing of data was performed using Microsoft Excel 2010 “Analysis package”. To predict the changes in indices, a polynominal trend line for the future 5 years with approximation reliability value ( R 2) not less than 0.85 was developed. Reliability of difference between relative indices was proved by Student’s test ( p < 0.05). Results. It was established that general sickness rate for all diseases and separate classes indicated prognostic growth up to 2012, even with negative tendencies for indices in 2012-2016. General sickness rate structure in the dispensary group somewhat changed during the studied period: positions 1 and 2 are held by circulatory and endocrine system diseases, position 3 (by the year 2016) - by eye and supplementary organs diseases, moving aside digestive diseases, respiratory diseases, urinary diseases. General noninfectious chronic diseases sickness rate, as a whole, and by most separate classes of diseases is higher among the registered population. Annual fluctuations of sickness rate by the analogous classes of diseases in the dispensary group and in the registered population are not identical. Conclusions. In conditions of the existing order of dispensary observation, it is necessary to study thoroughly its organization, so as to explain the above phenomenon.
Perm Medical Journal. 2017;34(5):102-106
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SIGNIFICANCE OF REGISTER OF INCURABLE CHILDREN FOR ORGANIZATION OF REGIONAL PALLIATIVE MEDICAL CARE
Voronova E.A., Rudakova E.A., Smirnova K.A., Podluzhnaya M.Y.
Abstract
Aim. To analyze the formation of pediatric palliative medical care on the basis of the register of those in need, to describe the method of its compiling and significance for further organization of pediatric palliative care in Perm Krai. Materials and methods. Regional normative-legal documents were studied, method used for compiling the register of children, requiring palliative medical care, was described, experience of work of children’s specialized palliative unit for 2014-2016 was analyzed. Results. Nowadays, pediatric palliative service is being actively formed in Perm Krai, the register of 445 children, requiring palliative care, was formed; the structure of childhood pathology was determined. The basic pathologies are: congenital malformations (50.5 %), central nervous system diseases (30.7 %), oncopathology (9.4 %), metabolic diseases (6.4 %) and other pathology (3 %). Conclusions. For further development of pediatric palliative medical care in the regions, it is necessary to work out federal documents such as: professional standards for physicians and nurses; clinical recommendations, standards and protocols of patients’ management; palliative care selection criteria, estimation of efficiency of palliative service activity.
Perm Medical Journal. 2017;34(5):107-112
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Features of regulation of training and continuing development of the plastic surgeon in the Russian Federation
Kochubey V.
Abstract

The article presents an analysis of regulatory documents governing the training and continuous professional development of plastic surgeons. We revealed the lack of integrity of the educational programs of the specialty and residency, the failure of the Federal state educational standards to ensuring high and uniform quality of training in residency, the lack of occupational standard for a specialist in plastic surgery

Perm Medical Journal. 2017;34(5):
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Original studies
The role of pathological stress increase in blood pressure as a risk factor for hypertensive remodeling of the left ventricle in young people with different baseline blood pressure levels
Sklyannaya E.
Abstract

Objective: To assess the role of pathological stress increase of blood pressure as a risk factor for hypertensive remodeling of the left ventricle (LV) in young people with different baseline blood pressure (BP) level. Materials and methods. 981 people aged 20-29 years were examined. BP was measured before and during the stress. Transthoracic echocardiography was performed. Results. Hypertensive LV remodeling was detected in 199 (32.10%) persons. The pathological stress response of BP was observed in 66 (10.64%) subjects. The pathological stress response of BP was associated with hypertensive remodeling of the LV (OR 8.45, 95% CI 4.97-14.36). Conclusion: The pathological stress response of BP is a risk factor for the hypertensive LV remodeling in patients without hypertension by the office BP measurement.

Perm Medical Journal. 2017;34(5):
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