Uxilongo noLawulo lwe-Arthritis yeRheumatoid

Mayelana nabantu abayi-1.5 abantu base-United States bane-arthritis ye-rheumatoid. Irheumatoid arthritis, okanye i-RA, isifo esingasigxina, esizimeleyo esichazwe intlungu kunye nokuvuvukala kwamalungu. Nge-RA, isimiso somzimba sokuzivikela, esikhusela impilo yethu ngokuhlasela izinto zangaphandle njengebhaktheriya kunye neentsholongwane, ukuhlaselwa ngamacandelo ngamacandelo. I-rheumatoid arthritis ixhaphaza kakhulu izihlanganisi zezandla, iinyawo, izibonda, izibonda, amadolo kunye namaqaqa. Uninzi lwezonyango zonyango lucebisa ukuxilongwa kwangaphambili kunye nokwelashwa kwe-RA.  

Abstract

  Isifo samathambo sesona sifo sixhaphakileyo esihlasela isifo. Abasetyhini, abatshayayo, kunye nabo banembali yosapho yesi sifo bahlala bechaphazeleka. Iikhrayitheriya zokuchonga isifo zibandakanya ukuba lilungu elinye okungenani kunye nokudumba okungacaciswanga sesinye isifo. Amathuba okuchongwa kwesifo samathambo anyuka ngenani lamalungu amancinci abandakanyekayo. Kwisigulana esinesifo samathambo esidumbisayo, ubukho bento ebangela irheumatoid okanye iprotein antibody ye-anti-citrullinated, okanye inqanaba eliphezulu le-C-esebenzayo leprotein okanye inqanaba le-sedryation ye-erythrocyte iphakamisa ukufumanisa isifo samathambo. Uvavanyo lokuqala lwelebhu kufuneka lubandakanye ukubala okupheleleyo kwegazi ngokungafaniyo kunye nokuvavanywa kokusebenza kwezintso kunye ne-hepatic function. Izigulana ezithatha iiarhente zebhayiloji kufuneka zivavanyelwe i-hepatitis B, hepatitis C, kunye nesifo sephepha. Ukuchongwa kwangoko kwe-rheumatoid arthritis kuvumela unyango lwangaphambili ngezifo ezinokuguqula isifo. Ukudityaniswa kwamayeza kuhlala kusetyenziswa ukulawula isifo. I-Methotrexate ngesiqhelo sisiyobisi kumqolo wokuqala kwisifo samathambo. Iiarhente zebhayoloji, ezinjenge-tumor necrosis factor inhibitors, zihlala zithathwa njengeearhente zodidi lwesibini okanye zinokongezwa kunyango olubini. Iinjongo zonyango zibandakanya ukunciphisa iintlungu ezidibeneyo kunye nokudumba, ukuthintela ukonakaliswa kwemitha kunye nokukhubazeka okubonakalayo, kunye nokuqhubeka komsebenzi kunye nemisebenzi yobuqu. Ukutshintshwa okuhlangeneyo kubonisiwe kwizigulana ezinomonakalo omkhulu ngokudibeneyo onempawu ezilawulwa gwenxa ngabaphathi bezonyango. (NdinguGqirha weNdawo. 2011; 84 (11): 1245-1252. Ilungelo lokushicilela 2011 American Academy of Family Physicians.) I-rheumatoid arthritis (RA) yiyona nto ixhaphakileyo isifo se-arthritis, esinexesha lokuphila elide ukuya kuma-1 ekhulwini emhlabeni wonke. I-1 Inset ingafumaneka nanini na ubudala, kodwa iphakama phakathi kwe-30 kunye ne-50 yeminyaka. Ukukhubazeka kwe-2 kuqhelekile kwaye kubalulekile. Kwiqela elikhulu lase-United States, i-35 ipesenti yezigulane ezine-RA zazikhubazekile emsebenzini emva kweminyaka eyi-10.3  

Etiology kunye nePathophysiology

  Njengezifo ezininzi ezizimeleyo, i-etiology ye-RA i-multifactorial. Ukuchaphazeleka kwemfuza kuyabonakala ekuhlanganiseni usapho kunye ne-monozygotic yamawele, kunye neepesenti ezingama-50 zomngcipheko we-RA obangelwa zizinto zofuzo. Izifundo zomanyano ngokubanzi ziye zachonga utyikityo lwemfuzo olongezelelekileyo olonyusa umngcipheko we-RA kunye nezinye izifo ezizimele, kubandakanya i-STAT4 gene kunye ne-CD45 locus. 1 Ukutshaya yeyona nto ibangela imeko ye-RA, ngakumbi kwabo banofuzo. Inokuthi ichaze impendulo yokuzimela, akukho nto ibonakalisiweyo ibangela ukuba i-RA.6,7 RA ibonakaliswe ngeendlela ezivuthayo ezikhokelela ekwandeni kweeseli ze-synovial kumalungu. Ukuqulunqwa kwepannus emva koko kunokukhokelela ekutshatyalalisweni kwe-cartilage kunye ne-bony erosions. Ukuveliswa ngaphezulu kwee-cytokines zepro-inflammatory, kubandakanya i-tumor necrosis factor (TNF) kunye ne-interleukin-4, eqhuba inkqubo etshabalalisayo.40  

Izinto zobungozi

  Ubudala obudala, imbali yentsapho yesifo, kunye nesondo sesifazana zidibaniswa nomngcipheko wokwanda kwe-RA, nangona ukuhlukana kwesondo kungabonakali kakhulu kwizigulane ezidala. = 1, ukuya kuthi ga kwi-1.4 kwiminyaka engaphezu kwe-2.2 ye-pack-pack-years) .40 Ukukhulelwa kudla ngokubangela ukuxolelwa kwe-RA, mhlawumbi ngenxa yokunyamezela kwe-immunologic.11 I-Parity ingaba nefuthe elide elide; I-RA ayinakwenzeka ukuba ifunyanwe kubasetyhini be-parous kunabasetyhini abangenayo (RR = 12) .0.61 Ukuncancisa kunciphisa umngcipheko we-RA (RR = 13,14 kubasetyhini abancancisayo ubuncinane kwiinyanga ezingama-0.5), kanti ukuqala kokuya esikhathini�(RR = 24 kwabo bahamba kwi-mearche kwiminyaka eyi-1.3 ubudala okanye encinci) kunye nexesha elingaqhelekanga kakhulu lokuya esikhathini (RR = 10) kwandisa umngcipheko.1.5 Ukusetyenziswa kweepilisi zokukhulelwa komlomo okanye i-vitamin E ayichaphazeli umngcipheko we-RA.14  

Ukuqondwa

   

Ukunikezelwa Kwendlela

  Izigulane ezine-RA zikhona ngokubuhlungu kunye nokuqina kumalungu amaninzi. Izibonda, amanxeba aphakathi kwe-interphalangeal joints, kunye nama-metacarpophalangeal joints athile abandakanyekayo. Ukuqina koMasa okuhlala ngaphezu kweyure enye kubonisa i-etiology evuthayo. Ukuthumba kwe-Boggy ngenxa ye-synovitis inokubonakala (Umfanekiso we-1), okanye ukunyaniseka kwe-synovial kungabonakaliswa kwiimviwo ezidibeneyo. Izigulana zingabonisa nge-indulent arthralgias ngaphezulu kokuqala kokuvuvukala komzimba ngokubonakalayo. Iimpawu eziqhelekileyo zokukhathala, ukulahleka kwesisindo, kunye ne-fever-grade-fever iyakwenzeka ngezifo ezisebenzayo.  

Iimpawu zokuxilonga

  Ngo-2010, i-American College of Rheumatology kunye ne-European League Against Rheumatism zasebenzisana ukuyila iikhrayitheriya ezintsha zokwahlulahlula i-RA (1 Table) .16 Iikhrayitheriya ezintsha ziinzame zokuchonga i-RA ngaphambili kwizigulana ezingenakho ukuhlangabezana nohlelo lwe-1987 lweKholeji yaseMelika yeRheumatology iikhrayitheriya. Iikhrayitheriya zika-2010 azibandakanyi ubukho bamaqhuqhuva e-rheumatoid okanye utshintsho lwe-radiographic erosive, zombini ezo zinqabileyo kwi-RA yokuqala. Ububanzi be-symmetric abufuneki kwiikhrayitheriya zika-2010, ukuvumela ukuboniswa kwangoko kokulinganisa. Ukongeza, abaphandi baseDatshi baphuhlisile kwaye baqinisekisa umthetho wokuxelwa kwangaphambili kweklinikhi yeRA (Itheyibhile 2) .17,18 Injongo yalo mthetho kukunceda ekuchongeni izigulana ezinesifo samathambo esingachazwanga ekunokwenzeka ukuba siqhubele phambili ukuya kwiRA, kunye nokukhokela ukulandela- phezulu kunye nokuthunyelwa.  

Uvavanyo lweNgcaciso

  Izifo ezizimelayo ezifana ne-RA zihlala zibonakaliswa bubukho be-autoanti- body. I-Rheumatoid factor ayingqalanga kwi-RA kwaye inokubakho kwizigulana ezinezinye izifo, ezifana ne-hepatitis C, nakubantu abadala abasempilweni. I-anti-citrullinated protein antibody ibaluleke ngakumbi kwi-RA kwaye inokudlala indima kwi-pathogenesis yesifo.6 Malunga nama-50 ukuya kuma-80 ekhulwini abantu abaneRA bane-rheumatoid factor, anti-citrullinated protein antibody, okanye zombini.10 Izigulane ezineRA zisenokuba nazo. iziphumo zovavanyo lwe-antinuclear antibody, kwaye uvavanyo lubalulekile kwi-prognostic kwiindlela zolutsha zesi sifo. Imilinganiselo yokuhlelwa kwe-RA.19 Amanqanaba eprotheyini asebenzayo kunye ne-erythrocyte sedimentation rate ingasetyenziselwa ukulandela umsebenzi wesifo kunye nokuphendula kumayeza. Isiseko sobalo lwegazi olupheleleyo olunokwahluka kunye novavanyo lwezintso kunye nomsebenzi wesibindi luluncedo kuba iziphumo zinokuchaphazela iindlela zonyango (umzekelo, isigulana esinokusilela kwezintso okanye i-thrombocytopenia ebalulekileyo ekunokwenzeka ukuba ayinakumiselwa ichiza elichasene nokudumba [NSAID]). I-anemia encinci yesifo esingapheliyo yenzeka kwi-16 ukuya kwi-33 ipesenti yazo zonke izigulane ezine-RA, i-60 nangona ukulahleka kwegazi kwesisu kufuneka kuqwalaselwe kwizigulane ezithatha i-corticosteroids okanye i-NSAID. I-Methotrexate ichasene nezigulane ezine-hepatic disease, ezifana ne-hepatitis C, kunye nezigulane ezinokukhubazeka okukhulu kwezintso.20 Unyango lwe-Biologic, olufana ne-TNF inhibitor, ludinga uvavanyo olubi lwe-tuberculin okanye unyango lwe-tuberculosis efihliweyo. Ukuvuselelwa kwe-Hepatitis B kunokuphinda kwenzeke ngokusetyenziswa kwe-TNF inhibitor.21 I-Radiography yezandla kunye neenyawo kufuneka yenziwe ukuvavanya iimpawu ze-periarticular erosive change, �enokuthi ibonise i-RA encinci ye-RA.22  

Ukuxilongwa ngokungafani

  Iziphumo zolusu zibonisa ukuba i-systemic lupus erythematosus, i-systemic sclerosis, okanye i-psoriatic arthritis. I-Polymyalgia rheumatica kufuneka ithathelwe ingqalelo kwisigulane esikhulileyo kunye neempawu eziphambili egxalabeni nasesinqeni, kwaye isigulane kufuneka sibuzwe imibuzo enxulumene ne-arteritis yesikhashana. I-radiography yesifuba iluncedo ukuvavanya i-sarcoidosis njenge-etiology ye-arthritis. �Izigulane ezineempawu ezivuthayo zangasemva, imbali yesifo sesibindi esivuthayo, okanye isifo samehlo esivuthayo sinokuba ne-spondyloarthropathy. Abantu abangaphantsi kweeveki ezintandathu zeempawu banokuba nenkqubo yentsholongwane, njenge-parvovirus. Iziqendu eziphindaphindiweyo zokudumba ngokudibeneyo zicebisa i-crystal arthropathy, kwaye i-arthrocentesis kufuneka yenziwe ukuvavanya i-monosodium urate monohydrate okanye i-calcium pyrophosphate dihydrate crystals. Ubukho bamanqaku amaninzi e-myofascial trigger kunye neempawu ze-somatic zinokucebisa i-fibromyalgia, enokuthi ihlale kunye ne-RA. Ukunceda ukukhokela ukuxilongwa kunye nokumisela isicwangciso sonyango, izigulane ezine-arthritis ezivuthayo kufuneka zithunyelwe ngokukhawuleza kwi-rheumatology subspecialist.16,17  

I-rheumatoid arthritis, okanye i-RA, uhlobo oluqhelekileyo lwe-arthritis. I-RA iyisifo esingenakuzimela, esibangelwa xa isistim somzimba, isistim somzimba wokhuselo lomzimba, sihlasela iiseli zayo kunye nezicubu, ngokukodwa amajoyina. I-rheumatoid arthritis idlalwa rhoqo ngeempawu zentlungu kunye nokuvuvukala, okuhlala kuthintela amaqela amancinci ezandla, izibonda kunye neenyawo. Ngokutsho kweengcali ezininzi zonyango, ukuxilongwa kwangaphambili kunye nokwelashwa kwe-RA kubalulekile ukukhusela umonakalo ohlangeneyo kunye nokunciphisa iimpawu ezibuhlungu. UDkt Alex Jimenez DC, i-CCST Insight

 

impatho

  Emva kokuba i-RA ifunyenwe kwaye uhlolo lokuqala luyenziwe, unyango lufanele luqale. Izikhokelo zakutsha zijongene nolawulo lwe-RA, i-21,22 kodwa ukhetho lwesigulane ludlala indima ebalulekileyo. Kukho iingqwalasela ezikhethekileyo kubasetyhini bexesha lokubeletha ngenxa yokuba amaninzi amayeza aneempembelelo ezingekho phantsi kokukhulelwa. Iinjongo zonyango ziquka ukunciphisa intlungu kunye nokuvuvukala, ukuthintela ukubola (njengokuphambuka kwe-ulnar) kunye nomonakalo we-radiographic (njengemibhobhozo), ukugcina umgangatho wobomi (umntu kunye nomsebenzi), nokulawula imbonakalo eyongezelelweyo. Izidakamizwa zokuguqula izifo (anti-hyheumatic drugs) (i-DMARD) yiyona nto ephambili ye-RA.  

DMARD

  I-DMARD ingaba yi-biologic okanye i-nonbiologic (Itheyibhile 3) .23 i-Biologic agents ziquka i-antibodies ye-monoclonal kunye ne-recombinant receptors ukuvimba i-cytokines ekhuthaza i-cascade evuthayo ejongene neempawu ze-RA. I-Methotrexate inconywa njengonyango lokuqala kwizigulane ezine-RA esebenzayo, ngaphandle kokuba iphikisana okanye ayinyamezelwanga. I-Sulfasalazine (Azulfidine) okanye i-hydroxychloroquine (i-Plaquenil) i-pro-inflammatory njenge-monotherapy kwizigulana ezinezifo eziphantsi-umsebenzi okanye ezingenazo iimpawu zokubikezela (umzekelo, i-seronegative, i-RA engasebenziyo). ngaphezu kwe-monotherapy; nangona kunjalo, iziphumo ezibi nazo zingaba zikhulu.21 Ukuba i-RA ayilawulwa kakuhle nge-DMARD engeyona i-biologic, i-DMARD ye-biologic kufuneka iqalwe. Ukuba i-TNF inhibitors ayisebenzi, unyango olongezelelweyo lwebhayoloji lunokuqwalaselwa. Ukusetyenziswa ngaxeshanye ngaphezu konyango lwebhayoloji enye (umz., adalimumab [Humira] ene-abatacept [Orencia]) ayikhuthazwa ngenxa yezinga elingamkelekanga lemiphumo emibi.21,22  

IiNSAID kunye neCorostosteroids

  Ukusetyenziswa kweziyobisi kwi-RA kunokubandakanya ii-NSAID kunye ne-oral, intramuscular, okanye intraticular corticosteroids yokulawula intlungu kunye nokuvuvukala. Ngokufanelekileyo, i-NSAID kunye ne-corticosteroids zisetyenziselwa ukuphathwa kwexesha elifutshane. I-DMARD yonyango olukhethiweyo.21,22  

Iinkqubo eziPheleleyo

  Ukungenelela kokutya, kubandakanywa nokutya kwemifuno kunye neMeditera, kufundwe kunyango lwe-RA ngaphandle kobungqina obukholisayo benzuzo. kunye ne-RA.25,26 Ukongeza, i-thermotherapy kunye ne-ultrasound yonyango ye-RA ayizange ifundwe ngokwaneleyo.27,28 Ukuhlaziywa kwe-Cochrane yonyango lwe-herbal ye-RA yagqiba ukuba i-gamma-linolenic acid (ukusuka kwi-primrose ngokuhlwa okanye ioli ye-currant emnyama) kunye ne-Tripterygium. i-wilfordii (i-thunder god vine) ineenzuzo ezinokubakho.29,30 Kubalulekile ukwazisa izigulane ukuba iziphumo ezibi kakhulu ziye zaxelwa ngokusetyenziswa kwonyango lwe-herbal.31  

Ukuzivocavoca kunye noTyhila

  Iziphumo zezilingo ezilawulwa ngononophelo zixhasa ukuzivocavoca umzimba ukuze kuphuculwe umgangatho wobomi kunye namandla omzimba kwizigulane ezine-RA.32,33 Iiprogram zokuqeqesha uqeqesho azibonakalanga zineempembelelo ezingathandekiyo kwimisebenzi yesifo se-RA, amanqaku eentlungu okanye umonakalo odibeneyo we-radiographic.34 Tai i-chi iboniswe ukuphucula uluhlu lwezandla lwabantu abane-RA, nangona iilingo ezingenangqiqo zilinganiselwe. I-35 izilingo ezilawulwa ngokungaqhelekanga ze-Iyengar yoga kubantu abadala abase-RA bayaqhubeka.36  

Ubude bonyango

  Ukuxolelwa kuyafumaneka kwiipesenti ezili-10 ukuya kwezi-50 zezigulane ezine-RA, kuxhomekeke kwindlela ukuxolelwa okuchazwe ngayo kunye nokunyanzeliswa kwonyango. 10 Ukuxolelwa kunokwenzeka kakhulu kubantu besilisa, abangatshayiyo, abantu abangaphantsi kweminyaka engama-40, nakwabo abanezifo zokuqala emva kwexesha ( abaguli abadala kuneminyaka eyi-65), benesifo esifutshane, sinesifo esibukhali, ngaphandle kwesigulo se-acute, kwaye ngaphandle kwesifo se-rheumatoid okanye iiprotein anti-citrullinated protein antibody. kwelona xabiso liphantsi liyimfuneko. Izigulana ziya kufuna ukubekwa esweni rhoqo ukuqinisekisa ngeempawu ezizinzileyo, kwaye ukonyuka ngokukhawuleza kwamayeza kuyacetyiswa ngezifo ezothusayo.37  

Ukutshintshwa okuhlangeneyo

  Ukutshintshwa okuhlangeneyo kuboniswe xa kukho umonakalo omkhulu kunye nokulawulwa okungenakuqinisekiswa kweempawu kunye nolawulo lwezonyango. Iziphumo zexesha elide zixhasa, nge-4 kuphela kwipesenti ze-13 zengxowankulu ezinkulu ezifakelwayo ezifuna ukuhlaziywa phakathi kwe-10 iminyaka.38 I-hip kunye namadolo ngamalungu amaninzi afanelekileyo.  

Ukujonga ilanga elide

  Nangona i-RA ithathwa njengesifo samalungu, ikwasisifo senkqubo esikwaziyo ukubandakanya iinkqubo ezininzi zamalungu. Izibonakaliso ezongezelelweyo ze-RA zibandakanyiwe kwiThebhile 4.1,2,10 Izigulane ezine-RA zinengozi ephindwe kabini eyongeziweyo ye-lymphoma, ekucingelwa ukuba ibangelwa yinkqubo yokuvuvukala ephantsi, kwaye kungekhona umphumo wonyango.39 Izigulane ezine-lymphoma I-RA nayo isengozini enkulu ye-coronary artery disease, kwaye oogqirha kufuneka basebenze kunye nezigulane ukuguqula izinto ezinobungozi, ezifana nokutshaya, uxinzelelo lwegazi oluphezulu, kunye ne-cholesterol ephezulu. ukuchasana nokusebenzisa i-TNF inhibitors, enokuthi ibangele iziphumo ze-CHF zibe zibi nakakhulu. Ii-DMARD ze-Biologic, i-methotrexate, kunye ne-leflunomide akufanele ziqaliswe kwizigulane ezine-herpes zoster esebenzayo, ukusuleleka kwefungal ephawulekayo, okanye ukusuleleka kwebhaktheriya kufuna i-antibiotics.40,41 Iingxaki ze-RA kunye nonyango zidweliswe kwiThebhile 21  

Prognosis

  Iziguli ezine-RA zihlala ezintathu ukuya kwi-12 iminyaka engaphantsi kobonke abantu .40 Ukufa okuphezulu kwezi zi gulane kubangelwa kakhulu ngokukhawuleza kwezifo zengqondo, ngokukodwa kulabo abanesifo esiphakamileyo somzimba kunye nokuvuvukala okungapheliyo. Iindlela ezintsha zokwelapha ze-biologic ziyakunqanda ukuqhubela phambili kwe-atherosclerosis kunye nokwandisa ubomi kulabo abane-RA.41 Imithombo yolwazi: Uphando lwe-PubMed lugqityiwe kwiiNkcazo zeZliniki usebenzisa amagama asemqoka i-rheumatoid arthritis, imbonakalo eyongeziweyo, kunye ne-anti-thermatic agents. Ukukhangela kwakuquka ukuhlaziywa kweemitha, ukuhlolwa okungahleliwe, ukuvavanywa klinikhi kunye nokuhlolwa. Kwakhona kuphandwe yiArhente yeeNgxelo zoPhando lwezeMpilo kunye noBungqina bemiGangatho, ubungqina bezonyango, inkcazelo yaseCchrane, Ubungqina obuBalulekileyo kunye ne-UpToDate. Umhla wosesho: Septemba 20, 2010. Ukubhaliweyo kombhali: Akukho manyano lwemali olufanelekileyo olunokuchazwa. Ukuqukumbela, isifo samathambo sisifo esingapheliyo, isifo esizimelayo esibangela iimpawu ezibuhlungu, ezifana nentlungu kunye nokungahambi kakuhle, ukuvuvukala kunye nokuvuvukala kwamalungu, phakathi kwabanye. Umonakalo odibeneyo obonakaliswe njenge-RA ulingana, oku kuthetha ukuba uchaphazela macala omabini omzimba. Ukuxilongwa kwangoko kubalulekile kunyango lwe-RA. Ubungakanani bolwazi lwethu lukhawulelwe kwi-chiropractic kunye nemiba yempilo yomgogodla. Ukuxoxa ngalo mbandela, nceda uzive ukhululekile ukubuza uGqr. Jimenez okanye uqhagamshelane nathi apha915-850-0900�. Uphethwe nguDkt Alex Jimenez  

Ingongoma eyongezelelweyo Ingxoxo: Ukuxoxisa ubuhlungu be-Knee Pain ngaphandle kokuPhenywa

  Intlungu yedolo luphawu olwaziwayo olunokuthi lwenzeke ngenxa yeengozi zamadolo kunye / okanye iimeko, kubandakanya ukulimala kwezemidlalo. Amadolo ngenye yezona zinto ezinzima kakhulu emzimbeni womntu njengoko zenziwe yintlupheko yamathambo amane, iigamente ezine, iintlobo ezihlukahlukeneyo, i-menisci emibini, kunye ne-cartilage. Ngokwe-American Academy ye-Family Physicians, izizathu eziqhelekileyo zokubandezeleka kwamadolo zibandakanya i-patellar subluxation, i-patellar tendinitis okanye i-jumper, kunye ne-Osgood-Schlatter. Nangona ubuhlungu beentolo buya kwenzeka kubantu abantu abangaphezu kwe-60 ubudala, ubuhlungu beendolo buya kwenzeka kubantwana nakwishumi elivisayo. Iintlungu zesisu zingaphathwa ekhaya emva kweendlela ze-RICE, nangona kunjalo, ukulimala kwamadolo amakhulu kunokufuna ukunyangwa kwangoko kunyango, kubandakanya ukunakekelwa kwe-chiropractic.  

I-EXTRA EXTRA | INGXELO EBALULEKILEYO: El Paso, TX I-Chiropractor Kunconywe

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