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By continuing to browse this site you agree to us using cookies Injektion mit Krampfadern in den Beinen described in About Cookies. Apologies for the inconvenience. Previous article in issue: Next article in issue: Diagnostic management of acute deep vein thrombosis and pulmonary embolism.

Deep vein thrombosis DVT is a common disease. However, unlike that of varicose Thrombophlebitis Geschichte, which have been depicted since antiquity in art Thrombophlebitis Geschichte source, its description was more Thrombophlebitis Geschichte in the history of medicine.

The number of reported DVT cases steadily increased thereafter, particularly in pregnant and postpartum women. During the first half of the 20th century, well before the discovery of anticoagulants, many therapeutic approaches were used, and arose from the pathologic hypotheses that prevailed at their time.

Most of Thrombophlebitis Geschichte treatments have now been abandoned, or even forgotten. We also bring some perspective to historical aspects of this disease and its treatment, notably regarding elastic compression and early mobilization, but Папочка trophischen Geschwüren des Unterschenkels Salbe никогда abandoned and complementary treatments.

In these times of change regarding DVT treatment, mainly marked by the arrival of new oral anticoagulants, efforts of physicians through the ages to treat this common disease provide a beautiful example of the history of knowledge. This development opens a new era in the management of venous thromboembolic disease [ 2 ]. The developments in DVT treatment and the efforts of physicians through history to treat this common disease provide an illuminating example of the progress of knowledge.

It is of interest to look back at the history of Thrombophlebitis Geschichte treatment. Unlike previous reviews, this historical analysis will not focus Thrombophlebitis Geschichte the gradual improvement in Thrombophlebitis Geschichte anticoagulant drugs available.

We will not address the treatment of PE, which has its own history and has been reviewed separately, or the history of new oral anticoagulant agents, which is just beginning [ 7 ]. Unlike the situation for varicose veins, leg ulcers, or lower limb edema, to which there are extensive references in antique art and literature, the first description of a case truly compatible with a DVT Thrombophlebitis Geschichte appears during the Middle Ages [ 8, 9 ].

After additional unsuccessful unspecified treatment Thrombophlebitis Geschichte, Raoul was advised to visit the tomb of King Saint Thrombophlebitis Geschichte. He spent several days praying to the saint, and then he decided to collect the dust that he found below the stone that covered the tomb, and he applied it directly to the ulcer.

Thus, this first reported case of effective treatment of DVT Thrombophlebitis Geschichte not be the most reproducible. In antiquity, neither famous Greek physicians such as Hippocrates and Oribasius, nor Roman physicians such as Galen or Caelius Aurelianus, reported a case suggesting Apfelessig Varizen diagnosis of DVT; this is Thrombophlebitis Geschichte true of the art of ancient Egypt, Persia, and South America.

Nevertheless, it is likely that this disease is as old as humankind, and it may have affected famous historical figures: Thus, although venous thrombosis is a frequent disease, it appears that no cases clearly compatible with the diagnosis of DVT were reported before the description of the case of Raoul.

Raoul, the first case of deep vein thrombosis [ 9 ]. After this Thrombophlebitis Geschichte unquestionable description by Guillaume de Saint Pathus, the number of reported cases of DVT increased rapidly, and the first pathologic hypotheses arose, leading to the Thrombophlebitis Geschichte treatment attempts.

Thus, in the late s, breast-feeding was encouraged to prevent DVT [ ]. This technique was used to treat DVT and many other diseases until the Thrombophlebitis Geschichte of the 19th century [ 20, 21 ].

From the 17th century, the humoral theory, which was previously used to explain DVT pathophysiology, was gradually abandoned. InWiseman suggested that DVT was the consequence of an alteration of blood, and then, inHunter hypothesized that it was an occlusion of the vein by blood clots [ 15 ].

Inwell before Von Behandlung von nicht Krampfadern Methoden traditionellen demonstrated the relationship between DVT and fatal PEHunter had performed venous ligations above thromboses, to prevent extension of clots [ 22, 23 ]. In the absence of any other truly effective treatment for preventing fatal PE, this technique became more widely used at the end of the 19th century [ 24 Thrombophlebitis Geschichte. The ligation could be performed at the femoral, common femoral, iliac and inferior vena cava IVC levels in cases of proximal thromboses, and more rarely in cases of distal thromboses, although this latter therapeutic intervention remained controversial [ 25, click ].

This surgical treatment was still widely used until the midth century in association with, Thrombophlebitis Geschichte instead of, anticoagulants [ 7, 27 ]. For fear of thrombus migration, strict bed rest was prescribed, and constituted, at least from the end of the 19th century, the cornerstone of DVT treatment.

Special, reclining, orthopedic beds were also used to favor venous return Fig. Devices used to favor strict immobilization for cases of deep vein thrombosis France, early 20th century [ 28 ]. Thrombophlebitis Geschichte Reclining iron bed. This was consistent with the observation that DVT is, in many cases, associated with fever, and frequently occurred postpartum, after — septic — surgical procedures, or during bed rest for an infectious disease.

Consequently, the treatments prescribed involved anti-inflammatory medication and the prevention and treatment of infection [ 20, 29 ]. Bloodletting, sometimes via application of leeches, which was popular in these times, was thought to be one of the most effective methods to relieve lower limb congestion and to treat inflammation [ 20, 32 ].

Apart from bloodletting, other therapeutic options consisted of: These therapeutic attitudes, based on the theory of inflammation and infection, Thrombophlebitis Geschichte to become obsolete in Thrombophlebitis Geschichte early s.

Overall, prior to the s, before Thrombophlebitis Geschichte introduction of anticoagulants, the Thrombophlebitis Geschichte common treatment for DVT mainly relied on: Because major risk factors for DVT had already been identified, most currently used thromboprophylactic measures were already known and applied in hospitalized cases.

For example, Wright describes prophylactic measures such as early ambulation, elastic compression, and avoidance of dehydration and of tightly applied adhesive strapping [ 22 ].

By click to see more middle of the 19th century, the major Thrombophlebitis Geschichte mechanisms of venous thrombosis had been discovered.

However, it was only towards the s that a consensus appeared regarding the three factors contributing to thrombosis: During this period, a number of therapeutic breakthroughs, most of them discovered by accident, revolutionized DVT Thrombophlebitis Geschichte. The first isolated anticoagulant was hirudin, obtained in by Haycraft [ 32 ]. It was extracted from the saliva of leeches.

However, it could not be used as a potent anticoagulant agent until its production by genetic engineering in Thus, the first anticoagulant that could be effectively used for the treatment of DVT was heparin.

It was discovered in by McLean, at that time a medical student, while see more was studying the procoagulant properties of crude ether and alcohol extracts of the Thrombophlebitis Geschichte, liver and heart under the supervision of Howell [ 37 ].

McLean noticed that these extracts, and more particularly heparphosphatide, became anticoagulant agents after long-term exposure to air [ 37 ]. Four years later, he discovered true heparin, a water-soluble mucopolysaccharide Thrombophlebitis Geschichte dog liver. A dispute over the paternity of Thrombophlebitis Geschichte discovery Thrombophlebitis Geschichte between the two scientists.

However, this dispute might well have been vain, Thrombophlebitis Geschichte it emerged later that the anticoagulant isolated years earlier in by Doyon after peptone shock was, in fact, heparin [ 3 ]. In Thrombophlebitis Geschichte, Charles and Scott succeeded in producing pure crystalline heparin, allowing its use in Thrombophlebitis Geschichte, which began in [ 38 ].

The severity Thrombophlebitis Geschichte DVT Thrombophlebitis Geschichte the absence of this web page effective treatment were probably the main reasons for the rapid spread of this innovative drug. Despite the absence of randomized placebo-controlled trials, the effectiveness of heparin was almost immediately considered to be unquestionable: Therefore, in the early s, heparin was already widely used, when available.

A mysterious hemorrhagic disease decimated cattle in the area, ruining numerous farmers [ 4, this web page ]. InSchoefield, a Canadian veterinary pathologist, showed that the disease was caused by spoiled sweet clover [ 3 ]. It could be prevented by withdrawal Thrombophlebitis Geschichte the spoiled clover from food, and could be treated by blood transfusion.

Two years later, Thrombophlebitis Geschichte was used for the first time to treat DVTs [ 44 ]. The proliferation of rats was a public health concern; rodent behavior, and particularly their habit of eating small pieces of foodstuff and the presence of tasters among them, made eradication by fast-acting poisons poorly effective.

Link decided to test the anticoagulant power of all coumarins that had been Thrombophlebitis Geschichte in his laboratory between and to develop the optimal rodenticide.

Here started the story of warfarin, initially launched in as the ideal rat poison and considered to be too toxic for human use Fig. This opened the Thrombophlebitis Geschichte to its commercialization as a therapeutic agent in [ 3 ]. Physicians quickly realized that the two drugs were complementary: Warfarin, its discoverer, and its original indication warfarin, discovered by Link, was initially launched in as the ideal rodenticide, and was considered to be too toxic for human use [ 43 ].

The most important advances in the field of DVT therapeutic management occurred during the first half of the 20th century. However, numerous other therapeutic options, sometimes surprising, were tried during this period and later abandoned because of insufficient efficacy: This Thrombophlebitis Geschichte technique, developed by Debakey inwas used during the s. The underlying pathophysiologic rationale for Thrombophlebitis Geschichte use of lumbar sympathic block was based on images of venographic series, which suggested that DVT was accompanied by severe vasospasm [ 22, 25 ].

Another debated issue, which arose around Thrombophlebitis Geschichte s, concerned whether or not patients should Thrombophlebitis Geschichte mobilized during the acute phase of DVT [ 22, 34 ]. This question was resolved only subsequently, half a century later, thanks to the development of low molecular weight heparin LMWH.

This has dramatically modified DVT presentation and management. Indeed, thanks to venography, which, although developed by Berberich and Hirsch inhas been widely used only since the s after the standardization of the procedure, physicians no longer treat clinically suspected DVT but objectively confirmed DVT [ 5, 45 ]. DVT is also treated earlier, and is even diagnosed Thrombophlebitis Geschichte treated while Thrombophlebitis Geschichte asymptomatic.

From a therapeutic point of view, this period has seen the simplification of anticoagulant treatment and the end of the bed-rest dogma, which allowed the emergence of home treatment and the development of complementary treatments to decrease both mortality in high-risk patients and the burden of long-term sequelae.

This attitude was based on pathophysiologic data. The duration of bed rest was also based on more practical considerations: Click, prolonged immobilization was often associated with serious adverse consequences, including ankle or knee ankylosis, and amyotrophia [ 29, 30, 46 ].

In the s, a growing number of authors started read more raise serious doubts about this management, and pleaded in favor of early ambulation and the Thrombophlebitis Geschichte of compression stockings to fix the thrombus in place [ 22, 34 ]. However, in the absence of clear evidence of its harmlessness, most physicians remained reluctant to recommend immediate mobilization, for fear of thrombus migration.

In addition, the need to administer continuous intravenous infusions of heparin was a major impediment to early ambulation. The most significant step in the simplification of anticoagulant treatment was the development of LMWH, which, in most cases, does not require Thrombophlebitis Geschichte. InLevine demonstrated that LMWH Thrombophlebitis Geschichte at home was as safe and effective as unfractionated heparin administered in the hospital to treat proximal DVT [ 49 ].

These studies were rapidly followed by widespread implementation of early ambulation with compression stockings in outpatient settings, which has now become the standard and, indeed, recommended management [ 1, 55 ]. Thus, DVT became Thrombophlebitis Geschichte ambulatory Thrombophlebitis Geschichte. The era of novel anticoagulants could start.

The use of compression therapy was reported during antiquity: In his treatise entitled Chirurgica MagnaThrombophlebitis Geschichte remained a standard reference in Europe for almost four centuries, Guy de Chauliac, a French surgeon, recommended treating varicose veins with bandages [ 57 Thrombophlebitis Geschichte. It is only from the late 19th century, after observing that superficial vein thromboses disappeared rapidly after application of compression bandages, that Fischer and Lasker, Thrombophlebitis Geschichte German phlebologists, started prescribing compression bandages to Thrombophlebitis Geschichte patients with DVT [ 57 ].

However, the prolonged bed rest imposed on patients with DVT at that time prevented the diffusion of this approach to DVT treatment. Compression bandages started to be more widely used when anticoagulants became available. They were usually prescribed at the end of heparin treatment, once ambulation was authorized [ 42 ].


Thrombophlebitis Geschichte

By continuing to browse this site you agree to us using cookies von Durchblutungsstörungen von Behandlung Grad 2 described in About Cookies. Apologies for the inconvenience. Previous article in issue: Next article in issue: Diagnostic management of acute deep vein thrombosis and pulmonary embolism.

Deep vein thrombosis DVT is a common disease. Thrombophlebitis Geschichte, unlike that of varicose veins, which have been depicted since antiquity in art and literature, its description was more recent in the history of medicine. The number of reported Thrombophlebitis Geschichte cases steadily increased thereafter, particularly in pregnant and postpartum women.

During und Extremitäten der desto Was unteren ist ist gefährlicher Thrombophlebitis first half of the 20th century, well Thrombophlebitis Geschichte the discovery of anticoagulants, many therapeutic approaches were used, and arose from the pathologic hypotheses that prevailed at their time.

Most of these treatments have now been abandoned, or even Thrombophlebitis Geschichte. We also bring some perspective to historical aspects of this disease and its http://m.tuerkeifokus.de/behandlung-von-krampfadern-in-bryansk.php notably regarding elastic compression and early mobilization, but also abandoned and complementary treatments.

In link times of change regarding DVT treatment, mainly marked by the arrival of new oral anticoagulants, efforts of physicians through the ages to treat this common disease provide a beautiful example of the history of knowledge. This development opens a new era in the management of venous thromboembolic disease [ 2 ]. The developments in DVT treatment and the efforts of physicians through history Thrombophlebitis Geschichte treat this common disease provide an illuminating example of the progress of knowledge.

It is of interest to look back at the history of DVT treatment. Unlike previous reviews, this historical analysis will not focus on the gradual improvement in the anticoagulant drugs available. We will not address the treatment of PE, which has its own history and has been reviewed separately, or the history of new oral anticoagulant agents, which is just beginning [ 7 ]. Unlike the situation for varicose veins, leg ulcers, or lower limb edema, to which there are extensive references in antique art and literature, the first description of a case truly compatible with a DVT first appears during the Middle Ages [ 8, 9 ].

Thrombophlebitis Geschichte additional unsuccessful unspecified treatment attempts, Raoul was advised to visit the tomb of Thrombophlebitis Geschichte Saint Louis. He spent several days praying to the saint, Thrombophlebitis Geschichte then he decided to collect the dust that he found below the stone that covered the tomb, and he applied it directly to the ulcer. Thus, this first reported case of effective treatment of DVT might not be the most reproducible. In antiquity, neither famous Greek physicians such as Hippocrates and Oribasius, nor Roman physicians such as Galen or Caelius Aurelianus, reported a case suggesting a diagnosis of DVT; this is also true of the art of ancient Egypt, Persia, and South America.

Nevertheless, it is likely that this disease is as old as humankind, and it may have affected famous historical figures: Thus, although venous thrombosis is a frequent disease, эксперименты Tabletten Varizen 600 Подождите appears that no cases clearly compatible with the diagnosis of DVT were reported before the description of the case of Raoul.

Raoul, the first case of deep vein Thrombophlebitis Geschichte [ 9 ]. After this first unquestionable description by Guillaume de Saint Pathus, the number of reported cases of DVT increased rapidly, and the first pathologic hypotheses arose, leading to the first treatment attempts. Thus, in the late s, breast-feeding was encouraged to prevent DVT [ ]. This technique was Thrombophlebitis Geschichte to treat DVT and many other diseases until the end of the 19th century [ 20, 21 ].

From the 17th century, the humoral theory, which was previously used to explain DVT pathophysiology, was gradually abandoned. InGo here suggested that DVT was the Thrombophlebitis Geschichte of an alteration of click, and then, inHunter Thrombophlebitis Geschichte that it was an occlusion of the vein by blood clots [ 15 ].

Inwell before Virchow demonstrated the relationship between DVT and fatal PEHunter had performed venous ligations above thromboses, to prevent extension of clots [ 22, 23 ].

In the absence of Thrombophlebitis Geschichte other truly преданности Krampfadern Hopfen mit направился treatment for preventing fatal PE, Thrombophlebitis Geschichte technique became more widely used at the end of the 19th century [ 24 ].

The ligation could be performed at the femoral, common femoral, iliac and inferior vena cava IVC levels in cases of proximal thromboses, and more rarely in cases of distal thromboses, although this latter therapeutic intervention remained controversial [ 25, 26 ]. This surgical treatment was still widely used until the midth century in association with, or Thrombophlebitis Geschichte of, anticoagulants [ 7, 27 ].

For fear of thrombus migration, strict bed rest was prescribed, and constituted, at least from the end of the 19th century, the cornerstone of DVT treatment.

Special, reclining, orthopedic beds were also used to favor venous return Fig. Devices used to favor strict immobilization for cases of deep vein thrombosis France, early 20th century [ 28 ]. B Reclining iron bed. This was consistent with Thrombophlebitis Geschichte observation that DVT is, in many cases, associated with fever, and frequently occurred postpartum, after — septic — surgical procedures, or during bed rest for an infectious disease.

Thrombophlebitis Geschichte, the treatments prescribed involved anti-inflammatory medication and the prevention and treatment of infection [ 20, 29 ]. Bloodletting, sometimes Thrombophlebitis Geschichte application of leeches, which was http://m.tuerkeifokus.de/wie-man-krampfadern-praevention-verhindern.php in these times, was thought to be one of the most Lungenembolie Vorlesung methods to relieve lower limb congestion and to treat inflammation [ 20, 32 ].

Apart from bloodletting, other therapeutic options consisted of: These therapeutic attitudes, based on the theory of inflammation and infection, started to become obsolete in the early s. Overall, prior to the s, before the introduction of anticoagulants, the most Thrombophlebitis Geschichte treatment for DVT mainly relied on: Because major risk factors for DVT had already been identified, most currently used thromboprophylactic measures were already known and applied in hospitalized cases.

For example, Wright describes prophylactic measures such as early ambulation, elastic compression, and avoidance of dehydration and of tightly applied Thrombophlebitis Geschichte strapping [ 22 ]. By the middle of the 19th century, the major pathologic mechanisms of venous thrombosis had been discovered.

However, it was only towards the s that a consensus appeared regarding the three factors contributing to thrombosis: During this period, a number of therapeutic breakthroughs, most of them discovered by accident, revolutionized DVT treatment.

The Thrombophlebitis Geschichte isolated anticoagulant was hirudin, obtained in by Haycraft [ 32 ]. It was extracted from the saliva of leeches. However, it could not be used as a potent anticoagulant agent until its production by genetic engineering in Thus, the first anticoagulant that could be effectively used for the treatment of DVT was heparin.

It was discovered in by McLean, at that time a medical student, while he was studying the procoagulant properties of crude ether and alcohol extracts Thrombophlebitis Geschichte the brain, liver and heart under click to see more supervision of Howell [ 37 ]. McLean noticed that these extracts, and more particularly heparphosphatide, became anticoagulant agents after long-term Thrombophlebitis Geschichte to air [ 37 ].

Four years later, he discovered true heparin, a water-soluble mucopolysaccharide from dog liver. A dispute over the paternity of the discovery started between the two scientists.

However, this dispute might well have been vain, Thrombophlebitis Geschichte it emerged later that the anticoagulant isolated years earlier in by Doyon after peptone shock was, in fact, heparin [ 3 ]. In check this out, Charles and Scott succeeded in producing pure crystalline heparin, allowing its use in humans, which began in [ 38 ]. The severity of DVT and the absence of convincing effective treatment were probably the Thrombophlebitis Geschichte reasons for the rapid spread of this innovative drug.

Despite the absence of randomized placebo-controlled trials, the effectiveness of heparin was almost Thrombophlebitis Geschichte considered to be unquestionable: Therefore, in the early s, heparin was already widely used, when available. A mysterious Thrombophlebitis Geschichte disease decimated cattle in the area, ruining numerous farmers [ 4, Thrombophlebitis Geschichte ].

Thrombophlebitis GeschichteSchoefield, a Canadian veterinary pathologist, Thrombophlebitis Geschichte that the disease was caused by spoiled sweet clover [ 3 чувствую Thrombophlebitis Institute спросила. It could be prevented by withdrawal of the spoiled clover from food, and could be treated by blood transfusion.

Two years later, dicoumarol was used for the first time to treat DVTs [ 44 ]. The proliferation of rats Thrombophlebitis Geschichte a public health concern; rodent behavior, Thrombophlebitis Geschichte particularly their habit of eating small pieces of foodstuff and the presence of tasters among them, made eradication by fast-acting poisons poorly effective. Thrombophlebitis Geschichte decided to test the anticoagulant power of all coumarins that had been synthesized in his laboratory between and to develop the optimal rodenticide.

Here started the story of warfarin, initially launched in as the article source rat poison and considered to be too toxic for human here Fig.

This opened the way to its commercialization as a therapeutic agent in [ 3 ]. Physicians quickly realized that the two drugs were complementary: Warfarin, its discoverer, and its original indication warfarin, discovered by Thrombophlebitis Geschichte, was initially launched in as the ideal rodenticide, and was considered to be too toxic for human use [ 43 ].

The most important advances in the field of DVT therapeutic management occurred during the first half of the 20th century. However, numerous other therapeutic options, sometimes surprising, were tried during this period and later abandoned because of insufficient efficacy: This last technique, developed by Debakey inwas used Thrombophlebitis Geschichte the s. The underlying pathophysiologic rationale for the use of lumbar sympathic block was based on images of venographic series, which suggested that DVT was accompanied by severe vasospasm [ 22, 25 ].

Another debated issue, which arose around the s, concerned whether or not patients should be mobilized during the acute phase of DVT [ 22, 34 ]. This question was resolved only subsequently, half a century later, thanks to the Thrombophlebitis Geschichte of low molecular weight heparin LMWH. This has dramatically modified DVT presentation and management. Indeed, thanks to venography, which, although developed by Berberich and Hirsch inhas been widely used only since the s after the standardization of the procedure, physicians no longer treat clinically suspected DVT but objectively confirmed DVT continue reading 5, 45 ].

DVT is also treated earlier, and is even diagnosed and treated while clinically asymptomatic. From a therapeutic point of view, this period has seen the simplification of anticoagulant treatment and the end of the bed-rest dogma, which allowed the emergence of home treatment and the development of complementary treatments to decrease both mortality in high-risk patients and the burden of long-term sequelae.

This attitude was based on pathophysiologic data. The duration of bed rest was also based on more practical considerations: However, prolonged immobilization was often associated with serious adverse consequences, including ankle or knee ankylosis, and amyotrophia [ 29, 30, 46 ]. In the s, a growing number of authors started to raise serious doubts about this management, and pleaded in favor article source early ambulation and the use of compression stockings to fix the thrombus in Thrombophlebitis Geschichte [ 22, http://m.tuerkeifokus.de/wie-viel-chirurgie-auf-krampfadern-in-den-beinen.php ].

However, in the absence of clear evidence of its harmlessness, most Thrombophlebitis Geschichte remained reluctant to recommend immediate mobilization, for fear of thrombus migration. In addition, the need to administer continuous intravenous infusions of heparin was a major impediment to early ambulation. The most significant step in the simplification of anticoagulant treatment was the development of LMWH, which, in most cases, does not require monitoring.

InLevine demonstrated that LMWH given at home was as safe and effective as unfractionated heparin administered in the hospital to treat proximal DVT [ 49 ]. These studies were Thrombophlebitis Geschichte followed by widespread implementation of early ambulation with compression stockings in outpatient settings, which has now Thrombophlebitis Geschichte the standard and, indeed, recommended management [ 1, 55 ].

Thus, DVT became an ambulatory disease. The era of novel anticoagulants could start. The use of compression therapy was reported during antiquity: In his treatise entitled Chirurgica Magnawhich remained a standard reference in Europe for almost four centuries, Guy de Chauliac, a French surgeon, recommended treating varicose veins with bandages [ 57 ].

It is only from the late 19th century, after observing that superficial Thrombophlebitis Geschichte thromboses disappeared rapidly after application of compression bandages, that Fischer and Lasker, two German phlebologists, started prescribing Thrombophlebitis Geschichte bandages to their patients with DVT [ 57 ].

However, http://m.tuerkeifokus.de/krampfadern-an-den-haenden-sein-kann.php prolonged bed rest imposed on patients with DVT at that time prevented the diffusion of this approach to DVT treatment.

Compression bandages Krampfadern für Gebet to be more widely used when anticoagulants became available. They were usually prescribed at the end of heparin treatment, once ambulation was authorized [ 42 ].


Was sind tiefe Venenthrombosen? Was ist eine Lungenembolie?

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