The nose is a vital organ and an important aesthetic unit, being placed in the middle of the face. It is also one of the most frequent site involved by skin cancer, and surgical reconstruction can be sometimes challenging. We present two cases of full thickness nasal ala defects, managed with turnover flaps with and without earlobe cartilage graft.
{"title":"Turnover flap variations in the reconstruction of full-thickness nasal ala defects.","authors":"Paola Monari, Alessandra Petruzzellis, Sara Mezzana, Simone Soglia, Pier Giacomo Calzavara-Pinton, Luca Bianchi, Giulio Gualdi","doi":"10.4081/dr.2024.9848","DOIUrl":"10.4081/dr.2024.9848","url":null,"abstract":"<p><p>The nose is a vital organ and an important aesthetic unit, being placed in the middle of the face. It is also one of the most frequent site involved by skin cancer, and surgical reconstruction can be sometimes challenging. We present two cases of full thickness nasal ala defects, managed with turnover flaps with and without earlobe cartilage graft.</p>","PeriodicalId":11049,"journal":{"name":"Dermatology Reports","volume":"16 3","pages":"9848"},"PeriodicalIF":2.3,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11582956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Danny Surya, Melani Marissa, Windy Keumala Budianti, Rahadi Rihatmadja, Inge Ade Krisanti, Dewi Friska, Sandra Widaty
Background. Hand eczema (HE) commonly occurs in healthcare services, especially during COVID-19 pandemic era. Vitamin D shows various effects on skin inflammation. This study aims to analyze the correlation between HE severity and vitamin D levels as measured by serum 25(OH)D in healthcare workers. Method. This is an analytic descriptive study with a cross-sectional design conducted in Indonesia between September-October 2022. HE severity was assessed using Hand Eczema Severity Index (HECSI). Results. Among 44 healthcare workers with HE, 29 people had mild HE, 11 had moderate HE, and 4 had severe HE. The mean serum 25(OH)D level in subjects with mild, moderate, and severe HE was 17.85 ng/mL, 16.45 ng/mL, and 17.87 ng/mL, respectively, which belonged to vitamin D deficiency category. There was no statistically significant correlation between serum 25(OH)D levels and HE severity (r = -0.056; p = 0.359). Conclusions. There was no significant difference in serum 25(OH)D levels between subjects with mild, moderate, and severe HE. Serum 25(OH)D level was not inversely correlated with HE severity.
{"title":"Correlation between serum 25(OH)D levels with severity of work-related hand eczema among healthcare workers: a cross-sectional study","authors":"Danny Surya, Melani Marissa, Windy Keumala Budianti, Rahadi Rihatmadja, Inge Ade Krisanti, Dewi Friska, Sandra Widaty","doi":"10.4081/dr.2023.9861","DOIUrl":"https://doi.org/10.4081/dr.2023.9861","url":null,"abstract":"Background. Hand eczema (HE) commonly occurs in healthcare services, especially during COVID-19 pandemic era. Vitamin D shows various effects on skin inflammation. This study aims to analyze the correlation between HE severity and vitamin D levels as measured by serum 25(OH)D in healthcare workers. Method. This is an analytic descriptive study with a cross-sectional design conducted in Indonesia between September-October 2022. HE severity was assessed using Hand Eczema Severity Index (HECSI). Results. Among 44 healthcare workers with HE, 29 people had mild HE, 11 had moderate HE, and 4 had severe HE. The mean serum 25(OH)D level in subjects with mild, moderate, and severe HE was 17.85 ng/mL, 16.45 ng/mL, and 17.87 ng/mL, respectively, which belonged to vitamin D deficiency category. There was no statistically significant correlation between serum 25(OH)D levels and HE severity (r = -0.056; p = 0.359). Conclusions. There was no significant difference in serum 25(OH)D levels between subjects with mild, moderate, and severe HE. Serum 25(OH)D level was not inversely correlated with HE severity.","PeriodicalId":11049,"journal":{"name":"Dermatology Reports","volume":"18 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135216801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paolo Iacovelli, Alessia Pacifico, Maria Mariano, Diego Orsini, Andrea D'Arino, Flavia Pigliacelli
Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma, clinically characterized by erythematous-scaly patches and erythematous-violaceous nodules. Phototherapy plays an important role in MF, currently used as first line treatment in the early stages. The aim of this study is to analyze and review the different options of phototherapy on cutaneous lymphoma.
{"title":"Phototherapy and mycosis fungoides: what’s new?","authors":"Paolo Iacovelli, Alessia Pacifico, Maria Mariano, Diego Orsini, Andrea D'Arino, Flavia Pigliacelli","doi":"10.4081/dr.2023.9830","DOIUrl":"https://doi.org/10.4081/dr.2023.9830","url":null,"abstract":"Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma, clinically characterized by erythematous-scaly patches and erythematous-violaceous nodules. Phototherapy plays an important role in MF, currently used as first line treatment in the early stages. The aim of this study is to analyze and review the different options of phototherapy on cutaneous lymphoma.","PeriodicalId":11049,"journal":{"name":"Dermatology Reports","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135995023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michela Curzio, Vittorio Macchini, Giovanni Di Lella, Antonio Massaro, Giulio Sonego
We present the case of a 55 years old male patient who came to our attention because of a basal cell carcinoma of the right retroauricolar area, near the mastoid-auricle border. The tumour had a size of about 1,5 cm. Repairing retroauricolar surgical defects may be actually very challenging, firstly because an incorrect reconstruction may result in severe deformities which are extremely hard to conceal; so we decided to employ the "jigsaw puzzle" advancement flap, a versatile flap, firstly successfully used in the reconstruction of a nasal ala defect.
{"title":"Reconstruction of retroauricolar surgical defect using the \"Jigsaw puzzle\" advancement flap","authors":"Michela Curzio, Vittorio Macchini, Giovanni Di Lella, Antonio Massaro, Giulio Sonego","doi":"10.4081/dr.2023.9724","DOIUrl":"https://doi.org/10.4081/dr.2023.9724","url":null,"abstract":"We present the case of a 55 years old male patient who came to our attention because of a basal cell carcinoma of the right retroauricolar area, near the mastoid-auricle border. The tumour had a size of about 1,5 cm. Repairing retroauricolar surgical defects may be actually very challenging, firstly because an incorrect reconstruction may result in severe deformities which are extremely hard to conceal; so we decided to employ the \"jigsaw puzzle\" advancement flap, a versatile flap, firstly successfully used in the reconstruction of a nasal ala defect.","PeriodicalId":11049,"journal":{"name":"Dermatology Reports","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135996078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alice Verdelli, Daniela Massi, Vincenza Maio, Gabriele Cavazza, Alberto Corrà, Elena Biancamaria Mariotti, Lavinia Quintarelli, Valentina Ruffo Di Calabria, Cristina Aimo, Emiliano Antiga, Marzia Caproni
Lupus erythematosus tumidus (LET) is a subset of cutaneous lupus erythematosus that generally presents with urticaria-like papules and plaques located on sun-exposed areas. Systemic treatment with antimalarials, especially hydroxychloroquine (HCQ), is the first-line systemic therapy for LET. Even if these drugs have a safe profile, side effects such as retinal toxicity, maculopapular rash, gastrointestinal upset, hemolytic anemia and blue-gray discoloration of the skin or the mucous membranes, have been rarely reported in the literature. Herein, we describe a rare case of a 46-year-old smoking woman with LET who developed a generalized myopathy after HCQ treatment.
{"title":"Hydroxychloroquine-induced generalized myopathy in a patient with lupus tumidus: a case report","authors":"Alice Verdelli, Daniela Massi, Vincenza Maio, Gabriele Cavazza, Alberto Corrà, Elena Biancamaria Mariotti, Lavinia Quintarelli, Valentina Ruffo Di Calabria, Cristina Aimo, Emiliano Antiga, Marzia Caproni","doi":"10.4081/dr.2023.9771","DOIUrl":"https://doi.org/10.4081/dr.2023.9771","url":null,"abstract":"Lupus erythematosus tumidus (LET) is a subset of cutaneous lupus erythematosus that generally presents with urticaria-like papules and plaques located on sun-exposed areas. Systemic treatment with antimalarials, especially hydroxychloroquine (HCQ), is the first-line systemic therapy for LET. Even if these drugs have a safe profile, side effects such as retinal toxicity, maculopapular rash, gastrointestinal upset, hemolytic anemia and blue-gray discoloration of the skin or the mucous membranes, have been rarely reported in the literature. Herein, we describe a rare case of a 46-year-old smoking woman with LET who developed a generalized myopathy after HCQ treatment.","PeriodicalId":11049,"journal":{"name":"Dermatology Reports","volume":"918 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135993245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cutaneous lymphomas can be difficult to be even suspected in the clinical practise as they are simulators of many other dermatological inflammatory ands neoplastic diseases. The support of non-invasive techniques for skin analysis as dermoscopy and reflectance confocal microscopy are still anecdotic. On the practical prospective, as non-invasive techniques showed the potential of identify macro and micro features supporting the clinical suspicious of lymphomas, as they can be useful for differential diagnosis, and can support the biopsy site selection, a deeper and more spread study including large number of cases focusing on their effective usefulness merits to be considered. In this manuscript we report a narrative concise overview on dermoscopy and reflectance confocal microscopy features of cutaneous lymphomas.
{"title":"Non-invasive techniques in the clinical diagnosis of cutaneous lymphomas","authors":"Marco Ardigò","doi":"10.4081/dr.2023.9814","DOIUrl":"https://doi.org/10.4081/dr.2023.9814","url":null,"abstract":"Cutaneous lymphomas can be difficult to be even suspected in the clinical practise as they are simulators of many other dermatological inflammatory ands neoplastic diseases. The support of non-invasive techniques for skin analysis as dermoscopy and reflectance confocal microscopy are still anecdotic. On the practical prospective, as non-invasive techniques showed the potential of identify macro and micro features supporting the clinical suspicious of lymphomas, as they can be useful for differential diagnosis, and can support the biopsy site selection, a deeper and more spread study including large number of cases focusing on their effective usefulness merits to be considered. In this manuscript we report a narrative concise overview on dermoscopy and reflectance confocal microscopy features of cutaneous lymphomas.","PeriodicalId":11049,"journal":{"name":"Dermatology Reports","volume":"73 6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136112685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 91 years old woman presented with a recurrent cutaneous squamous cell carcinoma (CSCC) involving the right lower eyelid and cheek. Recurrence occurred after one month from an incomplete surgical excision: histology reported a tumor infiltration of the subcutaneous tissue and deep margin. [...]
{"title":"A lower eyelid and cheek defect reconstruction","authors":"Vittoria Cioppa, Pietro Rubegni, Ernesto De Piano","doi":"10.4081/dr.2023.9859","DOIUrl":"https://doi.org/10.4081/dr.2023.9859","url":null,"abstract":"A 91 years old woman presented with a recurrent cutaneous squamous cell carcinoma (CSCC) involving the right lower eyelid and cheek. Recurrence occurred after one month from an incomplete surgical excision: histology reported a tumor infiltration of the subcutaneous tissue and deep margin. [...]","PeriodicalId":11049,"journal":{"name":"Dermatology Reports","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136116343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nhi Thi Uyen Pham, Thuong Van Nguyen, Hao Trong Nguyen
Psoriasis, a chronic inflammatory skin disorder affects people worldwide and is associated with the HLA-Cw6 allele which varies across ethnicities, and is higher in Caucasians than in Asians. We investigated the HLA-Cw6 prevalence in Vietnamese patients with psoriasis and its correlation with onset age and disease severity. We examined the association between HLA-Cw6 and the clinical features in 121 patients with psoriasis and 30 healthy controls and observed that HLA-Cw6 was significantly higher in patients with psoriasis (64.5%) than in the controls (26.7%) (p=0.0001) with an OR of 4.98 (2.04–12.15). The mean age of psoriasis onset was significantly lower in patients with positive HLA-Cw6 than those with negative HLA-Cw6. The AA genotype was more common in patients with mild psoriasis (100%), whereas the TA genotype was prevalent in patients with moderate and severe psoriasis (47.2% and 59.0%, respectively) and in those with high PASI scores (55.1% and 54.1%, respectively). Hence, HLA-Cw6 is a major genetic risk factor for psoriasis in Vietnamese patients, with higher prevalence in patients with early-onset disease. Furthermore, different HLA-Cw6 genotypes are associated with different disease severities.
{"title":"HLA-Cw6 increases the risk of psoriasis and early onset before twenty-seven years of age among the Vietnamese population","authors":"Nhi Thi Uyen Pham, Thuong Van Nguyen, Hao Trong Nguyen","doi":"10.4081/dr.2023.9854","DOIUrl":"https://doi.org/10.4081/dr.2023.9854","url":null,"abstract":"Psoriasis, a chronic inflammatory skin disorder affects people worldwide and is associated with the HLA-Cw6 allele which varies across ethnicities, and is higher in Caucasians than in Asians. We investigated the HLA-Cw6 prevalence in Vietnamese patients with psoriasis and its correlation with onset age and disease severity. We examined the association between HLA-Cw6 and the clinical features in 121 patients with psoriasis and 30 healthy controls and observed that HLA-Cw6 was significantly higher in patients with psoriasis (64.5%) than in the controls (26.7%) (p=0.0001) with an OR of 4.98 (2.04–12.15). The mean age of psoriasis onset was significantly lower in patients with positive HLA-Cw6 than those with negative HLA-Cw6. The AA genotype was more common in patients with mild psoriasis (100%), whereas the TA genotype was prevalent in patients with moderate and severe psoriasis (47.2% and 59.0%, respectively) and in those with high PASI scores (55.1% and 54.1%, respectively). Hence, HLA-Cw6 is a major genetic risk factor for psoriasis in Vietnamese patients, with higher prevalence in patients with early-onset disease. Furthermore, different HLA-Cw6 genotypes are associated with different disease severities.","PeriodicalId":11049,"journal":{"name":"Dermatology Reports","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136115938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Filipa David, Ana Catarina Trigo, José Ribeiro, Joana Cancela
Heparin-induced thrombocytopenia is the most clinically relevant non-haemorrhagic complication of heparin and is characterised by the presence of anti-PF4/heparin-IgG antibodies. The circulating PF4/heparin-IgG immune complex binds to platelets via their FcyIIa receptors, activating them and promoting their aggregation, with consequent platelet consumption, thrombocytopenia and thrombotic phenomena. Despite thrombocytopenia, this condition is not typically associated with bleeding complications. Instead, thrombosis is the most serious complication of Heparin-induced thrombocytopenia, contributing to increased morbidity and mortality. Thrombotic events can be venous and arterial, such as deep vein thrombosis, pulmonary embolism, myocardial infarction, and thrombotic stroke. Skin necrosis at the site of heparin injections is a rare but well-described manifestation of Heparin-induced thrombocytopenia. We report a case of Heparin-induced thrombocytopenia presented as skin necrosis, highlighting the importance of recognising this potentially fatal condition and the need for an immediate cessation of all sources of heparin and its replacement by other anticoagulants.
{"title":"Heparin-induced thrombocytopenia: a rare presentation with skin necrosis","authors":"Filipa David, Ana Catarina Trigo, José Ribeiro, Joana Cancela","doi":"10.4081/dr.2023.9855","DOIUrl":"https://doi.org/10.4081/dr.2023.9855","url":null,"abstract":"Heparin-induced thrombocytopenia is the most clinically relevant non-haemorrhagic complication of heparin and is characterised by the presence of anti-PF4/heparin-IgG antibodies. The circulating PF4/heparin-IgG immune complex binds to platelets via their FcyIIa receptors, activating them and promoting their aggregation, with consequent platelet consumption, thrombocytopenia and thrombotic phenomena. Despite thrombocytopenia, this condition is not typically associated with bleeding complications. Instead, thrombosis is the most serious complication of Heparin-induced thrombocytopenia, contributing to increased morbidity and mortality. Thrombotic events can be venous and arterial, such as deep vein thrombosis, pulmonary embolism, myocardial infarction, and thrombotic stroke. Skin necrosis at the site of heparin injections is a rare but well-described manifestation of Heparin-induced thrombocytopenia. We report a case of Heparin-induced thrombocytopenia presented as skin necrosis, highlighting the importance of recognising this potentially fatal condition and the need for an immediate cessation of all sources of heparin and its replacement by other anticoagulants.","PeriodicalId":11049,"journal":{"name":"Dermatology Reports","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136115008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Our purpose was to translate and validate the Patient Oriented Eczema Measure (POEM) in Greek. POEM translation was carried out with parallel back-translation procedure. To examine reliability and validity, 59 AD adult patients were recruited. A questionnaire including demographics, POEM, and Dermatology Life Quality Index (DLQI) was completed through physicians’ interview with patients. A second POEM completion took place 3-7 days after the initial visit. POEM items showed good internal consistency among study participants [Cronbach’s alpha = 0.88] and no overall floor and ceiling effects were detected. The POEM and DLQI scores were significantly correlated (Spearman rho = 0.71; p<0.001). The average ICC (95% CI) of POEM score between interviews was 0.89 (0.80, 0.94) indicating good to excellent test-retest reliability. As the use of patient reported outcome measures in Greece is increasing, it is important to have access in Greek translated - validated tools that are commonly used in literature.
{"title":"Translation and validation of patient-oriented eczema measure in the Greek language","authors":"Garyfallia Stefanou, Stamatis Gregoriou, Mihalis Bakakis, Styliani Mastraftsi, Alexandros Stratigos, Stathis Kontodimas, Konstantinos Sfaelos, Georgia Kourlaba","doi":"10.4081/dr.2023.9689","DOIUrl":"https://doi.org/10.4081/dr.2023.9689","url":null,"abstract":"Our purpose was to translate and validate the Patient Oriented Eczema Measure (POEM) in Greek. POEM translation was carried out with parallel back-translation procedure. To examine reliability and validity, 59 AD adult patients were recruited. A questionnaire including demographics, POEM, and Dermatology Life Quality Index (DLQI) was completed through physicians’ interview with patients. A second POEM completion took place 3-7 days after the initial visit. POEM items showed good internal consistency among study participants [Cronbach’s alpha = 0.88] and no overall floor and ceiling effects were detected. The POEM and DLQI scores were significantly correlated (Spearman rho = 0.71; p<0.001). The average ICC (95% CI) of POEM score between interviews was 0.89 (0.80, 0.94) indicating good to excellent test-retest reliability. As the use of patient reported outcome measures in Greece is increasing, it is important to have access in Greek translated - validated tools that are commonly used in literature.","PeriodicalId":11049,"journal":{"name":"Dermatology Reports","volume":"101 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136098503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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