Modern approaches to the treatment of chronic pelvic pain

Pain in the region of the costal arches is a fairly common symptom and intercostal neuralgia often has to be differentiated from pain of a cardiogenic nature. The term intercostal neuralgia means the involvement of the intercostal nerves and the presence of pain. The causes of intercostal neuralgia can be various diseases that lead to damage to nerve fibers. First of all, these are degenerative diseases of the spine (osteochondrosis, hernia, disc protrusion, spondylosis), rheumatological diseases such as ankylosing spondylitis, infectious diseases (herpes zoster, brucellosis, tuberculosis).

These may be diseases of the nervous system such as multiple sclerosis, polyradiculoneuropathy, systemic diseases (diabetes mellitus, hepatitis), vitamin deficiency due to alcoholism or malabsorption in the gastrointestinal tract. Damage to the intercostal nerves is possible due to intoxication (heavy metals, some drugs).

When the blood supply to the nerves is disrupted, hypoxia of the nerve trunks occurs and this occurs in cardiovascular diseases (hypertension, atherosclerosis) and anemia. Disturbances in the endocrine system can lead to changes in the spine, which in turn lead to intercostal neuralgia (thyrotoxicosis, adrenal diseases, endocrine system disorders in postmenopausal women). So there are quite a lot of factors contributing to the development of intercostal neuralgia and, as a rule, a combination of factors is important, and not just one factor. Intercostal neuralgia occurs most often in elderly people, when there are involutional changes in the spine and in the body

Causes

At the moment, anococcygeus pain has not been sufficiently studied, but experts identify possible provoking factors:

• bruised tailbone;
• fracture (even an old one);
• nervous disorders in the muscle tissues of the pelvic and retroanal areas;
• pathological changes in the musculoskeletal system in this area;
• neuralgic diseases of the spine;
• problems in the intestines (hemorrhoids, fissures, etc.);
• organ prolapse;
• tense mental states;
• problems with bowel movements (frequent constipation, diarrhea).

Prognosis and prevention

To avoid the recurrence of nerve inflammation, you need to move more, but not overload the body, and also eat as many healthy foods as possible.

You also need to promptly treat infectious diseases, avoid hypothermia, and get proper rest.

With proper and timely treatment, the prognosis for recovery is favorable. However, if the situation is neglected, the following complications are possible:

• limitation of limb mobility;
• degradation of the myelin sheath of the nerve;
• painful attacks that cannot be controlled with the use of painkillers.

At the moment, there is no way to restore the damaged nerve, but it is possible to reduce the manifestation of inflammation and stop the further development of the disease. To do this, you need to contact a doctor for qualified help at the first sign.

Anococcygeal pain syndrome (coccydynia) is a pathological condition characterized by paroxysmal or constant pain in the coccyx, anus and rectum in the absence of organic pathology. The pain syndrome is more pronounced at rest and at night, and is not associated with the act of defecation. The disease is debilitating, causes insomnia, depression, sexual dysfunction, and often leads to disability. The disease is diagnosed based on complaints and examination data after excluding other diseases. Treatment is physical therapy, psychotherapy; if ineffective, surgery is indicated.

• Causes of coccydynia
• Symptoms of coccydynia
• Diagnosis of coccydynia
• Treatment of coccydynia
• Prognosis for coccydynia
• Treatment prices

Symptoms

The main indicator of the presence of a problem is severe pain in the rectum, interfering with normal life activities. These signs appear in:

• coccyx (called “coccydynia”);
• anus (anal neuralgia). Usually they have no prerequisites for their appearance.

The pain may:

• be a constant companion of the victim;
• occur suddenly and continue for any time, but usually no more than half an hour and at night.

The pain can be either dull or stabbing. Sometimes they are of such a nature that it is impossible to determine the exact location.

Neuralgia is accompanied by:

• spasms;
• burning in the tailbone;
• heaviness in the stomach;
• priapism;
• pale skin;
• increased sweating.

Anorectal pain (neuralgia) adds the following zones to the painful areas described above:

• buttocks;
• vagina;
• hips;
• sacral region.

Most often occurs in women over 50 who suffer from:

• hypochondria;
• depression.

If the underlying disease is persistent cancerophobia, then the patient is indicated for surgical intervention due to organic factors.

Clinical picture

Many people confuse this type of neuralgia with a pinched sciatic nerve. The symptoms are indeed similar, the difference lies in the location. Pelvic neuralgia is most often caused by pinching of the hip nerve.

This process is characterized by severe pain while walking and running. The disease also manifests itself as burning and numbness of the lower extremities. If the external thigh nerve is pinched, the pain syndrome will be present at rest, even during sleep.

A peculiarity of pain with pelvic neuralgia is the fact that it does not have a specific localization - unpleasant sensations can appear in different places. Sometimes there is no pain at all, but there is a burning sensation, numbness of the affected area, and limited movement.

In addition to all the above signs of the disease, men experience pain during urination and ejaculation, a burning sensation and pain in the urethra, as well as blood in the seminal fluid. These symptoms are characteristic of other ailments, so diagnosis must be carried out especially carefully.

Women may confuse the signs of pelvic neuralgia with genital infections, PMS and dysmenorrhea. Characteristic symptoms of the disease can be considered:

Additional signs of rectal neuralgia are pain in the anus, pale skin, and increased sweating. Sometimes they are accompanied by heaviness in the lower abdomen and a burning sensation in the tailbone.

Symptoms of this form of neuralgia are constant pain in the pelvic area, which is aching in nature.

Additional signs also appear:

• burning, especially when sitting;
• increased sensitivity of the skin in the genital area;
• sensation of a foreign body in the genitals;
• urination disorders (for some they occur involuntarily, while for others, on the contrary, with acute pain).

Patients complain of pain in the perineum and in the coccyx area. At the same time, discomfort during walking increases, which is why the gait may change - it becomes shuffling, patients move in small steps.

Classification

Doctors identify several classification bases, each of which describes the nature of the disease:

1. By location:

• in the coccyx area – coccydynia;
• in the anus - anorectal syndrome.

1. Type:

• primary;
• secondary. It is a symptom of other diseases, mainly in neighboring organs (prostatitis, acute urethritis, problems “on the female side”, etc.).

1. According to the nature of the manifestations:

• Night. The pain occurs at night and lasts for an indefinite period of time. Additional localization: in the perineum, pelvic floor.
• Spastic. Determined by the presence of gastrointestinal diseases and stool disorders.
• Anusolgia (“flying proctalgia”). It is distinguished from the nocturnal type by a known cause: back injuries, infectious diseases of the urinary system, and sometimes constipation.

Definition of disease

Pelvic neuralgia is a pinched nerve in the hip joint.
In this condition, the nerve that is located between the bones, ligaments and tendons is pinched, which causes severe pain. Sometimes the pain lasts only a few minutes, and sometimes it drags on for 2-3 days. Pathology develops in both men and women. The danger is that this disease can disguise other ailments. Therefore, the treatment is carried out incorrectly.

Disease code according to ICD-10: M79.2. Pelvic neuralgia also includes anorectal neuralgia. This is an inflammation of the nerves in the coccyx and anus, as well as in the perineum. The inflammatory process is accompanied by acute pain. Also a type of pelvic neuralgia is pudendal neuralgia.

Diagnostics

Anococcygeal pain syndrome is made as a diagnosis only after excluding the possibility of organic pathologies:

• problems with the intestines - hemorrhoids, anal fissures, etc.
• diseases of the reproductive system – endometritis, prostatitis, etc.
• rheumatological diseases – radiculitis, sciatica.
• neuralgia.

If the examination establishes that the cause of the painful sensations is not a disease of a certain organ, then a diagnosis of “ancoccygeal syndrome” is made.

The examination is carried out by a proctologist and gynecologist.

The proctologist determines the absence of:

• damage to the anus;
• foci of inflammation;
• injuries of the sacrum or coccyx;
• muscle spasm in this area.

A gynecologist is recommended for women to analyze the condition of the reproductive organs.

Laboratory tests are required. Standard procedures include:

• coprogram;
• feces for testing bacteria and the presence of blood in the composition;
• general urine analysis;
• gynecological tests for both sexes.

For a full diagnosis, consultations with a urologist, traumatologist, andrologist, neurologist, and psychotherapist are often necessary. Only after their conclusions does the attending physician make a final decision regarding the nature of the disease.

Sigmoidoscopy and anoscopy

Many additional studies are aimed at excluding possible other causes of pain. These include:

• sigmoidoscopy – study of the condition of the large intestine;
• anoscopy – analysis of the health of the anal canal.

Both procedures provide information about:

• the condition of the internal mucous surfaces;
• the presence of hemorrhoids and polyps;
• the presence of papillitis.

Irrigography

At its core, it is an X-ray of the intestine. Finds:

• tumor formations;
• abnormal narrowing;
• problems in the coccyx, sacral area, hip joint.

Electrophysiological and ultrasound examination

The first looks for muscle spasms, collects data on intestinal motility and functionality. The second allows you to “see” the organs in the pelvic area, especially the genitals.

Prevention and prognosis

If the root cause is not injury or pathology of the spinal column or pelvic bones, then anococcygeus syndrome does not lead to complications.

It is impossible to single out preventive measures. Doctors advise to be attentive to emerging symptoms and try to rearrange your life in such a way as to reduce the intensity of their manifestation.

The usual rules are:

• active lifestyle, regular non-exhausting sports, walks;
• prevention of spinal diseases and elimination of existing problems;
• treatment of the gastrointestinal tract, especially the intestines;
• proper nutrition with healthy foods.

The main danger of neuralgia is unpredictable pain, which can last up to 30 minutes and interfere with normal life. Complex therapy helps suppress symptoms, but only a reasonable attitude towards one’s health can help reduce the syndrome. Prevention available to everyone is a healthy lifestyle and timely treatment of the spine and internal organs.

Neuralgia causes severe pain and interferes with a full life. That is why it is important to recognize the disease in time and begin its treatment.

In this article we will talk about pelvic neuralgia (inflammation of the inguinal, pudendal, and pudendal nerves) in men and women, its symptoms, and treatment of hip joint pathology.

Treatment

The effectiveness of therapy is determined by:

• completeness of the examination;
• correct diagnosis;
• correct identification of the root cause.

Treatment is carried out in 3 areas:

• Etiological. They try to rid the patient of the factors that provoke the disease.
• Pathogenetic. If possible, the development of the problem is slowed down.
• Symptomatic. First of all, pain relief.

A popular method is physiotherapy:

• laser radiation;
• UZ;
• UHF;
• mud treatment;
• massage.

Local preparations include suppositories, microenemas with painkillers and anti-inflammatory substances.

Since a common cause is an unstable psychological state, consultations with specialists in this field are often prescribed.

Analgesic methods

Treatment of pain, especially of unknown origin, is one of the areas for study in modern medicine. There are medical institutions all over the planet that are engaged in the prevention and relief of their patients from syndromes of this kind.

Doctors prefer not narcotic drugs, but various analgesics:

• Novocaine blocks nerve transmissions;
• local anesthesia relieves pain;
• hot applications relieve discomfort.

Cortisone has now proven its own ineffectiveness and the harm it causes to patients.

Placebo is applicable for psychogenic origin of the syndrome.

Sedatives and tranquilizers are prescribed for those suffering from:

• depression;
• anxiety;
• neurotic conditions.

Surgical intervention

Indicated in the most extreme cases if:

• coccydynia appeared only due to the injury;
• there is a separation of the tip of the coccyx.

In this situation, the operation is called extirpation. During the procedure, the coccyx is fixed at the sacrum.

Etiology

Pain in the area of ​​the inflamed nerve may decrease and become stronger. All this depends on the degree of load.

Possible causes of pelvic neuralgia:

callus, the development of which leads to joint injury;

• acquired diseases of joints and ligaments (this includes various types of arthrosis and arthritis);
• strong physical activity;
• narrowing of the opening in the tubules of the spinal cord and vertebral hernia;
• bone tuberculosis, which leads to damage to bone tissue in the pelvic area;
• severe illnesses of the circulatory system, including cancer;
• injury to bone and joint tissue.

In women during pregnancy, the uterus increases in size, because of this it puts pressure on the sacral plexus, from which the nerve endings emerge. Such processes lead to pinched nerves and severe pain. In some cases, the symptoms of the disease appear after childbirth - this occurs with malpresentation of the fetus or difficult labor (more about neuralgia during pregnancy in this article).

Also, the causes of pelvic neuralgia include excess weight, diabetes of any type, and in some cases, shingles if it is localized in the lumbar region. In children, injuries most often lead to the development of pelvic neuralgia.

Intercostal neuralgia with osteochondrosis

Intercostal neuralgia is pain that occurs as a result of compression of the roots of the intercostal nerve and spreads throughout the chest. Typically, intercostal neuralgia indicates the development of thoracic osteochondrosis. The condition occurs with constant or paroxysmal pain, and numbness, tingling or a burning sensation may occur.

httpv://www.youtube.com/watch?v=embed/H52cAXO1qSU

In addition, intercostal neuralgia is accompanied by:

• increased sweating;
• pallor or, conversely, redness of the skin;
• contraction and twitching of muscles.

In some situations, pain due to osteochondrosis can radiate to the back, shoulder blade, and cardiac area. Typically, the pain increases after changing position, when walking, coughing or sneezing, or deep breathing.

Intercostal neuralgia can also develop with the following diseases:

• Angina pectoris.
• Myocardial infarction.
• Mitral valve prolapse, etc.

The onset of the disease develops in the form of an acute muscle spasm that occurs after physical activity, sleeping in an uncomfortable position, unsuccessful movement, or working in an awkward position. Often, intercostal neuralgia can occur as a result of hypothermia, being in a draft, after a cold, stress, or chest injury.

Read: Neck massage for osteochondrosis at home

Treatment of intercostal neuralgia primarily depends on the root cause of the disease. When choosing a treatment method, the doctor takes into account various individual indicators of the patient. Painkillers and ointments are not effective in the fight against this disease.

It is necessary to understand that nausea, dizziness, pain, intercostal neuralgia are only manifestations of spinal osteochondrosis. That is why the underlying disease that caused the above symptoms should be treated.

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Measuring the pH of the esophageal contents

To measure pH, an electrode is inserted into the esophagus to a position 5 cm above the lower esophageal sphincter. pH measurement is carried out simultaneously with the study of esophageal motility or during daily pH measurements.

pH measurement after esophageal motility study

pH measurement after esophageal motility testing involves a hydrochloric acid clearance test in which 15 ml of 0.1 M hydrochloric acid is injected into the lower esophagus and the patient is asked to take empty sips every 30 s until the pH returns. to the original value. Normally, 15 sips are enough. In diseases that impair esophageal motility, such as systemic scleroderma, achalasia cardia, and other esophageal motility disorders, or that reduce salivary flow, such as systemic scleroderma and Sjögren's syndrome, the removal of hydrochloric acid from the esophagus is delayed. Measurement of pH in the lower third of the esophagus is used in the diagnosis of gastroesophageal reflux. In this case, pH is measured with the patient lying on his back, on his stomach, on the right and left side, in the knee-chest position, in a relaxed state and after straining. Then 300 ml of 0.1 M hydrochloric acid is injected into the patient’s stomach and the pH measurement is repeated in all specified positions. A pH value below 4.0 recorded in any position before the administration of hydrochloric acid or in two positions after its administration indicates reflux of acidic gastric contents into the esophagus. Determination of esophageal peristalsis during administration of hydrochloric acid may reveal motility disorders causing chest pain.

Daily pH-metry on an outpatient basis

Devices have been developed that make it possible to continuously record the pH of the esophagus for 24 hours during the daily activities of the patient. This is especially useful when identifying symptoms of gastroesophageal reflux at night or when performing certain activities. Patients are asked to write down the symptoms they experience.

Wireless pH monitoring devices (such as Bravo capsule)

Wireless pH monitoring devices (such as the Bravo capsule) make testing more convenient for the patient and increase the sensitivity of pH measurements. The capsule is placed into the distal esophagus using endoscopy. It makes it possible to measure pH longer (48 hours instead of 24 hours). Longer monitoring helps to better understand the physiology of gastroesophageal reflux, recording all its changes at each point in time. In addition, with the help of long-term monitoring, it is possible to evaluate the effectiveness of therapy aimed at suppressing the secretion of hydrochloric acid, without conducting repeated studies.

Multichannel intraesophageal impedancemetry

Multichannel intraesophageal impedancemetry is a new research technique for reflux esophagitis and esophageal motility disorders. It allows you to study the process of passage of a bolus of food through the esophagus, as in an X-ray contrast study with barium sulfate, and to assess how high the stomach contents are thrown into the esophagus. Multichannel intraesophageal impedance testing can be used in combination with esophageal manometry to comprehensively assess esophageal motor function.

High resolution manometry

High-resolution manometry uses solid-state probes with 36 circular sensors located at a distance of 1 cm from each other (the outer diameter of the sensors is 4.2 mm). Each of them consists of 12 isolated sensor elements located around the circumference, recording pressure on a 2.5 mm long section of the esophagus. The probe is inserted into the esophagus and pressure readings are recorded during 10 sips, after which the probe is removed. The values ​​measured by the sensitive elements of each sensor are averaged.

High-resolution manometry is a simpler, faster and more accurate method compared to conventional esophageal manometry. It allows you to obtain complete information about the motor function of the esophagus from the pharynx to the lower esophageal sphincter without moving the catheter, as well as accurately measure the pressure in the area of ​​the esophageal sphincter and assess the intensity of peristalsis.

Preparatory activities for manometry

The examination method requires preparation. The attending physician who prescribes manometry must conduct explanatory conversations with the patient, explain in detail how the study will take place, what rules need to be taken into account, and how to prepare the body.

• A few days before the examination, rinsing of the esophagus through a thick gastric tube is prescribed.
• The day before the test, limit your intake of spicy, fatty foods. It is recommended to eat light broths to reduce the load on the gastrointestinal tract. 12 hours before the procedure you should not eat or drink.
• If you are taking medications, your doctor should know about it.
• On the day of manometry, you should not use painkillers, antispasmodics, or sedatives; the procedure is performed on an empty stomach.

Pathology of the anus

Bleeding and prolapse of the mucous membrane through the anus often occur with hemorrhoids. The diagnosis is made by performing sigmoidoscopy.

Papillomatosis of the skin around the anus, fibroepithelial polyps and thrombosis of external nodes are relatively less severe situations, but can provoke a serious clinical picture. If necessary, patients are referred to a surgeon to remove these formations.

Prolapse of the rectal mucosa can be mistakenly regarded as prolapse of hemorrhoids. The diagnosis is made by making the patient strain as if having a bowel movement. Although unattractive, it is best to examine such a patient while sitting on the toilet rather than in the left lateral decubitus position.

Anal fissures sometimes cause unbearable pain

Diagnosis is carried out based on complaints and anamnestic data with a careful examination of the anal canal. Sometimes such a study must be carried out using anesthetics

Treatment of anal fissures is currently conservative. Less commonly performed are traditional sphincterotomy and the discredited method of stretching (digital dilatation) of the anus.

Abscesses in the anorectal area usually form when infection penetrates into the anal glands located along the dentate line. An acute inflammatory process can cause abscess formation and the formation of a chronic fistula. Anorectal abscesses vary in length; they can be peri-anal, ischiorectal, intersphincteric and supralevator.

Drugs

Help with medicines

If, after diagnosis, the patient has excluded the possibility of concomitant pathologies and neuralgia is detected, the proctologist prescribes symptomatic therapy using the following medications:

• drugs to improve sleep and calm the nervous system: Donormil, Valocordin, Valeriana forte, Sedasitron, Zoliclon;
• medications for pain relief - Anestezol, Clonidine, Salbutamol;
• tranquilizers – Diazepam, Gidozepam;

To relieve the pain of frequent attacks, novocaine blockade is used. With the help of the procedure, it is possible to quickly eliminate pain for a long time. However, doctors warn that it is not recommended to use such therapy often. As an alternative solution, pain relief can be carried out with microenemas with novacaine solution. Or sea buckthorn oil.

Gives to the stomach with osteochondrosis

Almost all organs of the peritoneum are connected to the nerve endings of the thoracic spine. Patients suffering from thoracic osteochondrosis most often note the formation of pain radiating to the abdomen.

Abdominal pain with osteochondrosis is distinguished by the following symptoms:

• non-diffuse pain;
• pain is localized in the area of ​​innervation of the affected area;
• pain occurs and also intensifies after the slightest movements or when turning, as well as coughing;
• pain is felt at the level of muscle tissue;
• usually the pain is one-sided, constant, dull or aching.

Pain in the abdomen in people suffering from osteochondrosis limits and impedes their movements. Usually the pain radiates to the stomach with such lesions of the ridge:

• in case of damage to the mid-thoracic nerves, pain is observed in the stomach;
• if the pathology is localized in the 8th and 9th roots, then the pain forms in the area of ​​the duodenum;
• if osteochondrosis affects the 7th, 8th, 9th thoracic roots on the right, then pain is felt in the hypochondrium on the right.

Read: Exercises for osteochondrosis of the thoracic region

Cervical and thoracic osteochondrosis, in addition to abdominal pain, can provoke problems with stool, impaired intestinal motility, and pathologies of gas formation.

Soreness in the stomach

When the spine is affected by osteochondrosis, patients often experience pain in the organs of the digestive system. Often such stomach pains are mistakenly diagnosed as gastroduodenitis.

Infringement of the spinal root in the vegetative part of the ridge causes spasm or irritation of the nerve. The result is heartburn and nagging pain. Over time, pain in the digestive organ becomes constant.

Stomach pain caused by osteochondrosis is easily differentiated from gastric disorders: pain due to pathologies of the spine increases with the slightest movements or turns.

Pain in the lower abdomen

Typically, pain in the lower abdomen is caused by pathology progressing in the lumbar region. If the disease affects the thoracic area of ​​the spinal column, then pain is felt on the right in the abdominal area. The symptoms resemble those of appendicitis, but without an increase in body temperature. In addition, pain in the lower abdomen is similar to manifestations of gastritis and colitis.

Osteochondrosis in this case is accompanied by the following symptoms:

• heartburn and nausea;
• feeling of heaviness in the right hypochondrium;
• cramps and bloating;
• stabbing pain in the right lower abdomen;
• constipation occurring with nagging pain;
• pain in the epigastric zone.

Read: How to treat osteochondrosis at home

It is very difficult to independently distinguish pain syndrome due to osteochondrosis from pathologies of the digestive organs. It is recommended to consult a specialist in a timely manner to avoid the development of complications.

Folk remedies

To improve intestinal health and overall well-being, you can use folk recipes. You can improve intestinal function with a composition made from buckthorn. Crushed bark (2 tbsp) is poured with 200 ml of boiled water and kept wrapped for 30 minutes. The solution is taken one spoon twice a day

Traditional methods

Orange juice can improve intestinal function, but the juice must be freshly squeezed. Fresh orange juice is consumed twice a day, half a glass. Juice from mint leaves is good for proctalgia. Only young leaves are suitable for preparing medicine. The product is taken at the rate of half a teaspoon of juice and 200 ml of water. After combining the two components, the solution is taken one time before meals. You need to take the product three times a day. To improve the taste, you can add a spoonful of honey to a glass with the prepared mixture.

Some patients recommend treatment with a remedy prepared from the rhizome of calamus. A composition is prepared from 3 tablespoons of raw materials and 400 ml of boiled water (cook over low heat for a quarter of an hour). After preparation, the medicine is filtered and drunk during the day in small portions.

To begin therapeutic measures, you must consult with your treating proctologist.

Diagnosing proctalgia

The diagnosis is established by a proctologist after carrying out the necessary research activities. Diagnosis of proctalgia is necessary to exclude other possible pathologies with similar symptoms. A gynecologist refers a woman to a proctologist after examining the female reproductive and genitourinary organs. A gynecological examination for proctalgia must be carried out, since the disease is often accompanied by additional proctological and genitourinary diseases.

At an appointment with a proctologist, the doctor examines the patient and conducts a digital examination of the rectal organ. This procedure is painless. If the doctor deems it necessary, sphincteromanometry of the urinary and genital areas is performed with testing of the sphincters (tone study).

Additional diagnostic measures are:

At the doctor

• laboratory blood test (detection of inflammatory processes);
• rectaromanoscopy – instrumental examination with a rectoscope;
• irrigoscopy - examination of the intestinal walls;
• colonoscopy – instrumental examination with a colonoscope (diagnosis of the intestine along the entire length);
• when no pathologies of the urinary tract are detected, the proctologist prescribes an additional examination with an ultrasound machine, as well as examinations by a urologist and gynecologist.

When no pathological changes are found in patients, but pain is present, proctalgia, the primary type, is diagnosed. Usually, before turning to specialists, patients have already tried to relieve painful symptoms on their own, so during a consultation with a proctologist, the patient should tell what measures he took and what results of treatment were noted.

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