Vol 88, No 2 (2016)

Editorial
Irritable bowel syndrome in the light of Rome consensus III (2006): 10 years later
Parfenov A.I., Albulova E.A., Ruchkina I.N.
Abstract
Irritable bowel syndrome (IBS) is the most common diagnosis in gastroenterology. Over 10 years after Rome consensus III (2006), there has been much new information on the pathogenesis of IBS and its therapy options. The paper analyzes basic investigations that have contributed to the theory of this disease and to a better quality of life in patients.
Terapevticheskii arkhiv. 2016;88(2):4-9
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The calcium-regulating system and recurrent peptic ulcer
Chernin V.V., Fomina L.A.
Abstract
Aim. To elucidate the functional state and value of the calcium-regulating system, calcium and phosphorus metabolism in the pathogenesis and sanogenesis of peptic ulcer (PU); to define the possible ways to correct shifts found in the treatment of disease relapse, by affecting the different levels of their disorders. Subjects and methods. A total of 220 patients with recurrent PU were examined by determining the blood levels of parathyrin, calcitonin, calcium and phosphorus, as well as gastric secretory and motor functions. Results. Recurrent PU was accompanied by a considerable increase in the blood concentration of parathyroid hormone and calcium, a slight rise in that of calcitonin, and a significant reduction in that of phosphorus. These changes were attended by a substantial increase in gastric acid- and pepsinogen-forming functions, a decrease in the production of gastric mucoproteins, and hypermotor dyskinesia. The use of calcitrin, nifedipine, and etidronic acid, which eliminate dysfunction of the calcium-regulating system at different levels of its impairments, leads to a significant reduction in the time of alleviation of the clinical and endoscopic manifestations of a recurrence. Conclusion. Recurrent PU runs in the presence of calcium-regulating system dysfunction. Incorporation of the thyroid C-cell hormone preparation calcitrin, the slow calcium-channel blocker nifedipine, and etidronic acid bisphosphonate into a complex of treatment for a disease recurrence is pathogenetically sound and clinically effective.
Terapevticheskii arkhiv. 2016;88(2):10-15
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Gastric and duodenal secretory and motor-evacuatory activity in patients with gastroesophageal reflux disease associated with different types of reflux
Dzhulay G.S., Sekareva E.V.
Abstract
Aim. To estimate esophageal and gastric pH values on an empty stomach and after stimulation of gastric secretion and gastric and duodenal motor-evacuatory activity in patients with gastroesophageal reflux disease (GERD) associated with pathological refluxes, such as gastroesophageal reflux (GER) and duodenogastroesophageal reflux (DGER). Subjects and methods. The observational cross-sectional study was conducted to investigate and compare the parameters of intraesophageal and intragastric pH metry and peripheral electrogastroenterography in 103 GERD patients with endoscopically positive distal reflux esophagitis in GER and DGER. Results. The patients with GERD developed pathological esophageal refluxes (both GER and DGER) in various degrees of impaired gastric production, from anacidity to hyperacidity. The patients with predominant DGER were found to have gastric hyperacidity and normal acidity slightly less frequently than those with predominant GER. The patients with GERD developing in the presence of predominant GER had moderate gastric stasis with discoordinated antroduodenal propulsion resulting from hypomotor dyskinesia of the stomach and duodenum. When DGER was predominant in the patients with GERD, the signs of gastric stasis and duodenal hyperkinesia were concurrent with discoordinated antroduodenal and duodenojejunal propulsion. Conclusion. The specific features of the esophagogastroduodenal secretory and motor evacuatory disorders found create conditions for the pathological refluxes into the esophagus, which differ in the composition of refluxate.
Terapevticheskii arkhiv. 2016;88(2):16-20
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Specific features of gastroesophageal reflux disease associated with obesity and overweight
Livzan M.A., Lapteva I.V., Krolevets T.S., Kiselev I.E.
Abstract
Aim. To reveal the specific features of gastroesophageal reflux disease (GERD) associated with obesity and overweight, by investigating the clinical and endoscopic manifestations of the disease, 24-hour pH-metry scores, and leptin levels. Subjects and methods. A total of 131 patients with GERD were examined. The data about complaints and those from life and medical histories were collected; anthropometric measurements and the results of blood biochemical tests, esophagoduodenoscopy (EPDS), and pH-metry were assessed; and the serum levels of leptin and its receptor were estimated. The patients were allocated into a study group (104 obese and/or overweight patients) and a comparison one (27 normal weight people). Results. Waist circumference, hip circumference, and blood glucose levels proved to be statistically significantly higher in the study group (p<0.00000, p<0.00002, and p<0.02, respectively). The obese patients were found to have a statistically significantly higher level of leptin and a lower level of its soluble receptors: the median leptin levels were 30.42 (13.42—45.62) ng/ml in the study group and 5.47 (3.35—7.68) ng/ml in the comparison group; the median levels of the receptors were 18.83 (14.98—25.11) ng/ml and 30.93 (24.68—33.53) ng/ml, respectively). This group showed a moderate negative correlation between these indicators (rs=–0.451; p<0.0004). The study group displayed higher pH values in the gastric cardia and body (p<0.05 and p<0.04, respectively). The mucosal contact time with the refluxate having with a low pH value (<4) in the above segments turned out to be longer in the comparison group (p<0.05). There were weight-independent relationships of the leptin level to its spread, aggressiveness quotient, to the highest pH value in the gastric cardia and body, and to the mucosal contact time with the refluxate having a pH below 4.0 (rs=0.543; p<0.006; rs=0.432; p<0.04; rs=0.431; p<0.04; rs=–0.450; p<0.03, respectively), leptin receptors with a pH ratio in the gastric cardia and body, to the number of reflux episodes longer than 5 minutes in the esophagus, and to the De Meester index for this indicator (rs=0.471; p<0.04; rs=–0.455; p<0.04; rs=–0,454; p<0.04, respectively). Conclusion. Obese and overweight patients develop GERD in the presence of leptin resistance and biliary tract disease, which determines the specific features of the disease (alkaline or mixed refluxate) and the need for individualized therapy.
Terapevticheskii arkhiv. 2016;88(2):21-27
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The frequency and clinical aspects of extraesophageal syndromes in elderly patients with gastroesophageal reflux disease
Tsukanov V.V., Kasparov E.V., Onuchina E.V., Vasyutin A.V., Butorin N.N., Amelchugova O.S., Tonkikh Y.L.
Abstract
Aim. To investigate the frequency of extraesophageal syndromes in elderly patients with gastroesophageal reflux disease (GERD). Subjects and methods. This cross-sectional study was conducted to compare the clinical manifestations of GERD in 1100 patients aged 60 to 75 years and in 453 patients aged 36 to 60 years. A control group consisted of 154 elderly patients without GERD and 178 mature-aged patients without this condition. GERD was diagnosed via analysis of its symptoms, esophagogastroduodenoscopy, and 24-hour pH monitoring on the basis of the Montreal consensus guidelines. Extraesophageal syndromes were detected actively using the current methods accepted to treat lung, heart, and ENT diseases and a simultaneous gastroesophageal examination. Results. Chronic cough, asthma, chronic laryngitis, cardialgias and cardiac arrhythmias were much more common in elderly patients with GERD than in those without this condition and prevalent in patients with erosive esophagitis and Barrett’s esophagus as compared with those with non-erosive reflux disease. The mature-aged patients were recorded to have similar but less pronounced trends. The authors proposed an algorithm for the management of patients with extraesophageal manifestations of GERD, the important aspect of which was two-month acid-suppressive therapy used as both diagnostic testing and empirical treatment for this pathology. Conclusion. The extraesophageal manifestations of GERD in elderly patients are a serious clinical problem calling for considerable attention.
Terapevticheskii arkhiv. 2016;88(2):28-32
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European Registry on the management of Helicobacter pylori infection (Hp-EuReg protocol): The first results of Russian centers
Bordin D.S., Yanova O.B., Abdulkhakov R.A., Tsukanov V.V., Livzan M.A., Burkov S.G., Zakharova N.V., Plotnikova E.Y., Osipenko M.F., Tarasova L.V., Maev I.V., Kucheryavyi Y.A., Butov M.A., Sablin O.A., Kolbasnikov S.V., Voinovan I.N., Abdulkhakov S.R., Vasyutin A.V., Lyalyukova E.A., Golubev N.N., Savilova I.V., Grigoryeva L.V., Kononova A.G., O'Morain C., Ramas M., Mcnicholl A.G., Gisbert J.P.
Abstract
Aim. To assess the clinical practice of diagnosis and treatment in patients with Helicobacter pylori infection and to compare this practice with the international guidelines in the European Registry on the management of Helicobacter pylori infection, Hp-EuReg protocol), a multicenter prospective observational study initiated by the European Helicobacter and Microbiota Study Group. Materials and methods. The data of 813 patients infected with H. pylori and entered in the Hp-EuReg register by the Russian centers in 2013—2015 were analyzed. Results. The most common methods for the primary diagnosis of H. pylori infection are histology (40.3%), rapid urease test (35.7%), and serology (17.2%). The duration of H. pylori eradication therapy was 7, 10, and 14 days in 18.0, 49.3, and 25.1%, respectively. To monitor the effectiveness of treatment, the investigators used a histological examination (34%), a urea breath test (27.3%), H. pylori stool antigen (22.8%), and a rapid urease test (16.3%). A serological test was carried out in 2.5% of the cases. No monitoring was done in 13.5% of the patients. The average eradication efficiency was 82.6%. If the therapy was ineffective, 80% of physicians did not intend to prescribe a new cycle of treatment. Conclusion. Significant differences were found between clinical practice and the current guidelines.
Terapevticheskii arkhiv. 2016;88(2):33-38
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Celiac disease detection rate in gastroenterological patients
Bykova S.V., Sabelnikova E.A., Gudkova R.B., Drozdov V.N., Shcherbakov P.L., Kirova M.V., Khomeriki S.G., Varvanina G.G., Belyaeva A.A., Parfenov A.I.
Abstract
Aim. To determine celiac disease detection rate in patients with digestive disease. Subjects and methods. A total of 318 gastroenterological patients admitted to be treated at the Central Research Institute of Gastroenterology in September to October 2012 were examined. The patients’ age was 18 to 74 years (mean 51.5±16.4 years). Immunoglobulin A (IgA) and immunoglobulin G (IgG) anti-gliadin antibodies (AGA), IgA anti-tissue transglutaminase (anti-tTG) antibodies and IgG anti-tTG antibodies were determined. When the antibodies were elevated, esophagogastroduodenoscopy with duodenal biopsy was performed. Results. Forty-one of the 318 patients were found to have higher AGA (12.9%); out of them IgA AGA were in 17 (5.35%) patients and IgG AGA were also in 17 (5.35%). Elevated levels of both antibodies (IgA AGA and IgG AGA) were seen in 7 (2.2%) patients. Overall, the detection rate of increased AGA levels was 12.9%. The antibodies were more commonly higher in patients with liver diseases (21.8%) and in those with inflammatory bowel diseases (21.6%). Both IgA anti-tTG, IgG anti-tTG and IgA AGA, IgG AGA were detected in 6 (1.9%) of the 318 patients. The diagnosis of celiac disease was verified by duodenal histological examination in 3 (0.94%) of the 318 patients. Conclusion. The celiac disease detection rate in gastroenterological patients was 0.94%.
Terapevticheskii arkhiv. 2016;88(2):39-43
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Use of mesenchymal stem cells in the combination therapy of ulcerative colitis
Knyazev O.V., Parfenov A.I., Konoplyannikov A.G., Boldyreva O.N.
Abstract
Conclusion. MSC application increases efficacy of anti-inflammatory treatment in patients with acute exacerbation of UC.
Terapevticheskii arkhiv. 2016;88(2):44-48
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A new non-invasive method for assessing steatosis in chronic liver diseases
Bakulin I.G., Sandler Y.G., Keyan V.A., Rotin D.L.
Abstract
Aim. To assess the diagnostic accuracy of the controlled attenuation parameter (CAP) to determine the grade of hepatic steatosis (HS) in patients with chronic liver diseases (CLD) of different etiologies and to compare the obtained results with morphological findings. Subjects and methods. A total of 45 patients (18 men and 27 women) aged 25 to 73 years with CLD were examined. All the patients underwent liver puncture biopsy for assessing the HS index and fibrosis stage, as well as determination of hepatic elasticity (F, kPa) for estimating the stage of fibrosis and the grade of HS by CAP (S, dB/m) using a FibroScan device. When assessing HS, the CAP values of <229, 230—249, 250—276, and more than 277 dB/m correspond to HS grade 0 (S0), S1, S2, and S3, respectively. This is a pilot study in Russia. Results. CAP is a rather high effective method in determining the absence of steatosis (S0) (the area under the receiver operating characteristics curve (AUROC) was 0.78) and severe steatosis (S3) (AUROC 0.90). AUROC was 0.64 and 0.59 for HS S1 and S2, which is regarded as satisfactory and poor results, respectively. Only 3 out of the 45 patients had HS, as evidenced by morphological examination; and the results of CAP showed another result; all the other cases had a HS grade corresponding to S1. In the entire cohort of the examinees, the sensitivity, specificity, and accuracy of CAP was 86, 69.5, and 78%, respectively; AUROC was 0.77 (95% CI, 0.6587—0.9006; p=0.40). Conclusion. CAP is a promising method for the rapid and non-invasive diagnosis of HS in patients with CLD. At the same time, our findings show that it is necessary to clarify the quantitative indicators of the compliance of CAP and morphological evaluation of HS.
Terapevticheskii arkhiv. 2016;88(2):49-57
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Evaluation of the efficiency of hepatoprotective monotherapy using succinic acid and methionine for nonalcoholic fatty liver disease at the stage of steatohepatitis
Semiserin V.A., Karakozov A.G., Malkuta M.A., Zolotareva L.A., Levchenko O.B., Kalyagin I.E., Eremin M.N.
Abstract
Aim. To evaluate the efficiency of Remaxol monotherapy in patients with nonalcoholic fatty liver disease (NAFLD) at the stage of steatohepatitis (SH). Subjects and methods. The treatment of 156 patients with NAFLD at the stage of SH was analyzed. A study group included 84 patients who had received intravenous Remaxol, 400 ml, dropwise at a rate of 40—60 drops per minute once daily in the morning for 10 days; a control group of 72 patients had been treated with the conventional scheme. Results. During the treatment, the study group showed a rapider relief of the manifestations of asthenovegetative and dyspeptic syndromes and a reduction in the magnitude of biochemical manifestations of cytolytic and cholestatic syndromes than did the control group. Conclusion. Incorporation of Remaxol into the therapy regimen in patients with NAFLD at the stage of SH enhances the effectiveness of treatment.
Terapevticheskii arkhiv. 2016;88(2):58-63
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Evaluation of cardiovascular remodeling and epicardial fat thickness in patients with chronic heart failure and metabolic syndrome
Drapkina O.M., Zyatenkova E.V.
Abstract
Aim. To estimate cardiac chamber sizes and epicardial fat (EF) thickness in patients with chronic heart failure (CHF) and metabolic syndrome (MS). Subjects and methods. The investigation enrolled 77 patients with CHF. The diagnosis of the latter was made on the basis of clinical symptoms and verified measuring N-terminal pro-brain natriuretic peptide levels in all the patients. A study group (SG) included 39 patients with CHF and MS. A control group comprised 38 CHF patients without MS. Clinical and biochemical blood tests and electrocardiography were performed in all the patients. Cardiac chamber sizes, myocardial wall thickness, and EF were estimated from echocardiographic findings. Fatty liver index (FLI) and nonalcoholic fatty liver disease (NAFLD) fibrosis score (NFS) were calculated in all the patients. Results. All the patients had clinical signs and symptoms of CHF. There were 25 (32%) men among the 77 patients. The mean age was 63.9±10.3 years. The patients with CHF and MS showed pronounced myocardial remodeling, which was manifested as significantly higher increases in the sizes of cardiac chambers and in the thickness of their walls and as larger EF thickness (EFT) and larger myocardial mass. In SG, EFT was 3.39±1.82 mm (p=0.00001). This group exhibited correlations between EFT and FLI (r=0.52; p=0.004), glycated hemoglobin levels (r=0.41; p=0.016), E peak (r=–0.25; p=0.005), E/A ratio (r=0.25; p=0.041), left ventricular (LV) end-systolic size (r=0.25; p=0.035), LV myocardial mass (r=0.29; p=0.038), NFS (r=0.29; p=0.002), and body mass index (r=0.29; p=0.003). Conclusion. The found correlations between EFT and the clinical and metabolic parameters of CHD and cardiovascular diseases allow EFT to be regarded as a new marker of risk for MS and cardiovascular diseases.
Terapevticheskii arkhiv. 2016;88(2):64-70
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Duodenal dystrophy: An interdisciplinary problem
Vinokurova L.V., Khatkov I.E., Izrailov R.E., Bordin D.S., Dubtsova E.A., Nikolskaya K.A., Agafonov M.A., Andrianov A.V.
Abstract
Duodenal dystrophy (DD) is the pathological change in the wall of the duodenum, which is caused by chronic inflammation in its ectopic pancreatic tissue. The most common complications of DD are acute or chronic pancreatitis and impaired duodenal patency, which along with severe pain are an indication for surgical treatment. Pancreaticoduodenal resection is recognized as the operation of choice. The paper describes a clinical case demonstrating the efficiency and safety of minimally invasive (laparoscopic) surgical technologies in this category of patients. Resectional interventions of this volume are also shown to be accompanied by the development of pancreatic insufficiency that necessitates continuous enzyme replacement therapy.
Terapevticheskii arkhiv. 2016;88(2):71-74
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Seronegative celiac disease: A case report
Krums L.M., Parfenov A.I., Sabelnikova E.A., Poleva N.I., Bykova S.V., Dubtsova E.A., Gudkova R.B., Khomeriki S.G., Rotin D.L., Pavlov M.V., Starostina N.S.
Abstract
The paper describes a rare case of celiac disease in the absence of serum anti-tissue transglutaminase (anti-tTG) antibodies. A 51-year-old patient has been suffering from diarrheas for 20 years. He has lost 15 kg gradually; weakness progressed; muscle cramps, leg edemas, and signs of dynamic pseudoobstruction appeared. Morphological examination revealed small intestinal mucosal (SIM) villous atrophy (Marsh IIIC stage). IgA anti-tTG and IgG anti-tTG antibodies were 0.086 and 0.178, respectively. The patient was prescribed a gluten-free diet, water electrolyte solutions to correct metabolic disturbances, and prednisolone. During a control examination after 6 months, the patient had no complaints and gained 22 kg, and the SIM villus height was increased. The specific feature of the case is specific negative serological tests for celiac disease.
Terapevticheskii arkhiv. 2016;88(2):75-77
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Visceral leishmaniasis concurrent with splenic marginal zone B-cell lymphoma
Julhakyan U.L., Magomedova A.U., Dvirnyk V.N., Kravchenko S.K.
Abstract
Splenic marginal zone B-cell lymphoma (SMZBCL) is a rare non-Hodgkin B-cell lymphoma that presents with morphologically mature lymphoid cells corresponding in their immunological characteristics to secondary follicular marginal zone lymphocytes. It is clinically characterized by splenomegaly, moderate lymphocytosis, usually focal bone marrow lesion, sometimes moderate of monoclonal immunoglobulin in the serum (generally IgM or IgG) and/or urea, and a relatively benign course. Leishmaniasis is a transmissible natural focal infectious endemic disease that has a great diversity of clinical manifestations. The authors describe Russia’s first case of SMZBCL concurrent with visceral leishmaniasis in a 52-year-old female patient admitted to a hematology hospital with weakness, splenomegaly, and lymphadenopathy. The simultaneous detection of lymphoma and leishmaniasis in the same biopsy specimen is extremely rare. Visceral leishmaniasis should be borne in mind as an opportunistic infection in patients with malignancies, particularly in immunocompromised persons who live or have stayed in the endemic areas.
Terapevticheskii arkhiv. 2016;88(2):78-80
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Nutritional status in patients with chronic pancreatitis
Maev I.V., Kucheryavyi Y.A., Andreev D.N., Bideeva T.V.
Abstract
Chronic pancreatitis (CP) is an inflammatory disease of the pancreas, accompanied by damage to the functioning parenchyma and ducts to develop irreversible structural changes (fibrosis, calcification) and irreparable loss of the endocrine and exocrine functions of this organ. Maldigestion is a typical outcome of CP of any etiology with a long-term history. Fat malabsorption is considered as a basis for malnutrition in patients with CP. The severity of malnutrition in patients with CP correlates with three major pathogenetic factors: primary nutrient deficiency, pancreatic maldigestion and secondary malabsorption syndrome (nutrient loss), hypermetabolism that is caused by an inflammatory process in the pancreas and that determines the severity of the disease. Malnutrition in patients with CP is not just a complication of this disease, but has an important impact on its course. Patients with severe malnutrition are noted to have the significantly lower activity of pancreatic enzymes in the duodenal contents, feces, and blood, which is correlated with the smaller blood amount of total protein and albumin.
Terapevticheskii arkhiv. 2016;88(2):81-89
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Current principles in the screening, diagnosis, and therapy of colorectal cancer
Khatkov I.E., Kagramanova A.V., Zakharzhevskaya N.B., Babikova E.A., Generozov E.V., Shcherbakov P.L., Parfenov A.I.
Abstract
The data available in the literature on the prevalence of colorectal cancer (CRC), its risk factors and genetic aspects are analyzed. Basic screening tests and their diagnostic value are described. The paper indicates the importance of methods (colonoscopy, occult blood feces analysis, fecal immunochemical test, determination of molecular genetic profile of fecal enterocytes) for the early primary diagnosis of colonic epithelial tumors and techniques (echography, computed tomography, magnetic resonance imaging, positron emission tomography) that are required to specify clinical TNM staging and enable one to choose an optimal treatment policy for CRC patients owing to the estimation of tumor volume and to the diagnosis of reginal and distant metastases. It also shows that new screening methods based on the detection of molecular markers for early (premorphological) tumor stages are promising. The role of primary CRC prevention aimed at molding and maintaining a healthy lifestyle in the population is demonstrated.
Terapevticheskii arkhiv. 2016;88(2):90-96
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Successes and unsolved problems in the study of celiac disease
Osipenko M.F., Shrainer E.V., Parfenov A.I.
Abstract
The review gives current views on the problem of celiac disease (gluten enteropathy). It presents the pathogenetic components of pathology development, associations with the specific features of the microflora in different parts of the gastrointestinal tract, as well as groups at risk for this pathology. The idea on other types of gluten intolerance is briefly given. Current elaborated approaches to gluten enteropathy therapy are provided.
Terapevticheskii arkhiv. 2016;88(2):97-100
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Aspects of pathogenetic pharmacotherapy for portal hypertension in liver cirrhosis
Garbuzenko D.V.
Abstract
The review of literature considers the principles of medical treatment for portal hypertension in liver cirrhosis, which are based on the current views of its development mechanisms. It describes both current pharmacotherapy methods for portal hypertension and drugs, the efficacy of which is being investigated.
Terapevticheskii arkhiv. 2016;88(2):101-108
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41st Border Extension Session of the Central Research Institute of Gastroenterology
Bordin D.S.
Terapevticheskii arkhiv. 2016;88(2):109-111
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