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Gautam Das asked:




Different radio frequency lesioning procedures are proving invaluable in pain management day by day. It is the best form of treatment for trigeminal neuralgia, different cancer pain and different kinds of spinal pain including low back pain and neck pain.

Radio Frequency (RF) lesioning involves passage of a very high frequency current through a 27 G thermocouple probe. This probe is passed through a 20/22G cannula (a kind of needle), which is insulated except at its tip. When a high frequency alternating current is passed (at 300 kHz) through the RF thermocouple probe the charged ions in the human tissue around the exposed tip of RF cannula moves to & fro. This produces electro-mechanical friction heat is generated. The thermocouple probe is not heated itself, it actually dissipates the heat generated at the surrounded tissue. Thus the heat is totally controlled by the operator. The lesion generated is shaped like a matchstick head with a diameter of 2-4mm. Beyond this distance; electrical field is weaker as it is dispersed, so no lesion is produced.

The temperature & therefore the heat lesion is maximum around the shaft and minimum at its tip. On the other hand the electrical field generated is maximum at its tip and minimum around the shaft. In the conventional RF rhizotomy type we are producing heat lesion. In the pulsed RF electrical field is producing the lesion. In pulsed RF temperature is not raised beyond 42-degree C. Electrical field produces some punch in the capacitor of small diameter nociceptive (pain transmitting) fibers. Thereby signal transmission through this fibre is stopped.

In the conventional type the nerves are regenerated in future & average pain-free period varies for type of nerve. In a properly performed lesion pain free period is 3-4 years. In the pulsed RF the average pain free period is 4-24 months.

The conventional RF rhizotomy is done at sympathetic ganglions, and at purely/ predominantly sensory nerves. It is always avoided in mixed or predominantly motor nerves. Before doing actual lesioning radiological and electrical tests are done to keep the probe away from these nerves in conventional RF lesioning. The commonly performed conventional RF rhizotomy procedures are at following nerves.

1. Trigeminal (Gasserian) ganglion and its divisions i.e. mandibular nerve & maxillary nerve.

2. Stellate ganglion

3. Cervical facet joint medial branch

4. Thoracic facet joint medial branch

5. Splanchnic nerves

6. Lumber sympathetic plexus

7. Superior Hypogastric plexus

8. Lumber facet joint medial branch

9. Sacro-Iliac joint supplying nerves

In Pulsed RF as there is no heat lesioning it is safe to perform it in most kinds of nerves. It is mostly effective in nerve ganglions but also effective trunks. It may be performed in all the above procedures except trigeminal ganglion. It is mainly indicated in Dorsal root ganglionostomy. It is also done in mixed peripheral nerves like suprascapular nerve.

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Dr Todd Sullivan asked:




Low back pain Chiropractic Care can be the result of over-straining, an accident injury or a whole host of other causes such as not lifting a heavy weight properly, or a sports injury. Being older and overweight can contribute to low back pain and Chiropractic Care.

Often with a bit a rest and self care, low back pain resolves itself in time, but sometimes the pain just doesn’t subside and the limited range of motion and pain begin to keep the person from being able to enjoy their life. That is when it is time to consider Chiropractic Care to relieve your low back pain.

Chiropractors take a natural approach to health care
While most people have probably heard of Chiropractors, not everyone is familiar with their approach to health care. This can lead some people to be a bit leery of considering Chiropractic care. A Chiropractor is a doctor who takes a holistic approach to health care. They focus on the spine, and the central nervous system, which are at the center of the musculoskeletal system of the body. They take the approach that everything within the body is interconnected, and their role is to remove whatever might impede the body’s own natural healing process.

Spinal manipulations help relieve pain and restore alignment
Chiropractors take a natural, non-surgical and drug-free approach to caring for bodies. They use spinal manipulations to treat physical disorders that have their origins in the nervous system and the musculoskeletal system. The goal of these spinal manipulations is to relieve pain and restore range of motion and mobility to the joint. When a Chiropractor does a spinal manipulation, they use their hands to apply a calculated and precise forceful motion pushing the restricted joint past its range of motion. This movement may cause a crack or a popping sound.

Other approaches that Chiropractors might take in treating low back pain might include ultrasound, electrical muscle stimulation or massage to warm, stretch and relax tight muscles.

Prevention of low back injury
Because low back pain is often the result of strain or over use, there are things that you can do to strengthen the back to prevent such injuries. A regular, consistent exercise routine that include stretching and weight training will help to build both strength and flexibility in the muscles and ligaments that support the spine. A strong, flexible back is far less prone to injury than a sedentary one.

Observing proper lifting techniques such as not attempting to lift a weight that is too heavy, remembering to lift from bent knees and not from the waist are good ways to protect the back.

Good posture can also prevent low back pain. If you work at a job that requires you to sit for long periods of time, make sure that your chair has proper back support, and try to stand up and stretch occasionally.

Low back pain and Chiropractic care might be the issue that brings you in to the Chiropractor’s office, but you may find that you will keep returning in order to keep you body in proper alignment to prevent future health complications.

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Back pain is in general a common problem that every one faces. It is a vulnerable problem that a person of any age experiences. Children, Adults, Pregnant woman, or a person of old age can also face the back pain problem. There may be several factors behind your back pain problem as it is not restricted only to one particular reason. And so people needs to face loads of trouble during back pain to cure it. Your prime duty is to know the causes and take some preventive measures so that you need not feel the pain during backache.

There can be varied causes for back pain:

Lumbar Muscle Strain: Straining of muscles is the most common cause of low back pain. Chances are bright in this case that a patient may completely feel relieve from muscle strain.

Spondylolisthesis: In this case the adjacent vertebra becomes unbalanced and begins to ‘slip’ which causes back pain and if it still prolongs then back pain can turn to be a serious problem.

Osteoporosis: A patient needs to face this problem because of compression fracture of the vertebra. You may face orthopedic problem and much of uneasiness too. It also leads to feeble bones.

Ruptured Disc: It is also called as Herniated Disc which causes back pain. The treatment of herniated disc depends and differs on an individual’s condition and circumstances. It is incorrectly being called in general as “Slipped Disc”, affecting the spine, in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion to bulge out. Herniated Discs are found in ? of adults older than 20.

Spinal Stenosis: This is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerve. In the aging population, when the spinal canal becomes too stiff then it can result into back pain. A patient suffering under this situation may even feel minor trauma causing irritation and nerve root impingement which indirectly results into back ache.

There are many of causes of back ache that can put you into serious health trouble. For acute back pain the underlying cause is meniscoid occlusion. You may get startled to know that the lower back pain causes also differ as per the person’s age. Some of the common causes of back pain for adults under age 50 include spinal disc, herniation and degenerative disc disease or isthmic spondylolisthesis. And for adults over age 50 include osteoarthritis (degenerative joint disease) and spinal stenosis, trauma, cancer, infection, fractures, and inflammatory disease.

Thus, to cure your back pain you need to practice exercises regularly. Collect information to know back pain causes and if the situation worsens then it is highly recommended to consult doctor for the betterment of your health.



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Lower Back Pain, affects both those unaccustomed to physical activity and regular exercisers.

The first step to understanding the various causes of low back pain is learning about the normal design anatomy of the tissues of this area. Important structures of the low back that can be related to symptoms there include the bony lumbar spine vertebrae, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area. Many muscle groups that are responsible for flexing, extending, and rotating the waist, as well as moving the lower extremities, attach to the lumbar spine through tendon insertions.

Fortunately, most occurrences of low back pain go away within a few days. Acute or short-term low back pain generally lasts from a few days to a few weeks. Low back pain may reflect nerve or muscle irritation or bone lesions. Most low back pain follows injury or trauma to the back, but pain may also be caused by degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, irritation to joints and discs, or congenital abnormalities in the spine. Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also may contribute to low back pain. Occasionally, low back pain may indicate a more serious medical problem.

Nearly everyone has low back pain sometime. The risk of experiencing low back pain from disc disease or spinal degeneration increases with age. Low back pain unrelated to injury or other known cause is unusual in pre-teen children.

A variety of diagnostic methods are available to confirm the cause of low back pain:. Discography involves the injection of a special contrast dye into a spinal disc thought to be causing low back pain. Computerized tomography CT is a quick and painless process used when disc rupture, spinal stenosis, or damage to vertebrae is suspected as a cause of low back pain. Most low back pain can be treated without surgery. Exercise may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. Medications are often used to treat acute and chronic low back pain. Musculoskeletal pain syndromes that produce low back pain include myofascial pain syndromes and fibromyalgia. Other skeletal causes of low back pain include osteomyelitis orsacroiliitis infections of the bones of the spine.

Most low back pain is triggered by some combination of overuse, muscle strain, and injury to the muscles, ligaments, and discs that support the spine. When low back pain strikes, we become acutely aware of just how much we rely on a flexible, strong back. The causes of low back pain tend to be interrelated. Most people have at least one episode of recurrent low back pain. The term “low back pain” is used to describe a spectrum of symptoms. Depending on the cause, low back pain may be dull, burning, or sharp, covering a broad area or confined to a single point. Leg symptoms can be caused by lower spine problems that place pressure on a nerve to the leg; they can occur on their own or along with low back pain. Your health professional can assess acute low back pain by talking to you about your medical history and your work and physical activities, and doing a simple physical examination. However, some episodes of low back pain are signs of more serious conditions. Low back pain can result from something simple, like cleaning house or lifting a heavy box, or it can be caused by a diagnosable spine condition like a herniated disc or degenerative disc disease.

Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies including BioFreeze. Some type of Lumbar Support is also important for constant support for low back pain. Wonder-Roll which is a self inflating lumbar support pillow is a good solution that you can take anywhere with you.

The vast majority of lower back pain conditions will get better with time and can be addressed with non-surgical treatments, such as osteopathic or chiropractic manipulation, physical therapy, pain medications, etc.. Low back pain responds very well to appropriate conservative treatment such as physical therapy and proper medication which can be prescribed by your physician.

Author: Donna Nocero



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Acute back pain may begin suddenly and usually lasts around 3 months. Chronic back pain sometimes lasts throughout life.

The most common back pain is low back pain (LBP). It is is often described as sudden, sharp, persistent, or dull pain felt below the waist. LBP is very common and affects the majority of people at some point during their life. Up to 70%–85% of all people have back pain at some time in their lives. LBP is the most common cause of a limitation of activity in people younger than 45 years of age. It is the second most frequent reason for visits to a physician, and the third most common indication for surgery. It is the fifth-ranking cause of hospital admissions and is one of the leading causes of disability.

Low back pain is most commonly caused by muscle strain associated with heavy physical work, lifting or forceful movement, bending or twisting, awkward positions, or standing in one position too long. Any of these movements can exacerbate a prior or existing back disorder. Other conditions that can cause low back pain include spinal stenosis, arthritis (osteoarthritis), spinal infection (osteomyelitis), spinal tumors (benign and malignant), spondylolisthesis, and vertebral fractures (e.g. burst fracture).

Low back pain is either acute or chronic. Acute LBP may begin suddenly with intense pain usually lasting fewer than three months. Chronic pain is persistent long-term pain, sometimes lasting throughout life. Even chronic pain may present episodes of acute pain. Other symptoms include localized pain in a specific area of the low back, general aching, and/or pain that radiates into the low back, general aching, and/or pain that radiates into the low back, buttocks and leg(s). Sometimes pain is accompanied by neurological symptoms such as numbness, tingling, or weakness. Neurological symptoms requiring immediate medical attention include bowel or bladder dysfunction, groin or leg weakness or numbness, severe symptoms that do not subside after a few days, or pain prohibiting everyday activities.

Pain felt in the low back is not always indicative of a spinal problem. A thorough physical and neurological assessment may reveal the cause of the low back pain. The physical examination begins with the patient’s current condition and medical history. Examination of a patient with low back pain involves examining the patient’s range of spinal motion while standing straight, bending forward, and to the side. Asymmetry, posture, and leg length is noted. Methodical palpation of the spine can reveal muscle spasm, possible bony displacement, and tender points. Abdominal palpation is performed to determine if the cause of low back pain is possibly organ related (e.g. pancreas). The neurological assessment evaluates weakness, absence of reflexes, tingling, burning, pain, diminished function, and other signs that may indicate nerve involvement.

If infection, malignancy, fracture, or other risk factors are suspected, routine lab tests may be ordered. These tests may include complete blood count (CBC), erythrocyte sedimentation (ESR), and urinalysis. In some cases electrodiagnostic studies such as electromyography (EMG) or nerve condition velocity (NCV) are performed to confirm a diagnosis or localize the site of nerve injury. Plain radiographs (x-rays), CT Scan, and/or MRI studies are performed when fracture or neurological dysfunction is suspected. A MRI represents the gold standard in imaging today. A MRI renders high-resolution images of spinal tissues such as the spinal cord and intervertebral discs. X-rays are still the imaging methods of choice to study the bony elements in the low back. The results of the physical and neurological examinations combines with test results are carefully evaluated to confirm a diagnosis.

Most patients with low back pain are treated without surgery. A conventional treatment plan may include bed rest for a day or two combines with medication to reduce inflammation and pain. Medications recommended by the physician are based on the patient’s medical condition, age, other drugs the patient currently takes, and safety. The first choice for pain relief is often nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs should be taken with food to prevent stomach upset and stomach bleeding. Muscle relaxants may provide relief from muscle spasm but are actually benign sedatives, which often cause drowsiness. Narcotic pain relievers are prescribed for use during the acute phase and often for chronic pain management in appropriate patients.

Other modalities to treat low back pain might include physical therapy (PT), transcutaneous electrical nerve stimulator (TENS) trial, ultrasound therapy, acupuncture and massage therapy. A managed PT program can help build muscle strength and flexibility, improve mobility, coordination, stability and balance, and promote relaxation. Patients who participate in a structured physical therapy program often progress to wellness more rapidly than those who do not. This includes low back maintenance through a home exercise program developed for the patient by the physical therapist.

Although the number of spinal surgeries done every year is on the rise, it is rarely required to treat low back pain. Surgery may be considered if the patient is experiencing bowel or bladder dysfunction, increased nerve impairment, progressive weakness, incapacitating pain, or spinal instability. The surgical procedure depends on the diagnosis or the cause of low back pain. To prevent low back pain, first and foremost, follow the treatment plan outlined by the physician. To enhance recovery from an episode of low back pain, or to help prevent future exacerbation, try to maintain good posture, be consistent in a home exercise program, and eat sensibly to maintain proper body weight.

About Walton Rehabilitation Health System:

Walton Rehabilitation Health Systems (WRHS) is a leading not-for-profit comprehensive, multi-specialty, dedicated provider of physical medicine and rehabilitation. Our mission is to be an advocate for wellness by providing a continuum of services to treat the whole person. WRHS, whose reputation extends throughout the south, is a trusted partner with just the right expertise and treatments to help people with disabling injuries and illnesses return to work and to a fulfilling life. By pursuing its mission, WRHS has grown to include Walton Pain and Headache Centers, Walton Community Services, Walton Options for Independent Living, Walton Foundation for Independence, and Walton Technologies. We are located at: 1355 Independence Drive, Augusta, GA 30901-1037. For more information visit www.wrh.org or call 866-4-WALTON.



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So you thought your back pain would go away by itself…

A recent study involving sufferers of low back pain in the British Medical Journal (2/05/98), contradicted the previous claim in the BMJ that back pain resolved itself naturally. A follow up found that 91% of those in the survey were still experiencing back pain 12 months later.

Make no mistake; if you have low back pain, you have a problem.

Most low back pain is the result of an injury. Sometimes these injuries happened years ago. I often have patients tell me that they have had low back pain before, but it has “always gone away”. This is usually the worst type of problem. Our body uses pain to tell us that we have a problem. (I promise the problem is not a shortage of Motrin in your body!) In our infinite wisdom, we take the drugs, cover up the back pain without fixing the problem, and our back pain temporarily goes away. We think we are fine, until it happens again and it always does. This time the back pain is a little worst and takes longer to go away and we continue this insanity until the problem is severe.

What causes low back injuries resulting in low back pain?

There are many ways low back injuries occur. The more important question is what do I do now?

Few GP’s will admit, as Dr Phil Hammond does in his book Trust Me I’m A Doctor that “they are not very good at treating back pain”. Most GP’s are reluctant to refer outside the NHS, even though chiropractors are specially trained to identify and advise on the specific cause of your spinal dysfunction (back pain). The bones of your spine protect the spinal cord as well as the nerve roots, sometimes they lose their normal motion or position (vertebral subluxation complex), and this can irritate the nerves that branch off the spinal cord to all the tissues of your body, resulting in back pain being experienced.

In order for the spine to be flexible, the vertebrae are joined together by soft tissue structures known as discs. Each disc is made up of two parts – a central soft core and outer rings of tough cartilage. The discs allow movement and also help to absorb shock. A slipped disc is the rather inaccurate term used to describe the condition, often in the lower back, where trauma or ‘wear and tear’ have caused damage to the outer rings of cartilage, so that the core is squeezed outwards. This can result in a bulge which can press on the spinal cord, the nerve root or the nerve itself. It can cause excruciating back pain, or referred elsewhere – for example in the lower leg or foot. Over my 22 years in practice, I have developed techniques that mobilize the spine to reduce any pressure around the spinal cord or nerves; offering patients not only back pain relief, but correction of the problem that is causing the back pain.

Do Medical Treatments and Surgery help?

The medical approach is at times necessary – even back surgery has a place. But according to some studies, most spinal surgery for acute lower back pain should be rarely performed. Many people who have had back surgery report a recurrence of their back pain within a year or two of the operation and may return to the operating table. In some cases the surgery makes no difference in their back pain whatsoever, and in some cases it does not give long-term relief.

The Chiropractic Approach:

Barton Chiropractic in Concord has helped thousands of people with low back pain, saving them from pain, disability, drugs and surgery. The approach at Barton Chiropractic in Concord is to make your spine and its nerves, discs ligaments and muscles healthier, stronger and more stable by correcting your vertebral subluxation. Anyone suffering from back pain should contact Barton Chiropractic in Concord to make sure they have no subluxations and have them corrected with a chiropractic adjustment if necessary. This may make the difference between a life of ease, health and comfort and a life of back pain, disease and disability.

What did the Government Studies reveal?

Major government studies from the US, Canada and UK have reaffirmed what chiropractic patients have been telling their friends with back pain for years: “Why don’t you see my chiropractor? You’ll get better much faster than from drugs or surgery- and it’s safer too.

In 1991 the Medical Research Council established chiropractic as one of the preferred and most effective methods of care for acute low back pain. “Chiropractic almost certainly confers worthwhile long term benefits in comparison with hospital outpatient management”. “If all these patients were referred for chiropractic instead of hospital treatment, the annual cost would be a reduction of some 290,000 days in sickness absence during 2 years, saving about 13 million in output and 2.9 million in social security payments”. British Medical Journal, June 2nd 1990 – www.chiropractic-uk.co.uk.

A panel of medical experts spent 2.5 years reviewing nearly 4,000 studies and reported that expensive tests (MRI, CAT scans) and therapies typically used to diagnose and treat acute lower back pain are largely useless. Instead the experts recommended the non-drug chiropractic approach.

The Manga Report commissioned by the government of Ontario in Canada, found that chiropractic care for patients with low back pain is superior to medical care in terms of safety, scientific evidence of effectiveness, cost and patient satisfaction.

Chiropractic is better for you!

Studies have shown chiropractic works better, is safer and less costly than standard medicine for lower back pain.Why are the results so overwhelmingly in favor of Barton Chiropractic in Concord? Because Drugs (painkillers, muscle relaxants, Valium…), physical therapy and surgery are not designed to correct vertebral subluxation only cover up your back pain and allow you to die more comfortably. Call us today at 925 685-2002 to make an appointment. We Can Help You!



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Acupuncture is one of the oldest, most commonly used medical procedures in the world. Acupuncture is a traditional Chinese medical technique. It is also called Oriental medicine. Acupuncture scientific name is paradigm. Each meridian corresponds to one organ, or group of organs, that governs particular bodily functions. Acupuncture is thought to restore health by removing energy imbalances and blockages in the body. Acupuncture is the practice of inserting thin needles into specific body points to improve health and well-being. Acupuncture originated in China more than 2,000 years ago, making it one of the oldest and most commonly used medical procedures in the world. It is widely used in both private and NHS settings. Acupuncture is a family of procedures involving stimulation of anatomical locations on or in the skin by a variety of techniques. Traditional Chinese medicine is not based on knowledge of modern physiology, biochemistry, nutrition, anatomy, or any of the known mechanisms of healing. Acupuncture’s record of success has stimulated a number of research projects investigating its mechanisms as well as its efficacy. It’s commonly used to treat pain, relieve common ailments and promote general health. There is a growing body of research evidence on the effectiveness of acupuncture, especially to treat nausea (particularly postoperative), dental problems and low back pain. Acupuncture has been shown to induce reproducible patterns of neural activity in a wide variety of brainstem, midbrain and cerebral cortical structures.There is sufficient evidence, however, of acupuncture’s value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value.

Acupuncturists believe it regulates the flow of ‘vital energy’, known as ‘Qi’ (pronounced ‘chee’). The most frequently offered defense of acupuncture by its defenders commits the pragmatic fallacy. The effects of acupuncture are complex. Acupuncture needles are metallic, solid, and hair-thin. People experience acupuncture differently, but most feel no or minimal pain as the needles are inserted. Some people are energized by treatment, while others feel relaxed. Improper needle placement, movement of the patient, or a defect in the needle can cause soreness and pain during treatment. This is why it is important to seek treatment from a qualified acupuncture practitioner. Acupuncture is also thought to decrease pain by increasing the release of chemicals that block pain, called endorphins. Many acu-points are near nerves. When stimulated, these nerves cause a dull ache or feeling of fullness in the muscle. The stimulated muscle sends a message to the central nervous system (the brain and spinal cord), causing the release of endorphins (morphine-like chemicals produced in our own bodies during times of pain or stress). Endorphins, along with other neurotransmitters (body chemicals that modify nerve impulses), block the message of pain from being delivered up to the brain. Some of the biological effects of acupuncture have also been observed when “sham” acupuncture points are stimulated, highlighting the importance of defining appropriate control groups in assessing biological changes purported to be due to acupuncture.

Acupuncture is one of the CAM therapies that are more commonly covered by insurance. Acupuncture points are thought to correspond to physiological and anatomical features such as peripheral nerve junctions, and diagnosis is made in purely conventional terms. There are several different approaches to acupuncture. Among the most common in the United States today Acupuncture points employs penetration of the skin by thin, solid, metallic needles, which are manipulated manually or by electrical stimulation. The most common serious injury reported from the needles of acupuncture has been accidental puncture of the lung. The most common infection reported from acupuncture treatments is viral hepatitis, a potentially serious infection of the liver. Other side effects include bacterial infections locally at the site of needle insertion in the skin and elsewhere in the body. Generally, side effects seem to relate to poor hygiene and training of the acupuncturist. Acupuncture as a therapeutic intervention is widely practiced in the United States. There have been many studies of its potential usefulness. However, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebo and sham acupuncture groups. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma where acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program.



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