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Eberhard KE, Merchant GR, Nakajima HH, Neely ST. Toward Automating Diagnosis of Middle- and Inner-ear Mechanical Pathologies With a Wideband Absorbance Regression Model. Ear Hear 2024:00003446-990000000-00283. [PMID: 38797886 DOI: 10.1097/aud.0000000000001516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
OBJECTIVES During an initial diagnostic assessment of an ear with normal otoscopic exam, it can be difficult to determine the specific pathology if there is a mechanical lesion. The audiogram can inform of a conductive hearing loss but not the underlying cause. For example, audiograms can be similar between the inner-ear condition superior canal dehiscence (SCD) and the middle-ear lesion stapes fixation (SF), despite differences in pathologies and sites of lesion. To gain mechanical information, wideband tympanometry (WBT) can be easily performed noninvasively. Absorbance , the most common WBT metric, is related to the absorbed sound energy and can provide information about specific mechanical pathologies. However, absorbance measurements are challenging to analyze and interpret. This study develops a prototype classification method to automate diagnostic estimates. Three predictive models are considered: one to identify ears with SCD versus SF, another to identify SCD versus normal, and finally, a three-way classification model to differentiate among SCD, SF, and normal ears. DESIGN Absorbance was measured in ears with SCD and SF as well as normal ears at both tympanometric peak pressure (TPP) and 0 daPa. Characteristic impedance was estimated by two methods: the conventional method (based on a constant ear-canal area) and the surge method, which estimates ear-canal area acoustically.Classification models using multivariate logistic regression predicted the probability of each condition. To quantify expected performance, the condition with the highest probability was selected as the likely diagnosis. Model features included: absorbance-only, air-bone gap (ABG)-only, and absorbance+ABG. Absorbance was transformed into principal components of absorbance to reduce the dimensionality of the data and avoid collinearity. To minimize overfitting, regularization, controlled by a parameter lambda, was introduced into the regression. Average ABG across multiple frequencies was a single feature.Model performance was optimized by adjusting the number of principal components, the magnitude of lambda, and the frequencies included in the ABG average. Finally, model performances using absorbance at TPP versus 0 daPa, and using the surge method versus constant ear-canal area were compared. To estimate model performance on a population unknown by the model, the regression model was repeatedly trained on 70% of the data and validated on the remaining 30%. Cross-validation with randomized training/validation splits was repeated 1000 times. RESULTS The model differentiating between SCD and SF based on absorbance-only feature resulted in sensitivities of 77% for SCD and 82% for SF. Combining absorbance+ABG improved sensitivities to 96% and 97%. Differentiating between SCD and normal using absorbance-only provided SCD sensitivity of 40%, which improved to 89% by absorbance+ABG. A three-way model using absorbance-only correctly classified 31% of SCD, 20% of SF and 81% of normal ears. Absorbance+ABG improved sensitivities to 82% for SCD, 97% for SF and 98% for normal. In general, classification performance was better using absorbance at TPP than at 0 daPa. CONCLUSION The combination of wideband absorbance and ABG as features for a multivariate logistic regression model can provide good diagnostic estimates for mechanical ear pathologies at initial assessment. Such diagnostic automation can enable faster workup and increase efficiency of resources.
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Affiliation(s)
- Kristine Elisabeth Eberhard
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
- Copenhagen Hearing and Balance Centre, Department of Otolaryngology, Head and Neck Surgery & Audiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | | | - Hideko Heidi Nakajima
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
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Sugimoto H, Toya T, Watanabe Y, Takei W, Nagai R, Donjo Y, Motoo R, Inaba M, Yoshizaki T, Murakoshi M. Wideband frequency impedance for diagnosis of ossicular chain abnormality. Acta Otolaryngol 2023; 143:958-964. [PMID: 38134217 DOI: 10.1080/00016489.2023.2292168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND The accurate estimation of the ossicular chain abnormalities using existing functional examinations has been difficult. AIMS/OBJECTIVES This study aimed to verify the accuracy of preoperative diagnosis of ossicular chain abnormalities using a wideband frequency impedance (WFI) meter, which can measure the dynamic characteristics of the middle ear. MATERIAL AND METHODS Retrospective cohort study. Fourteen ears of patients with ossicular chain abnormalities that were definitively diagnosed surgically were included in this study. The following data were collected for each participant: sound pressure level (SPL) curve measured using the WFI meter and a sweep frequency impedance (SFI) meter, WFI measurements plotted on the resonance frequency (RF)-ΔSPL plane, distribution map of the dynamic characteristics of the middle ear, preoperative audiometry results, and the definitive surgical diagnosis. RESULTS The SPL curve obtained using the WFI meter had lesser noise than that obtained using the SFI meter. The distribution map revealed that the ossicular chain separation range and ossicular chain fixation range were completely separated. The hearing data tended to be poor in cases with small ΔSPL. CONCLUSIONS AND SIGNIFICANCE WFI can potentially enhance the accuracy of SFI. In addition, it can also be used for the classification of ossicular chain separation and fixation as well as the quantification of fixation in cases of ossicular chain anomalies that cannot be diagnosed using conventional tests.
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Affiliation(s)
- Hisashi Sugimoto
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Teruki Toya
- Faculty of Engineering, University of Yamanashi, Kofu, Japan
| | - Yoshihiro Watanabe
- Innovative Clinical Research Center, Kanazawa University Hospital, Japan
| | - Wataru Takei
- Faculty of Education, Institute of Human and Social Sciences, Kanazawa University, Japan
| | - Risa Nagai
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yasunori Donjo
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Ryosei Motoo
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Manabu Inaba
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Tomokazu Yoshizaki
- Department of Otolaryngology-Head and Neck Surgery, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Michio Murakoshi
- Faculty of Frontier Engineering, Institute of Science and Engineering, Kanazawa University, Japan
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Sackmann B, Eberhard P, Lauxmann M. Parameter Identification From Normal and Pathological Middle Ears Using a Tailored Parameter Identification Algorithm. J Biomech Eng 2022; 144:1119456. [PMID: 34505125 DOI: 10.1115/1.4052371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Indexed: 11/08/2022]
Abstract
Current clinical practice is often unable to identify the causes of conductive hearing loss in the middle ear with sufficient certainty without exploratory surgery. Besides the large uncertainties due to interindividual variances, only partially understood cause-effect principles are a major reason for the hesitant use of objective methods such as wideband tympanometry in diagnosis, despite their high sensitivity to pathological changes. For a better understanding of objective metrics of the middle ear, this study presents a model that can be used to reproduce characteristic changes in metrics of the middle ear by altering local physical model parameters linked to the anatomical causes of a pathology. A finite-element model is, therefore, fitted with an adaptive parameter identification algorithm to results of a temporal bone study with stepwise and systematically prepared pathologies. The fitted model is able to reproduce well the measured quantities reflectance, impedance, umbo and stapes transfer function for normal ears and ears with otosclerosis, malleus fixation, and disarticulation. In addition to a good representation of the characteristic influences of the pathologies in the measured quantities, a clear assignment of identified model parameters and pathologies consistent with previous studies is achieved. The identification results highlight the importance of the local stiffness and damping values in the middle ear for correct mapping of pathological characteristics and address the challenges of limited measurement data and wide parameter ranges from the literature. The great sensitivity of the model with respect to pathologies indicates a high potential for application in model-based diagnosis.
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Affiliation(s)
- Benjamin Sackmann
- Reutlingen Research Institute, Reutlingen University, Reutlingen 72762, Germany
| | - Peter Eberhard
- Institute of Engineering and Computational Mechanics, University of Stuttgart, Stuttgart 70569, Germany
| | - Michael Lauxmann
- School of Engineering, Reutlingen University, Reutlingen 72762, Germany
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Preserving Wideband Tympanometry Information With Artifact Mitigation. Ear Hear 2022; 43:563-576. [PMID: 34387582 PMCID: PMC8855961 DOI: 10.1097/aud.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Absorbance measured using wideband tympanometry (WBT) has been shown to be sensitive to changes in middle and inner ear mechanics, with potential to diagnose various mechanical ear pathologies. However, artifacts in absorbance due to measurement noise can obscure information related to pathologies and increase intermeasurement variability. Published reports frequently present absorbance that has undergone smoothing to minimize artifact; however, smoothing changes the true absorbance and can destroy important narrow-band characteristics such as peaks and notches at different frequencies. Because these characteristics can be unique to specific pathologies, preserving them is important for diagnostic purposes. Here, we identify the cause of artifacts in absorbance and develop a technique to mitigate artifacts while preserving the underlying WBT information. DESIGN A newly developed Research Platform for the Interacoustics Titan device allowed us to study raw microphone recordings and corresponding absorbances obtained by WBT measurements. We investigated WBT measurements from normal hearing ears and ears with middle and inner ear pathologies for the presence of artifact and noise. Furthermore, it was used to develop an artifact mitigation procedure and to evaluate its effectiveness in mitigating artifacts without distorting the true WBT information. RESULTS We observed various types of noise that can plague WBT measurements and that contribute to artifacts in computed absorbances, particularly intermittent low-frequency noise. We developed an artifact mitigation procedure that incorporates a high-pass filter and a Tukey window. This artifact mitigation resolved the artifacts from low-frequency noise while preserving characteristics in absorbance in both normal hearing ears and ears with pathology. Furthermore, the artifact mitigation reduced intermeasurement variability. CONCLUSIONS Unlike smoothing algorithms used in the past, our artifact mitigation specifically removes artifacts caused by noise. It does not change frequency response characteristics, such as narrow-band peaks and notches in absorbance at different frequencies that can be important for diagnosis. Also, by reducing intermeasurement variability, the artifact mitigation can improve the test-retest reliability of these measurements.
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(-)-Epigallocatechin-3-gallate (EGCG) prevents aminoglycosides-induced ototoxicity via anti-oxidative and anti-apoptotic pathways. Int J Pediatr Otorhinolaryngol 2021; 150:110920. [PMID: 34500358 DOI: 10.1016/j.ijporl.2021.110920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/17/2021] [Accepted: 09/03/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Aminoglycoside-induced cochlear ototoxicity causes inner ear hair cells (HCs) loss and leads to hearing impairment in patients, but no treatment completely eliminates the ototoxic effect. This study aims to determine the effectiveness of (-)-Epigallocatechin-3-gallate (EGCG) as a protective agent against aminoglycoside-induced ototoxicity. METHODS Zebrafish were exposed to EGCG for 24 h and then co-treated with EGCG and ototoxic agent (amikacin and gentamicin) for 5 h to explore the protective effect of EGCG on zebrafish HCs. Network pharmacology analysis and molecular docking simulation were conducted to explore its potential mechanism, and in vitro cell experiments were used to validate the outcome of the result. RESULT EGCG against ototoxicity of aminoglycosides in zebrafish HCs. Network pharmacology analysis and molecular docking showing that molecules related to cellular response regulation to oxidative stress, including AKT1, DHFR, and MET, may be the target proteins of EGCG, which were verified in vitro experiments. Further experiments demonstrated thatEGCG can antagonize the death of HCs caused by amikacin and gentamicin by reducing intracellular reactive oxygen species (ROS) accumulation and anti-apoptosis. CONCLUSION EGCG can be an otoprotective drug against aminoglycosides-induced ototoxicity, prevent cellular apoptosis and significantly reduce oxidative stress.
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Merchant GR, Neely ST. The influence of otitis media with effusion on middle-ear impedance estimated from wideband acoustic immittance measurements. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 150:969. [PMID: 34470321 PMCID: PMC8349246 DOI: 10.1121/10.0005822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/14/2021] [Accepted: 07/14/2021] [Indexed: 06/13/2023]
Abstract
The goal of this work was to estimate the middle-ear input impedance ( Zme) from wideband acoustic immittance (WAI) measures and determine whether Zme improves the clinical utility of WAI. The data used in this study were from a previously reported set of WAI measurements in ears with otitis media with effusion [OME; Merchant, Al-Salim, Tempero, Fitzpatrick, and Neely (2021). Ear Hear., published online]. Ears with OME were grouped based on effusion volume, which was confirmed during tube surgery. Zme was estimated from the measured ear-canal impedance. An electrical-analog model of ear-canal acoustics and middle-ear mechanics was used to model the ear canal and Zme. The model results fit the measured responses well for all conditions. A regression approach was used to classify the responses of different variable types to effusion volume groups and determine the specificity and sensitivity of the binary classifications. The Zme magnitude increased with increasing effusion volume. The area under the receiver operating characteristic curve (AUC) was compared for binary decisions of the OME categories. The Zme estimate resulted in a clinically meaningful improvement in the AUC for distinguishing healthy ears from ears with OME. Overall, these results suggest that Zme estimation may provide useful information of potential clinical value to improve the diagnostic utility of WAI measurements for OME.
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Affiliation(s)
- Gabrielle R Merchant
- Center for Hearing Research, Boys Town National Research Hospital, 555 North 30th Street, Omaha, Nebraska, USA
| | - Stephen T Neely
- Center for Hearing Research, Boys Town National Research Hospital, 555 North 30th Street, Omaha, Nebraska, USA
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Merchant GR, Schulz KM, Patterson JN, Fitzpatrick D, Janky KL. Effect of Cochlear Implantation on Vestibular Evoked Myogenic Potentials and Wideband Acoustic Immittance. Ear Hear 2021; 41:1111-1124. [PMID: 32032225 PMCID: PMC7392788 DOI: 10.1097/aud.0000000000000831] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective of this study was to determine if absent air conduction stimuli vestibular evoked myogenic potential (VEMP) responses found in ears after cochlear implantation can be the result of alterations in peripheral auditory mechanics rather than vestibular loss. Peripheral mechanical changes were investigated by comparing the response rates of air and bone conduction VEMPs as well as by measuring and evaluating wideband acoustic immittance (WAI) responses in ears with cochlear implants and normal-hearing control ears. The hypothesis was that the presence of a cochlear implant can lead to an air-bone gap, causing absent air conduction stimuli VEMP responses, but present bone conduction vibration VEMP responses (indicating normal vestibular function), with changes in WAI as compared with ears with normal hearing. Further hypotheses were that subsets of ears with cochlear implants would (a) have present VEMP responses to both stimuli, indicating normal vestibular function and either normal or near-normal WAI, or (b) have absent VEMP responses to both stimuli, regardless of WAI, due to true vestibular loss. DESIGN Twenty-seven ears with cochlear implants (age range 7 to 31) and 10 ears with normal hearing (age range 7 to 31) were included in the study. All ears completed otoscopy, audiometric testing, 226 Hz tympanometry, WAI measures (absorbance), air conduction stimuli cervical and ocular VEMP testing through insert earphones, and bone conduction vibration cervical and ocular VEMP testing with a mini-shaker. Comparisons of VEMP responses to air and bone conduction stimuli, as well as absorbance responses between ears with normal hearing and ears with cochlear implants, were completed. RESULTS All ears with normal hearing demonstrated 100% present VEMP response rates for both stimuli. Ears with cochlear implants had higher response rates to bone conduction vibration compared with air conduction stimuli for both cervical and ocular VEMPs; however, this was only significant for ocular VEMPs. Ears with cochlear implants demonstrated reduced low-frequency absorbance (500 to 1200 Hz) as compared with ears with normal hearing. To further analyze absorbance, ears with cochlear implants were placed into subgroups based on their cervical and ocular VEMP response patterns. These groups were (1) present air conduction stimuli response, present bone conduction vibration response, (2) absent air conduction stimuli response, present bone conduction vibration response, and (3) absent air conduction stimuli response, absent bone conduction vibration response. For both cervical and ocular VEMPs, the group with absent air conduction stimuli responses and present bone conduction vibration responses demonstrated the largest decrease in low-frequency absorbance as compared with the ears with normal hearing. CONCLUSIONS Bone conduction VEMP response rates were increased compared with air-conduction VEMP response rates in ears with cochlear implants. Ears with cochlear implants also demonstrate changes in low-frequency absorbance consistent with a stiffer system. This effect was largest for ears that had absent air conduction but present bone conduction VEMPs. These findings suggest that this group, in particular, has a mechanical change that could lead to an air-bone gap, thus, abolishing the air conduction VEMP response due to an alteration in mechanics and not a true vestibular loss. Clinical considerations include using bone conduction vibration VEMPs and WAI for preoperative and postoperative testing in patients undergoing cochlear implantation.
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Affiliation(s)
| | - Kyli M. Schulz
- Boys Town National Research Hospital, Omaha, NE 68131
- The University of Texas at Austin, TX 78712
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Nørgaard KM, Allen JB, Neely ST. On causality and aural impulse responses synthesized using the inverse discrete Fourier transform. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2021; 149:3524. [PMID: 34241097 DOI: 10.1121/10.0005048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/30/2021] [Indexed: 06/13/2023]
Abstract
Causality is a fundamental property of physical systems and dictates that a time impulse response characterizing any causal system must be one-sided. However, when synthesized using the inverse discrete Fourier transform (IDFT) of a corresponding band-limited numerical frequency transfer function, several papers have reported two-sided IDFT impulse responses of ear-canal reflectance and ear-probe source parameters. Judging from the literature on ear-canal reflectance, the significance and source of these seemingly non-physical negative-time components appear largely unclear. This paper summarizes and clarifies different sources of negative-time components through ideal and practical examples and illustrates the implications of constraining aural IDFT impulse responses to be one-sided. Two-sided IDFT impulse responses, derived from frequency-domain measurements of physical systems, normally occur due to the two-sided properties of the discrete Fourier transform. Still, reflectance IDFT impulse responses may serve a number of practical and diagnostic purposes.
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Affiliation(s)
| | - Jont B Allen
- Department of Electrical and Computer Engineering, University of Illinois, Urbana-Champaign, 306 North Wright Street, Champaign, Illinois 61820, USA
| | - Stephen T Neely
- Boys Town National Research Hospital, 555 North 30th Street, Omaha, Nebraska 68131, USA
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Nørgaard KM, Fernandez-Grande E, Schmuck C, Laugesen S. Reproducing ear-canal reflectance using two measurement techniques in adult ears. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2020; 147:2334. [PMID: 32359297 DOI: 10.1121/10.0001094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/27/2020] [Indexed: 06/11/2023]
Abstract
Clinical diagnostic applications of ear-canal reflectance have been researched extensively in the literature, however, the measurement uncertainty associated with the conventional measurement technique using an insert ear probe is unknown in human ear canals. Ear-canal reflectance measured using an ear probe is affected by multiple sources of error, including incorrect estimates of the ear-canal cross-sectional area and oblique ear-probe insertions. In this paper, ear-canal reflectance measurements are reproduced in an occluded-ear simulator and in 54 adult ear canals using two different measurement techniques: a conventional ear probe and a two-microphone probe that enables the separation of reverse- and forward-propagating plane waves. The two-microphone probe is inserted directly into test subjects' ear canals, and the two-microphone method is distinguished by not requiring the ear-canal cross-sectional area to calculate the ear-canal reflectance. The results show a reasonable agreement between the two measurement techniques. The paper further examines the influence of oblique ear-probe insertions and the compensation for such oblique insertions, which results in an improved agreement between the two measurement techniques.
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Affiliation(s)
- Kren Monrad Nørgaard
- Acoustic Technology, Department of Electrical Engineering, Technical University of Denmark, Ørsteds Plads, Building 352, Kongens Lyngby, DK-2800, Denmark
| | - Efren Fernandez-Grande
- Acoustic Technology, Department of Electrical Engineering, Technical University of Denmark, Ørsteds Plads, Building 352, Kongens Lyngby, DK-2800, Denmark
| | | | - Søren Laugesen
- Interacoustics Research Unit, Technical University of Denmark, Ørsteds Plads, Building 352, Kongens Lyngby, DK-2800, Denmark
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