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Li ZH, Chen C, Wilkinson AR, Jiang ZD. Maximum length sequence brainstem auditory evoked response in low-risk late preterm babies. J Matern Fetal Neonatal Med 2010; 24:536-40. [PMID: 20624012 DOI: 10.3109/14767058.2010.501126] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Recent research indicates that there is delayed development in the more central part of the auditory brainstem in very preterm babies. We aimed to study whether this is also the case for late preterm babies. METHODS The maximum length sequence brainstem auditory evoked response (MLS BAER) was used to study functional status of the auditory brainstem. Babies born at 33-36 week gestation and without any major perinatal complications were recruited. MLS BAER was recorded and analyzed at term age. RESULTS No significant correlation was found between most MLS BAER variables and physiological factors (gender, postconceptional age, bodyweight, and head circumference obtained at time of testing). Wave latencies and amplitudes, and I-V and I-III intervals in the preterm babies were essentially similar to those in the term controls at all click rates. However, III-V interval increased significantly at 227-910/s clicks (p<0.05-0.01). All latencies, amplitudes and intervals correlated significantly with click rates (all p<0.001). No differences were found in the slopes of MLS BAER variables-rate functions between the later preterm babies and term controls. CONCLUSIONS Babies born at 33-36 weeks gestation without major complications had an increased III-V interval at high-rate stimulation. This suggests that late preterm babies have a mild delay in neural conduction in the more central part of the auditory brainstem.
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Affiliation(s)
- Zhi H Li
- Division of Neonatology, Children's Hospital of Fudan University, Shanghai, China
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Differences in impaired brainstem conduction between neonatal chronic lung disease and perinatal asphyxia. Clin Neurophysiol 2010; 121:725-33. [PMID: 20097607 DOI: 10.1016/j.clinph.2009.12.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Revised: 11/06/2009] [Accepted: 12/08/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore any differences in impaired brainstem function between preterm infants with neonatal chronic lung disease (CLD) and term infants after perinatal asphyxia. METHODS Brainstem auditory evoked responses (BAERs) collected using maximum length sequence (MLS) technique were compared at term equivalent age between 43 CLD infants and 117 asphyxiated infants. RESULTS In both CLD and asphyxiated infants there was a significant increase in wave V latency and I-V interval in MLS BAER. CLD infants showed a significant increased III-V interval but a normal I-III interval at all click rates. However, asphyxiated infants showed a significant increase in both III-V and I-III intervals. I-III interval was shorter and III-V/I-III interval ratio was greater in CLD infants than in asphyxiated infants. The slope of I-III interval-rate function was steeper in asphyxiated infants than in CLD infants, while the slope of III-V/I-III interval ratio-rate function was the other way around. CONCLUSIONS CLD infants had a major increase in more central components of MLS BAER, without appreciable abnormality in more peripheral components. However, asphyxiated infants had a significant increase in both central and peripheral components. SIGNIFICANCE Neonatal CLD affects more central regions of the brainstem, whereas perinatal asphyxia affects both peripheral and central regions. This difference, which is likely related to the different nature of hypoxia in CLD and asphyxia, may have some significance for neuroprotective interventions for the two problems.
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Dzulkarnain AA, Wilson WJ, Bradley AP, Petoe M. The effects of electrode montage on the amplitude of wave V in the auditory brainstem response to maximum length sequence stimuli. Audiol Neurootol 2007; 13:7-12. [PMID: 17715464 DOI: 10.1159/000107432] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 04/25/2007] [Indexed: 11/19/2022] Open
Abstract
The use of maximum length sequence (MLS) stimuli to elicit an auditory brainstem response (ABR) has been limited, in part, by the observation that these stimuli reduce ABR wave amplitudes. This study recorded ABR waveforms from 14 normally hearing adults using MLS click stimuli (maximum stimulus rate = 250 clicks per second) at stimulus levels of 70, 60, 50, 40, 30 and 20 dB nHL, with a vertical and then an ipsilateral electrode montage. The vertical electrode montage produced significantly larger (p < 0.05) wave V amplitudes, with no change in wave V latencies (p > 0.05), at all stimulus levels. This result suggests a vertical electrode montage could be used to counter some of the loss in wave V amplitude observed when using MLS stimuli.
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Affiliation(s)
- Ahmad Aidil Dzulkarnain
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Brisbane, Australia
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Jiang ZD, Xiu X, Brosi DM, Shao XM, Wilkinson AR. Sub-optimal function of the auditory brainstem in term infants with transient low Apgar scores. Clin Neurophysiol 2007; 118:1088-96. [PMID: 17368093 DOI: 10.1016/j.clinph.2007.01.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Revised: 01/23/2007] [Accepted: 01/28/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To assess functional integrity of the auditory brainstem in neonates with transient low Apgar scores. METHODS Forty-two term infants were studied with brainstem auditory evoked response (BAER) using the maximum length sequence during the first month of life. All had transient low Apgar scores but no clinical signs of hypoxic-ischaemic encephalopathy (HIE). RESULTS The latencies of BAER waves I and III in these infants were similar to those of age-matched normal controls at all click rates (91/s, 227/s, 455/s and 910/s) during the period studied. Wave V latency was increased at 910/s on day 1 (P<0.01), but did not differ from that in the controls on any other days. I-V interval was increased significantly at 455/s and 910/s on day 1 (P<0.01 and 0.001) and day 3 (P<0.05 and 0.01). On days 5 and 7, BAER wave latencies and intervals were similar to those in the controls. On day 30, all latencies and intervals reached the values in the controls. No abnormalities were seen in BAER wave amplitude variables on any days. CONCLUSIONS Neonates with transient low Apgar scores but without HIE had a significant increase in I-V interval at very high click rates on the first three days of life. SIGNIFICANCE Brainstem auditory function is sub-optimal during the first few days in neonates with transient low Apgar scores.
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Affiliation(s)
- Ze D Jiang
- Children's Hospital, Fudan University, Shanghai, China.
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Abstract
Over the last three decades, the brainstem auditory evoked response (BAER) has been used to assess functional integrity and development of the auditory system and the brain in conditions that affect the brainstem auditory pathway. As a non-invasive objective test, BAER is particularly suitable in very young or sick infants. It is the major tool to detect hearing impairment in high-risk infants, and a component in universal hearing screening. BAER is also a valuable adjunct to detect neurological impairment in many developmental disorders and functional abnormalities in a range of neurological diseases. The maximum length sequence (MLS) technique has recently been incorporated into neonatal BAER study. Recent results indicate that the MLS has the potential to improve the diagnostic value of BAER in some clinical situations, although the wider utility of this relative new technique remains to be further explored.
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Affiliation(s)
- Andrew R Wilkinson
- Neonatal Unit, Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
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Jiang ZD, Brosi DM, Wilkinson AR. Maximum length sequence BAER at term in low-risk babies born at 30-32 week gestation. Brain Dev 2006; 28:1-7. [PMID: 15925465 DOI: 10.1016/j.braindev.2005.02.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2004] [Revised: 01/06/2005] [Accepted: 02/24/2005] [Indexed: 10/25/2022]
Abstract
Thirty babies born at 30-32 week gestation without any major perinatal problems were studied at term with brainstem auditory evoked response (BAER) to detect any abnormalities in central auditory function in low-risk very preterm babies. The BAER was recorded and analyzed at 37-42 week postconceptional age using maximum length sequence technique (MLS). The data obtained were compared with those of 38 normal term controls. Wave I and III latencies in the very preterm babies did not show any significant differences from the controls at all repetition rates of click stimuli used (91-910 s(-1)). Wave V latency and I-V interpeak interval tended to increase at all click rates, and differed significantly from the controls at the highest rate 910 s(-1) (P < 0.05). Both III-V interval and III-V/I-III interval ratio increased significantly at all click rates, particularly at 455 and 910 s(-1) (P < 0.05-0.001). On the other hand, I-III interval tended to decrease. None of wave I, III and V amplitudes showed any abnormalities. Neither did V/I nor V/III amplitude ratios. These results suggest that development of the central auditory system is slightly delayed, which can be shown by MLS BAER at very high rate-stimulation, in low-risk very preterm babies.
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Affiliation(s)
- Ze Dong Jiang
- Neonatal Unit, Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
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Jiang ZD, Brosi DM, Wang J, Wilkinson AR. Brainstem auditory-evoked responses to different rates of clicks in small-for-gestational age preterm infants at term. Acta Paediatr 2004. [PMID: 14989444 DOI: 10.1111/j.1651-2227.2004.tb00678.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To clarify further the influence of intrauterine growth retardation (IUGR) on early neural development. METHODS In 30 small-for-gestational age (SGA) preterm infants at term, brainstem auditory-evoked responses (BAERs) were recorded with clicks of different repetition rates. All infants had a birthweight < 3rd centile, without any other major perinatal complications. RESULTS Compared with the BAER in 36 appropriate-for-gestational age (AGA) term infants, the preterm SGA infants did not show any abnormalities at 21 s(-1) clicks, except for a slight increase in wave III amplitude. At 51 s(-1) clicks, there was an increase in III-V/I-III interval ratio (ANOVA p < 0.05). At 91 s(-1), the I-III interval shortened, whereas the III-V interval and III-V/I-III interval ratio increased (all p < 0.05). Wave V amplitude tended to increase slightly at all repetition rates of clicks used, although this increase did not reach statistical significance. The III-V interval and III-V/I-III interval ratio in the preterm SGA infants at different click rates correlated inversely with occipitofrontal head circumference at the time of testing, i.e. the smaller the head the longer the III-V interval (all p < 0.01). Wave III amplitude at 21 s(-1) also correlated inversely with head circumference (p < 0.01), suggesting that the slight increase in this amplitude in the preterm SGA infants is related to their relatively small head size. CONCLUSION There were no major abnormalities in the BAER up to 91 s(-1) clicks at term in preterm SGA infants. The slight increase in III-V interval at high-rate stimulation suggests a subtle degree of central neural dysfunction, which is associated with small head size following IUGR.
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Affiliation(s)
- Z D Jiang
- Neonatal Unit, Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, UK.
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Jiang ZD, Brosi DM, Wang J, Xu X, Chen GQ, Shao XM, Wilkinson AR. Time course of brainstem pathophysiology during first month in term infants after perinatal asphyxia, revealed by MLS BAER latencies and intervals. Pediatr Res 2003; 54:680-7. [PMID: 12869665 DOI: 10.1203/01.pdr.0000084084.62571.12] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Dynamic changes in electrophysiology of brainstem auditory neurons during the first month after birth were studied in 51 term infants after perinatal asphyxia using maximum length sequence brainstem auditory evoked responses. The responses were recorded on d 1, 3, 5, 7, 10, 15, and 30 after birth. On d 1, wave III and V latencies and all interpeak intervals increased significantly at all repetition rates of clicks used (91-910/s), especially the higher rates (ANOVA, p < 0.05-0.0001). On d 3, all these latencies and intervals increased further and differed more significantly from the normal control subjects. Thereafter, the latencies and intervals decreased progressively. On d 7, wave V latency and all intervals still differed significantly from the control subjects. These dynamic changes were more significant at higher rates of clicks than at lower rates. On d 10 and 15, all intervals decreased significantly. On d 30, all wave latencies decreased to the values in the normal control subjects on the same day. The intervals also approached normal values, although the III-V and I-V intervals still increased slightly. These results indicate that hypoxic-ischemic brain damage persists during the first week, with a peak on d 3, and recovers progressively thereafter. By 1 mo, the damage has largely returned to normal. Maximum length sequence brainstem auditory evoked responses results correlated well with the stage of hypoxic-ischemic encephalopathy during the first week. The present study revealed a general time course of brainstem pathophysiology after asphyxia, although there were individual variations. Our findings can be used as a reference to monitor cerebral function and help judge the value of neuroprotective or therapeutic interventions. The first week, particularly the first 3 d, is a critical period of hypoxic-ischemic brain damage, and early intervention may prevent or reduce deterioration of the damage.
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Affiliation(s)
- Ze D Jiang
- Neonatal Unit, Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford OX3 9DU, United Kingdom.
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Mahajan V, Gupta P, Tandon O, Aggarwal A. Brainstem auditory evoked responses in term small for gestational age newborn infants born to undernourished mothers. Eur J Paediatr Neurol 2003; 7:67-72. [PMID: 12697429 DOI: 10.1016/s1090-3798(03)00015-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Our aim was to assess the effect of intrauterine growth retardation on neurosensory development by evaluating brainstem auditory evoked responses (BAER) in term small for gestational age (SGA) newborn infants born to undernourished mothers. This prospective clinical study included 25 singleton healthy SGA newborn infants born between 38 and 41 weeks to undernourished mothers (weight <45kg, height <145cm, haemoglobin <8g/dl, and serum albumin <2.5g/dl). An equal number of age- and sex-matched appropriate for gestational age newborn infants born to healthy mothers served as controls. Mothers with other risk factors and newborns with complications during delivery or immediate newborn period were excluded. BAER was recorded within first 3 days of life. Interpeak latency (IPL), absolute peak latency (APL) and amplitudes of various waveforms were determined and compared between the groups. No statistically significant differences were observed for the mean interpeak and absolute latencies between term SGA and AGA infants (p>0.05). The absolute peak latency (wave V) and central conduction time (I-V interval) were borderline prolonged in the study group compared with controls (p=0.051 and 0.088 respectively). Using multiple regression analysis, maternal haemoglobin was identified to be the only parameter having a negative correlation with both IPL (waves I-V) (F[1,46]=4.12, p=0.048) and APL (wave V) (F[1,46]=5.80, p=0.02). Maternal undernourishment may have a minor effect on intrauterine development of the auditory brainstem. Maternal haemoglobin is the only factor significantly associated with these changes.
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Affiliation(s)
- Viresh Mahajan
- Department of Paediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, New Delhi, India
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Bell SL, Allen R, Lutman ME. Optimizing the acquisition time of the middle latency response using maximum length sequences and chirps. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2002; 112:2065-2073. [PMID: 12430818 DOI: 10.1121/1.1508791] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
The middle latency response (MLR) may be used as an indicator of anesthetic depth but has been criticized due to its long acquisition time. This study explores methods for optimizing recording of the MLR to maximize signal-to-noise ratio (SNR) and hence reduce acquisition time. The first experiment investigates the effects of increasing stimulation rate beyond conventional values and also using higher rates by means of maximum length sequences (MLS). The second experiment compares the use of click and chirp stimuli to elicit the MLR, both at conventional and MLS stimulation rates. For all conditions total recording duration is fixed at 185 s and stimulation level is fixed at 60 dB SL. It was found that SNR increases progressively with rate using conventional click stimulation until the theoretical rate limit is reached at the reciprocal of the response duration. The SNR improvement is equivalent to increasing test speed by a factor of 3. Using MLS stimulation, the SNR increases further until a maximum is reached at a rate of 167 clicks/s, equivalent to a fivefold test speed improvement relative to a conventional recording at 5 clicks/s. The use of chirp stimuli designed to compensate for the frequency dependent cochlear traveling wave delay produces an increase in wave V-Na amplitude at all recording rates. For the later latency waves of the response an increase in amplitude is seen for MLS, but not for conventional chirp trains. The optimum SNR was obtained using chirp stimuli at a MLS rate of 167 opportunities/s. It is concluded that the combination of chirps and MLS can reduce acquisition time to less than one-tenth of that required for conventional stimulation at 5 clicks/s for the same SNR. This would confer material benefits for estimating anesthetic depth using MLR.
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Affiliation(s)
- Steven L Bell
- Institute of Sound and Vibration Research, University of Southampton, Highfield, United Kingdom
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Bell SL, Allen R, Lutman ME. The feasibility of maximum length sequences to reduce acquisition time of the middle latency response. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2001; 109:1073-1081. [PMID: 11303921 DOI: 10.1121/1.1340645] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Maximum length sequences (MLS) have been used to improve the signal-to-noise ratio (SNR) of otoacoustic emissions [Thornton, J. Acoust. Soc. Am. 94, 132-136 (1993)] and the auditory brainstem response [Thornton and Slaven, Br. J. Audiol. 27, 205-210 (1993)]. By implication, a shorter recording time would be required to give equal signal-to-noise ratio (SNR). This study aimed to establish whether it is also possible to improve the SNR of the auditory-evoked potential termed the middle latency response (MLR) using maximum length sequences (MLS). Recordings of 180 s each were made using a conventional recording rate and MLS rates of 42, 89, and 185 clicks/s. Three different stimulus intensities were used in the range 30 to 70 dB nHL. The rate of 89 clicks/s was found to produce most improvement in SNR for both the Na-Pa region of the MLR and the Na-Pb region. This improvement in SNR using MLS implies that an MLS rate of 89 clicks/s would produce a fourfold reduction in recording time for equal SNR over conventional recording for the Pa-Nb region of the MLR at a stimulus intensity of 70 dB nHL. The latency of the Nb wave was found to reduce significantly using MLS. An MLR could not be recorded from every subject in this study, but more subjects had an identifiable response for MLS than for conventional recordings. Use of MLS to record the MLR appears to offer the potential for reduction in test time and better wave identification.
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Affiliation(s)
- S L Bell
- Institute of Sound and Vibration Research, University of Southampton, Highfield, United Kingdom.
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Jiang ZD, Brosi DM, Shao XM, Wilkinson AR. Maximum length sequence brainstem auditory evoked responses in term neonates who have perinatal hypoxia-ischemia. Pediatr Res 2000; 48:639-45. [PMID: 11044485 DOI: 10.1203/00006450-200011000-00015] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Maximum length sequence brainstem auditory evoked response (BAER) was studied within the first week after birth in 28 term neonates who had perinatal hypoxia-ischemia, or asphyxia. In the BAER recorded using conventional averaging techniques (click rate 21/s), the only abnormality was a slight increase in III-V interval, in addition to an increase in wave latencies when including those who had an elevated threshold (t test, all p<0.05). In the maximum length sequence BAER, however, both the III-V and I-V intervals in the asphyxiated infants were significantly increased at all the 91/s, 227/s, 455/s, and particularly 910/s click rates (p<0.05-0.001). The I-III interval was also increased significantly at 455/s and 910/s click rates (both p< 0.05). Wave V amplitude was significantly reduced at all the click rates used (ANOVA, p<0.05-0.001), particularly at 910/s, which sometimes was the only abnormality indicative of brain damage. Both the amplitude ratios V/I and V/III were significantly decreased at 455/s and 910/s click rates (p<0.01 or 0.001). A general trend was that BAER abnormalities after hypoxia-ischemia became more prominent as click rate was increased. Significant abnormalities occurred mainly at very high click rates (455/s and 910/s), which can be achieved using the maximum length sequence technique but not by using conventional averaging techniques. Thus, this technique, which can be used at the cribside, appears to be a better method for the early detection of brain damage after hypoxia-ischemia than using conventional averaging techniques, enhancing the diagnostic value of the BAER.
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Affiliation(s)
- Z D Jiang
- Neonatal Unit, Department of Paediatrics, John Radcliffe Hospital, University of Oxford, Headington, Oxford OX3 9DU, United Kingdom
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