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Суточный ритм мочеобразования и мочеотделения при недержании мочи у женщин
Суточный ритм мочеобразования и мочеотделения при недержании мочи у женщин
Осипова Н.А., Ниаури Д.А., Зиятдинова Г.М. Суточный ритм мочеобразования и мочеотделения при недержании мочи у женщин. Гинекология. 2015; 17(2): 74–76.
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Аннотация
Целью настоящего исследования явилась оценка изменений суточного ритма мочеобразования как этиологического фактора развития ноктурии у женщин с недержанием мочи.
Были обследованы 277 женщин с недержанием мочи в возрасте от 18 до 55 лет. Обследование включало: клиническое обследование, эхографию уретровезикального сегмента и уродинамическое исследование. У 143 женщин было диагностировано стрессовое недержание мочи, у 43 – императивное и 91 – смешанное. Для оценки качества жизни женщин с недержанием мочи использовали индекс оценки качества жизни – QOL (оценка качества жизни в связи с имеющимися расстройствами мочеиспускания) и шкалу суммарной оценки симптомов инконтиненции – IIQ (Incontinence Impact Questionnarie).
Из 277 обследованных женщин с недержанием мочи ноктурия была выявлена у 110 (39,7±2,9%). У 26 (23,6±4,1%) пациенток причиной учащенного ночного мочеиспускания явилось снижение ночной емкости мочевого пузыря, у 33 (30,0±4,4%) – ночная полиурия (ноктурия),
у 27 (24,5±4,1%) – сочетание ночной полиурии и снижения ночной емкости мочевого пузыря, у 24 (21,8±3,9%) – полиурия. Таким образом, инверсия суточного ритма мочеобразования – ноктурия имела место у 60 (54,5±4,7%) женщин с учащенным ночным мочеиспусканием (ноктурией). Частота ноктурии была одинакова при всех типах недержания мочи, но увеличивалась с возрастом (r=0,84, p<0,001). При сравнительной оценке качества жизни при разных типах недержания мочи оказалось, что женщины с императивным недержанием мочи чаще дают максимально негативную оценку своему состоянию независимо от числа ночных мочеиспусканий.
Ключевые слова: суточный ритм мочеобразования, недержание мочи, ноктурия.
277 patients with complaints of urinary incontinence were analysed according to a specific protocol: urodynamic testing, transperineal ureterovesical segment ultrasonography, a 3-day frequency-volume (FV) chart. Subjects had to fill in a standardised quality of life questionnaire as well. Nocturia was defined as two or more micturitions per night calculated from the FV chart. The overall prevalence of nocturia was 39,7%. The nocturics were classified into one of the responsible pathophysiologic categories: nocturnal polyuria in 30%, a low functional bladder capacity in 23,6%, a combination of both in 24,5%, polyuria in 21,8% of the cases. In 54,5% of nocturics nocturia is due to change of physiological urine formation rhythm-nocturnal polyuria. So nocturnal polyuria is a frequent symptom among urinaryincontinent patients, with a negative impact on several aspects of the quality of life.
Key words: circadian rhythm of urine formation, urinary incontinence, nocturnal polyuria.
Были обследованы 277 женщин с недержанием мочи в возрасте от 18 до 55 лет. Обследование включало: клиническое обследование, эхографию уретровезикального сегмента и уродинамическое исследование. У 143 женщин было диагностировано стрессовое недержание мочи, у 43 – императивное и 91 – смешанное. Для оценки качества жизни женщин с недержанием мочи использовали индекс оценки качества жизни – QOL (оценка качества жизни в связи с имеющимися расстройствами мочеиспускания) и шкалу суммарной оценки симптомов инконтиненции – IIQ (Incontinence Impact Questionnarie).
Из 277 обследованных женщин с недержанием мочи ноктурия была выявлена у 110 (39,7±2,9%). У 26 (23,6±4,1%) пациенток причиной учащенного ночного мочеиспускания явилось снижение ночной емкости мочевого пузыря, у 33 (30,0±4,4%) – ночная полиурия (ноктурия),
у 27 (24,5±4,1%) – сочетание ночной полиурии и снижения ночной емкости мочевого пузыря, у 24 (21,8±3,9%) – полиурия. Таким образом, инверсия суточного ритма мочеобразования – ноктурия имела место у 60 (54,5±4,7%) женщин с учащенным ночным мочеиспусканием (ноктурией). Частота ноктурии была одинакова при всех типах недержания мочи, но увеличивалась с возрастом (r=0,84, p<0,001). При сравнительной оценке качества жизни при разных типах недержания мочи оказалось, что женщины с императивным недержанием мочи чаще дают максимально негативную оценку своему состоянию независимо от числа ночных мочеиспусканий.
Ключевые слова: суточный ритм мочеобразования, недержание мочи, ноктурия.
________________________________________________
277 patients with complaints of urinary incontinence were analysed according to a specific protocol: urodynamic testing, transperineal ureterovesical segment ultrasonography, a 3-day frequency-volume (FV) chart. Subjects had to fill in a standardised quality of life questionnaire as well. Nocturia was defined as two or more micturitions per night calculated from the FV chart. The overall prevalence of nocturia was 39,7%. The nocturics were classified into one of the responsible pathophysiologic categories: nocturnal polyuria in 30%, a low functional bladder capacity in 23,6%, a combination of both in 24,5%, polyuria in 21,8% of the cases. In 54,5% of nocturics nocturia is due to change of physiological urine formation rhythm-nocturnal polyuria. So nocturnal polyuria is a frequent symptom among urinaryincontinent patients, with a negative impact on several aspects of the quality of life.
Key words: circadian rhythm of urine formation, urinary incontinence, nocturnal polyuria.
Полный текст
Список литературы
1. Аполихина И.А., Ромих В.В., Андикян В.М. Современные принципы консервативного лечения недержания мочи у женщин. Урология. 2005; 5: 72–5. / Apolikhina I.A., Romikh V.V., Andikyan V.M. Sovremennye printsipy konservativnogo lecheniya nederzhaniya mochi u zhenshchin. Urologiya. 2005; 5: 72–5. [in Russian]
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3. Cooper J, Annappa M, Quigley A et al. Prevalence of female urinary incontinence and its impact on quality of life in a cluster population in the United Kingdom (UK): a community survey. Prim Health Care Res Dev 2014; 2: 1–6.
4. Kogan MI, Zachoval R, Ozyurt C et al. Epidemiology and impact of urinary incontinence, overactive bladder, and other lower urinarytract symptoms: results of the EPIC survey in Russia, Czech Republic, and Turkey. Curr Med Res Opin 2014; 30 (10): 2119–30.
5. Zumrutbas AE, Bozkurt AI, Tas E et al. Prevalence of lower urinary tract symptoms, overactive bladder and urinary incontinence in western Turkey: results of a population-based survey. Int J Urol 2014; 21 (10): 1027–33.
6. Massolt ET, Wooning MM, Stijnen T, Vierhout ME. Prevalence, impact on the quality of life and pathophysiological determinants of nocturia in urinary incontinent women. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16 (2): 132–7.
7. Van Kerrebroeck P, Abrams P, Chaikin D et al. The standardization of terminology in nocturia: report from the Standardization Subcommittee of the International Continence Society Neurourol Urodyn 2000; 211: 79–83.
8. Yoo SS, Shim BS, Lee DH et al. Correlation between Nocturia and Sleep: A Questionnaire Based Analysis. Korean J Urol 2010; 51 (11): 757–62.
9. Clinical guidelines for nocturia. Committee for Establishment of the Clinical Guidelines for Nocturia of the Neurogenic Bladder Society. Int J Urol 2010; 17 (5): 397–409.
10. Desgrandchamps F, Cortesse A, Rousseau T et al. Normal voiding behaviour in women. Study of the I-PSS in an unselected population of women in general practice. Eur Urol 1996; 30 (1): 18–23.
11. Hsu A, Nakagawa S, Walter LC et al. The burden of nocturia among middle-aged and older women. Obstet Gynecol 2015; 125 (1): 35–43.
12. Blanker MH, Bernsen RM, Bosch JL et al. Relation between nocturnal voiding frequency and nocturnal urine production in older men: a population-based study. Urology 2002; 60 (4): 612–5.
13. Saito M, Kondo A, Kato T, Yamada Y. Frequency-volume charts: comparison of frequency between elderly and adult patients. Br J Urol 1993; 72 (1): 38–41.
14. Kay L, Stigsby B, Brasso K et al. Lower urinary tract symptoms-a population survey using the Danish Prostatic Symptom Score (DAN-PSS) questionnaire. Scand J Urol Nephrol 1999; 33 (2): 94–9.
15. Jackson S. Lower urinary tract symptoms and nocturia in men and women: prevalence, aetiology and diagnosis. BJU Int 1999; 84 (Suppl. 1): 5–8.
16. Weiss JP, Blaivas JG. Nocturia. J Urol. 2000; 163 (1): 5–12.
17. Puri VN. Urinary levels of antidiuretic hormone in nocturnal enuresis. Indian Pediatr 1980; 17 (8): 675–6.
18. Djurhuus JC, Nørgaard JP, Rittig S. Monosymptomatic bedwetting. Scand J Urol Nephrol (Suppl.) 1992; 141: 7–17; discussion 18–9.
19. Kamperis K, Rittig S, Radvanska E et al. The effect of desmopressin on renal water and solute handling in desmopressin resistant monosymptomatic nocturnal enuresis. J Urol 2008; 180 (2): 707–13; discussion 713–4.
20. Kuznetsova AA, Natochchin IuV, Papaian AV. A physiological analysis of kidney ion-regulating function in children with enuresis. Fiziol Zh Im I M Sechenova 1996; 82 (12): 78–86.
21. Natochin YV, Kuznetsova AA. Nocturnal enuresis: correction of renal function by desmopressin and diclofenac. Pediatr Nephrol 2000; 14 (1): 42–7.
22. Van Herzeele C, de Bruyne P, Evans J et al. Safety profile of desmopressin tablet for enuresis in a prospective study. Adv Ther 2014; 31 (12): 1306–16.
2. Balan V.E., Ankirskaia A.S., Esesidze Z.T. et al. Patogenez atroficheskogo tsistouretrita i razlichnye vidy nederzhaniia mochi u zhenshchin v klimakterii. Consilium Medicum. 2001; 3 (7): 326–31. [in Russian]
3. Cooper J, Annappa M, Quigley A et al. Prevalence of female urinary incontinence and its impact on quality of life in a cluster population in the United Kingdom (UK): a community survey. Prim Health Care Res Dev 2014; 2: 1–6.
4. Kogan MI, Zachoval R, Ozyurt C et al. Epidemiology and impact of urinary incontinence, overactive bladder, and other lower urinarytract symptoms: results of the EPIC survey in Russia, Czech Republic, and Turkey. Curr Med Res Opin 2014; 30 (10): 2119–30.
5. Zumrutbas AE, Bozkurt AI, Tas E et al. Prevalence of lower urinary tract symptoms, overactive bladder and urinary incontinence in western Turkey: results of a population-based survey. Int J Urol 2014; 21 (10): 1027–33.
6. Massolt ET, Wooning MM, Stijnen T, Vierhout ME. Prevalence, impact on the quality of life and pathophysiological determinants of nocturia in urinary incontinent women. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16 (2): 132–7.
7. Van Kerrebroeck P, Abrams P, Chaikin D et al. The standardization of terminology in nocturia: report from the Standardization Subcommittee of the International Continence Society Neurourol Urodyn 2000; 211: 79–83.
8. Yoo SS, Shim BS, Lee DH et al. Correlation between Nocturia and Sleep: A Questionnaire Based Analysis. Korean J Urol 2010; 51 (11): 757–62.
9. Clinical guidelines for nocturia. Committee for Establishment of the Clinical Guidelines for Nocturia of the Neurogenic Bladder Society. Int J Urol 2010; 17 (5): 397–409.
10. Desgrandchamps F, Cortesse A, Rousseau T et al. Normal voiding behaviour in women. Study of the I-PSS in an unselected population of women in general practice. Eur Urol 1996; 30 (1): 18–23.
11. Hsu A, Nakagawa S, Walter LC et al. The burden of nocturia among middle-aged and older women. Obstet Gynecol 2015; 125 (1): 35–43.
12. Blanker MH, Bernsen RM, Bosch JL et al. Relation between nocturnal voiding frequency and nocturnal urine production in older men: a population-based study. Urology 2002; 60 (4): 612–5.
13. Saito M, Kondo A, Kato T, Yamada Y. Frequency-volume charts: comparison of frequency between elderly and adult patients. Br J Urol 1993; 72 (1): 38–41.
14. Kay L, Stigsby B, Brasso K et al. Lower urinary tract symptoms-a population survey using the Danish Prostatic Symptom Score (DAN-PSS) questionnaire. Scand J Urol Nephrol 1999; 33 (2): 94–9.
15. Jackson S. Lower urinary tract symptoms and nocturia in men and women: prevalence, aetiology and diagnosis. BJU Int 1999; 84 (Suppl. 1): 5–8.
16. Weiss JP, Blaivas JG. Nocturia. J Urol. 2000; 163 (1): 5–12.
17. Puri VN. Urinary levels of antidiuretic hormone in nocturnal enuresis. Indian Pediatr 1980; 17 (8): 675–6.
18. Djurhuus JC, Nørgaard JP, Rittig S. Monosymptomatic bedwetting. Scand J Urol Nephrol (Suppl.) 1992; 141: 7–17; discussion 18–9.
19. Kamperis K, Rittig S, Radvanska E et al. The effect of desmopressin on renal water and solute handling in desmopressin resistant monosymptomatic nocturnal enuresis. J Urol 2008; 180 (2): 707–13; discussion 713–4.
20. Kuznetsova AA, Natochchin IuV, Papaian AV. A physiological analysis of kidney ion-regulating function in children with enuresis. Fiziol Zh Im I M Sechenova 1996; 82 (12): 78–86.
21. Natochin YV, Kuznetsova AA. Nocturnal enuresis: correction of renal function by desmopressin and diclofenac. Pediatr Nephrol 2000; 14 (1): 42–7.
22. Van Herzeele C, de Bruyne P, Evans J et al. Safety profile of desmopressin tablet for enuresis in a prospective study. Adv Ther 2014; 31 (12): 1306–16.
2. Балан В.Е., Анкирская А.С., Есесидзе З.Т. и др. Патогенез атрофического цистоуретрита и различные виды недержания мочи у женщин в климактерии. Consilium Medicum. 2001; 3 (7): 326–31. / Balan V.E., Ankirskaia A.S., Esesidze Z.T. et al. Patogenez atroficheskogo tsistouretrita i razlichnye vidy nederzhaniia mochi u zhenshchin v klimakterii. Consilium Medicum. 2001; 3 (7): 326–31. [in Russian]
3. Cooper J, Annappa M, Quigley A et al. Prevalence of female urinary incontinence and its impact on quality of life in a cluster population in the United Kingdom (UK): a community survey. Prim Health Care Res Dev 2014; 2: 1–6.
4. Kogan MI, Zachoval R, Ozyurt C et al. Epidemiology and impact of urinary incontinence, overactive bladder, and other lower urinarytract symptoms: results of the EPIC survey in Russia, Czech Republic, and Turkey. Curr Med Res Opin 2014; 30 (10): 2119–30.
5. Zumrutbas AE, Bozkurt AI, Tas E et al. Prevalence of lower urinary tract symptoms, overactive bladder and urinary incontinence in western Turkey: results of a population-based survey. Int J Urol 2014; 21 (10): 1027–33.
6. Massolt ET, Wooning MM, Stijnen T, Vierhout ME. Prevalence, impact on the quality of life and pathophysiological determinants of nocturia in urinary incontinent women. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16 (2): 132–7.
7. Van Kerrebroeck P, Abrams P, Chaikin D et al. The standardization of terminology in nocturia: report from the Standardization Subcommittee of the International Continence Society Neurourol Urodyn 2000; 211: 79–83.
8. Yoo SS, Shim BS, Lee DH et al. Correlation between Nocturia and Sleep: A Questionnaire Based Analysis. Korean J Urol 2010; 51 (11): 757–62.
9. Clinical guidelines for nocturia. Committee for Establishment of the Clinical Guidelines for Nocturia of the Neurogenic Bladder Society. Int J Urol 2010; 17 (5): 397–409.
10. Desgrandchamps F, Cortesse A, Rousseau T et al. Normal voiding behaviour in women. Study of the I-PSS in an unselected population of women in general practice. Eur Urol 1996; 30 (1): 18–23.
11. Hsu A, Nakagawa S, Walter LC et al. The burden of nocturia among middle-aged and older women. Obstet Gynecol 2015; 125 (1): 35–43.
12. Blanker MH, Bernsen RM, Bosch JL et al. Relation between nocturnal voiding frequency and nocturnal urine production in older men: a population-based study. Urology 2002; 60 (4): 612–5.
13. Saito M, Kondo A, Kato T, Yamada Y. Frequency-volume charts: comparison of frequency between elderly and adult patients. Br J Urol 1993; 72 (1): 38–41.
14. Kay L, Stigsby B, Brasso K et al. Lower urinary tract symptoms-a population survey using the Danish Prostatic Symptom Score (DAN-PSS) questionnaire. Scand J Urol Nephrol 1999; 33 (2): 94–9.
15. Jackson S. Lower urinary tract symptoms and nocturia in men and women: prevalence, aetiology and diagnosis. BJU Int 1999; 84 (Suppl. 1): 5–8.
16. Weiss JP, Blaivas JG. Nocturia. J Urol. 2000; 163 (1): 5–12.
17. Puri VN. Urinary levels of antidiuretic hormone in nocturnal enuresis. Indian Pediatr 1980; 17 (8): 675–6.
18. Djurhuus JC, Nørgaard JP, Rittig S. Monosymptomatic bedwetting. Scand J Urol Nephrol (Suppl.) 1992; 141: 7–17; discussion 18–9.
19. Kamperis K, Rittig S, Radvanska E et al. The effect of desmopressin on renal water and solute handling in desmopressin resistant monosymptomatic nocturnal enuresis. J Urol 2008; 180 (2): 707–13; discussion 713–4.
20. Kuznetsova AA, Natochchin IuV, Papaian AV. A physiological analysis of kidney ion-regulating function in children with enuresis. Fiziol Zh Im I M Sechenova 1996; 82 (12): 78–86.
21. Natochin YV, Kuznetsova AA. Nocturnal enuresis: correction of renal function by desmopressin and diclofenac. Pediatr Nephrol 2000; 14 (1): 42–7.
22. Van Herzeele C, de Bruyne P, Evans J et al. Safety profile of desmopressin tablet for enuresis in a prospective study. Adv Ther 2014; 31 (12): 1306–16.
________________________________________________
2. Balan V.E., Ankirskaia A.S., Esesidze Z.T. et al. Patogenez atroficheskogo tsistouretrita i razlichnye vidy nederzhaniia mochi u zhenshchin v klimakterii. Consilium Medicum. 2001; 3 (7): 326–31. [in Russian]
3. Cooper J, Annappa M, Quigley A et al. Prevalence of female urinary incontinence and its impact on quality of life in a cluster population in the United Kingdom (UK): a community survey. Prim Health Care Res Dev 2014; 2: 1–6.
4. Kogan MI, Zachoval R, Ozyurt C et al. Epidemiology and impact of urinary incontinence, overactive bladder, and other lower urinarytract symptoms: results of the EPIC survey in Russia, Czech Republic, and Turkey. Curr Med Res Opin 2014; 30 (10): 2119–30.
5. Zumrutbas AE, Bozkurt AI, Tas E et al. Prevalence of lower urinary tract symptoms, overactive bladder and urinary incontinence in western Turkey: results of a population-based survey. Int J Urol 2014; 21 (10): 1027–33.
6. Massolt ET, Wooning MM, Stijnen T, Vierhout ME. Prevalence, impact on the quality of life and pathophysiological determinants of nocturia in urinary incontinent women. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16 (2): 132–7.
7. Van Kerrebroeck P, Abrams P, Chaikin D et al. The standardization of terminology in nocturia: report from the Standardization Subcommittee of the International Continence Society Neurourol Urodyn 2000; 211: 79–83.
8. Yoo SS, Shim BS, Lee DH et al. Correlation between Nocturia and Sleep: A Questionnaire Based Analysis. Korean J Urol 2010; 51 (11): 757–62.
9. Clinical guidelines for nocturia. Committee for Establishment of the Clinical Guidelines for Nocturia of the Neurogenic Bladder Society. Int J Urol 2010; 17 (5): 397–409.
10. Desgrandchamps F, Cortesse A, Rousseau T et al. Normal voiding behaviour in women. Study of the I-PSS in an unselected population of women in general practice. Eur Urol 1996; 30 (1): 18–23.
11. Hsu A, Nakagawa S, Walter LC et al. The burden of nocturia among middle-aged and older women. Obstet Gynecol 2015; 125 (1): 35–43.
12. Blanker MH, Bernsen RM, Bosch JL et al. Relation between nocturnal voiding frequency and nocturnal urine production in older men: a population-based study. Urology 2002; 60 (4): 612–5.
13. Saito M, Kondo A, Kato T, Yamada Y. Frequency-volume charts: comparison of frequency between elderly and adult patients. Br J Urol 1993; 72 (1): 38–41.
14. Kay L, Stigsby B, Brasso K et al. Lower urinary tract symptoms-a population survey using the Danish Prostatic Symptom Score (DAN-PSS) questionnaire. Scand J Urol Nephrol 1999; 33 (2): 94–9.
15. Jackson S. Lower urinary tract symptoms and nocturia in men and women: prevalence, aetiology and diagnosis. BJU Int 1999; 84 (Suppl. 1): 5–8.
16. Weiss JP, Blaivas JG. Nocturia. J Urol. 2000; 163 (1): 5–12.
17. Puri VN. Urinary levels of antidiuretic hormone in nocturnal enuresis. Indian Pediatr 1980; 17 (8): 675–6.
18. Djurhuus JC, Nørgaard JP, Rittig S. Monosymptomatic bedwetting. Scand J Urol Nephrol (Suppl.) 1992; 141: 7–17; discussion 18–9.
19. Kamperis K, Rittig S, Radvanska E et al. The effect of desmopressin on renal water and solute handling in desmopressin resistant monosymptomatic nocturnal enuresis. J Urol 2008; 180 (2): 707–13; discussion 713–4.
20. Kuznetsova AA, Natochchin IuV, Papaian AV. A physiological analysis of kidney ion-regulating function in children with enuresis. Fiziol Zh Im I M Sechenova 1996; 82 (12): 78–86.
21. Natochin YV, Kuznetsova AA. Nocturnal enuresis: correction of renal function by desmopressin and diclofenac. Pediatr Nephrol 2000; 14 (1): 42–7.
22. Van Herzeele C, de Bruyne P, Evans J et al. Safety profile of desmopressin tablet for enuresis in a prospective study. Adv Ther 2014; 31 (12): 1306–16.
Авторы
Н.А.Осипова*1, 2, Д.А.Ниаури2, Г.М.Зиятдинова2
1. ФГБУ Северо-Западный федеральный медицинский исследовательский центр Минздрава России. 197341, Санкт-Петербург, ул. Аккуратова, д. 2;
2. ФГБОУ ВПО Санкт-Петербургский государственный университет. 2199034, Санкт-Петербург, Университетская наб., д. 7–9
*naosipova@mail.ru
1. Federal state budgetary institution Northwest Federal Medical Research Center of Ministry of Health of the Russian Federation. 197341, Saint Petersburg, ul. Akkuratov, d. 2;
2. Federal public budgetary educational institution of higher education St. Petersburg State University. 199034, Saint Petersburg, Universitetskaya nab., d. 7–9
*naosipova@mail.ru
1. ФГБУ Северо-Западный федеральный медицинский исследовательский центр Минздрава России. 197341, Санкт-Петербург, ул. Аккуратова, д. 2;
2. ФГБОУ ВПО Санкт-Петербургский государственный университет. 2199034, Санкт-Петербург, Университетская наб., д. 7–9
*naosipova@mail.ru
________________________________________________
1. Federal state budgetary institution Northwest Federal Medical Research Center of Ministry of Health of the Russian Federation. 197341, Saint Petersburg, ul. Akkuratov, d. 2;
2. Federal public budgetary educational institution of higher education St. Petersburg State University. 199034, Saint Petersburg, Universitetskaya nab., d. 7–9
*naosipova@mail.ru
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