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Diabetic Nephropathy Histology

Diabetes And Others

Diabetes And Others

Renal involvement in diabetes mellitus and other metabolic diseases: hyperuricemia , oxalosis The kidney is frequently affected in systemic diseases and, in some cases, the severity of the renal damage is a determining factor for the survival of the patient. Among the diseases that we grouped here, diabetes mellitus is most important by its frequency. Other metabolic or genetic diseases will be discussed in the chapter of hereditary diseases. Diabetes mellitus is one of the main causes of terminal renal disease. Diabetic nephropathy (DN) develops in 25-35% of patients with insulin-dependent diabetes mellitus (IDDM) and in 15-25% of non-insulin-dependent (NIDDM); renal changes in both types of diabetes are morphologically and physiopathologically similar. Proteinuria is the main marker of the DN and this disease is one of the most common causes of nephrotic syndrome. The pathogenesis of DN is not completely understood. Nonenzymatic glycation of proteins seems to be one of the main mechanisms of glomerular injury; terminal products of the glycation can be united to amino groups of other proteins, their accumulation in the collagen and other proteins of the matrix can diminish the adhesion and replication of endothelial cells, vasoconstriction by mesangial cells, and increase lipoprotein and immune complexes adhesion to monocitos and macrophages. Hemodynamic factors that cause glomerular hyperfiltration are another mechanism of renal damage. It has been suggested that many complex pathways contribute to the pathobiology of diabetic complications including hyperglycaemia itself, the production of advanced glycation end products (AGEs) and interaction with the receptors for AGEs such as the receptor for advanced glycation end products (RAGE), as well as the activation of va Continue reading >>

Diabetic Glomerulosclerosis

Diabetic Glomerulosclerosis

In diabetes, basement membranes of majority of capillaries in the body are thickened by deposits of nonenzymatic glycosilated proteins (diabetic microangiopathy): retinopathy, coronary arteries, and peripheral vessels. In kidney, diabetic nephropathy includes : diabetic glomerulosclerosis, arteriolosclerosis and papillary necrosis, with an increased risk for pyelonephritis. Diabetic glomerulosclerosis is characterized by thickening of glomerular basement membrane with increased permeability. With time, the mesangial space becomes larger by deposits of proteins (collagen IV), initially diffuse, then nodular. Diffuse diabetic glomerulosclerosis. The deposits appear diffusely on the basement membranes of capillary loops of the glomeruli, as well as on basement membranes of tubules and arterioles. (PAS, ob. x40) In nodular diabetic glomerulosclerosis, PAS-positive nodular deposits (containing mucopolysaccharides, fibrils and collagen) may appear in the mesangial space, at the periphery of the glomerulus, pushing the capillaries. The lesion is focal (glomeruli are not entirely affected), and some of them are spared. This pattern is also called Kimmelstiel-Wilson lesion. (PAS, ob. x20) The recently launched journal Archive of Clinical Cases welcomes submission for publication of original papers - clinical cases covering all fields of Medicine. Details : Continue reading >>

Clinical And Histological Correlation Of Diabetic Nephropathy Afroz T, Sagar R, Reddy S, Gandhe S, Rajaram K G - Saudi J Kidney Dis Transpl

Clinical And Histological Correlation Of Diabetic Nephropathy Afroz T, Sagar R, Reddy S, Gandhe S, Rajaram K G - Saudi J Kidney Dis Transpl

The prevalence of diabetes mellitus, especially type-2 diabetes, is rapidly increasing in the Asian population. Approximately 50% of diabetic patients develop proteinuria within 20 years of diabetes. Diabetes tends to affect a much younger age group among Asian population in comparison with Western population. [1] Renal involvement with progression to end-stage renal disease is more common in Asian population in comparison with Western population. [2] , [3] The classification of diabetic nephropathy is based on glomerular lesions and displays heterogeneous morphology. An accurate estimate of the amount of damage in the tubulo-interstitial compartment and type of glomerular lesions can be done by histological analysis of the tissue. The indications for renal biopsy in diabetes are rapid onset of proteinuria, absence of retinopathy, presence of hematuria, active urine sediment, and rapid unexplained deterioration of renal function to rule out nondiabetic causes of renal dysfunction. [4] The aim of this study was to classify the renal lesions according to the classification proposed by Tervaert et al and correlate the histopathological features with clinical findings. This classification was based on changes in all the compartments of the renal biopsy. The material for this study is from the department of pathology in a tertiary care hospital which is a referral laboratory for renal biopsies. The indications for renal biopsy included proteinuria, rapidly deteriorating renal function, absence of retinopathy, and active urine sediment. Biopsy was also done to exclude nondiabetic renal disease or coexisting renal disease. Three biopsy cores were sampled for light microscopy (LM), immunoflourescence (IF), and electron microscopy (EM) study. LM and IF were done routinely and E Continue reading >>

High Resolution Molecular And Histological Analysis Of Renal Disease Progression In Zsf1 Fa/facp Rats, A Model Of Type 2 Diabetic Nephropathy

High Resolution Molecular And Histological Analysis Of Renal Disease Progression In Zsf1 Fa/facp Rats, A Model Of Type 2 Diabetic Nephropathy

Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . High resolution molecular and histological analysis of renal disease progression in ZSF1 fa/faCP rats, a model of type 2 diabetic nephropathy * E-mail: [email protected] (KD); [email protected] (RVM) Affiliation Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America Roles Data curation, Formal analysis, Resources, Visualization, Writing original draft Affiliation Clinical Bioinformatics, Early Clinical Development, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America Roles Data curation, Formal analysis, Investigation, Project administration, Resources, Supervision, Visualization Affiliation Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America Affiliation Drug Safety, Pfizer Worldwide Research and Development, Andover, Massachusetts, United States of America Roles Data curation, Investigation, Supervision, Writing original draft, Writing review & editing Affiliation Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America Affiliation Inflammation and Immunology, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America Affiliation Clinical Bioinformatics, Early Clinical Development, Pfizer Worldwide Research and Development, Cambridge, Massachusetts, United States of America Affiliation Drug Safety, Pfizer Worldwide Research and Development, Andover, Massachusetts, United States of America Affiliation Drug Safety, Pfizer Worldwide Research and Development, And Continue reading >>

Histopathology Of Diabetic Nephropathy

Histopathology Of Diabetic Nephropathy

Department of Medical and Surgical Sciences, University of Padova Medical School, Italy; Pediatric Nephrology, University of Minnesota Medical School, Minneapolis, MN, USA Corresponding Author: Paola Fioretto, Department of Medical and Surgical Sciences, University of Padova, via Giustiniani 2, 35128 Padova, Italy; Tel: +39-049-8211879, fax: +39-049-8212151, e-mail: [email protected] The publisher's final edited version of this article is available at Semin Nephrol See other articles in PMC that cite the published article. The clinical manifestations of diabetic nephropathy, proteinuria, increasing blood pressure, decreased glomerular filtration rate and are similar in type 1 and type 2 diabetes; however the renal lesions underlying renal dysfunction in the two conditions may differ. Indeed, although tubular, interstitial and arteriolar lesions are ultimately present in type 1 diabetes, as the disease progresses, the most important structural changes involve the glomerulus. In contrast, a substantial subset of type 2 diabetic patients, despite the presence of microalbuminuria or proteinuria, have normal glomerular structure with or without tubulo-interstitial and/or arteriolar abnormalities. The clinical manifestations of diabetic nephropathy are strongly related to the structural changes, especially with the degree of mesangial expansion in both type 1 and type 2 diabetes. However, several other important structural changes are involved. Previous studies using light and electron microscopic morphometric analysis have described the renal structural changes and the structural-functional relationships of diabetic nephropathy. This review focuses on these topics, emphasizing the contribution of research kidney biopsy studies to the understanding of the pathogenesis Continue reading >>

Histological Appearance Of Diabetic Nephropathy

Histological Appearance Of Diabetic Nephropathy

Acute and chronic complications of diabetes The histological lesions of classical diabetic nephropathy (DN) have a characteristic pattern that can be identified by light and electron microscopy. Although much of the literature concentrates on the structural changes seen in the glomerulus, abnormalities are also found in the tubulointerstitium, particularly at later stages of disease. Early in DN there is thickening of the glomerular basement membrane and as disease progresses mesangial expansion occurs, resulting in the loss of available filtration surface. In more advanced DN, there is arteriolar hyalinosis, interstitial fibrosis and global glomerular sclerosis. In the majority of type 1 patients the clinical manifestations of diabetic nephropathy - the loss of protein into the urine (albuminuria), increasing blood pressure and a decline in renal function (measured by the glomerular filtration rate (GFR)), - correlate with the characteristic structural parameters of DN. However, many type 2 patients with progressive CKD do not have albuminuria and the histological pattern of renal injury follows a non-classical route. Glomeruli are composed of a network of capillaries supported by a framework of mesangial tissue. In diabetic nephropathy, the major structural abnormality seen by light microscopy is mesangial expansion. This increase in mesangial tissue is due to both cell proliferation and increased matrix deposition. As disease progresses however, matrix accumulation is the predominant mesangial change [1] The lesions can be identified as either diffuse or nodular. The diffuse glomerular lesion appears as an expansion of mesangial tissue that extends into the capillary loops, thus reducing the area available for filtration. The Kimmelsteil-Wilson (KW) nodule is a well Continue reading >>

Renal Histologic Changes And The Outcome In Patients With Diabetic Nephropathy

Renal Histologic Changes And The Outcome In Patients With Diabetic Nephropathy

Renal histologic changes and the outcome in patients with diabetic nephropathy National Clinical Research Center of Kidney Diseases Jinling Hospital, Nanjing University School of Medicine Correspondence and offprint requests to: Zhihong Liu; E-mail: [email protected] ; [email protected] Search for other works by this author on: National Clinical Research Center of Kidney Diseases Jinling Hospital, Nanjing University School of Medicine National Clinical Research Center of Kidney Diseases Jinling Hospital, Nanjing University School of Medicine National Clinical Research Center of Kidney Diseases Jinling Hospital, Nanjing University School of Medicine National Clinical Research Center of Kidney Diseases Jinling Hospital, Nanjing University School of Medicine National Clinical Research Center of Kidney Diseases Jinling Hospital, Nanjing University School of Medicine National Clinical Research Center of Kidney Diseases Jinling Hospital, Nanjing University School of Medicine National Clinical Research Center of Kidney Diseases Jinling Hospital, Nanjing University School of Medicine National Clinical Research Center of Kidney Diseases Jinling Hospital, Nanjing University School of Medicine Nephrology Dialysis Transplantation, Volume 30, Issue 2, 1 February 2015, Pages 257266, Yu An, Feng Xu, Weibo Le, Yongchun Ge, Minlin Zhou, Hao Chen, Caihong Zeng, Haitao Zhang, Zhihong Liu; Renal histologic changes and the outcome in patients with diabetic nephropathy, Nephrology Dialysis Transplantation, Volume 30, Issue 2, 1 February 2015, Pages 257266, The progression of diabetic nephropathy (DN) is frequently determined by clinical parameters; however, the predictive value of histologic lesions remains largely unknown. Our aim was to evaluate the relationship between histolo Continue reading >>

Classification And Differential Diagnosis Of Diabetic Nephropathy

Classification And Differential Diagnosis Of Diabetic Nephropathy

Copyright © 2017 Chenyang Qi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Diabetic nephropathy (DN) is a major cause of end-stage renal disease throughout the world in both developed and developing countries. This review briefly introduces the characteristic pathological changes of DN and Tervaert pathological classification, which divides DN into four classifications according to glomerular lesions, along with a separate scoring system for tubular, interstitial, and vascular lesions. Given the heterogeneity of the renal lesions and the complex mechanism underlying diabetic nephropathy, Tervaert classification has both significance and controversies in the guidance of diagnosis and prognosis. Applications and evaluations using Tervaert classification and indications for renal biopsy are summarized in this review according to recent studies. Meanwhile, differential diagnosis with another nodular glomerulopathy and the situation that a typical DN superimposed with a nondiabetic renal disease (NDRD) are discussed and concluded in this review. 1. Introduction Diabetic nephropathy (DN) caused by diabetes mellitus is one of the major causes of end-stage renal failure worldwide [1]. Clinically, microalbuminuria is an important index to assess the progression of DN [2]. However, it is not accurate to evaluate the severity or prognosis simply based on the degree of proteinuria. It is now well recognized that not all diabetic patients who develop renal function failure have massive albuminuria [3]. Therefore, nephrologists and endocrinologists should be aware of the significance of pathological c Continue reading >>

Histological Changes Of Kidney In Diabetic Nephropathy

Histological Changes Of Kidney In Diabetic Nephropathy

Histological changes of kidney in diabetic nephropathy We are experimenting with display styles that make it easier to read articles in PMC. The ePub format uses eBook readers, which have several "ease of reading" features already built in. The ePub format is best viewed in the iBooks reader. You may notice problems with the display of certain parts of an article in other eReaders. Generating an ePub file may take a long time, please be patient. Histological changes of kidney in diabetic nephropathy Mohsen Pourghasem, PhD, Hamid Shafi, MD, and Zahra Babazadeh, PhD Diabetes mellitus is the most common cause of chronic renal disorders and end-stage kidney disease in developed countries. It is the major cause of dialysis and transplantation. Failure in renal function causes wide disorders in the body. Diabetes results in wide range of alterations in the renal tissue. It is believed that early histological changes in diabetic nephropathy are detectable 2 years after diabetes is diagnosed. The glomerular alterations are the most important lesions in the diabetic nephropathy (DN). The Renal Pathology Society provides a new pathological classification for the detection of histopathology of DN. It divides diabetic nephropathy into four hierarchical glomerular lesions. Alloxan or streptozotocin induced diabetic rat is the one most widely used specie to study DN. Histological changes in the rat DN closely resemble the human disease and the most information of this review was obtained through the study of rat DN. All cell types of the kidney such as mesangial cells, podocytes and tubulointerstitial cells are liable to be affected in the event of DN. Severity of renal lesions is associated to the clinical aspect of renal outcome, but the aim of this article was only to review the Continue reading >>

Diabetic Nephropathyworkup

Diabetic Nephropathyworkup

Author: Vecihi Batuman, MD, FASN; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Diabetic nephropathy is characterized by the following: Persistent albuminuria (>300 mg/d or >200 g/min) that is confirmed on at least 2 occasions 3-6 months apart A relentless decline in the glomerular filtration rate (GFR) The rate of decline in the GFR in various stages of type 1 and type 2 diabetes is shown in the image below. Rate of decline in glomerular filtration rate in various stages of type 1 and type 2 diabetes. Whether cystatin C or creatinine-based calculation of GFR is the most sensitive measure for assessing early decline in renal function in patients with type 2 diabetes who have mild-to-moderate chronic kidney disease is controversial. The two methods were compared in a cohort of 448 patients with type 2 diabetes. Creatinine-based calculation was found to be more accurate than cystatin-C, which confirms the current practice in diabetes literature of reporting estimated GFR primarily by creatinine decrements and the modification of diet in renal disease (MDRD) calculation. [ 17 ] A 24-hour urinalysis for urea, creatinine, and protein is extremely useful in quantifying protein losses and estimating the GFR. Typically, the urinalysis results from a patient with established diabetic nephropathy show proteinuria varying from 150 mg/dL to greater than 300 mg/dL, glucosuria, and occasional hyaline casts. Microalbuminuria is defined as albumin excretion of more than 20 g/min or an albumin-to-creatinine ratio (g/g) of greater than 30. This phase indicastes incipient diabetic nephropathy and calls for aggressive management, at which stage the disease may be potentially reversible (ie, microalbuminuria can regress). (See the image below.) Screening for and prevention of the pr Continue reading >>

Diabetic Nephropathy

Diabetic Nephropathy

Author: Vecihi Batuman, MD, FASN; Chief Editor: Romesh Khardori, MD, PhD, FACP more... Diabetic nephropathy is a clinical syndrome characterized by the following [ 1 ] : Persistent albuminuria (>300 mg/d or >200 g/min) that is confirmed on at least 2 occasions 3-6 months apart Progressive decline in the glomerular filtration rate (GFR) Elevated arterial blood pressure (see Workup) Proteinuria was first recognized in diabetes mellitus in the late 18th century. In the 1930s, Kimmelstiel and Wilson described the classic lesions of nodular glomerulosclerosis in diabetes associated with proteinuria and hypertension. (See Pathophysiology.) By the 1950s, kidney disease was clearly recognized as a common complication of diabetes, with as many as 50% of patients with diabetes of more than 20 years having this complication. (See Epidemiology.) Currently, diabetic nephropathy is the leading cause of chronic kidney disease in the United States and other Western societies. It is also one of the most significant long-term complications in terms of morbidity and mortality for individual patients with diabetes. Diabetes is responsible for 30-40% of all end-stage renal disease (ESRD) cases in the United States. (See Prognosis.) Generally, diabetic nephropathy is considered after a routine urinalysis and screening for microalbuminuria in the setting of diabetes. Patients may have physical findings associated with long-standing diabetes mellitus. (See Clinical Presentation.) Good evidence suggests that early treatment delays or prevents the onset of diabetic nephropathy or diabetic kidney disease. This has consistently been shown in both type1 and type 2 diabetes mellitus. (See Treatment and Management). Regular outpatient follow-up is key in managing diabetic nephropathy successfully. ( Continue reading >>

Renal Histology In Diabetic Nephropathy:

Renal Histology In Diabetic Nephropathy: "a Novel Perspective" Sahay M, Mahankali R K, Ismal K, Vali P S, Sahay R K, Swarnalata G - Indian J Nephrol

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease all over the world. India has a high incidence and prevalence of diabetes and >30% have nephropathy. Recently, a histological classification has been proposed. This study analyzed the renal histology in 114 diabetic patients with renal dysfunction. Nearly 75% of patients had DN. Fifty five (63.95%) were males. Mean duration of diabetes was 7.04 4.9 years. Mean serum creatinine in study group was 5.2 2.9 mg/dl, with mean estimated glomerular filtration rate of 23.43 21.48 ml/min/1.732 m 2 . Forty eight patients (55.81%) had diabetic retinopathy (DR); prevalence of DR was more in patients who had diabetes for > 10 years than patients who had diabetes for <6 years (P = 0.022). The most common histological class was Class IV observed in 37 (43.02. %) cases, Class III DN in 24 (27.90%) cases, Class IIa and Class IIb in 11 (12.79%) cases each and Class I DN in 3 (3.48%) cases. Higher histological class was associated with higher proteinuria, lower glomerular filtration rate (P < 0.001) and was more likely to be associated with retinopathy (P = 0.012) and hypertension (P = 0.0003) but did not correlate with duration of diabetes (P = 0.85). There was a poor correlation between retinopathy and DN. Biopsy helps to stage the renal lesions in diabetics with renal dysfunction. Keywords:Diabetes, diabetic nephropathy, non-diabetic renal disease, renal histology, retinopathy Sahay M, Mahankali R K, Ismal K, Vali P S, Sahay R K, Swarnalata G. Renal histology in diabetic nephropathy: "A novel perspective". Indian J Nephrol 2014;24:226-31 Sahay M, Mahankali R K, Ismal K, Vali P S, Sahay R K, Swarnalata G. Renal histology in diabetic nephropathy: "A novel perspective". Indian J Nephrol [serial online] 2014 [cited20 Continue reading >>

Diabetic Nephropathy

Diabetic Nephropathy

Diabetic nephropathy (diabetic kidney disease) (DN)[1] is the chronic loss of kidney function occurring in those with diabetes mellitus. It is a serious complication, affecting around one-quarter of adult diabetics in the United States. It usually is slowly progressive over years. [2] Pathophysiologic abnormalities in DN begin with long-standing poorly controlled blood glucose levels. This is followed by multiple changes in the filtration units of the kidneys, the nephrons. (There are normally about 3/4-1 1/2 million nephrons in each adult kidney).[3] Initially, there is constriction of the efferent arterioles and dilation of afferent arterioles, with resulting glomerular capillary hypertension and hyperfiltration; this gradually changes to hypofiltration over time.[4] Concurrently, there are changes within the glomerulus itself: these include a thickening of the basement membrane, a widening of the slit membranes of the podocytes, an increase in the number of mesangial cells, and an increase in mesangial matrix. This matrix invades the glomerular capillaries and produces deposits called Kimmelstiel-Wilson nodules. The mesangial cells and matrix can progressively expand and consume the entire glomerulus, shutting off filtration.[5] The status of DN may be monitored by measuring two values: the amount of protein in the urine - proteinuria; and a blood test called the serum creatinine. The amount of the proteinuria is a reflection of the degree of damage to any still-functioning glomeruli. The value of the serum creatinine can be used to calculate the estimated glomerular filtration rate (eGFR), which reflects the percentage of glomeruli which are no longer filtering the blood.[citation needed] Treatment with an angiotensin converting enzyme inhibitor (ACEI) or angiotensi Continue reading >>

Pathologic Classification Of Diabetic Nephropathy

Pathologic Classification Of Diabetic Nephropathy

Pathologic Classification of Diabetic Nephropathy *Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands; Department of Pathology, University of Erlangen-Nuernberg, Erlangen, Germany; Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, California; Department of Histopathology, Hammersmith Hospital, London, United Kingdom; Department of Pathology, University of Maryland, Baltimore, Maryland; Renal Immunopathology Center, San Carlo Borromeo Hospital, Milan, Italy; **Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee; Division of Pathology, Sendai-Shaho Hospital, Sendai City, Japan; Department of Pathology, Hpital Necker, Universit Ren Descartes, Paris, France; Department of Medicine, Columbia University, New York, New York; and Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York Dr. Antien L. Mooyaart, Department of Pathology, Building 1, L1-Q, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. Phone: 0031715266574; Fax: 0031715266952; E-mail: a.l.mooyaart{at}lumc.nl Although pathologic classifications exist for several renal diseases, including IgA nephropathy, focal segmental glomerulosclerosis, and lupus nephritis, a uniform classification for diabetic nephropathy is lacking. Our aim, commissioned by the Research Committee of the Renal Pathology Society, was to develop a consensus classification combining type1 and type 2 diabetic nephropathies. Such a classification should discriminate lesions by various degrees of severity that would be easy to use internationally in clinical practice. We divide diabetic nephropathy into four hierarchical glomerular lesions with a separate evaluation for degrees of interstitial and Continue reading >>

Histopathology Of Diabetic Nephropathy

Histopathology Of Diabetic Nephropathy

Volume 27, Issue 2 , March 2007, Pages 195-207 Get rights and content The clinical manifestations of diabetic nephropathy, proteinuria, increased blood pressure, and decreased glomerular filtration rate, are similar in type 1 and type 2 diabetes; however, the renal lesions underlying renal dysfunction in the 2 conditions may differ. Indeed, although tubular, interstitial, and arteriolar lesions are ultimately present in type 1 diabetes, as the disease progresses, the most important structural changes involve the glomerulus. In contrast, a substantial subset of type 2 diabetic patients, despite the presence of microalbuminuria or proteinuria, have normal glomerular structure with or without tubulointerstitial and/or arteriolar abnormalities. The clinical manifestations of diabetic nephropathy are strongly related with the structural changes, especially with the degree of mesangial expansion in both type 1 and type 2 diabetes. However, several other important structural changes are involved. Previous studies, using light and electron microscopic morphometric analysis, have described the renal structural changes and the structural-functional relationships of diabetic nephropathy. This review focuses on these topics, emphasizing the contribution of research kidney biopsy studies to the understanding of the pathogenesis of diabetic nephropathy and the identification of patients with a higher risk of progression to end-stage renal disease. Finally, evidence is presented that the reversal of established lesions of diabetic nephropathy is possible. Continue reading >>

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