adenoidectomy

腺样体切除术
  • 文章类型: Journal Article
    UNASSIGNED: Ciprofol is a novel anesthetic agent, its efficacy and safety had been verified and its clinical implementation has been expanded. However, the knowledge about ciprofol in children is meager. The aim of study is to evaluate the safety and effectiveness of ciprofol in general anesthesia in children undergoing adenoidectomy and adenotonsillectomy, compared with propofol.
    UNASSIGNED: We retrospectively analyzed data of children who underwent adenoidectomy or adenotonsillectomy with general anesthesia from June to August 2023 to evaluate the safety and effectiveness of ciprofol. The primary outcomes included hemodynamic changes during induction and postoperative complications in post-anesthesia care unit. The secondary outcomes were extubation time, pediatric anesthesia emergence delirium (PAED) score. Meanwhile, subgroup analysis was performed based on age.
    UNASSIGNED: 301 children met the inclusion criteria, 157 received ciprofol induction and 144 received propofol. Patient demographics and operation-related information were similar in the two groups. However, the dosage of dexmedetomidine in the propofol group was significantly higher than that of the ciprofol group (p=0.001). The trends of hemodynamic shift during induction and intubation were the same in the two groups. The PAED scores on post-extubation 10min and 20min were significantly reduced in the ciprofol group (p<0.001 and p=0.046). Moreover, in the ≤72 months and the >72 months subgroups, the scores were also significantly lower in the ciprofol group on post-extubation 10min. With the score of >10, the incidence of emergence delirium of the ciprofol group was significantly lower on post-extubation 10min and 20min in the population and the ≤72 months subgroups (p=0.03 and p=0.02). There were no obvious postoperative complications in both groups.
    UNASSIGNED: Ciprofol exhibited advantageous characteristics in the induction of children, such as stable hemodynamics, a relatively lower incidence of postoperative delirium without apparent post-anesthesia complications. Ciprofol may emerge as a novel option for general anesthesia in pediatric patients.
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  • 文章类型: Journal Article
    静脉注射利多卡因预防儿童术后呕吐(POV)的剂量反应尚不清楚。这项研究调查了接受扁桃体切除术(有或没有腺样体切除术)而无严重并发症的儿童术后24小时内静脉注射利多卡因剂量依赖性地降低POV风险。从2021年12月至2022年3月,计划进行选择性扁桃体切除术(有或没有腺样体切除术)的3-12岁(美国麻醉医师协会I-II级)患者。根据利多卡因剂量(A[0mgkg-1],B[1mgkg-1],C[1.5mgkg-1],和D[2mgkg-1]),并按照相同的诱导方案(舒芬太尼,异丙酚,和氯化三甲铵)。用七氟醚维持麻醉。术后24h内POV的发生率在A组中分别为46、40、36和20%,B,C,D,分别,D组与A组术后镇痛抢救比较差异有统计学意义,B,C,D分别为62%、36%、34%和16%,分别,D组和B组之间存在显着差异,C和A,D和A.未报告严重不良事件。静脉注射利多卡因具有剂量依赖性作用,可以降低接受扁桃体切除术(有或没有腺样体切除术)的儿童的POV风险,而没有严重的不良事件。试验注册:中国临床试验注册中心,ChiCTR2100053006。
    The dose-response of intravenous lidocaine in preventing postoperative vomiting (POV) in children remains unclear. This study investigated whether intravenous lidocaine dose-dependently decreased POV risk within 24 h postoperatively in children undergoing tonsillectomy (with or without adenoidectomy) without severe complications. Patients aged 3-12 years (American Society of Anesthesiologists grade I-II) scheduled for elective tonsillectomy (with or without adenoidectomy) were enroled from December 2021 to March 2022. They were randomly grouped according to the lidocaine dose (A [0 mg kg-1], B [1 mg kg-1], C [1.5 mg kg-1], and D [2 mg kg-1]) and were administered the same induction protocol (sufentanil, propofol, and suxamethonium chloride). Anaesthesia was maintained with sevoflurane. The incidence of POV within 24 h postoperatively was 46, 40, 36, and 20% in groups A, B, C, and D, respectively, with significant differences between groups D and A. Postoperative analgesic rescues in groups A, B, C, and D were 62, 36, 34, and 16%, respectively, with significant differences between groups D and B, C and A, and D and A. No severe adverse events were reported. Intravenous lidocaine has a dose-dependent effect on reducing the risk of POV in children undergoing tonsillectomy (with or without adenoidectomy) without serious adverse events.Trial registration: Chinese Clinical Trial Registry, ChiCTR2100053006.
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  • 文章类型: Journal Article
    背景:腺样体作为细菌病原体和免疫分子的储库,并且它们显著涉及患有渗出性中耳炎(OME)的儿童。作为细胞间物质传递和信号转导的重要载体,具有不同生物学功能的外泌体可以由各种类型的细胞分泌。关于外泌体与OME的临床相关性仍然存在显著的不确定性,特别是在其病理生理发展中。在这项研究中,我们将寻求确定伴有OME的腺样体肥大(AHOME)儿童外泌体的生物学功能。
    方法:4-10岁儿童OME的诊断标准包括病程至少3个月,B型或C型声导纳,和不同程度的传导性听力损失。当鼻内窥镜检查显示鼻孔中至少有60%的腺样体闭塞或鼻咽侧位X线显示A/N>0.6时,可诊断为腺样体肥大。符合腺样体切除术适应症的儿童接受腺样体切除术。外周血,鼻咽拭子,从病人身上收集腺样体组织,和外泌体将从样品中分离。在最初的收集之后,患者将接受腺样体切除术,3个月后将再次收集外周血和鼻咽拭子。
    结果:本研究旨在确定AHOME患儿和单纯腺样体肥大患儿术前腺样体组织和外周血样本的外泌体差异。此外,它试图确定这些群体之间腺样体组织中微生物多样性的变化。
    结论:这些发现有望为OME的诊断和治疗提供新的见解,为了识别新的生物标志物,并增强我们对OME病理生理学的理解,可能导致创新诊断和治疗方法的发展。
    BACKGROUND: The adenoids act as a reservoir of bacterial pathogens and immune molecules, and they are significantly involved in children with otitis media with effusion (OME). As an essential carrier of intercellular substance transfer and signal transduction, exosomes with different biological functions can be secreted by various types of cells. There remains significant uncertainty regarding the clinical relevance of exosomes to OME, especially in its pathophysiologic development. In this study, we will seek to determine the biological functions of exosomes in children with adenoid hypertrophy accompanied by OME (AHOME).
    METHODS: The diagnostic criteria for OME in children aged 4-10 years include a disease duration of at least 3 months, type B or C acoustic immittance, and varying degrees of conductive hearing loss. Adenoidal hypertrophy is diagnosed when nasal endoscopy shows at least 60% adenoidal occlusion in the nostrils or when nasopharyngeal lateral X-ray shows A/N > 0.6. Children who meet the indications for adenoidectomy surgery undergo adenoidectomy. Peripheral blood, nasopharyngeal swab, and adenoid tissue will be collected from patients, and the exosomes will be isolated from the samples. Following the initial collection, patients will undergo adenoidectomy and peripheral blood and nasopharyngeal swabs will be collected again after 3 months.
    RESULTS: This study aims to identify differences in exosomes from preoperative adenoid tissue and peripheral blood samples between children with AHOME and those with adenoid hypertrophy alone. Additionally, it seeks to determine changes in microbial diversity in adenoid tissue between these groups.
    CONCLUSIONS: The findings are expected to provide new insights into the diagnosis and treatment of OME, to identify novel biomarkers, and to enhance our understanding of the pathophysiology of OME, potentially leading to the development of innovative diagnostic and therapeutic approaches.
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  • 文章类型: Journal Article
    背景:术后呼吸不良事件是小儿麻醉中最常见的围手术期并发症,在接受扁桃体切除术和腺样体切除术的儿童中尤其普遍,发病率高达50%。麻醉诱导方案的选择直接影响诱导期呼吸不良事件的发生率。然而,这种效应对术后结局的影响似乎很小.术后呼吸不良事件的发生率可能与麻醉维持阶段密切相关。然而这种关系目前仍然不确定。
    方法:本研究的目的是评估不同麻醉维持方案对扁桃体切除术和腺样体切除术患儿术后呼吸道不良事件的影响。AmPRAEC研究是一个多中心,随机化,双盲对照试验。从12个医疗中心共招募717名儿科患者,随机分为三组:A组(静脉维持组,接受丙泊酚输注);B组(静脉吸入联合组,用1%七氟烷联合丙泊酚维持;和C组(吸入维持组,维持2-3%七氟醚吸入)。主要结果指标是术后呼吸不良事件的发生率。
    结论:本临床试验旨在阐明各种麻醉维持方案对儿科患者术后呼吸不良事件的影响。这项研究的结果预计将有助于麻醉医师制定更全面的围手术期管理策略。增强舒适度,并改善该患者人群的临床结果。
    背景:中国临床试验注册中心(http://www.chictr.org.cn)ChiCTR2300074803。2023年8月16日注册。
    BACKGROUND: Postoperative respiratory adverse events are the most common perioperative complications in pediatric anesthesia, particularly prevalent in children undergoing tonsillectomy and adenoidectomy, with an incidence rate as high as 50%. The choice of anesthetic induction regimen directly influences the incidence of respiratory adverse events during the induction period. However, this effect seems to have minimal impact on postoperative outcomes. The occurrence rate of postoperative respiratory adverse events is likely more closely associated with the anesthetic maintenance phase, yet this relationship remains uncertain at present.
    METHODS: The objective of this study was to assess the impact of different anesthetic maintenance regimens on postoperative respiratory adverse events in pediatric patients undergoing tonsillectomy and adenoidectomy. The AmPRAEC study is a multicenter, randomized, double-blind controlled trial. A total of 717 pediatric patients were recruited from 12 medical centers and randomly assigned to three groups: group A (intravenous maintenance group, receiving propofol infusion); group B (intravenous-inhalational combination group, maintained with 1% sevoflurane combined with propofol); and group C (inhalational maintenance group, maintained with 2-3% sevoflurane inhalation). The primary outcome measure was the incidence rate of postoperative respiratory adverse events.
    CONCLUSIONS: This clinical trial aims to elucidate the impact of various anesthetic maintenance regimens on postoperative respiratory adverse events in pediatric patients. The outcomes of this study are anticipated to facilitate anesthesiologists in devising more comprehensive perioperative management strategies, enhancing comfort, and improving the clinical outcomes for this patient population.
    BACKGROUND: Chinese Clinical Trial Registry ( http://www.chictr.org.cn ) ChiCTR2300074803. Registered on August 16, 2023.
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  • 文章类型: Journal Article
    小儿睡眠呼吸紊乱是一组常见的病症,从习惯性打鼾到阻塞性睡眠呼吸暂停综合征,影响了很大一部分儿童。本文总结了近年来小儿OSA的诊断和治疗的最新知识,重点是该领域的治疗和外科进展。OSA的进展,如生物标志物,改善持续压力治疗的依从性,新的药物疗法,并讨论了高级手术。
    Pediatric sleep-disordered breathing disorders are a group of common conditions, from habitual snoring to obstructive sleep apnea (OSA) syndrome, affecting a significant proportion of children. The present article summarizes the current knowledge on diagnosis and treatment of pediatric OSA focusing on therapeutic and surgical advancements in the field in recent years. Advancements in OSA such as biomarkers, improving continuous pressure therapy adherence, novel pharmacotherapies, and advanced surgeries are discussed.
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  • 文章类型: Journal Article
    目的:确定在腺样体扁桃体切除术中使用吸入式电刀相关的不良事件(AE)。
    方法:使用术语“抽吸烧灼,“\”抽吸电灼术,\"\"吸Bovie,从2014年1月到2023年12月,“和”抽吸凝结器“。
    结果:165例AE报告来自MAUDE数据库医疗器械报告(MDRs)。36符合纳入标准。在22份(61.1%)报告中发现患者受伤,在14份(38.9%)报告中发现装置故障事件。所有患者受伤均为热烧伤(N=22,100%)。烧伤部位包括嘴唇(N=6,27.3%),口腔连合(N=5,22.7%),和舌头(N=4,18.2%)。AE的最常见原因是设备绝缘不足(N=7,19.4%)。
    结论:吸入式电灼器可能会发生故障并导致患者烧伤。设备故障主要是由于设备绝缘不足,凝血问题,和设备部件的分离。外科医生必须意识到这些潜在的并发症,并就AE向父母和患者提供咨询。
    OBJECTIVE: To identify adverse events (AEs) related to suction electrocautery use during adenotonsillectomy.
    METHODS: The US Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database was searched using the terms \"suction cautery,\" \"suction electrocautery,\" \"suction Bovie,\" and \"suction coagulator\" from January 2014 to December 2023.
    RESULTS: 165 AE reports were gathered from the MAUDE database medical device reports (MDRs). 36 met inclusion criteria. Patient injuries were found in 22 (61.1 %) reports and device malfunction events were found in 14 (38.9 %) reports. All patient injuries were thermal burns (N = 22, 100 %). Location of burn injuries included the lip (N = 6, 27.3 %), oral commissure (N = 5, 22.7 %), and tongue (N = 4, 18.2 %). The most common cause of an AE was inadequate device insulation (N = 7, 19.4 %).
    CONCLUSIONS: The suction electrocautery apparatus may malfunction and cause patient burn injuries. Device failures mainly result from inadequate device insulation, coagulation problems, and detachment of device components. Surgeons must be aware of these potential complications and counsel parents and patients regarding AEs.
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  • 文章类型: Journal Article
    目的:评估普通儿科耳鼻喉科手术中工作人员暴露于气溶胶生成的程度(扁桃体切除术,腺样体切除术,和鼓膜造口术),并确定在这些程序中产生大多数气溶胶的手术阶段。
    方法:在35个儿科耳鼻咽喉科手术期间使用光学颗粒计测量气溶胶生成,所述光学颗粒计测量颗粒尺寸在0.3μm和10.0μm之间的气溶胶浓度。记录每个程序中使用的不同阶段和仪器。手术室背景气溶胶水平和咳嗽被用作参考。
    结果:与鼓膜造口术(p=0.011和p=0.042)和空室背景气溶胶浓度(p=0.0057和p<0.001)相比,扁桃体切除术和腺样体切除术期间的总气溶胶浓度明显更高。扁桃体切除术期间的气溶胶浓度与咳嗽没有差异,这被认为是高风险气溶胶程序的标准。在鼓膜造口术中,气溶胶浓度甚至低于围手术期浓度.气溶胶生成相比吸力没有统计学上的显著差异,电灼术,冷仪器,发现了穿刺术.
    结论:根据本研究的结果,鼓膜造口术是低风险的气溶胶生成程序。另一方面,小儿扁桃体切除术产生的气溶胶与咳嗽相当,指出它们是显着的气溶胶产生程序和病毒传播理论上在术中是可能的。
    OBJECTIVE: To assess the extent of staff exposure to aerosol generation in common pediatric otorhinolaryngological procedures (tonsillotomies, adenoidectomies, and tympanostomies) and determine the surgical phases responsible for most aerosol generation in these procedures.
    METHODS: Aerosol generation was measured during 35 pediatric otolaryngological procedures using an Optical Particle Sizer that measures aerosol concentrations for particle sizes between 0.3 and 10.0 μm. The different phases of and instruments used in each procedure were logged. Operating room background aerosol levels and coughing were used as references.
    RESULTS: Total aerosol concentrations were significantly higher during tonsillotomies and adenoidectomies when compared to tympanostomies (p = 0.011 and p = 0.042) and to empty room background aerosol concentrations (p = 0.0057 and p < 0.001). Aerosol concentration during tonsillotomies did not differ from coughing, which is considered as standard for high-risk aerosol procedures. During tympanostomies, aerosol concentrations were even lower than during perioperative concentrations. No statistically significant difference in aerosol generation comparing suction, electrocautery, cold instruments, and paracentesis was found.
    CONCLUSIONS: According to the results of this study, tympanostomies are low-risk aerosol-generating procedures. On the other hand, pediatric tonsillotomies produced aerosols comparable to coughing, pointing to them being significantly aerosol-producing procedures and viral transmission is theoretically possible intraoperatively.
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  • 文章类型: Journal Article
    背景:术后恶心和呕吐(PONV)是儿科手术后的一个重要问题,和挥发性麻醉剂是这种现象的重要原因。BIS引导麻醉,通过减少麻醉药的消耗,导致成人患者PONV降低。
    目的:评估BIS引导麻醉在降低儿科PONV发生率中的作用。
    方法:前瞻性,随机化,双盲研究.
    方法:捷克共和国大学医院的单中心研究,从2021年6月到2022年11月。
    方法:共有163名儿童,纳入年龄为3~8岁的ASAI~II患者,在全身麻醉下接受内镜腺样体切除术.
    方法:在干预组中,麻醉深度维持在40~60的BIS之间.
    方法:主要结果是术后24h恶心和呕吐的发生率。
    结果:与对照组相比,使用BIS引导麻醉导致恶心和呕吐发生率显着降低[17%vs.53%;RR(95CI)0.48(0.27-0.86);p<0.001和16%vs.34%;RR(95CI)0.33(0.20-0.54);p=0.01,分别]。
    结论:BIS引导麻醉可降低儿童腺样体切除术后恶心和呕吐的发生率。
    背景:Clinicaltrials.gov标识符:NCT04466579。
    BACKGROUND: Postoperative nausea and vomiting (PONV) is a significant problem following paediatric surgery, and volatile anaesthetics are an important cause of this phenomenon. BIS-guided anaesthesia, by reducing the consumption of anaesthetics, leads to a decrease in PONV in adult patients.
    OBJECTIVE: Evaluate the role of BIS-guided anaesthesia in reducing the incidence of paediatric PONV.
    METHODS: Prospective, randomized, double-blind study.
    METHODS: A single center study in university hospital in Czech republic, from June 2021 to November 2022.
    METHODS: A total of 163 children, aged 3-8 years with ASA I-II who underwent endoscopic adenoidectomy under general anaesthesia were included.
    METHODS: In the intervention group, the depth of anaesthesia was maintained to values between 40 and 60 of BIS.
    METHODS: The primary outcome was the incidence of postoperative nausea and vomiting during 24 h after surgery.
    RESULTS: The use of BIS-guided anaesthesia led to a significant decrease in the incidence of nausea and vomiting compared to the control group [17% vs. 53%; RR (95%CI) 0.48 (0.27-0.86); p < 0.001and 16% vs. 34%; RR (95%CI) 0.33 (0.20-0.54); p = 0.01, respectively].
    CONCLUSIONS: BIS-guided anaesthesia decreases the incidence of postoperative nausea and vomiting in children undergoing adenoidectomy.
    BACKGROUND: Clinicaltrials.gov identifier: NCT04466579.
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  • 文章类型: Journal Article
    目的:为了研究高乌甲素(TLA)透皮贴剂的镇痛作用和副作用,布洛芬混悬液(IS),腺样体切除术和扁桃体切除术后TLA联合IS(TLACIS)。
    方法:前瞻性,随机临床试验。
    方法:根据不同的镇痛药物方案,将患者随机分为三组:TLA组,IS组,和TLACIS组。收集术后2、12和24小时的疼痛评分以及术后第一周内的不良事件报告。
    结果:最终,这项研究包括TLA组102例,IS组101例,TLACIS组101例。手术后2小时,TLA和TLACIS组的疼痛评分均明显低于IS组(均P<0.05)。手术后12和24小时,TLACIS组的疼痛评分明显低于TLA和IS组(均P<0.05);IS组疼痛评分明显低于TLA组(P<0.05)。手术后1周内,不良事件发生率无显著差异.
    结论:添加TLA贴片可以加速镇痛的开始。在镇痛作用方面,单独IS比单独TLA更有利,而TLA和IS的联合镇痛效果最好。三种方案的不良事件发生率无显著差异。
    OBJECTIVE: To study the analgesic effects and side effects of a transdermal lappaconitine (TLA) patch, ibuprofen suspension (IS), and TLA combined with IS (TLACIS) after adenoidectomy and tonsillectomy.
    METHODS: Prospective, randomized clinical trial.
    METHODS: The patients were randomized into three groups defined by different analgesic drug regimens: the TLA group, the IS group, and the TLACIS group. Pain scores at 2, 12, and 24 hours after surgery and adverse-event reports within the first postoperative week were collected.
    RESULTS: Ultimately, this study included 102 cases in the TLA group, 101 cases in the IS group, and 101 cases in the TLACIS group. At 2 hours after surgery, the pain scores of the TLA and the TLACIS groups were both significantly lower than that of the IS group (all P < .05). At 12 and 24 hours after surgery, the pain score of the TLACIS group was significantly lower than those of the TLA and IS groups (all P < .05); furthermore, the pain score of the IS group was significantly lower than that of the TLA group (P < .05). Within 1 week after the operation, there was no significant difference in the incidence of adverse events.
    CONCLUSIONS: The addition of a TLA patch can speed the onset of analgesia. In terms of analgesic effects, IS alone is more advantageous than TLA alone, while the combination of TLA and IS has the best analgesic effect. No significant differences were found in the incidence of adverse events among the three regimens.
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  • 文章类型: Journal Article
    介绍腺样体切除术是耳鼻喉科医师最常见的手术之一。传统的腺样体刮治是盲目进行的,这可能导致腺样体的去除不足和对周围结构的损伤。目的对腺样体清扫术后鼻咽部进行经鼻内镜检查。方法本前瞻性研究包括100名儿童,平均年龄为4.2±3.07岁。它由两个步骤组成:由住院医师进行常规刮刮术腺样体切除术;通过0°望远镜对鼻咽进行内窥镜评估,以评估腺样体残留物,损伤手术区域或邻近结构,和出血点。结果42%的病例在多个部位行常规腺样体刮除后出现腺样体残留,例如鼻咽部的顶部(24%),输卵管扁桃体(12%),咽后壁(4%),和鼻中隔的后端(2%)。在46%的病例中观察到手术区域和邻近结构的损伤(咽后壁:23%;咽侧壁:11%;帕萨万特脊:10%;咽鼓管口:2%)。在29%的病例中观察到内窥镜出血;13%的病例来自腺样体残留物,10%,从粘膜,6%,从咽部肌肉。19%的病例出血轻微,中等在9%,严重的是1%。结论常规腺样体刮除后鼻咽的内镜评估提供了有关腺样体残留物的重要数据。损伤手术区域或附近结构,和出血点,这有助于提供最佳护理和实现更好的结果。
    Introduction  Adenoidectomy is one of the most common procedures performed by otolaryngologists. Traditional adenoid curettage is performed blindly, which can result in inadequate removal of the adenoid and injury to the surrounding structures. Objective  To perform transnasal endoscopic examinations to assess the nasopharynx after conventional curettage adenoidectomy. Methods  The present prospective study included 100 children with a mean age of 4.2 ± 3.07 years. It is composed of two steps: conventional curettage adenoidectomy by a resident trainee; and endoscopic evaluation of the nasopharynx through a 0° telescope to assess adenoidal remnants, injury to the surgical field or adjacent structures, and bleeding points. Results  Adenoid remnants were observed in 42% of the cases after conventional adenoid curettage in multiple locations, such as the roof of the nasopharynx over the choana (24%), the tubal tonsil (12%), the posterior pharyngeal wall (4%), and the posterior end of the nasal septum (2%). Injury to the surgical field and adjacent structures was observed in 46% of the cases (posterior pharyngeal wall: 23%; lateral pharyngeal wall: 11%; Passavant ridge: 10%; and the Eustachian tube orifice: 2%). Endoscopic bleeding was observed in 29% of the cases; 13% of the cases were from adenoid remnants, 10%, from the mucosa, and 6%, from the pharyngeal muscles. Bleeding was mild in 19% of the cases, moderate in 9%, and severe in 1%. Conclusion  Endoscopic evaluation of the nasopharynx following conventional adenoid curettage provides important data regarding adenoid remnants, injury to the surgical field or nearby structures, and bleeding points, which aids in the provision of optimal care and in the achievement of a better outcome.
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