Pediatric Gastrointestinal Diseases: Diagnosis and Management

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: closed (15 December 2023) | Viewed by 22528

Special Issue Editor


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Guest Editor
Department of Pediatrics I, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540136 Targu Mures, Romania
Interests: diagnosis; nutrition assessment; child nutrition; childhood obesity; metabolic diseases; metabolism

Special Issue Information

Dear Colleagues,

The purpose of this Special Issue is to allow researchers from around to the world to report on new insights in pediatric gastrointestinal diseases. Therefore, we aim to include papers related to both the diagnosis and management of a wide-spectrum of pediatric gastrointestinal diseases, such as celiac disease, acute and chronic diarrhea, inflammatory bowel disease, food allergies, nutritional disorders, gastritis, and other functional gastrointestinal disorders. Assessing and reporting novel information regarding different gastrointestinal disorders is highly important, as it is a major concern of pediatricians in clinical practice. It is a well-documented fact that gastrointestinal diseases represent the most important cause of morbidity in pediatric patients. The proper diagnosis and management of these pathologies independently of their organic or functional etiology will create healthier adult populations, decreasing the costs related to health services and improving the care that might be individualized for each patient.

Prof. Dr. Cristina Oana Marginean
Guest Editor

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Keywords

  • celiac disease
  • acute diarrhea
  • chronic diarrhea
  • inflammatory bowel disease
  • food allergies
  • nutritional disorders
  • gastritis
  • functional gastrointestinal disorders
  • gastro-esophageal reflux

Published Papers (11 papers)

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Editorial

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3 pages, 185 KiB  
Editorial
Multidisciplinarity and Trandisciplinarity in the Diagnosis and Treatment of Pediatric Gastrointestinal Diseases
by Cristina Oana Mărginean
Diagnostics 2024, 14(8), 852; https://doi.org/10.3390/diagnostics14080852 - 20 Apr 2024
Viewed by 598
Abstract
It is an honor and a privilege to have helped bring this Special Issue titled “Multidisciplinarity and Trandisciplinarity in the Diagnosis and Treatment of Pediatric Gastrointestinal Diseases” to you [...] Full article
(This article belongs to the Special Issue Pediatric Gastrointestinal Diseases: Diagnosis and Management)

Research

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12 pages, 3154 KiB  
Article
The Usefulness of the Eosinophilic Esophagitis Histology Scoring System in Predicting Response to Proton Pump Inhibitor Monotherapy in Children with Eosinophilic Esophagitis
by Jovan Jevtić, Nina Ristić, Vedrana Pavlović, Jovana Svorcan, Ivan Milovanovich, Milica Radusinović, Nevena Popovac, Ljubica Simić, Aleksandar Ćirović, Miloš Đuknić, Maja Životić, Nevena Poljašević, Danilo Obradović, Jelena Filipović and Radmila Janković
Diagnostics 2023, 13(22), 3445; https://doi.org/10.3390/diagnostics13223445 - 15 Nov 2023
Cited by 3 | Viewed by 1490
Abstract
Background: Eosinophilic esophagitis (EoE) is an immune-mediated esophageal disease with rising incidence. While proton pump inhibitors (PPIs) are the first-line treatment, a significant proportion of patients do not respond. This study aimed to determine if the EoE Histology Scoring System (EoEHSS) can predict [...] Read more.
Background: Eosinophilic esophagitis (EoE) is an immune-mediated esophageal disease with rising incidence. While proton pump inhibitors (PPIs) are the first-line treatment, a significant proportion of patients do not respond. This study aimed to determine if the EoE Histology Scoring System (EoEHSS) can predict PPI responsiveness. Methods: A cross-sectional study was conducted on 89 pediatric patients diagnosed with EoE between 2016 and 2022. Patients were categorized into PPI responders (PPIREoE) and non-responders (PPINREoE) based on post-treatment biopsies. EoEHSS values from biopsies of the esophagus (distal, middle, and proximal segments) were compared between the two groups. Results: No significant differences in EoEHSS scores were observed for the distal and proximal esophagus between the groups. However, the middle esophagus showed a significantly higher EoEHSS grade score in the PPINREoE group, indicating a more pronounced disease severity. Specific histological features, particularly eosinophilic abscesses and surface layering of the middle segment of the esophagus, were significantly different between the groups. Conclusions: Performing a biopsy of each esophageal segment, particularly the middle, is crucial for diagnostic precision and predicting PPI responsiveness. The EoEHSS can serve as a valuable tool in predicting therapy response, emphasizing the need for personalized therapeutic approaches in EoE management. Full article
(This article belongs to the Special Issue Pediatric Gastrointestinal Diseases: Diagnosis and Management)
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12 pages, 645 KiB  
Article
Is There a Potential Link between Gastroesophageal Reflux Disease and Recurrent Respiratory Tract Infections in Children?
by Vasile Valeriu Lupu, Gabriela Stefanescu, Ana Maria Laura Buga, Lorenza Forna, Elena Tarca, Iuliana Magdalena Starcea, Cristina Maria Mihai, Laura Florescu, Andrei Tudor Cernomaz, Adriana Mocanu, Viorel Tarca, Aye Aung Thet and Ancuta Lupu
Diagnostics 2023, 13(13), 2310; https://doi.org/10.3390/diagnostics13132310 - 7 Jul 2023
Cited by 3 | Viewed by 1457
Abstract
Background: The implications of gastroesophageal reflux disease in respiratory tract infections have been investigated over time. The aim of our study was to evaluate the relationship between these two pathologic entities and the outcome after proper antireflux treatment. Methods: A group of 53 [...] Read more.
Background: The implications of gastroesophageal reflux disease in respiratory tract infections have been investigated over time. The aim of our study was to evaluate the relationship between these two pathologic entities and the outcome after proper antireflux treatment. Methods: A group of 53 children with recurrent respiratory tract infections admitted in the gastroenterology clinic of a children’s hospital in North-East Romania was investigated for gastroesophageal reflux disease through 24 h pH-metry. Those with a Boix-Ochoa score higher than 11.99 received proton pump inhibitor treatment and were reevaluated after 2 months. Results: A total of 41 children were found with a positive Boix-Ochoa score. After 2 months of antireflux therapy, eight patients still had a positive Boix-Ochoa score. Conclusions: Recurrent respiratory tract infections with symptoms resistant to treatment should be considered a reason to investigate for gastroesophageal reflux, because the symptoms may be due to micro- or macro-aspiration of the gastric refluxate or to an esophageal-bronchial reflex mediated through the vagal nerve. Full article
(This article belongs to the Special Issue Pediatric Gastrointestinal Diseases: Diagnosis and Management)
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11 pages, 1901 KiB  
Article
Helicobacter pylori Infection in Children: A Possible Reason for Headache?
by Ancuta Lupu, Cristina Gavrilovici, Vasile Valeriu Lupu, Anca Lavinia Cianga, Andrei Tudor Cernomaz, Iuliana Magdalena Starcea, Cristina Maria Mihai, Elena Tarca, Adriana Mocanu and Silvia Fotea
Diagnostics 2023, 13(7), 1293; https://doi.org/10.3390/diagnostics13071293 - 29 Mar 2023
Cited by 3 | Viewed by 1651
Abstract
(1) Background: The correlation between infection with Helicobacter pylori (H. pylori) and headache has been argued and explored for a long time, but a clear association between the simultaneous presence of the two in children has not been established yet. In [...] Read more.
(1) Background: The correlation between infection with Helicobacter pylori (H. pylori) and headache has been argued and explored for a long time, but a clear association between the simultaneous presence of the two in children has not been established yet. In this study, we aimed to explore this relationship in children from the Northeast region of Romania. (2) Methods: A retrospective study exploring the correlation between children having H. pylori infection and headache or migraine was conducted on a batch of 1757 children, hospitalized over 3 years in a pediatric gastroenterology department in Northeast Romania. (3) Results: A total of 130 children of both sexes had headache. From 130 children, 54 children (41.5%) also presented H. pylori infection. A significant association between headache and H. pylori infection (χ2; p < 0.01) was noticed. (4) Conclusions: More studies are needed on this relationship, and we emphasize the importance of further analyses, as they present great clinical importance for both prompt diagnosis and treatment. Full article
(This article belongs to the Special Issue Pediatric Gastrointestinal Diseases: Diagnosis and Management)
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11 pages, 2677 KiB  
Article
Omicron in Infants—Respiratory or Digestive Disease?
by Anca Cristina Drăgănescu, Victor Daniel Miron, Oana Săndulescu, Anuţa Bilaşco, Anca Streinu-Cercel, Roxana Gabriela Sandu, Adrian Marinescu, Deniz Gunșahin, Karina Ioana Hoffmann, Daria Ștefana Horobeț, Daniela Pițigoi, Adrian Streinu-Cercel and Doina Anca Pleșca
Diagnostics 2023, 13(3), 421; https://doi.org/10.3390/diagnostics13030421 - 23 Jan 2023
Cited by 2 | Viewed by 1593
Abstract
The Omicron variant of SARS-CoV-2 has caused a large number of cases and hospitalizations in the pediatric population. Infants due to their age are susceptible to viral infections that may have a worse prognosis. Therefore, the aim of the current study has been [...] Read more.
The Omicron variant of SARS-CoV-2 has caused a large number of cases and hospitalizations in the pediatric population. Infants due to their age are susceptible to viral infections that may have a worse prognosis. Therefore, the aim of the current study has been to characterize the clinical features and the outcome of infants hospitalized with confirmed SARS-CoV-2 infection during the Omicron wave. We conducted a retrospective study of all consecutive infants hospitalized with symptomatic COVID-19 and no other co-infections, from January to September 2022 in one of the largest infectious diseases hospitals from Bucharest, Romania. A total of 613 infants were included in the analysis. The median age was 5 months (IQR: 3, 8 months). The clinical features were dominated by fever (96.4%), cough (64.8%) and loss of appetite (63.3%), and overall, respiratory symptoms were the most numerous (76.0%). Infants between 1-3 months old had a 1.5-fold increased risk of elevated alanine aminotransferase (ALT) values, and a longer length of hospitalization as compared to older infants. Infants between 7-9 months of age had 1.5-fold higher odds of loss of appetite, 1.7-fold more frequent cough and 1.6-fold more frequent digestive symptoms compared to infants in other age groups. The presence of digestive symptoms increased the probability of hepatic cytolysis (increased ALT) by 1.9-fold. Continued monitoring of COVID-19 among infants is very necessary, given the progressive character of SARS-CoV-2, in order to take correct and rapid therapeutic measures and to adapt to clinical changes driven by viral variant change. Full article
(This article belongs to the Special Issue Pediatric Gastrointestinal Diseases: Diagnosis and Management)
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12 pages, 1829 KiB  
Article
Epidemiological Characteristics of Helicobacter pylori Infection in Children in Northeast Romania
by Ancuta Lupu, Ingrith Crenguta Miron, Andrei Tudor Cernomaz, Cristina Gavrilovici, Vasile Valeriu Lupu, Iuliana Magdalena Starcea, Anca Lavinia Cianga, Bogdan Stana, Elena Tarca and Silvia Fotea
Diagnostics 2023, 13(3), 408; https://doi.org/10.3390/diagnostics13030408 - 23 Jan 2023
Cited by 6 | Viewed by 2229
Abstract
(1) Background: Although gastritis has been associated with multiple etiologies, in pediatrics the main etiology is idiopathic. Many studies have reported mild-to-severe gastritis Helicobacter pylori (H. pylori) as an etiological factor. We evaluated the distribution of the infection with H. pylori [...] Read more.
(1) Background: Although gastritis has been associated with multiple etiologies, in pediatrics the main etiology is idiopathic. Many studies have reported mild-to-severe gastritis Helicobacter pylori (H. pylori) as an etiological factor. We evaluated the distribution of the infection with H. pylori by age, gender and place of living; (2) Methods: A retrospective study was conducted over a period of 3 years, over a cohort of 1757 patients of both sexes, aged between 1 and 18 years, admitted to a regional gastroenterology center in Iasi, Romania, with clinical signs of gastritis which underwent upper gastrointestinal endoscopy. The research was based on the analysis of data from patient observation charts and hospital discharge tickets, as well as endoscopy result registers; (3) Results: Out of the 1757 children, in 30.8% of cases the H. pylori infection was present. Out of them, 26.8% were males and 73.2% females. The average age of children with an H. pylori infection was higher (14.1 + 2.8 DS), compared with children without H. pylori (12.8 + 3.7 SD), an average difference of 1.3 years (95% confidence interval 0.96 to 1.66; p < 0.001). By place of living, children with H. pylori infection were from urban areas at 24.7% and from rural areas at 75.3%; (4) Conclusions: H. pylori infection incidence is still high in children, especially in teenagers, so extensive prevention and treatment programs are needed. Full article
(This article belongs to the Special Issue Pediatric Gastrointestinal Diseases: Diagnosis and Management)
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10 pages, 716 KiB  
Article
Iron Deficiency Anemia in Pediatric Gastroesophageal Reflux Disease
by Vasile Valeriu Lupu, Ingrith Miron, Ana Maria Laura Buga, Cristina Gavrilovici, Elena Tarca, Anca Adam Raileanu, Iuliana Magdalena Starcea, Andrei Tudor Cernomaz, Adriana Mocanu and Ancuta Lupu
Diagnostics 2023, 13(1), 63; https://doi.org/10.3390/diagnostics13010063 - 26 Dec 2022
Cited by 5 | Viewed by 5093
Abstract
(1) Background: Gastroesophageal reflux disease (GERD) can cause several complications as a result of the acidic pH over various cellular structures, which have been demonstrated and evaluated over time. Anemia can occur due to iron loss from erosions caused by acidic gastric content. [...] Read more.
(1) Background: Gastroesophageal reflux disease (GERD) can cause several complications as a result of the acidic pH over various cellular structures, which have been demonstrated and evaluated over time. Anemia can occur due to iron loss from erosions caused by acidic gastric content. In children, anemia has consequences that, in time, can affect their normal development. This study evaluates the presence of anemia as a result of pediatric gastroesophageal reflux disease. (2) Methods: 172 children were diagnosed with gastroesophageal reflux in the gastroenterology department of a regional children’s hospital in northeast Romania by esophageal pH-metry and they were evaluated for presence of anemia. (3) Results: 23 patients with GERD from the studied group also had anemia, showing a moderate correlation (r = −0.35, p = 0.025, 95% confidence interval) and lower levels of serum iron were found in cases with GERD, with statistical significance (F = 8.46, p = 0.012, 95% confidence interval). (4) Conclusions: The results of our study suggest that there is a relationship between anemia or iron deficiency and gastroesophageal reflux due to reflux esophagitis in children, which needs to be further studied in larger groups to assess the repercussions on children’s development. Full article
(This article belongs to the Special Issue Pediatric Gastrointestinal Diseases: Diagnosis and Management)
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Review

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24 pages, 1018 KiB  
Review
Diagnosis and Management of Gastrointestinal Manifestations in Children with Cystic Fibrosis
by Dana-Teodora Anton-Păduraru, Alina Mariela Murgu, Laura Iulia Bozomitu, Dana Elena Mîndru, Codruța Olimpiada Iliescu Halițchi, Felicia Trofin, Carmen Iulia Ciongradi, Ioan Sârbu, Irina Mihaela Eṣanu and Alice Nicoleta Azoicăi
Diagnostics 2024, 14(2), 228; https://doi.org/10.3390/diagnostics14020228 - 22 Jan 2024
Viewed by 1178
Abstract
Cystic fibrosis (CF) is primarily known for its pulmonary consequences, which are extensively explored in the existing literature. However, it is noteworthy that individuals with CF commonly display gastrointestinal (G-I) manifestations due to the substantial presence of the cystic fibrosis transmembrane conductance regulator [...] Read more.
Cystic fibrosis (CF) is primarily known for its pulmonary consequences, which are extensively explored in the existing literature. However, it is noteworthy that individuals with CF commonly display gastrointestinal (G-I) manifestations due to the substantial presence of the cystic fibrosis transmembrane conductance regulator (CFTR) protein in the intestinal tract. Recognized as pivotal nonpulmonary aspects of CF, G-I manifestations exhibit a diverse spectrum. Identifying and effectively managing these manifestations are crucial for sustaining health and influencing the overall quality of life for CF patients. This review aims to synthesize existing knowledge, providing a comprehensive overview of the G-I manifestations associated with CF. Each specific G-I manifestation, along with the diagnostic methodologies and therapeutic approaches, is delineated, encompassing the impact of innovative treatments targeting the fundamental effects of CF on the G-I tract. The findings underscore the imperative for prompt diagnosis and meticulous management of G-I manifestations, necessitating a multidisciplinary team approach for optimal care and enhancement of the quality of life for affected individuals. In conclusion, the authors emphasize the urgency for further clinical studies to establish a more robust evidence base for managing G-I symptoms within the context of this chronic disease. Such endeavors are deemed essential for advancing understanding and refining the clinical care of CF patients with G-I manifestations. Full article
(This article belongs to the Special Issue Pediatric Gastrointestinal Diseases: Diagnosis and Management)
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15 pages, 651 KiB  
Review
Impact of Helicobacter pylori Infection upon the Evolution and Outcome of Pediatric Immune Thrombocytopenic Purpura: A Comprehensive Review
by Maria Oana Săsăran, Cristina Oana Mărginean and Ana Maria Koller
Diagnostics 2023, 13(20), 3205; https://doi.org/10.3390/diagnostics13203205 - 13 Oct 2023
Viewed by 1041
Abstract
In adults with immune thrombocytopenic purpura (ITP), the identification of H. pylori infection and its subsequent eradication proved to aid platelet recovery. Similar findings, at a smaller scale, were allegedly reported by some pediatric studies. This review’s objective was to establish the influence [...] Read more.
In adults with immune thrombocytopenic purpura (ITP), the identification of H. pylori infection and its subsequent eradication proved to aid platelet recovery. Similar findings, at a smaller scale, were allegedly reported by some pediatric studies. This review’s objective was to establish the influence of H. pylori infection and its eradication upon platelet count and recovery in pediatric ITP. Three databases, namely Pubmed, Scopus and Web of Science, were searched for pediatric studies which investigated a link between H. pylori infection and thrombocytopenia. The search results retrieved a number of 21 articles which complied to the inclusion and exclusion criteria. Some studies report lower platelet values among children with ITP and documented H. pylori infection, as well as an improve in platelet numbers after H. pylori treatment. However, results are controversial, as multiple authors failed to identify a higher prevalence of H. pylori among children with ITP or a lack of significant change in therapeutic outcome with the addition of an eradication regimen to standard treatment. The main limitations of current pediatric studies remain the small study samples and the short follow-up periods of the included subjects. Hence, the long-term impact of H. pylori in children with ITP is still uncertain. Full article
(This article belongs to the Special Issue Pediatric Gastrointestinal Diseases: Diagnosis and Management)
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15 pages, 517 KiB  
Review
Association between Childhood Onset Inflammatory Bowel Disease and Psychiatric Comorbidities in Adulthood
by Andreea Sălcudean, Andreea Georgiana Nan, Cristina Raluca Bodo, Marius Cătălin Cosma, Elena Gabriela Strete and Maria Melania Lica
Diagnostics 2023, 13(11), 1868; https://doi.org/10.3390/diagnostics13111868 - 26 May 2023
Cited by 3 | Viewed by 1541
Abstract
Inflammatory bowel disease (IBD), which includes Crohn’s disease, ulcerative colitis, and unspecified inflammatory bowel disease, is a chronic, unpredictable and immune-mediated condition of the gastrointestinal tract. In pediatric populations, the diagnosis of a chronic and debilitating pathology significantly reduces quality of life. Children [...] Read more.
Inflammatory bowel disease (IBD), which includes Crohn’s disease, ulcerative colitis, and unspecified inflammatory bowel disease, is a chronic, unpredictable and immune-mediated condition of the gastrointestinal tract. In pediatric populations, the diagnosis of a chronic and debilitating pathology significantly reduces quality of life. Children diagnosed with IBD may cope with physical symptoms such as abdominal pain or fatigue, but mental and emotional well-being are also important for preventing and reducing the risk of developing psychiatric conditions. Short stature, growth delay and delayed puberty can contribute to poor body image and low self-esteem. Furthermore, treatment per se can alter psycho-social functioning due to the side effects of medication and surgical procedures such as colostomy. It is essential to acknowledge and treat early signs and symptoms of psychiatric distress in order to prevent the development of serious psychiatric disorders in adult life. The literature underlines the importance of incorporating psychological and mental health services as part of the management of inflammatory bowel disease. Diagnosing mental health problems in pediatric patients with IBD can improve their adherence to treatment and pathology course and, consequently, reduce long-term morbidity and mortality. Full article
(This article belongs to the Special Issue Pediatric Gastrointestinal Diseases: Diagnosis and Management)
20 pages, 714 KiB  
Review
The Crosstalk between Vitamin D and Pediatric Digestive Disorders
by Cristina Oana Mărginean, Lorena Elena Meliț, Reka Borka Balas, Anca Meda Văsieșiu and Tudor Fleșeriu
Diagnostics 2022, 12(10), 2328; https://doi.org/10.3390/diagnostics12102328 - 27 Sep 2022
Cited by 5 | Viewed by 3396
Abstract
Vitamin D is a cyclopentane polyhydrophenanthrene compound involved mainly in bone health and calcium metabolism but also autophagy, modulation of the gut microbiota, cell proliferation, immune functions and intestinal barrier integrity. The sources of vitamin D include sunlight, diet and vitamin D supplements. [...] Read more.
Vitamin D is a cyclopentane polyhydrophenanthrene compound involved mainly in bone health and calcium metabolism but also autophagy, modulation of the gut microbiota, cell proliferation, immune functions and intestinal barrier integrity. The sources of vitamin D include sunlight, diet and vitamin D supplements. Vitamin D3, the most effective vitamin D isoform is produced in the human epidermis as a result of sunlight exposure. Vitamin D undergoes two hydroxylation reactions in the liver and kidney to reach its active form, 1,25-dihydroxyvitamin D. Recent studies highlighted a complex spectrum of roles regarding the wellbeing of the gastrointestinal tract. Based on its antimicrobial effect, it was recently indicated that vitamin D supplementation in addition to standard eradication therapy might enhance H. pylori eradication rates. Moreover, it was suggested that low levels of vitamin D might also be involved in the acquisition of H. pylori infection. In terms of celiac disease, the negative effects of vitamin D deficiency might begin even during intrauterine life in the setting of maternal deficiency. Moreover, vitamin D is strongly related to the integrity of the gut barrier, which represents the core of the pathophysiology of celiac disease onset, in addition to being correlated with the histological findings of disease severity. The relationship between vitamin D and cystic fibrosis is supported by the involvement of this micronutrient in preserving lung function by clearing airway inflammation and preventing pathogen airway colonization. Moreover, this micronutrient might exert anticatabolic effects in CF patients. Inflammatory bowel disease patients also experience major benefits if they have a sufficient level of circulating vitamin D, proving its involvement in both induction and remission in these patients. The findings regarding the relationship between vitamin D, food allergies, diarrhea and constipation remain controversial, but vitamin D levels should be monitored in these patients in order to avoid hypo- and hypervitaminosis. Further studies are required to fill the remaining gaps in term of the complex impact of vitamin D on gastrointestinal homeostasis. Full article
(This article belongs to the Special Issue Pediatric Gastrointestinal Diseases: Diagnosis and Management)
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