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Dr. Rakesh Middha

MBBS, MD - R & D

Radiologist, Jodhpur

21 Years Experience  ·  300 at clinic  ·  ₹300 online
Dr. Rakesh Middha MBBS, MD - R & D Radiologist, Jodhpur
21 Years Experience  ·  300 at clinic  ·  ₹300 online
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Personal Statement

I'm dedicated to providing optimal health care in a relaxed environment where I treat every patients as if they were my own family....more
I'm dedicated to providing optimal health care in a relaxed environment where I treat every patients as if they were my own family.
More about Dr. Rakesh Middha
He has had many happy patients in his 21 years of journey as a Radiologist. He has done MBBS, MD - R & D . Don’t wait in a queue, book an instant appointment online with Dr. Rakesh Middha on Lybrate.com.

Lybrate.com has a nexus of the most experienced Radiologists in India. You will find Radiologists with more than 43 years of experience on Lybrate.com. You can view profiles of all Radiologists online in Jodhpur. View the profile of medical specialists and their reviews from other patients to make an informed decision.

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Education
MBBS - Bikaner Medical College - 1997
MD - R & D - Bikaner Medical College - 2000

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Nothing posted by this doctor yet. Here are some posts by similar doctors.

I've been suffering from L5-S1 slipped disc from 7 months. I've been doing exercises for it. Now also started strength workout in gym. For betterment of my health I am taking supradyn multivitamins, evion 600 mg, bicasule B complex, and vitamin C limcee 500 mg chewable tablets. I wanted to know for about what period I should/can take limcee tablets?

BPTh/BPT
Physiotherapist, Bangalore
Start physiotherapy asap, vitamin tablets taken temporarily along with physiotherapy, go for protein rich low carb diet, will help your muscles to not to go for fatigue.
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Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

MBBS, MD, FIMSA, FIPP
Pain Management Specialist, Delhi
Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

  • Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
  • Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
  • High risk of primary or consequential damage to neural, bony or disc element
  • Increased wedging, deformity & increase incidence of adjacent VB
  • Chronic pain of altered spine mechanics
  • Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
  • Cost of surgery and hospital treatment
  • Cost of implants
  • Phobia of surgery
  • Prolonged recovery period & Extensive rehabilitation
  • Changed spinal mechanics & transition syndrome
  • Major surgery & anesthesia with its own complications

Results / Outcome

  • PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
  • Different studies show an immediate pain relief in (85 – 90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
  • PVP does augment height of VB but ideal would be kyphoplasty
  • Patient is either off medicine or on reduced doses.
  • Patient feels so well that he almost forgets if he had VB
     

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are  Metastatic VB,  Multiple myeloma VB, VB haemangioma,  Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF)   which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis.  Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient  back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

  • Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
  • Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
  • GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
  • High risk of primary or consequential damage to neural, bony or disc elements.
  • Increased wedging, deformity & increase incidence of adjacent VB
  • Chronic pain of altered spine mechanics.
  • Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.

Morbidity and complication of spinal surgery 

  • Cost of surgery and hospital treatment
  • Cost of implants
  • Phobia of surgery
  • Prolonged recovery period & Extensive rehabilitation
  • Changed spinal mechanics & transition syndrome
  • Major surgery & anesthesia with its own complications

Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

  • Cementing of fragments.
  • Thermal neurolysis of VB nerve ending due to heat of polymerization.
  • Washing away of nociceptor chemicals.
  • Neurolytic action of liquid monomer.
  • By allowing early ambulation decreasing pains of immobility & bed rest.

Complications 

  1. PVP is generally safe with low risk.
  2. Ectopic cement leak is frequent but generally inconsequential.

Outcome 

  1. PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
  2. Different studies show an immediate pain relief in (85 – 90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
  3. PVP does augment height of VB but ideal would be kyphoplasty.
  4. Patient is either off medicine or on reduced doses.
  5. Patient feels so well that he almost forgets if he had VB

In case you have a concern or query you can always consult an expert & get answers to your questions!

4342 people found this helpful

I have a Acl tear in my left knee doctor advised for an operation should I go for it I am a athlete and 21 year old male.

BPT
Physiotherapist, Hyderabad
I have a Acl tear in my left knee doctor advised for an operation should I go for it I am a athlete and 21 year old m...
Hi, we physiotherapist and rehabilitation can restore the knee to a condition close to its pre-injury state and educate the patient on how to prevent instability. This may be supplemented with the use of a hinged knee brace.
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Facts Of Human Brain

MBBS,CCA,DCA,AASECT,FPA,AAD,F.H.R.SM.I.M.S
General Physician, Bangalore
Facts Of Human Brain

The human brain is the most complex and least understood part of the human anatomy. There may be a lot we don’t know, but here are a few interesting facts that we’ve got covered.

Nerve impulses to and from the brain travel as fast as 170 miles per hour. Ever wonder how you can react so fast to things around you or why that stubbed toe hurts right away? it’s due to the super-speedy movement of nerve impulses from your brain to the rest of your body and vice versa, bringing reactions at the speed of a high powered luxury sports car.

The brain operates on the same amount of power as 10-watt light bulb. The cartoon image of a light bulb over your head when a great thought occurs isn’t too far off the mark. Your brain generates as much energy as a small light bulb even when you’re sleeping.

The human brain cell can hold 5 times as much information as the encyclopedia britannica. Or any other encyclopedia for that matter. Scientists have yet to settle on a definitive amount, but the storage capacity of the brain in electronic terms is thought to be between 3 or even 1, 000 terabytes. The national archives of britain, containing over 900 years of history, only takes up 70 terabytes, making your brain’s memory power pretty darn impressive.

Your brain uses 20% of the oxygen that enters your bloodstream. The brain only makes up about 2% of our body mass, yet consumes more oxygen than any other organ in the body, making it extremely susceptible to damage related to oxygen deprivation. So breathe deep to keep your brain happy and swimming in oxygenated cells.

The brain is much more active at night than during the day. Logically, you would think that all the moving around, complicated calculations and tasks and general interaction we do on a daily basis during our working hours would take a lot more brain power than, say, lying in bed. Turns out, the opposite is true. When you turn off your brain turns on. Scientists don’t yet know why this is but you can thank the hard work of your brain while you sleep for all those pleasant dreams.

Scientists say the higher your i. q. The more you dream. While this may be true, don’t take it as a sign you’re mentally lacking if you can’t recall your dreams. Most of us don’t remember many of our dreams and the average length of most dreams is only 2-3 seconds–barely long enough to register.

Neurons continue to grow throughout human life. For years scientists and doctors thought that brain and neural tissue couldn’t grow or regenerate. While it doesn’t act in the same manner as tissues in many other parts of the body, neurons can and do grow throughout your life, adding a whole new dimension to the study of the brain and the illnesses that affect it.

Information travels at different speeds within different types of neurons. Not all neurons are the same. There are a few different types within the body and transmission along these different kinds can be as slow as 0.5 meters/sec or as fast as 120 meters/sec.

The brain itself cannot feel pain. While the brain might be the pain center when you cut your finger or burn yourself, the brain itself does not have pain receptors and cannot feel pain. That doesn’t mean your head can’t hurt. The brain is surrounded by loads of tissues, nerves and blood vessels that are plenty receptive to pain and can give you a pounding headache.

80% of the brain is water. Your brain isn’t the firm, gray mass you’ve seen on tv. Living brain tissue is a squishy, pink and jelly-like organ thanks to the loads of blood and high water content of the tissue. So the next time you’re feeling dehydrated get a drink to keep your brain hydrated.

2 people found this helpful

Is ozone therapy is successful in case of slip disc? Surgery would be better or slip disc?

B.P.T, M.P.T(ORTHO), Certification in Gym Instructor & Prenatal and Post natal
Physiotherapist, Gurgaon
Dear sir Surgery is d last option keep it in mind. Ozone therapy results as per our knowledge is 60 to 70percent. You can also try matrix rhythm German therapy you can contact us for further discussion
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Hello doctor. I am I 32 years female and I have slip disc problem from last two years .I have 2 years baby vd normal delivery. I am not able to sleep properly because when I sleep suddenly I awake 2-3 times at night nd I try to sleep again but I sleep after 30 to 40 min. Now I am gaining fat and weight also. I take proper meal and I don't take more junk food also. Please tell me what to do? My all checkup report are normal & thyroid also.

BAMS, MD (Panchkarma)
Ayurveda, Mumbai
Hello doctor. I am I 32 years female and I have slip disc problem from last two years .I have 2 years baby vd normal ...
Hello lybrate user, thanks for writing. If you want fast, permanent weight loss, you can try our research oriented holistic medicines for assures results. You can lose up to 10 kg weight per month, without crush dieting, with out side effect, without gym, without surgery. Tips for you: 1. Eat plenty vegetable and fruits. 2. Drink 9 glass of water per day. 3. Avoid dieting for weight loss. 4. Avoid oily thing. 5. Have 5to 6 servings of food per day. If you have any questions you can contact us by lybrate.
6 people found this helpful

Diet Tips After Kidney Transplant

M.Sc. in Dietetics and Food Service Management , Post Graduate Diploma In Computer Application, P.G.Diploma in Clinical Nutrition & Dietetics , B.Sc.Clinical Nutrition & Dietetics
Dietitian/Nutritionist, Mumbai
Diet Tips After Kidney Transplant

Post kidney transplant, most people have a low immunity due to the powerful medications that are prescribed to avoid rejection of the organ. These medications tend to make the patients more prone to infections and hence, following strict dietary guidelines is necessary to avoid any complication. Also, as most people suffering from kidney failure are diabetic, hypertensive or suffer from heart disease, dietary control is mandatory. Moreover, the use of immunosuppressive drugs can increase your risk of diabetes, hypertension or heart disease. 

#1: eat a protein rich diet

After a kidney transplant, the body requires more proteins to aid in the healing process and improve immunity. This is the reason, why consuming proteins should not be limited. Also, patients who were previously on dialysis had a lower protein intake, post kidney transplant, the consumption of proteins is recommended to be increased. Here are 6 protein sources for vegetarians.


#2: do not eat raw fruits

Intake of raw fruits is not advised as there is a high risk of infection due to raw food. However, you can eat fruits in stewed form as cooking lowers the active bacterial load, thereby lowering your risk of infection.


#3: include curd in your diet

Curd contains good quality protein, which is required for healing post-transplant, hence, curd should be eaten. As far as sour foods like lime and tamarind are concerned, eating them is also okay. But avoid eating grapes as they are known to interact with immune suppressive drugs and hinder healing of the kidney. Also read about 11 diet do’s and don’ts for people with kidney problems.


#4: you need not avoid fruits/ vegetables with seeds

Foods with seeds like tomato, brinjal, ladies finger, guava, watermelon, etc are considered harmless and can be taken after transplant, provided other biochemical parameters like electrolytes and cholesterol are within normal range. Also, ensure that the level of potassium in the blood is within control. However, if you are suffering from kidney stones, it is better to avoid these foods.

#5: you might need to take protein supplements

People who undergo kidney transplants are recommended protein supplements during the initial stage, however, it varies from person to person. In most cases, post kidney transplant, patients recover their appetite, hence there’s no need for any supplements. However, if the patient feels that his protein intake is not optimal, he can continue taking supplements post-transplant, but only after consulting a nephrologist.

Unlike the common misconception that kidney transplant recipients can eat everything after a transplant, you need to follow a disciplined dietary routine with numerous restrictions, depending upon your overall recovery and health. You can start eating out after three to six months of kidney transplantation, as it is the average time taken for the immuno-suppression to be stable and be at a low level. However, raw food, salads, fruits and foods kept open should be strictly avoided, even in general.

2 people found this helpful

I have L4-L5 disc bulge and also sciatic pain ,please can you tell me the treatment.

BHMS
Homeopath, Hooghly
Do regular exercise,,yoga,u need proper homoeopathic treatment if u wants to cure ur problem permanently,,only by proper constitutional homoeopathic treatment can cure this,,with this u need proper homoeopathic treatment
1 person found this helpful
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I am suffering from l5-s6 disc prolapse from a year. Not undergone surgery. Little weight lift becomes problem in next morning. Is there a permanent solution for my problem. Thanks in advance.

Hand Surgery, M.S. (Orthopaedics
Orthopedist, Ahmedabad
Dear well, there is nonoperative treatment which is manipulation of spine, but should be done by a qualified person. There are risks involved and so you need proper evaluation and then I can decide if you are a proper candidate for the same or not.
2 people found this helpful
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Breast Cancer - In A Nutshell

Post Doctoral Research (Ph.D.) (A.M) (Oncology), Integrative Oncology For Physicians (MSKCC, N.Y, USA), Doctor of Natural Medicine (N.D/ N.M.D), PG Diploma In Clinical Counseling, PG Diploma In Oncology & Haematology (A.M), Ayurveda (I) Certification, Clinically Relevant Herb-Drug Interactions (CME) (Cine-Med Inc. USA), Advanced Strategic Management (APSM), B.E (Computer Sc. & Engg.), Certificate Course in Homeopathic Oncology
Alternative Medicine Specialist, Bhubaneswar
Breast Cancer - In A Nutshell

Breast cancer begins when cells in the breast(s) start to grow out of control. It is understood as being the most common cancer, seen predominantly in females, globally. It is reasonably treatable and often curable.

1. Type: Adenocarcinomas constitute more than 95% of breast cancers with infiltrating ductal carcinoma (IDC) being the most common form of invasive breast cancer.

Frequently occurring breast cancers present as one of the following types mainly

1. Ductal Carcinoma In Situ (DCIS): Is the most common type of non-invasive breast cancer and is confined to the milk ducts of the breast. There is no invasion in the basement membrane. Pure DCIS metastasizes rarely. Non comedo cribrioform carcinoma is the most common DCIS found which, when compared to the comedo type, is mostly non-aggressive.

2. Infiltrating Ductal Carcinoma (IDC): Represents majority (about 3/4th) of the breast cancers, and is known to metastasize commonly to bones, lungs and liver.

3. Lobular Carcinoma In Situ (LCIS): Develops in multiple lobules of the breast (bilaterally). LCIS is less commonly seen, compared to DCIS.

4. Infiltrating Lobular Carcinoma (ILC): Represent about a tenth of all breast cancers and tends to metastasize to other regions of the body.

Less commonly occurring breast cancers such as

5. Inflammatory Breast Cancer: Is relatively uncommon and are caused probably owing to viral infections. The breast is warm, red and swollen.

6. Paget’s disease of the nipple: Is a rare form of breast cancer. It begins in the milk ducts and spreads to the nipple and areola.

7. Medullary Carcinoma

8. Mutinous Carcinoma

9. Tubular Carcinoma

10. Phylloides tumor etc all.

2. Gender: Affects the female populace predominantly. However, a small percentage of breast cancer is attributable to the male populace as well.

3. Etiology: No definite cause is known. However, diet, lifestyle, environment, hormonal/ reproductive factors, personal or family history of breast cancer especially in first degree relatives and also any benign breast disease history etc all are known to increase the risk of breast cancers. Specifically, excessive fatty diet, obesity, type 2 diabetes mellitus, benign breast disease, heredity/ inheritance of mutated breast cancer genes 1 (BRCA1) and 2 (BRCA2), smoking, alcohol intake, infertility, estrogen therapy/ hormone replacement therapy (long term) in post menopausal women, delayed age at first pregnancy, nulliparity (not having child), early menstruation, delayed onset of menopause, lactating mothers not breast feeding, exposure to ionizing radiation, sedentary lifestyle, depression, exposure to MMTV virus etc all can potentially increase the risk for breast cancer.

4. Features: Signs & symptoms, of breast cancer, manifest majorly in the following ways

  1. Lump/ nodule in the breast that gets attached to the skin of the breast over time. The lump / nodule could be hard and painless with irregular edges or it could also be soft, rounded, tender and painful.

  2. Enlarged lymph nodes in the axilla which are palpable.

  3. Swelling of whole or a part of a breast. This is even if there is no distinct lump felt.

  4. Retraction or thickening of the nipple(s).

  5. Pain in the breast or nipple.

  6. Discharge from nipple other than breast milk.

  7. Irritation/ scaliness of skin over the breast.

  8. Redness of nipples

  9. Rarely, red, swollen and tender breast.

5. Screening: Is generally recommended for asymptomatic populations goal of which, as usual, is to be able to detect & diagnose breast cancer at an early stage which is potentially curable. It is mostly radiologic with mammography/ USG being instrumental in raising suspicions for further diagnostics (i.e. biopsy) that help detect breast cancer, if any, early.

6. Diagnosis: A self-examination/ clinical exam of the breast(s)/ axilla that reveals a palpable mass prompts the following diagnostics. Abnormal blood test results may be indicative of malignancy, but a follow up imaging/ biopsy is always the gold standard for accurate diagnosis.

  1. Blood: ER/ PR/ HER2/neu, uPA, PAI-1, CA15-3, CA27.29 etc all tumor markers are helpful.
  2. Imaging: Mammography/ USG Scan usually, as relevant. Again, CT Scan of abdomen & pelvis and chest, PET CT scan, bone scan etc all help detect metastasis, if any, for cancers in stage III & above.
  3. Biopsy: either excisional, incisional, fine needle aspiration (FNA) or core biopsy technique, as contextually appropriate, is frequently employed and a histopathological examination (HPE) thereof clinches the diagnosis and the nature of the disease.

7. Treatment: Conventional treatment includes surgery, radiotherapy, hormone therapy/ chemotherapy as deems appropriate. Simultaneously, an adjunctive or integrative naturopathic treatment with suitable complementary & alternative medicines (CAM) too can help improve clinical outcomes and facilitate recovery as would be feasible contextually.

8. Prognosis: Preventive measures, earlier diagnosis and right early treatment is key for an effective therapeutic management & better prognosis. Like most other cancers, the chances of cure for an early stage breast cancer are more. The cure/ recovery chances are influenced by the type, grade, stage of cancer, recurrence and the patient’s general health & vitality etc all. Above-mentioned apart, age, menopause status, lymph node status, ER/ PR/ HER-2/ neu status, size & extent of breast cancer etc all also influence the treatment outlook in breast cancer. The five year survival rate is strongly correlated with the stage of breast cancer.

9. Prevention: Rightly said, prevention is always a better choice. Although genetic risks are difficult to modify, still an increased focus on protective factors and avoidance of the risk factors can be of help. An adherence to a Mediterranean diet, maintaining an ideal body weight and an active lifestyle with due emphasis on regular exercising (for at least 30 minutes daily), de-stressing and relaxation is highly recommended for reducing the risks of breast cancer. A healthy eating plate comprises essentially a low fat diet, fibre rich foods including whole grain cereals, green leafy vegetables cooked using healthy vegetable oils, fresh fruits of all colours as seasonally available and healthy proteins/ fats including fresh fish, poultry, beans, nuts etc all. It is advisable to limit milk/ dairy, preferably of low fat content, to 1 to 2 servings max daily. Although alcohol is optional and is not for everyone, the consumption of the same, if any, has to be strictly in moderation, and is best avoided. Smoking is to be avoided as well. Again, red meat, butter, refined grains, sweets, sugary drinks including carbonated beverages and other high calorie foods etc all, if any, are to be taken sparingly or are best avoided too. Limiting dosage/ duration of hormone therapy, if any, especially to counteract post menopausal symptoms and also avoiding exposure to radiation and environmental pollution can help reduce the risks of breast cancer. Apart from the above-mentioned, for high risk cases, a prophylactic oophorectomy, prophylactic radical mastectomy, long term hormone therapy etc all can help reduce the chances/ risks of developing breast cancer significantly. Breastfeeding is known to confer protection against breast cancer risk too.

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