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Article ; Online: Pyomyoma after caesarean section: a rare entity.

Siwatch, Sujata / Bagga, Rashmi / Singh, Tulika / Khastgir, Gaurav

BMJ case reports

2024 Volume 17, Issue 3

Abstract: Pyomyoma, a rare complication of a myoma undergoing infarction and subsequent infection, may be a diagnostic challenge in patients with unexplained puerperal fever. A woman in her 30s presented with fever and foul-smelling discharge per vaginum, 6 months ...

Abstract	Pyomyoma, a rare complication of a myoma undergoing infarction and subsequent infection, may be a diagnostic challenge in patients with unexplained puerperal fever. A woman in her 30s presented with fever and foul-smelling discharge per vaginum, 6 months after her first caesarean section (CS). She underwent an elective CS for symptomatic placenta praevia at 34 weeks of gestation. Intra-operatively, post-partum haemorrhage was managed with uterotonics and blood transfusions. However, 2 weeks later, she developed a high-grade fever that was non-responsive to parenteral antibiotics. She continued to have intermittent episodes of high-grade fever, which were treated on an outpatient basis. Six months later, she developed purulent vaginal discharge, which grew
MeSH term(s)	Pregnancy ; Humans ; Female ; Cesarean Section/adverse effects ; Cesarean Section/methods ; Leiomyoma/surgery ; Postpartum Period ; Anti-Bacterial Agents/therapeutic use ; Myoma
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2024-03-22
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2023-257190
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Article: Folic Acid Levels During Pregnancy Regulate Trophoblast Invasive Behavior and the Possible Development of Preeclampsia.

Rahat, Beenish / Hamid, Abid / Bagga, Rashmi / Kaur, Jyotdeep

Frontiers in nutrition

2022 Volume 9, Page(s) 847136

Abstract: Background: One of the unique features of placentation is its similarity to tumorigenesis yet being very well regulated. It allows rapid proliferation, migration, and invasion of mononuclear trophoblast cells into the maternal uterus and remodeling the ... ...

Abstract	Background: One of the unique features of placentation is its similarity to tumorigenesis yet being very well regulated. It allows rapid proliferation, migration, and invasion of mononuclear trophoblast cells into the maternal uterus and remodeling the maternal vasculature. This pseudomalignant nature of trophoblastic cells is strictly regulated and its importance becomes evident in abnormal pregnancies that are characterized by aberrant trophoblast proliferation/invasion like preeclampsia. In addition to this, the importance of folic acid supplementation during pregnancy is well documented. We aimed to analyze the molecular and epigenetic regulation of the pseudomalignant nature of placentation Methods: Placental tissue samples were collected from different pregnancies in three different gestational stages. We estimated the impact of folic acid levels on global methylation, Results: Development of preeclampsia was observed to be associated with lower folate levels in placental tissue, higher global methylation level, and higher expression of Conclusion: Lower folic acid levels are associated with preeclampsia development and folic acid supplementation regulates the invasive potential of placental trophoblasts as mediated by various epigenetic changes in the placenta suggesting the protective effect of folic acid against preeclampsia.
Language	English
Publishing date	2022-04-28
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2776676-7
ISSN	2296-861X
ISSN	2296-861X
DOI	10.3389/fnut.2022.847136
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Article: Genital Micro-Organisms in Pregnancy.

Bagga, Rashmi / Arora, Parul

Frontiers in public health

2020 Volume 8, Page(s) 225

Abstract: The microbiome of the female genital tract may undergo changes in pregnancy due to metabolic, endocrinological, and immunological alterations. These dysbiotic states may cause infections which may ascend upwards to the feto-placental unit or may be ... ...

Abstract	The microbiome of the female genital tract may undergo changes in pregnancy due to metabolic, endocrinological, and immunological alterations. These dysbiotic states may cause infections which may ascend upwards to the feto-placental unit or may be seeded hematogenously. These low grade and often low virulent infectious states lead to chronic inflammatory states and maybe associated with adverse maternal and neonatal outcome. Organisms have been isolated from amniotic fluid and placentae from women delivering pre-term; however the possibility of contamination cannot be conclusively ruled out. Common vaginal dysbiotic states often cause symptoms that are overlooked and often untreated. Vulvovaginal Candidiasis (VVC), Bacterial Vaginosis (BV), and Trichomonas Vaginitis (TV) are the commonly occurring dysbiotic states leading to vaginal infective states in pregnancy. With the advent of novel technologies like Next Generation sequencing (NGS), it will soon be possible to comprehensively map the vaginal microbiome and assess the interplay of each microbial state with their effects in pregnancy. This may open new avenues for antibiotic recommendations, probiotics and potential alternate therapies for dysbiotic states leading to pregnancy complications.
MeSH term(s)	Candidiasis, Vulvovaginal ; Dysbiosis ; Female ; Humans ; Pregnancy ; Pregnancy Complications, Infectious ; Prevalence ; Trichomonas Vaginitis ; Vaginosis, Bacterial/diagnosis
Language	English
Publishing date	2020-06-16
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2711781-9
ISSN	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2020.00225
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Article ; Online: Validation of Grobman's graphical nomogram for prediction of vaginal delivery in Indian women with previous caesarean section.

Bhardwaj, Mahak / Gainder, Shalini / Chopra, Seema / Bagga, Rashmi / Saini, Shiv Sajan

European journal of obstetrics & gynecology and reproductive biology: X

2023 Volume 18, Page(s) 100188

Abstract: Purpose: To validate Grobman's nomogram for prediction of trial of labour after caesarean section (TOLAC) success in the Indian population.: Methods: A prospective observational study of women with previous lower segment caesarean sections (LSCS) who ...

Abstract	Purpose: To validate Grobman's nomogram for prediction of trial of labour after caesarean section (TOLAC) success in the Indian population. Methods: A prospective observational study of women with previous lower segment caesarean sections (LSCS) who were admitted for TOLAC between January 2019 and June 2020 at a tertiary care hospital We compared the Grobman's predicted VBAC success probability to the observed VBAC rate in the study population and devised a receiver-operator characteristics (ROC) curve for the nomogram. Results: Among the 124 women with prior LSCS who chose TOLAC and were included in the study, 68 (54.8%) had a successful VBAC and 56 (45.2%) had a failed TOLAC. The mean Grobman's predicted success probability for the cohort was 76.7%, significantly higher in VBAC women versus CS women (80.6% vs. 72.1%; p 0.001). The VBAC rate was 69.1% with a predicted probability of > 75% and only 42.9% with a probability of 50%. Women in the > 75% probability group had a nearly similar observed and predicted VBAC rate (69.1% vs. 86.3%; p = 0.002), and a greater number of women in the 50% probability group had successful VBAC than predicted (42.9% vs. 39.5%; p = 0.018). The area under the ROC curve for the study was 0.703 (95% CI 0.609-0.797; p 0.001). Grobman's nomogram had a sensitivity of 57.35%, a specificity of 82.14%, a positive predictive value (PPV) of 79.59%, and a negative predictive value (NPV) of 61.33% at a predicted probability cut-off of 82.5%. Conclusions: Women who had a higher Grobman's predicted probability had greater VBAC success rates than those with low predicted probability scores. The prediction ability of the nomogram was highly accurate at higher predicted probabilities, and even at lower predicted probabilities, women did have good odds of delivering vaginally.
Language	English
Publishing date	2023-03-30
Publishing country	Netherlands
Document type	Journal Article
ISSN	2590-1613
ISSN (online)	2590-1613
DOI	10.1016/j.eurox.2023.100188
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Article: Effects of the COVID-19 pandemic on post graduate gynecological training and surgical skills: Indian perspective.

Sarkar, Avir / Saha, Pradip Kumar / Bagga, Rashmi

Obstetrics & gynecology science

2021 Volume 64, Issue 5, Page(s) 467–469

Language	English
Publishing date	2021-07-30
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2814367-X
ISSN	2287-8580 ; 2287-8572
ISSN (online)	2287-8580
ISSN	2287-8572
DOI	10.5468/ogs.21208
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Article ; Online: Primary pure large cell neuroendocrine carcinoma of the ovary: histopathologic and immunohistochemical analysis with review of the literature.

Gupta, Parikshaa / Bagga, Rashmi / Rai, Bhavana / Srinivasan, Radhika

International journal of clinical and experimental pathology

2021 Volume 14, Issue 9, Page(s) 1000–1009

Abstract: Background: Primary ovarian large cell neuroendocrine carcinoma (POLNEC) is an extremely rare and highly aggressive malignancy. Establishing a definite diagnosis requires histopathologic examination with immunohistochemical demonstration of ... ...

Abstract	Background: Primary ovarian large cell neuroendocrine carcinoma (POLNEC) is an extremely rare and highly aggressive malignancy. Establishing a definite diagnosis requires histopathologic examination with immunohistochemical demonstration of neuroendocrine differentiation in the tumor cells. The histopathology may overlap with a variety of other ovarian malignancies; however, rendering an accurate diagnosis is essential, owing to the therapeutic and prognostic implications. Case: A 62-year-old, post-menopausal woman presented with complaints of abdominal fullness and dull-aching abdominal pain for the last three months. A pelvic ultrasound revealed the presence of a complex adnexal mass. Serum levels of tumor markers, CA125, carcinoembryonic antigen, alpha-fetoprotein, and beta-human chorionic gonadotropin, were within normal limits. Pelvic magnetic resonance imaging showed a heterogeneous lobulated right adnexal mass measuring 6.7×5.8×5.6 cm, which was T2-hyperintense and T1-hypointense. A provisional diagnosis of ovarian carcinoma was made, and a total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Results: Histopathology showed an organoid and nesting pattern with a focal perivascular arrangement of the tumor cells with large, moderately pleomorphic, round to oval nuclei, granular chromatin, conspicuous nucleoli, and a moderate amount of pale-eosinophilic cytoplasm. Brisk mitosis and lymphovascular space involvement were noted. On immunohistochemistry, the tumor cells showed positivity for chromogranin, synaptophysin, and neuron-specific enolase and were negative for PAX8, WT1, vimentin, and epithelial membrane antigen. p53 showed wild-type, and SMARCB1/INI-1 showed retained nuclear expression. Based on the histopathologic and immunohistochemical features, a final diagnosis of POLNEC was rendered. The patient received 4 cycles of adjuvant chemotherapy and is disease-free, 28 months post-treatment. Conclusions: The present report highlights the characteristic histopathologic and immunohistochemical features of POLCNEC to distinguish it from other clinicopathologic mimics and present a comprehensive review of the published literature of all such cases.
Language	English
Publishing date	2021-09-15
Publishing country	United States
Document type	Case Reports
ZDB-ID	2418306-4
ISSN	1936-2625 ; 1936-2625
ISSN (online)	1936-2625
ISSN	1936-2625
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Article: Lymph node involvement in an ovarian borderline serous tumor: a rare clinicopathologic presentation with management dilemma.

Aggarwal, Divya / Gupta, Parikshaa / Bagga, Rashmi / Srinivasan, Radhika / Das, Chandan Krushna

American journal of translational research

2023 Volume 15, Issue 11, Page(s) 6667–6672

Abstract: Borderline serous tumor (BST), earlier known as atypical proliferative serous tumor, is an ovarian neoplasm of low malignant potential. Extraovarian spread in the form of peritoneal implants is common in these tumors; however, lymph node (LN) involvement ...

Abstract	Borderline serous tumor (BST), earlier known as atypical proliferative serous tumor, is an ovarian neoplasm of low malignant potential. Extraovarian spread in the form of peritoneal implants is common in these tumors; however, lymph node (LN) involvement is infrequent. The prognostic implication of LN involvement in BST is controversial. We present a case of a 25-year-old female presenting with dull-aching abdominal pain in the left iliac fossa for the past 3 years, which was associated with constipation and abdominal bloating. Her serum Cancer antigen 125 (CA125) level was 841.3 units/ml. Pelvic ultrasonography and magnetic resonance imaging showed a large well-defined, solid-cystic, abdominopelvic mass arising from the right ovary, measuring 21×18×10 cm. The left ovary was also solid-cystic and measured 7×4×3 cm. A provisional clinico-radiologic diagnosis of ovarian malignancy was rendered. The patient underwent bilateral salpingo-oophorectomy with omentectomy and right-sided pelvic and para-aortic lymph node dissection. Histopathology revealed bilateral ovarian BST with involvement of pelvic and para-aortic lymph nodes. This was followed by adjuvant chemotherapy (in view of stage IIIA). She is disease-free at 3 years of regular follow-up. The prognosis and management of BST with LN is not yet fully elucidated. Nevertheless, the finding of such an involvement mandates thorough sampling of the primary ovarian tumor to exclude a possibility of low-grade serous carcinoma with LN metastasis.
Language	English
Publishing date	2023-11-15
Publishing country	United States
Document type	Case Reports
ZDB-ID	2471058-1
ISSN	1943-8141
ISSN	1943-8141
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Article ; Online: Expediting labor induction in severe pre-eclampsia by earlier initiation of oxytocin after cervical ripening: A randomized study from India.

Jangra, Himani / Bagga, Rashmi / Kalra, Jasvinder / Jain, Vanita / Saha, Subhas Chandra / Kumar, Praveen

Pregnancy hypertension

2023 Volume 33, Page(s) 1–7

Abstract: Objective: To observe whether induction of labor (IoL) among women with severe pre-eclampsia (PE) can be expedited by initiating oxytocin early (after 6 h) than after 12 h following cervical ripening with a combined method.: Methods: Women with ... ...

Abstract	Objective: To observe whether induction of labor (IoL) among women with severe pre-eclampsia (PE) can be expedited by initiating oxytocin early (after 6 h) than after 12 h following cervical ripening with a combined method. Methods: Women with severe PE and Bishop's < 6 (n = 96) were randomized into two groups. All women received cervical ripening with a combined method (intracervical Foley's plus dinoprostone gel 0.5 mg) following which Group 1 women received oxytocin after 6 h (with Foley's in-situ) and Group 2 after 12 h (after removing Foley's) RESULTS: Majority were nulliparous (63% in group 1 and 77% in group 2) and the mean gestation was similar (35.3 ± 2.98 weeks in group 1 and 35.5 ± 3.09 in group 2). Nearly half the women had partial HELLP/ HELLP (47.9% and 54.1%; in groups 1 and 2, respectively). The induction-delivery interval (IDI) was significantly reduced in group 1 (16 h 6 min vs 22 h 6 min in group 2; p = 0.001). The cesarean section (CS) rate was 37.5% in group 1 and 31.3% in group 2 (p = 0.525), but the study was underpowered to assess this outcome. The neonatal outcome was similar, 92/96 neonates were discharged after a hospital stay of 3-52 days. There were 4 neonatal deaths (1 in group 1 and 3 in group 2) of extreme or very preterm neonates (27-30 + 6 wks) with birth weight of 735-965 gm. Conclusion: Among women with severe PE undergoing IoL, initiating oxytocin 6 h after cervical ripening with a combined method reduced the IDI significantly as compared to initiating it after 12 h, with a similar CS rate and neonatal outcome.
MeSH term(s)	Infant, Newborn ; Pregnancy ; Female ; Humans ; Oxytocin ; Oxytocics ; Cesarean Section ; Cervical Ripening ; Pre-Eclampsia ; HELLP Syndrome ; Labor, Induced ; India
Chemical Substances	Oxytocin (50-56-6) ; Oxytocics
Language	English
Publishing date	2023-05-23
Publishing country	Netherlands
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	2584464-7
ISSN	2210-7797 ; 2210-7789
ISSN (online)	2210-7797
ISSN	2210-7789
DOI	10.1016/j.preghy.2023.05.002
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Article ; Online: Different dietary combinations of folic acid and vitamin B12 in parental diet results in epigenetic reprogramming of IGF2R and KCNQ1OT1 in placenta and fetal tissues in mice.

Mahajan, Aatish / Sapehia, Divika / Bagga, Rashmi / Kaur, Jyotdeep

Molecular reproduction and development

2021 Volume 88, Issue 6, Page(s) 437–458

Abstract: Genomic imprinting is important for mammalian development and its dysregulation can cause various developmental defects and diseases. The study evaluated the effects of different dietary combinations of folic acid and B12 on epigenetic regulation of ... ...

Abstract	Genomic imprinting is important for mammalian development and its dysregulation can cause various developmental defects and diseases. The study evaluated the effects of different dietary combinations of folic acid and B12 on epigenetic regulation of IGF2R and KCNQ1OT1 ncRNA in C57BL/6 mice model. Female mice were fed diets with nine combinations of folic acid and B12 for 4 weeks. They were mated and off-springs born (F1) were continued on the same diet for 6 weeks postweaning and were allowed to mate. The placenta and fetal (F2) tissues were collected at day 20 of gestation. Dietary deficiency of folate (BNFD and BOFD) and B12 (BDFN) with either state of other vitamin or combined deficiency of both vitamins (BDFD) in comparison to BNFN, were overall responsible for reduced expression of IGF2R in the placenta (F1) and the fetal liver (F2) whereas a combination of folate deficiency with different levels of B12 revealed sex-specific differences in kidney and brain. The alterations in the expression of IGF2R caused by folate-deficient conditions (BNFD and BOFD) and both deficient condition (BDFD) was found to be associated with an increase in suppressive histone modifications. Over-supplementation of either folate or B12 or both vitamins in comparison to BNFN, led to increase in expression of IGF2R and KCNQ1OT1 in the placenta and fetal tissues. The increase in the expression of IGF2R caused by folate over-supplementation (BNFO) was associated with decreased DNA methylation in fetal tissues. KCNQ1OT1 noncoding RNA (ncRNA), however, showed upregulation under deficient conditions of folate and B12 only in female fetal tissues which correlated well with hypomethylation observed under these conditions. An epigenetic reprograming of IGF2R and KCNQ1OT1 ncRNA in the offspring was evident upon different dietary combinations of folic acid and B12 in the mice.
MeSH term(s)	Animals ; Body Weight/drug effects ; Brain/embryology ; Brain/metabolism ; Diet ; Dose-Response Relationship, Drug ; Drug Interactions ; Epigenesis, Genetic/drug effects ; Female ; Fetus/drug effects ; Fetus/metabolism ; Folic Acid/administration & dosage ; Folic Acid/blood ; Folic Acid/pharmacology ; Folic Acid Deficiency/genetics ; Folic Acid Deficiency/metabolism ; Gene Expression Regulation, Developmental/drug effects ; Genomic Imprinting ; Homocysteine/blood ; Kidney/embryology ; Kidney/metabolism ; Liver/embryology ; Liver/metabolism ; Male ; Mice ; Placenta/drug effects ; Placenta/metabolism ; Pregnancy ; Pregnancy Complications/genetics ; Pregnancy Complications/metabolism ; RNA, Long Noncoding/genetics ; RNA, Long Noncoding/metabolism ; RNA, Messenger/biosynthesis ; RNA, Messenger/genetics ; Receptor, IGF Type 2/genetics ; Receptor, IGF Type 2/metabolism ; Vitamin B 12/administration & dosage ; Vitamin B 12/blood ; Vitamin B 12/pharmacology ; Vitamin B 12 Deficiency/genetics ; Vitamin B 12 Deficiency/metabolism
Chemical Substances	Igf2r protein, mouse ; KCNQ1OT1 RNA ; RNA, Long Noncoding ; RNA, Messenger ; Receptor, IGF Type 2 ; Homocysteine (0LVT1QZ0BA) ; Folic Acid (935E97BOY8) ; Vitamin B 12 (P6YC3EG204)
Language	English
Publishing date	2021-05-18
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	20321-x
ISSN	1098-2795 ; 1040-452X
ISSN (online)	1098-2795
ISSN	1040-452X
DOI	10.1002/mrd.23477
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Article ; Online: Incidence of Interstitial Alveolar Syndrome on Point-of-Care Lung Ultrasonography in Pre-eclamptic Women With Severe Features: A Prospective Observational Study.

Yagani, Seshagiribabu / Jain, Kajal / Bhatia, Nidhi / Singla, Karan / Bagga, Rashmi / Bahl, Ajay

Anesthesia and analgesia

2023 Volume 137, Issue 6, Page(s) 1158–1166

Abstract: Background: Lung interstitial edema is a clinically silent pathology that develops before overt pulmonary edema among pre-eclamptic women with severe features. Point-of-care lung ultrasonography (LUS) has been suggested as an accessible bedside tool ... ...

Abstract	Background: Lung interstitial edema is a clinically silent pathology that develops before overt pulmonary edema among pre-eclamptic women with severe features. Point-of-care lung ultrasonography (LUS) has been suggested as an accessible bedside tool that may identify lung interstitial edema before developing clinical signs and symptoms. Thus, we planned to use bedside LUS as a diagnostic tool in admitted pre-eclamptic women with severe features, with the aim of identifying alveolar-interstitial fluid, seen as B-lines. Our primary objective was to assess the incidence of interstitial alveolar syndrome on lung ultrasonography. Methods: We conducted a prospective, single-center, observational study on parturients with pre-eclampsia with severe features over a period of 15 months. LUS in 4 intercostal spaces (ICS) was performed on all eligible patients. The number of single or confluent B-lines in each space was recorded by an independent observer. A scoring system was used to grade the lung fluid content based on the number of single and confluent B-lines per ICS, with scores ranging from 0 to 32 (low, 0-10; moderate, 11-20; and high, 21+). The incidence of B-lines at admission and before and after delivery was calculated. In addition, bedside 2D echocardiography was performed to assess left ventricular systolic and diastolic function. Any correlation between presence of B-lines on LUS and blood pressure, clinical symptoms, or echocardiography findings was assessed. Results: Seventy patients were enrolled in the study. On LUS, B-lines were seen in 64.3% patients at admission (45/70 vs 25/70 without B-lines; P = .02), 65.7% patients before delivery (46/70 vs 24/70 without B-lines; P = .01), and 58.6% patients 24 hours postpartum (41/70 versus 29/70 without B-lines; P = .15). Nearly all patients (94.3%) exhibited low to moderate severity of pulmonary fluid burden at admission. Echocardiography revealed diastolic dysfunction in 47.1% (n = 33/70) patients with associated B-lines in the majority (n = 32/33). The total B-line score and E/e' ratio among patients with diastolic dysfunction was found to be strongly correlated (r = 0.848; P < .001). All pre-eclamptic women with presence of breathlessness (11/11; 100%) and facial puffiness (16/16; 100%) on admission had B-lines on LUS. Conclusions: We conclude that ultrasonographic pulmonary interstitial syndrome is present in more than half of the women with pre-eclampsia with severe features and correlates with diastolic dysfunction, high blood pressure records, and acute-onset breathlessness.
MeSH term(s)	Pregnancy ; Humans ; Female ; Prospective Studies ; Point-of-Care Systems ; Pre-Eclampsia/diagnostic imaging ; Pre-Eclampsia/epidemiology ; Incidence ; Ultrasonography ; Lung/diagnostic imaging ; Pulmonary Edema/diagnostic imaging ; Pulmonary Edema/epidemiology ; Edema ; Dyspnea
Language	English
Publishing date	2023-01-20
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	80032-6
ISSN	1526-7598 ; 0003-2999
ISSN (online)	1526-7598
ISSN	0003-2999
DOI	10.1213/ANE.0000000000006367
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