June 2013 References  Devin J. Starlanyl   for http://www.sover.net/~devstar

Bertolucci PH, de Oliveira FF. 2013. Cognitive impairment in fibromyalgia. Curr Pain Headache Rep. 17(7):344. “Cognitive and behavioral impairments are core manifestations of fibromyalgia and may be more disabling than pain itself. Involvement of the central nervous system is ascertained by the fact that frontoparietal and limbic cortices are often functionally and structurally affected along the course of this disease. Even though neuroimaging has brought some experimental evidence to support such network disruption, there are currently no clinically effective biomarkers that detect and quantify cognitive and behavioral disturbances in fibromyalgia; thus, traditional scales and tests of neuropsychiatric assessment remain the most important diagnostic tools. This review addresses the most common cognitive and behavioral impairments in people with fibromyalgia, while explaining their pathophysiological basis and currently available therapeutic options.”

Boldingh MI, Ljostad U, Mygland A et al. 2013. Comparison of interictal vestibular function in vestibular migraine vs. migraine without vertigo. Headache. [May 15 Epub ahead of print]. This study found vestibular abnormalities in all migraine patients tested. 


Buchmann J, Neustadt B, Buchmann-Barthel K et al. 2013. Objective measurement of tissue tension in myofascial trigger point areas before and during the administration of anesthesia with complete blocking of neuromuscular transmission. Clin J Pain. [May 17 Epub ahead of print]. Target muscles with TrPs (temporalis, upper trapezius, and extensor carpi radialis longus) and a control without TrPs were measured in 62 patients pre-surgery after anesthesia.  They found that increased muscle tension in the TrPs, rather than primary local inflammation with enhanced viscoelasticity.  They concluded that increased muscular tension in the taut band of the TrPs was due to increased spinal excitability, and recommend postisometric relaxation as a TrP therapy.

Chen KH, Hsiao KY, Lin CH et al. 2013. Remote effect of lower limb acupuncture on latent myofascial trigger point of upper trapezius muscle: a pilot study. Evid Based Complement Alternat Med. [Apr 28 Epub ahead of print]. “To demonstrate the use of acupuncture in the lower limbs to treat myofascial pain of the upper trapezius muscles via a remote effect…Five adults with latent myofascial trigger points (MTrPs) of bilateral upper trapezius muscles received acupuncture at Weizhong (UB40) and Yanglingquan (GB34) points in the lower limbs. Modified acupuncture was applied at these points on a randomly selected ipsilateral lower limb (experimental side) versus sham needling on the contralateral lower limb (control side) in each subject. Each subject received two treatments within a one-week interval. To evaluate the remote effect of acupuncture, the range of motion (ROM) upon bending the contralateral side of the cervical spine was assessed before and after each treatment….There was significant improvement in cervical ROM after the second treatment (P = 0.03) in the experimental group, and the increased ROM on the modified acupuncture side was greater compared to the sham needling side (P = 0.036). Conclusions: A remote effect of acupuncture was demonstrated in this pilot study. Using modified acupuncture needling at remote acupuncture points in the ipsilateral lower limb, our treatments released tightness due to latent MTrPs of the upper trapezius muscle.”

Close J. 2012. Are stress responses to geomagnetic storms mediated by the cryptochrome compass system? Proc Biol Sci 279(1736):2081-2090.  The cryptochrome compass system may be at least one of the geomagnetic response systems.  This system may affect hypothalamic-pituitary-adrenal (HPA) axis responses, including changes in circadian cycle, to the geomagnetic field.  The magnetosence is mediated by the HPA axis in migratory animals.  Vestibular system derived gravitational cues interact with the magnetosence to help migrating animals.  When the vestibular system is hyperstimulated, it stimulates a corresponding an acute stress response across the HPA axis. In rats, this also disturbs spatial sense. Humans were nomadic, migrating animals.  If the geomagnetic sense can interact with hormonal systems, it could provoke a general stress response. Geomagnetic effects are complex, and integrated with multiple response systems. The cryptochrome acts as geomagnetic compass in migrating animals, as well as modulator of circadian oscillation. Several studies have revealed a relationship between light exposure and geomagnetic and human-generated magnetic fields.  [We do not yet know the effects of geomagnetic storms on humans, especially those with disrupted HPA axes, such as FM patients.  If these patients also have vestibular dysfunction and optic dysfunction, the effects could be significant.  The interactions would be extremely complex, with a wide number of variables, and we as yet cannot test for this. DJS]


Cohen AH. 2013. Vision rehabilitation for visual-vestibular dysfunction: The role of the neuro-optometrist. NeuroRehabilitation. 32(3):483-492. “Dizziness, balance problems and the sensation that the space world is moving (vertigo) are one of the most commonly reported problems in general medical practice. Persons with a central nervous system injury or other idiopathic causes of visual processing problems or who have functional vision problems that are not adequately managed, often experience extreme difficulty with balance and movement, as well as with their perception of space. Consequently, the patient often experiences difficulty functioning in an environment with excessive visual stimulation such as a grocery store or shopping mall….The combination of neuro-optometric rehabilitative therapy and balance therapy will result is an effective treatment for reducing or resolving these symptoms.”

Davis MC, Zautra AJ. 2013. An online mindfulness intervention targeting socioemotional regulation in fibromyalgia: Results of a randomized controlled trial. Ann Behav Med. [May 14 Epub ahead of print]. “FM patients experience increases in self-efficacy for coping with pain and positive engagement in relationships, marginal increases in positive affect, and decreases in relationship stress from an automated online intervention that targets socioemotional regulation skills. Findings highlight the potential utility of widely accessible, low-cost intervention methods for fibromyalgia.”

Desai MJ, Shkolnikova T, Nava A et al. 2013. A critical appraisal of the evidence for botulinum toxin Type A in the treatment for cervico-thoracic myofascial pain syndrome. Pain Pract. [May 21 Epub ahead of print]. “Myofascial pain syndrome (MPS) is a musculoskeletal condition characterized by regional pain and muscle tenderness associated with the presence of myofascial trigger points (MTrPs). The last decade has seen an exponential increase in the use of botulinum toxin (BTX) to treat MPS. To understand the medical evidence substantiating the role of therapeutic BTX injections and to provide useful information for the medical practitioner, we applied the principles of evidence-based medicine to the treatment for cervico-thoracic MPS. A search was conducted through MEDLINE (PubMed, OVID, MDConsult), EMBASE, SCOPUS and the Cochrane database for the period 1966 to 2012 using the following keywords: myofascial pain, muscle pain, botulinum toxin, trigger points, and injections. A total of 7 trials satisfied our inclusion criteria and were evaluated in this review. Although the majority of studies found negative results, our analysis identified Gobel et al's as the highest quality study among these prospectively randomized investigations. This was due to appropriate identification of diagnostic criteria, excellent study design and objective endpoints. The 6 other identified studies had significant failings due to deficiencies in 1 or more major criteria. We conclude that higher quality, rigorously standardized studies are needed to more appropriately investigate this promising treatment modality.” [This study pointed out that there is a lot of sloppy research out there.  A study of myofascial trigger points must define criteria used to identify those TrPs. DJS]

Geib RW, Roberts BL, Li H et al. 2013. Using posturography to assess expertise among tai chi practitioners – biomed.  Biomed Sci Instrum. 49:195-200. “While standing, participants performed a series of movements from the Tai Chi for Arthritis form based on Sun style (commencement, open/close, single whip and wave hands in cloud). Master trainers and senior trainers were considered experts; all others were considered non-experts. Body sway was assessed....While standing, the experts displayed statistically greater displacement excursion and velocity when performing commencement and wave hands in clouds forms. The results of this pilot study indicated that posturography may be a useful method to assess the quality of Tai Chi movements and potentially link the expertise of Tai Chi practitioners to changes in health related outcomes.”

Hauser W, Galek A, Erbsloh-Moller B et al. 2013. Posttraumatic stress disorder in fibromyalgia syndrome: Prevalence, temporal relationship between posttraumatic stress and fibromyalgia symptoms, and impact on clinical outcome. Pain. [Apr 2 Epub ahead of print]. “FMS and PTSD are linked in several ways: PTSD is a potential risk factor of FMS and vice versa. FMS and PTSD are comorbid conditions because they are associated with common antecedent traumatic experiences.” [This paper highlights another set of interactive diagnoses. DJS]

Hocking MJ. 2013. Exploring the central modulation hypothesis: do ancient memory mechanisms underlie the pathophysiology of trigger points? Curr Pain Headache Rep. 17(7):347. The author proposes that central nervous system-maintained global changes in alpha-motorneuron function, resulting from sustained plateau polarization, rather than local dysfunction of the motor endplate, underlie the pathogenesis of TrPs.

Jiang GM, Lin MD, Wang LY. 2013. [Comparative study on effect of acupuncture and lidocaine block for lumbar myofascial pain syndrome]. Zhongguo Zhen Jiu. 33(3):223-226. [Article in Chinese] “To observe the clinical efficacy of acupuncture at Jiaji (EX-B 2) points mainly for lumbar myofascial pain syndrome (MPS)….Sixty-six cases of MPS were randomized into an acupuncture group and a lidocaine group, 33 cases in each group. The acupuncture group was treated with acupuncture at Jiaji (EX-B 2) points combined with needling local myofascial trigger points (MTrP), and the lidocaine group was treated with local block at trigger points with lidocaine injection. The treatment was given once every 2 days. After three and five times of the treatment, the simplified McGill scale, Oswestry disability index (ODI) and pressure-pain threshold were assessed to compare the therapeutic effects between the two groups…Acupuncture at Jiaji (EX-B 2) points combined with needling MTrP is an effective and safe therapy for lumbar MPS, the therapeutic effect is equal to lidocaine block.”

Johnson M, Collett B, Castro-Lopes JM. 2013. The challenges of pain management in primary care: a pan-European survey. J Pain Res. 6:393-401. “A survey was conducted to assess the challenges of chronic nonmalignant pain (CNMP) management in primary care in Europe, focusing particularly on pain assessment, opioid therapy, and educational needs….These findings reveal that PCPs (Primary Care Physicians) in Europe find CNMP a challenge to treat. Areas to address with training include underuse of pain assessment tools and lack of confidence in use of opioid therapy. Guidelines on CNMP management in primary care would be welcomed.”

Kim J, Loggia ML, Edwards RR et al. 2013. Sustained deep-tissue pain alters functional brain connectivity. Pain. [Apr 11 Epub ahead of print].  “Recent functional brain connectivity studies have contributed to our understanding of the neurocircuitry supporting pain perception. However, evoked-pain connectivity studies have employed cutaneous and/or brief stimuli, which induce sensations that differ appreciably from the clinical pain experience. Sustained myofascial pain evoked by pressure cuff affords an excellent opportunity to evaluate functional connectivity change to more clinically relevant sustained deep-tissue pain. Connectivity in specific networks known to be modulated by evoked pain (sensorimotor, salience, dorsal attention, frontoparietal control, and default mode networks: SMN, SLN, DAN, FCN, and DMN) was evaluated with functional-connectivity magnetic resonance imaging, both at rest and during a sustained (6-minute) pain state in healthy adults. We found that pain was stable, with no significant changes of subjects' pain ratings over the stimulation period. Sustained pain reduced connectivity between the SMN and the contralateral leg primary sensorimotor (S1/M1) representation. Such SMN-S1/M1 connectivity decreases were also accompanied by and correlated with increased SLN-S1/M1 connectivity, suggesting recruitment of activated S1/M1 from SMN to SLN. Sustained pain also increased DAN connectivity to pain processing regions such as mid-cingulate cortex, posterior insula, and putamen. Moreover, greater connectivity during pain between contralateral S1/M1 and posterior insula, thalamus, putamen, and amygdala was associated with lower cuff pressures needed to reach the targeted pain sensation. These results demonstrate that sustained pain disrupts resting S1/M1 connectivity by shifting it to a network known to process stimulus salience. Furthermore, increased connectivity between S1/M1 and both sensory and affective processing areas may be an important contribution to interindividual differences in pain sensitivity.”

Kosharskyy B, Almonte W, Shaparin N et al. 2013. Intravenous infusions in chronic pain management. Pain Physician. 16(3):231-249. “In the United States, millions of Americans are affected by chronic pain, which adds heavily to national rates of morbidity, mortality, and disability, with an ever-increasing prevalence. According to a 2011 report titled Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research by the Institute of Medicine of the National Academies, pain not only exacts its toll on people's lives but also on the economy with an estimated annual economic cost of at least $560 - 635 billion in health care costs and the cost of lost productivity attributed to chronic pain. Intravenous infusions of certain pharmacologic agents have been known to provide substantial pain relief in patients with various chronic painful conditions. …This article will focus on non-opiate intravenous infusions (lidocaine, ketamine, phentolamine, dexmedetomidine, and bisphosphonates) that have been utilized for chronic painful disorders such as fibromyalgia, neuropathic pain, phantom limb pain, post-herpetic neuralgia, complex regional pain syndromes (CRPS), diabetic neuropathy, and central pain related to stroke or spinal cord injuries.”

Lewis RF, Haburcakova C, Gong W et al. 2013. Electrical stimulation of semicircular canal afferents affects the perception of head orientation. J Neurosci. 33(22):9530-9535. “Patients with vestibular dysfunction have visual, perceptual, and postural deficits.  ...These results demonstrate that electrical stimulation of canal afferents affects the perception of head orientation, and therefore suggest that motion-modulated stimulation of canal afferents by a vestibular prosthesis could potentially improve vestibular percepts in patients lacking normal vestibular function.” [Note: this small study was done in rhesus monkeys.  DJS]

Lovati C, Mariotti C, Giani L et al. 2013. Central sensitization in photophobic and non-photophobic migraineurs: possible role of retino nuclear way in the central sensitization process. Neurol Sci. 34 Suppl 1:133-135. “Overall, these findings suggest that light stimulation may contribute to central sensitization of pain pathways in migraineurs, possibly contributing to progression into chronic forms. The possible connections underlying this type of sensitization are offered by the recently published data on a non-image-forming visual retino-thalamo-cortical pathway which may allow photic signals to converge on a thalamic region which is selectively activated during migraine headache.”

Marcus NJ, Shrikhande AA, McCarberg B et al. 2013. A preliminary study to determine if a muscle pain protocol can produce long-term relief in chronic back pain patients. Pain Med. [May 20 Epub ahead of print]. This study was done on patients with neuraxal low back pain, testing before and after invasive treatments.  They used an electrical device to find possible sources of pain, rather than palpation.  The study found that identifying and treating painful muscles produced significantly lasting reductions in pain as well as function improvement.  Some patients cancelled their surgeries. Others had failed back surgery, failed epidural steroid injections, and/or TrP injections.  With treatment of muscle and tendon pain generator, their pain was significantly relieved using this muscle protocol.  Both the muscles and their tendon attachments were critical pain generators. 


Melnick MD, Harrison BR, Park S et al. 2013. A strong interactive link between sensory discriminations and intelligence. Curr Biol. [May 22 Epub ahead of print]. This study linked intelligence (IQ) with the ability to filter out less relevant low-level stimuli. “We conjecture that the ability to suppress irrelevant and rapidly process relevant information fundamentally constrains both sensory discriminations and intelligence, providing an information-processing basis for the observed link.”  [Fibromyalgia has been shown in research to suppress the normal filtering of information.  This contributes to what amounts to constant sensory overload.  The central nervous system is overwhelmed by stimuli, keeping the CNS hypersensitized and preoccupied.  DJS]

Oh S, Kim HK, Kwak J et al. 2013. Causes of hand tingling in visual display terminal workers. Ann Rehabil Med. 37(2):221-228. “To offer the basic data about the causes and distribution of hand tingling, symptoms and physical findings, and pressure pain threshold in desk workers… Five physiatrists participated in the screening test composed of history and physical examination. A total of 876 desk workers were evaluated and of them 37 subjects with hand tingling were selected. For further analyzing, detailed history taking and meticulous physical examination were taken. Pressure pain threshold (PPT) at the infraspinatus, upper trapezius, flexor carpi radialis, rhomboideus, and flexor pollicis longus were examined. PPT measurements were repeated three times with two minute intervals by a pressure algometer. Electrodiagnostic study was done to detect potential neurologic abnormalities….THE CAUSES OF HAND TINGLING IN ORDER OF FREQUENCY WERE: myofascial pain syndrome, 68%; cervical radiculopathy, 27%; rotator cuff syndrome, 11%; tenosynovitis, 8%; and carpal tunnel syndrome, 5%. The location of trigger points in the myofascial pain syndrome, which were proven to evoke a tingling sensation to the hand in order of frequency were: infraspinatus, 65.4%; upper trapezius, 57.7%; flexor carpi radialis, 38.5%; rhomboideus 15.4%; and flexor pollicis longus 11.5%. The PPT of the affected side was significantly lower than that of the unaffected side in myofascial pain syndrome (p<0.05)…The most common cause of hand tingling in desk workers was myofascial pain syndrome rather than carpal tunnel syndrome. Common trigger points to evoke hand tingling were in the infraspinatus and upper trapezius.”

Rowe PC, Fontaine KR, Violand RL. 2013. Neuromuscular strain as a contributor to cognitive and other symptoms in chronic fatigue syndrome: hypothesis and conceptual model. Front Physiol. 4:115. “Individuals with chronic fatigue syndrome (CFS) have heightened sensitivity and increased symptoms following various physiologic challenges, such as orthostatic stress, physical exercise, and cognitive challenges. Similar heightened sensitivity to the same stressors in fibromyalgia (FM) has led investigators to propose that these findings reflect a state of central sensitivity. A large body of evidence supports the concept of central sensitivity in FM. A more modest literature provides partial support for this model in CFS, particularly with regard to pain. Nonetheless, fatigue and cognitive dysfunction have not been explained by the central sensitivity data thus far. Peripheral factors have attracted attention recently as contributors to central sensitivity. Work by Brieg, Sunderland, and others has emphasized the ability of the nervous system to undergo accommodative changes in length in response to the range of limb and trunk movements carried out during daily activity. If that ability to elongate is impaired-due to movement restrictions in tissues adjacent to nerves, or due to swelling or adhesions within the nerve itself-the result is an increase in mechanical tension within the nerve. This adverse neural tension, also termed neurodynamic dysfunction, is thought to contribute to pain and other symptoms through a variety of mechanisms. These include mechanical sensitization and altered nociceptive signaling, altered proprioception, adverse patterns of muscle recruitment and force of muscle contraction, reduced intra-neural blood flow, and release of inflammatory neuropeptides. Because it is not possible to differentiate completely between adverse neural tension and strain in muscles, fascia, and other soft tissues, we use the more general term "neuromuscular strain." In our clinical work, we have found that neuromuscular restrictions are common in CFS, and that many symptoms of CFS can be reproduced by selectively adding neuromuscular strain during the examination. In this paper we submit that neuromuscular strain is a previously unappreciated peripheral source of sensitizing input to the nervous system, and that it contributes to the pathogenesis of CFS symptoms, including cognitive dysfunction.” [This is an interesting paper indicating that perhaps trigger points may be common in CFS, as they are in FM. DJS]

Schleip R. 2003. Fascial plasticityundefineda new neurobiological explanation: Part I. J Bdywrk Move Ther 7(1):11-19.  This article explains some of the mechanisms that may be involved during myofascial release of tight tissues.  The fascia and the nervous system are interconnected, and the response of the tissue to bodywork may be more due to its effects on the nervous system self-regulatory mechanisms than  on biophysics.  Fascia holds a great number of mechanoreceptors sensitive to pressure, and manual therapy can cause these to soften tissues and relax the tension of the sympathetic nervous system.  This article stresses the importance of the myotendinous junctions and the tendons themselves.  Golgi receptors, arranged in series with fascial fibers, respond to slow stretch  by communicating  through the spinal cord with the alpha motor neurons, getting the to lower their firing rate.  This can soften the related muscle fibers.  90% of the Golgi receptors found in dense connective tissue lives in myotendinous junctions, other attachments, joint capsules, and peripheral joint ligaments.  This article covers information on the interstitial (Types III and IV) receptor fibers, the most numerous.  Most of them have autonomic functions. Interstitial, diffuse swelling is often seen in fibromyalgia and insulin resistance.  “While many of the nerve fibers in a typical motor nerve have a vasomotor function, which regulates blood flow, the largest group of these fibers are sensory nerves.”  Some kinds of interstitial receptors are both high pressure sensitive and pain receptors. When pain and its resultant biochemical changes surround these receptors, they will fire in a strong and chronic manner, leading to pain without mechanical irritation.  [This may explain some of the autonomic effects associated with myofascia trigger points. DJS]

Schleip R. 2003. Fascial plasticityundefineda new neurobiological explanation: Part I. J Bdywrk Move Ther ):7(2)104-116. This article explains how mechanical stimulation of fascial receptors can change the viscosity of the ground substance.  The widespread network of interfascial autonomic nerves and sensory nerve endings and capillaries. There are also smooth muscle cells imbedded within fascia that likely are involved in setting up tension states in the fascia. “With fibromyalgia the main understanding has been that the pain receptors are in the muscle tissue.  Yet now we know that there are many sensory receptors, including pain receptors in fascia, which points our attention to fibromyalgia, as well as many other kinds of soft-tissue pain syndromes to a much higher value of therapeutic interventions in the fascia itself….Any intervention on the fascia is also an intervention on the autonomic system. “


Tu CH, Niddam DM, Yeh TC et al. 2013. Menstrual pain is associated with rapid structural alterations in the brain. Pain. [May 18 Epub ahead of print].  “Dysmenorrhea is the most prevalent gynecological disorder for women in the childbearing age. Dysmenorrhea is associated with central sensitization and functional and structural changes in the brain. Our recent brain morphometry study disclosed that dysmenorrhea is associated with trait-related abnormal gray matter (GM) changes even in the absence of menstrual pain, indicating that the adolescent brain is vulnerable to menstrual pain. Here we report rapid state-related brain morphological changes, i.e. between pain and pain-free states, in dysmenorrhea. We used T1-weighted anatomical magnetic resonance imaging to investigate regional GM volume changes between menstruation and peri-ovulatory phases, in 32 dysmenorrhea subjects and 32 age- and menstrual cycle-matched asymptomatic controls. An optimized voxel-based morphometry analysis was conducted to disclose the possible state-related regional GM volume changes across different menstrual phases. A correlation analysis was also conducted between GM differences and the current menstrual pain experience in the dysmenorrhea group. Compared to the peri-ovulatory phase, the dysmenorrhea subjects revealed greater hypertrophic GM changes than controls during the menstruation phase in regions involved in pain modulation, generation of the affective experience and regulation of endocrine function while atrophic GM changes were found in regions associated with pain transmission. Volume changes in regions involved in regulation of endocrine function and pain transmission correlated with the menstrual pain experience scores. Our results demonstrated that short-lasting cyclic menstrual pain is associated not only with trait-related but also rapid state-related structural alterations in the brain. Considering the high prevalence rate of menstrual pain, these findings mandate a great demand to revisit dysmenorrhea regarding its impact on the brain and other clinical pain conditions.”


Turo D, Otto P, Gebreab T et al. 2013. Shear wave elastography for characterizing muscle tissue in myofascial pain syndrome. J Acoust Soc Am. 133(5):3358. “Myofascial pain syndrome (MPS) affects 85% of chronic pain sufferers in a specialty pain center. Neck and low-back are commonly affected by MPS. Myofascial trigger points (MTrPs) are characteristic findings of MPS and are palpable tender nodules in the muscles of symptomatic subjects. Mechanical characterization of MTrPs and surrounding tissue can offer important insight about the pathophysiology of the MPS, which is currently poorly understood. In this study, we propose an inexpensive technique, based on ultrasound shear wave elastography, to objectively measure mechanical properties of MTrPs and surrounding tissue in the upper trapezius. In an ongoing clinical study, we recruited 34 subjects: 12 healthy controls, 10 with not spontaneously painful MTrPs (latent) and 12 with symptomatic chronic neck pain (>3 months) and active (spontaneously painful) MTrPs. Shear wave elastography was performed on the upper trapezius of all subjects using the Ultrasonix RP system and an external vibrator. Voigt's model was used to estimate shear modulus G and viscosity μ of the interrogated tissue. Preliminary analysis demonstrates that symptomatic muscle tissue in subjects with neck pain is stiffer …compared to muscle in control subjects… and that active MTrPs are more viscous …than surrounding tissue…. Latent MTrPs …and surrounding tissue … are more viscous than normal tissue ….”

Yigit S, Inanir A, Tekcan A et al. 2013. Association between fibromyalgia syndrome and polymorphism of the IL-4 gene in a Turkish population. Gene. [May 2 Epub ahead of print]. “Our findings suggest that there is an association of IL-4 gene 70bp VNTR polymorphism with susceptibility of a person for development of FM. As a result, further studies are necessary to determine whether IL-4 may be a genetic marker for FM in the Turkish population.”

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