This document summarizes recent research on the pathogenesis of minimal change nephrotic syndrome (MCNS). It discusses how MCNS was originally considered a disorder of T-cell function resulting in a circulating factor that increases glomerular permeability. While several candidate factors have been proposed, including various cytokines, none have been conclusively identified. Recent evidence suggests both immune cells like T cells and regulatory T cells, as well as podocytes, play a role in pathogenesis. The candidate molecules mediating steroid-dependent MCNS include CD80, hemopexin, and angiopoietin-like 4. The "two-hit" hypothesis proposes CD80 expression on podocytes and ineffective inhibition of podocyte CD80 by regulatory
This document discusses disseminated intravascular coagulation (CID), providing definitions, pathophysiology, risk factors, signs and symptoms, treatment options, and examples of research articles on the topic. Specifically, it defines CID as an alteration in coagulation factor V and VII that results in the excessive production of small blood clots within blood vessels. This causes thrombi to form in small blood vessels throughout the peripheral parts of the body. Risk factors include bacteria, viruses, and congenital factors. Signs may include purpura, microangiopathy, and cardiac congestion. Treatment involves blood transfusions, anticoagulants, and plasmapheresis. Examples of relevant research articles are also provided.
1. Periodontal medicine is a branch of periodontology that focuses on the relationship between periodontal health and systemic health. Periodontal disease can influence systemic health and vice versa through direct and indirect mechanisms.
2. Periodontal disease is associated with increased risk of adverse pregnancy outcomes like preterm birth and low birth weight. Factors like infection and inflammation are believed to contribute to the onset of preterm labor.
3. Periodontal disease is also linked to increased risk of diabetes and difficulty in controlling blood glucose levels. The chronic inflammatory response associated with periodontal infection contributes to insulin resistance. Periodontal treatment may help in improving glycemic control in diabetic patients.
ALTERACIONES EN LA DISFUNCION MULTIORGANICA.pdfzaragalicia
Sepsis is a life-threatening condition defined as organ dysfunction caused by a dysregulated immune response to infection. The immune response causes widespread vascular and microcirculatory dysfunction that leads to global hypoperfusion and injury of multiple organs. This results in organ failures of the kidneys, liver, lungs, heart, brain, and blood system - known as multiple organ failure - which determines whether the patient recovers or dies from the infection. While early treatment of the infection and restoring circulation are important, sepsis has heterogeneous pathophysiology that has made directly intervening on its mechanisms unsuccessful. Improved public health strategies and novel technologies are needed to better treat sepsis and reduce its high global burden.
Periodontal medicine is a branch of periodontology that focuses on the relationship between periodontal health/disease and systemic health/disease. Periodontal disease can influence systemic health through direct effects of bacteria or indirect host-mediated inflammatory responses. Common risk factors for periodontitis and systemic diseases like cardiovascular disease and diabetes include smoking and genetic factors. Periodontitis is associated with increased risk of atherosclerosis, myocardial infarction, and stroke potentially through elevated inflammatory markers and direct bacterial effects.
Periodontal disease has a two-way relationship with systemic health conditions. It can influence systemic health while certain systemic conditions can also increase susceptibility to periodontal disease. Periodontal disease is associated with increased risk of cardiovascular disease, cerebrovascular accidents, diabetes and other conditions. Potential mechanisms include direct effects of periodontal pathogens, host inflammatory responses, common risk factors and genetic predispositions. Periodontitis may enhance atherosclerosis through direct bacterial effects, increased inflammatory markers, platelet aggregation and other indirect host responses.
Periodontal medicine is a branch of periodontology that focuses on the relationship between periodontal health/disease and systemic health/disease. Periodontal disease can influence systemic health through direct effects of infectious agents or indirect host-mediated inflammatory responses. Periodontal disease has been linked to increased risk of cardiovascular disease, diabetes, and preterm low birth weight. Treatment of periodontal infection may help reduce systemic inflammation and improve conditions like diabetes and cardiovascular disease.
Periodontal medicine is the study of the relationship between periodontal health and systemic health. Periodontal disease can influence systemic health through direct effects of bacteria or indirect host-mediated inflammatory responses. Periodontitis has been linked to increased risk of cardiovascular disease, diabetes, and preterm low birth weight. Treatment of periodontal infection may help improve glycemic control in diabetic patients and reduce systemic inflammation.
This document discusses disseminated intravascular coagulation (CID), providing definitions, pathophysiology, risk factors, signs and symptoms, treatment options, and examples of research articles on the topic. Specifically, it defines CID as an alteration in coagulation factor V and VII that results in the excessive production of small blood clots within blood vessels. This causes thrombi to form in small blood vessels throughout the peripheral parts of the body. Risk factors include bacteria, viruses, and congenital factors. Signs may include purpura, microangiopathy, and cardiac congestion. Treatment involves blood transfusions, anticoagulants, and plasmapheresis. Examples of relevant research articles are also provided.
1. Periodontal medicine is a branch of periodontology that focuses on the relationship between periodontal health and systemic health. Periodontal disease can influence systemic health and vice versa through direct and indirect mechanisms.
2. Periodontal disease is associated with increased risk of adverse pregnancy outcomes like preterm birth and low birth weight. Factors like infection and inflammation are believed to contribute to the onset of preterm labor.
3. Periodontal disease is also linked to increased risk of diabetes and difficulty in controlling blood glucose levels. The chronic inflammatory response associated with periodontal infection contributes to insulin resistance. Periodontal treatment may help in improving glycemic control in diabetic patients.
ALTERACIONES EN LA DISFUNCION MULTIORGANICA.pdfzaragalicia
Sepsis is a life-threatening condition defined as organ dysfunction caused by a dysregulated immune response to infection. The immune response causes widespread vascular and microcirculatory dysfunction that leads to global hypoperfusion and injury of multiple organs. This results in organ failures of the kidneys, liver, lungs, heart, brain, and blood system - known as multiple organ failure - which determines whether the patient recovers or dies from the infection. While early treatment of the infection and restoring circulation are important, sepsis has heterogeneous pathophysiology that has made directly intervening on its mechanisms unsuccessful. Improved public health strategies and novel technologies are needed to better treat sepsis and reduce its high global burden.
Periodontal medicine is a branch of periodontology that focuses on the relationship between periodontal health/disease and systemic health/disease. Periodontal disease can influence systemic health through direct effects of bacteria or indirect host-mediated inflammatory responses. Common risk factors for periodontitis and systemic diseases like cardiovascular disease and diabetes include smoking and genetic factors. Periodontitis is associated with increased risk of atherosclerosis, myocardial infarction, and stroke potentially through elevated inflammatory markers and direct bacterial effects.
Periodontal disease has a two-way relationship with systemic health conditions. It can influence systemic health while certain systemic conditions can also increase susceptibility to periodontal disease. Periodontal disease is associated with increased risk of cardiovascular disease, cerebrovascular accidents, diabetes and other conditions. Potential mechanisms include direct effects of periodontal pathogens, host inflammatory responses, common risk factors and genetic predispositions. Periodontitis may enhance atherosclerosis through direct bacterial effects, increased inflammatory markers, platelet aggregation and other indirect host responses.
Periodontal medicine is a branch of periodontology that focuses on the relationship between periodontal health/disease and systemic health/disease. Periodontal disease can influence systemic health through direct effects of infectious agents or indirect host-mediated inflammatory responses. Periodontal disease has been linked to increased risk of cardiovascular disease, diabetes, and preterm low birth weight. Treatment of periodontal infection may help reduce systemic inflammation and improve conditions like diabetes and cardiovascular disease.
Periodontal medicine is the study of the relationship between periodontal health and systemic health. Periodontal disease can influence systemic health through direct effects of bacteria or indirect host-mediated inflammatory responses. Periodontitis has been linked to increased risk of cardiovascular disease, diabetes, and preterm low birth weight. Treatment of periodontal infection may help improve glycemic control in diabetic patients and reduce systemic inflammation.
- This study evaluated clinical outcomes of peritoneal dialysis (PD) patients depending on the absence or presence of liver cirrhosis (LC), using a propensity score matching method.
- They found that early technical complications, peritonitis, long-term PD use, and patient survival were not higher in patients with LC compared to those without. However, transition to hemodialysis occurred slightly faster in LC patients.
- The study suggests that PD can be recommended for end-stage renal disease patients with LC without additional risks, and may have advantages over hemodialysis for these patients.
This document summarizes the mechanisms of systemic lupus erythematosus (SLE). It discusses genetic and environmental risk factors for SLE, including a stronger prevalence in females which implicates a role for sex hormones. It describes the diverse clinical presentations of SLE and important autoantibodies involved, such as anti-double stranded DNA antibodies. The document also discusses how these autoantibodies can cause tissue damage by binding to antigens in organs and activating the complement system, as seen in lupus nephritis. Overall, it provides an overview of the pathogenesis of SLE by involving genetic, environmental, and immunological factors.
This document summarizes recent updates on lupus nephritis (LN), a form of kidney disease caused by systemic lupus erythematosus (SLE) that can lead to kidney failure. It discusses the epidemiology of SLE and LN, noting higher rates in women and certain racial groups. Genetic factors that may influence susceptibility and disease course are also reviewed. The pathogenesis of LN is complex and involves interferon response, neutrophil activation, and impaired clearance of cellular debris. Timely diagnosis via urine testing and kidney biopsy is important for treatment and preventing long-term kidney damage.
Evaluation of etiological differences in thrombocytopenia in underdeveloped c...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Ulcerative colitis is an inflammatory bowel disease that causes ulcers and inflammation in the lining of the large intestine. It typically begins in the rectum and lower colon and can extend further up the colon. The main symptoms are abdominal pain, frequent diarrhea, and bloody stool. The cause is unknown but likely involves genetic susceptibility and an abnormal immune response. Diagnosis involves blood tests, stool tests, imaging, and colonoscopy. Treatment focuses on reducing inflammation.
This document discusses cytokine production during hemodialysis and its potential clinical relevance. It finds that blood contact with dialysis membranes can activate monocytes and complement, inducing cytokine release. Produced cytokines like IL-1β, TNF-α, and IL-6 may cause acute side effects of hemodialysis like fever and hypotension, as well as chronic issues like anemia, bone disease, and sleep disorders. The extent of cytokine production depends on membrane biocompatibility and dialysate endotoxin levels. Understanding cytokine involvement could help address morbidity in hemodialysis patients.
1) Discitis is a bacterial infection of the intervertebral disc that is commonly caused by direct inoculation from surgery or hematogenous spread from another infection site.
2) MRI is the preferred imaging modality for diagnosing discitis, which shows inflammation and enhancement involving the vertebral bodies and discs.
3) While discitis is usually treated with long-term antibiotics, surgery may be needed for debridement and fusion if the infection fails to improve or causes neurological impairment.
Rheumatoid arthritis is an autoimmune disease characterized by inflammation of the joints. Genetic and environmental factors contribute to its pathogenesis. Genome-wide analyses have identified genes related to immune regulation that increase the risk of developing rheumatoid arthritis. Environmental triggers such as smoking can interact with genetic susceptibility factors like HLA-DRB1 alleles to further increase the risk. This leads to a breakdown of self-tolerance and production of autoantibodies against citrullinated proteins. While the cause is unknown, it is believed that citrullination of proteins by enzymes like peptidyl arginine deiminase 4 results in the formation of neo-epitopes that elicit an autoimmune response. This prearthritis phase
Post-transplant lymphoproliferative disorder (PTLD) is a B-cell proliferation disorder caused by Epstein-Barr virus infection due to immunosuppression after organ transplantation. The risk of PTLD is higher with more intense immunosuppression and occurs earlier. Treatment involves reducing immunosuppression to allow the immune system to control the proliferation. PTLD ranges from benign B-cell hyperplasia to aggressive lymphoma and has high mortality if not treated by reducing immunosuppression.
Austin Proteomics is an international, scholarly, peer- reviewed Open Access journal that aims to promote research in proteomics with a focus on protein structure & function.
As a comprehensive Open Access peer reviewed scientific journal, Austin Proteomics covers multidisciplinary fields. We provide limitless access to our literature hub which contains a colossal range of articles. The journal aims to publish high quality manuscript varieties such as Research, Review, Short Communications, and Perspectives (Editorials).
Austin Proteomics supports scientific modernization and enrichment of the proteomics research community by increasing access to peer- reviewed scientific literary works. Austin Publishing Group also brings universally peer- reviewed member journals under one roof, thereby encouraging knowledge sharing, collaboration and promotion of multidisciplinary science.
Acute lymphocytic leukemia (ALL) is a cancer of the lymphoid cells in the bone marrow. Early symptoms include fever, fatigue, and enlarged lymph nodes. Diagnostic tests include blood tests, bone marrow biopsies, imaging scans, and spinal fluid tests to determine the extent of the cancer's spread. Treatment involves induction therapy to eliminate leukemia cells, consolidation therapy to destroy remaining cells, and maintenance therapy to prevent regrowth of the cancer.
1. Meningococcal infection, caused by Neisseria meningitidis, manifests as meningitis or septicemia. It is a serious and life-threatening disease, especially in children.
2. N. meningitidis is a gram-negative coccus that colonizes the nasopharynx initially before invading the bloodstream and meninges. Virulence factors like capsular polysaccharides and pili aid in invasion and evading the immune system.
3. Diagnosis involves identifying the organism from blood or CSF cultures. Treatment involves antibiotics like ceftriaxone or penicillin. Outcomes range from full recovery to death, with purpura fulminans carrying the
Histiocytosis X refers to a group of syndromes involving abnormal proliferation of histiocytes, a type of immune cell. Langerhans cell histiocytosis is a specific disease within this group characterized by abnormal proliferation of Langerhans cells in tissues. Pulmonary Langerhans cell histiocytosis primarily affects young adult smokers and presents with nonspecific symptoms like cough, breathlessness, and chest pain. Diagnosis involves chest imaging showing characteristic nodules and cysts as well as pathology identification of Langerhans cells. Treatment involves smoking cessation and corticosteroids or chemotherapy for severe disease.
multiple myloma
By: Nader Amir Al-assadi
Supervised by : Dr/ Ghazi Alariqe
taiz university
Multiple myeloma (MM) is a plasma cell malignancy in which monoclonal plasma cells proliferate in bone marrow, resulting in an over abundance of monoclonal para protein (M protein), destruction of bone, and displacement of other hematopoietic cell lines.
The precise etiology of MM has not yet been established.
Roles have been suggested for a variety of factors, including genetic causes, environmental or occupational causes,radiation, chronic inflammation, and infection .
Austin Journal of Multiple Sclerosis & Neuroimmunology is an open access, peer review Journal publishing original research & review articles on aetiology, epidemiology, and pathogenesis of inflammatory demyelinating diseases of the central nervous system. Austin Journal of Multiple Sclerosis & Neuroimmunology is aimed to provide a strong platform for challenging cases that includes but not excludes the damage of insulating covers of both central nervous system and spine. It is a grounding platform for all neurologists, neuroimmunologists, neurovirologists, researchers, medical doctors, health professionals, scientists, and scholars to publish their research work & update the latest research information.
Topics include but not limited to Clinical Neurology, Biomarkers, Glial, Myelin Chemistry, Neuroimaging, Neuropathology, Neuroepidemiology, Therapeutics, Genetics/Transcriptomics, Experimental Models, Pathobiology, Neuroimmunology, Neuropsychology, Neurorehabilitation, Pathobiology of the Brain, Psychology, Measurement Scales, Teaching, and Neuroethics.
Austin Journal of Multiple Sclerosis & Neuroimmunology supports the scientific transformation and fortification in Medical and Clinical research community by magnifying access to peer reviewed scientific literary works. Austin also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.
Sepsis is a generalized infection caused by bacteria entering the bloodstream and overwhelming the body's defenses. It can result from various infections or invasive medical procedures. Key factors in its pathogenesis include bacterial toxins that trigger an overproduction of cytokines, which cause systemic inflammatory response and multi-organ dysfunction. Treatment involves identifying and treating the infection source, administering antibiotics and other measures to support organ function, and modulating the immune response.
This document summarizes acute leukaemias, including their epidemiology, etiology, clinical features, investigations, classification, treatment, and special considerations. Acute leukaemias result from malignant transformation of haematopoietic stem cells and can be myeloid, lymphoid, or biphenotypic. Risk factors include genetic syndromes, radiation, chemicals, and viruses. Treatment involves supportive care, chemotherapy consisting of induction and consolidation phases, and sometimes stem cell transplant. Prognosis has improved with advances in diagnosis and therapy but acute leukaemias still require rapid assessment and treatment initiation.
This document provides an overview of renal tubular acidosis (RTA). It defines RTA as a condition where the kidneys are unable to appropriately acidify the urine, resulting in acid accumulation in the body. There are four main types of RTA - type 1 involves a defect in the distal tubule, type 2 involves a defect in the proximal tubule, type 3 is a combined defect, and type 4 involves hyperkalemia. The document outlines the pathophysiology, clinical features, diagnostic testing and management considerations for each type of RTA.
- This study evaluated clinical outcomes of peritoneal dialysis (PD) patients depending on the absence or presence of liver cirrhosis (LC), using a propensity score matching method.
- They found that early technical complications, peritonitis, long-term PD use, and patient survival were not higher in patients with LC compared to those without. However, transition to hemodialysis occurred slightly faster in LC patients.
- The study suggests that PD can be recommended for end-stage renal disease patients with LC without additional risks, and may have advantages over hemodialysis for these patients.
This document summarizes the mechanisms of systemic lupus erythematosus (SLE). It discusses genetic and environmental risk factors for SLE, including a stronger prevalence in females which implicates a role for sex hormones. It describes the diverse clinical presentations of SLE and important autoantibodies involved, such as anti-double stranded DNA antibodies. The document also discusses how these autoantibodies can cause tissue damage by binding to antigens in organs and activating the complement system, as seen in lupus nephritis. Overall, it provides an overview of the pathogenesis of SLE by involving genetic, environmental, and immunological factors.
This document summarizes recent updates on lupus nephritis (LN), a form of kidney disease caused by systemic lupus erythematosus (SLE) that can lead to kidney failure. It discusses the epidemiology of SLE and LN, noting higher rates in women and certain racial groups. Genetic factors that may influence susceptibility and disease course are also reviewed. The pathogenesis of LN is complex and involves interferon response, neutrophil activation, and impaired clearance of cellular debris. Timely diagnosis via urine testing and kidney biopsy is important for treatment and preventing long-term kidney damage.
Evaluation of etiological differences in thrombocytopenia in underdeveloped c...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Ulcerative colitis is an inflammatory bowel disease that causes ulcers and inflammation in the lining of the large intestine. It typically begins in the rectum and lower colon and can extend further up the colon. The main symptoms are abdominal pain, frequent diarrhea, and bloody stool. The cause is unknown but likely involves genetic susceptibility and an abnormal immune response. Diagnosis involves blood tests, stool tests, imaging, and colonoscopy. Treatment focuses on reducing inflammation.
This document discusses cytokine production during hemodialysis and its potential clinical relevance. It finds that blood contact with dialysis membranes can activate monocytes and complement, inducing cytokine release. Produced cytokines like IL-1β, TNF-α, and IL-6 may cause acute side effects of hemodialysis like fever and hypotension, as well as chronic issues like anemia, bone disease, and sleep disorders. The extent of cytokine production depends on membrane biocompatibility and dialysate endotoxin levels. Understanding cytokine involvement could help address morbidity in hemodialysis patients.
1) Discitis is a bacterial infection of the intervertebral disc that is commonly caused by direct inoculation from surgery or hematogenous spread from another infection site.
2) MRI is the preferred imaging modality for diagnosing discitis, which shows inflammation and enhancement involving the vertebral bodies and discs.
3) While discitis is usually treated with long-term antibiotics, surgery may be needed for debridement and fusion if the infection fails to improve or causes neurological impairment.
Rheumatoid arthritis is an autoimmune disease characterized by inflammation of the joints. Genetic and environmental factors contribute to its pathogenesis. Genome-wide analyses have identified genes related to immune regulation that increase the risk of developing rheumatoid arthritis. Environmental triggers such as smoking can interact with genetic susceptibility factors like HLA-DRB1 alleles to further increase the risk. This leads to a breakdown of self-tolerance and production of autoantibodies against citrullinated proteins. While the cause is unknown, it is believed that citrullination of proteins by enzymes like peptidyl arginine deiminase 4 results in the formation of neo-epitopes that elicit an autoimmune response. This prearthritis phase
Post-transplant lymphoproliferative disorder (PTLD) is a B-cell proliferation disorder caused by Epstein-Barr virus infection due to immunosuppression after organ transplantation. The risk of PTLD is higher with more intense immunosuppression and occurs earlier. Treatment involves reducing immunosuppression to allow the immune system to control the proliferation. PTLD ranges from benign B-cell hyperplasia to aggressive lymphoma and has high mortality if not treated by reducing immunosuppression.
Austin Proteomics is an international, scholarly, peer- reviewed Open Access journal that aims to promote research in proteomics with a focus on protein structure & function.
As a comprehensive Open Access peer reviewed scientific journal, Austin Proteomics covers multidisciplinary fields. We provide limitless access to our literature hub which contains a colossal range of articles. The journal aims to publish high quality manuscript varieties such as Research, Review, Short Communications, and Perspectives (Editorials).
Austin Proteomics supports scientific modernization and enrichment of the proteomics research community by increasing access to peer- reviewed scientific literary works. Austin Publishing Group also brings universally peer- reviewed member journals under one roof, thereby encouraging knowledge sharing, collaboration and promotion of multidisciplinary science.
Acute lymphocytic leukemia (ALL) is a cancer of the lymphoid cells in the bone marrow. Early symptoms include fever, fatigue, and enlarged lymph nodes. Diagnostic tests include blood tests, bone marrow biopsies, imaging scans, and spinal fluid tests to determine the extent of the cancer's spread. Treatment involves induction therapy to eliminate leukemia cells, consolidation therapy to destroy remaining cells, and maintenance therapy to prevent regrowth of the cancer.
1. Meningococcal infection, caused by Neisseria meningitidis, manifests as meningitis or septicemia. It is a serious and life-threatening disease, especially in children.
2. N. meningitidis is a gram-negative coccus that colonizes the nasopharynx initially before invading the bloodstream and meninges. Virulence factors like capsular polysaccharides and pili aid in invasion and evading the immune system.
3. Diagnosis involves identifying the organism from blood or CSF cultures. Treatment involves antibiotics like ceftriaxone or penicillin. Outcomes range from full recovery to death, with purpura fulminans carrying the
Histiocytosis X refers to a group of syndromes involving abnormal proliferation of histiocytes, a type of immune cell. Langerhans cell histiocytosis is a specific disease within this group characterized by abnormal proliferation of Langerhans cells in tissues. Pulmonary Langerhans cell histiocytosis primarily affects young adult smokers and presents with nonspecific symptoms like cough, breathlessness, and chest pain. Diagnosis involves chest imaging showing characteristic nodules and cysts as well as pathology identification of Langerhans cells. Treatment involves smoking cessation and corticosteroids or chemotherapy for severe disease.
multiple myloma
By: Nader Amir Al-assadi
Supervised by : Dr/ Ghazi Alariqe
taiz university
Multiple myeloma (MM) is a plasma cell malignancy in which monoclonal plasma cells proliferate in bone marrow, resulting in an over abundance of monoclonal para protein (M protein), destruction of bone, and displacement of other hematopoietic cell lines.
The precise etiology of MM has not yet been established.
Roles have been suggested for a variety of factors, including genetic causes, environmental or occupational causes,radiation, chronic inflammation, and infection .
Austin Journal of Multiple Sclerosis & Neuroimmunology is an open access, peer review Journal publishing original research & review articles on aetiology, epidemiology, and pathogenesis of inflammatory demyelinating diseases of the central nervous system. Austin Journal of Multiple Sclerosis & Neuroimmunology is aimed to provide a strong platform for challenging cases that includes but not excludes the damage of insulating covers of both central nervous system and spine. It is a grounding platform for all neurologists, neuroimmunologists, neurovirologists, researchers, medical doctors, health professionals, scientists, and scholars to publish their research work & update the latest research information.
Topics include but not limited to Clinical Neurology, Biomarkers, Glial, Myelin Chemistry, Neuroimaging, Neuropathology, Neuroepidemiology, Therapeutics, Genetics/Transcriptomics, Experimental Models, Pathobiology, Neuroimmunology, Neuropsychology, Neurorehabilitation, Pathobiology of the Brain, Psychology, Measurement Scales, Teaching, and Neuroethics.
Austin Journal of Multiple Sclerosis & Neuroimmunology supports the scientific transformation and fortification in Medical and Clinical research community by magnifying access to peer reviewed scientific literary works. Austin also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.
Sepsis is a generalized infection caused by bacteria entering the bloodstream and overwhelming the body's defenses. It can result from various infections or invasive medical procedures. Key factors in its pathogenesis include bacterial toxins that trigger an overproduction of cytokines, which cause systemic inflammatory response and multi-organ dysfunction. Treatment involves identifying and treating the infection source, administering antibiotics and other measures to support organ function, and modulating the immune response.
This document summarizes acute leukaemias, including their epidemiology, etiology, clinical features, investigations, classification, treatment, and special considerations. Acute leukaemias result from malignant transformation of haematopoietic stem cells and can be myeloid, lymphoid, or biphenotypic. Risk factors include genetic syndromes, radiation, chemicals, and viruses. Treatment involves supportive care, chemotherapy consisting of induction and consolidation phases, and sometimes stem cell transplant. Prognosis has improved with advances in diagnosis and therapy but acute leukaemias still require rapid assessment and treatment initiation.
This document provides an overview of renal tubular acidosis (RTA). It defines RTA as a condition where the kidneys are unable to appropriately acidify the urine, resulting in acid accumulation in the body. There are four main types of RTA - type 1 involves a defect in the distal tubule, type 2 involves a defect in the proximal tubule, type 3 is a combined defect, and type 4 involves hyperkalemia. The document outlines the pathophysiology, clinical features, diagnostic testing and management considerations for each type of RTA.
This document summarizes acute leukaemias, which result from malignant transformation of haematopoietic stem cells. It covers the epidemiology, etiology, clinical features, investigations, classification, cytogenetics, risk factors, and treatment of both acute myeloid leukaemia and acute lymphoblastic leukaemia. Remission induction chemotherapy is the primary treatment, while stem cell transplant may be used in some cases. Overall survival has improved with recent advances, though acute leukaemias still require rapid assessment and treatment.
Snake bites are a major public health problem affecting millions each year, especially in rural areas of developing countries. Common symptoms include local swelling, bleeding disorders, paralysis, and kidney injury. Treatment involves supportive care, antivenom therapy, and monitoring for complications. Early administration of the correct antivenom within 4 hours of the bite is important to prevent mortality and morbidity from snake envenomation.
Disorders of Acid-Base Balance 2022 with narration.pdfAdamu Mohammad
This document discusses disorders of acid-base balance. It begins by introducing buffers that help maintain pH levels, such as bicarbonate and proteins. It then covers different types of acid-base imbalances including respiratory and metabolic acidosis and alkalosis. Key points include how to interpret arterial blood gases and identify the underlying cause of imbalances. Compensation mechanisms and features of acute vs chronic disorders are described. Various metabolic acidosis etiologies are outlined including renal tubular acidosis. Treatment principles focus on addressing underlying causes and correcting acidemia with alkali therapy.
This document discusses communication skills and ethics in clinical practice, with a focus on end-of-life care. It outlines the need for effective communication skills when interacting with patients, families, and colleagues. Key principles of medical ethics around autonomy, informed consent, privacy, and justice are also covered. The document then examines approaches to communicating with patients and obtaining consent. It provides examples of communicating in difficult situations and applying ethical considerations. Finally, it discusses end-of-life care, including identifying patients nearing end of life, components of end-of-life care, common problems, and ensuring quality care through the dying process.
July 2022 - ATYPICAL PRESENTATIONS Prof. A.E.A. Jaiyesimi.pdfAdamu Mohammad
The document discusses atypical presentations of diseases in the elderly. It notes that diseases may present differently in older patients compared to textbook descriptions. Conditions can manifest as falls, confusion, or worsening of other diseases, rather than typical symptoms. It is important for clinicians to consider any changes from an elderly patient's baseline as a potential medical problem. Misdiagnosis is common if presentations are not recognized as atypical. A thorough assessment accounting for multiple conditions and medications is crucial for accurate diagnosis and treatment of disease in older patients.
This document discusses investigations for kidney diseases. It describes various urine, blood, and radiological investigations that can help diagnose kidney diseases, identify risk factors, grade severity, and monitor treatment. Urine investigations include urinalysis, urine protein-creatinine ratio, and microscopic examination of urine sediments. Blood investigations include electrolytes, lipids, serology tests, and full blood count. Radiological tests discussed are ultrasound, CT, MRI, nuclear scintigraphy, and renal biopsy. The document provides details on the procedures and clinical indications for many of these important investigations in nephrology.
THERAPEUTIC DRUG MONITORING- NPMCN 260722.pdfAdamu Mohammad
This document discusses therapeutic drug monitoring (TDM), which involves measuring drug concentrations in the body to optimize pharmacotherapy. TDM includes monitoring the pharmaceutical, pharmacokinetic, pharmacodynamic, and therapeutic effects of drugs. It is useful for individualizing drug therapy, assessing compliance, diagnosing and preventing toxicity, and detecting drug interactions. Drugs that are good candidates for TDM have a narrow therapeutic index, variable pharmacokinetics, and a reasonable relationship between concentrations and effects. Common drugs monitored include antibiotics, anticonvulsants, cardiac glycosides, and immunosuppressants. Proper sample collection and interpretation considering the patient's details and potential confounders are important for TDM to effectively guide treatment decisions.
Mechanical ventilation & Pulmonary Rehabilitation -1.pdfAdamu Mohammad
Mechanical ventilation is used to support patients with respiratory failure by controlling parameters like tidal volume, respiratory rate, and pressure. It requires careful setting and monitoring to prevent complications. Modes include controlled, assisted, and combined settings. Pulmonary rehabilitation uses exercise, education, and breathing techniques to improve symptoms and quality of life for patients with chronic lung disease.
Common Geriatric Syndromes - July 2022 Dr. A.E.A. Jaiyesimi.pdfAdamu Mohammad
This document discusses geriatric syndromes and the increasing burden of diseases affecting the elderly population in Nigeria. It notes that life expectancy has improved worldwide, leading to an aging population. In Nigeria, reliable data is lacking but estimates suggest around 3.1% of the population is aged 65 and over, a proportion that is increasing. Common geriatric conditions discussed include stroke, Parkinson's disease, dementia, cancers, cardiovascular diseases, diabetes, arthritis, and renal diseases. The document emphasizes that geriatric syndromes can impact quality of life and notes some key problems to assess in elderly patients like falls, memory issues, incontinence, pain, mobility and more. Early detection of these conditions is important for treatment and rehabilitation.
This document provides an overview of chronic diarrhea and malabsorption syndrome. It discusses the pathophysiology of chronic diarrhea including osmotic, secretory, inflammatory, and motility disorders. Common causes are then outlined for both infectious and non-infectious etiologies. Management involves fluid/electrolyte replacement, treating the underlying cause, and symptomatic relief. Malabsorption syndrome and its causes relating to the pancreas, liver, intestine, and motility are also reviewed. Specific conditions like celiac disease and Whipple's disease are described.
Approach to the diagnosis and management of primary headache disorders-GP-rec...Adamu Mohammad
The document discusses the approach to diagnosing and managing primary headache disorders. It begins with an introduction to headaches and classification. It then covers the diagnostic criteria and treatment approaches for common primary headaches like migraine, tension-type headache, and cluster headache. The diagnosis involves taking a thorough headache history, performing an exam, and considering red flags for secondary headaches. Treatment involves both pharmacological options like triptans, beta-blockers, and oxygen for cluster headaches as well as non-pharmacological strategies like lifestyle modifications and avoiding triggers. The overall approach involves classifying the primary headache disorder and then selecting appropriate treatment strategies.
This document discusses chronic kidney disease (CKD), including its definition, staging, epidemiology, causes, progression, complications, and non-dialytic management. CKD is defined based on kidney damage or decreased glomerular filtration rate below 60 mL/min/1.73m2 for over 3 months. Common causes include hypertension, diabetes, glomerulonephritis, and HIV. Progression is monitored using GFR and proteinuria levels, with faster progression seen in diabetes. Complications involve fluid/electrolyte disorders, bone disease, cardiovascular issues, and others. Non-dialytic management focuses on treating the underlying cause, controlling blood pressure and other risk factors, and preparing for renal replacement
EPILEPSY CLASSIFICATION, PATHOENESIS, AND MANAGEMENT.pdfAdamu Mohammad
The document summarizes key aspects of epilepsy classifications, pathogenesis, and management. It describes:
1. The ILAE's 2017 classification system which focuses on seizures, epilepsies, and epilepsy syndromes, introducing new terminology like focal impaired awareness and focal to bilateral tonic-clonic.
2. Factors in epilepsy pathogenesis including neurotransmission pathways, molecular/genetic mechanisms, neurogenesis/rewiring, and inflammation. Epileptogenesis involves increased neuronal excitability.
3. Epilepsy categories of idiopathic, acquired, and cryptogenic based on identifiable brain lesions, and management considers seizure type, age of onset, family history, and test results.
This document provides an overview of sleep disorders and approaches to common sleep disorders. It defines sleep and the stages of sleep, including non-REM sleep divided into stages N1-N3 and REM sleep. It describes the brain mechanisms that generate wakefulness, non-REM sleep, and REM sleep through interconnected neural circuits. These circuits can become dissociated, causing parasomnias or overlap of sleep and wake behaviors. Recommended sleep durations are provided across the human lifespan. Common sleep disorders discussed include insomnia, narcolepsy, restless leg syndrome, and circadian rhythm disorders.
This document discusses the evaluation and management of chronic diarrhea and malabsorption syndrome. It begins with an introduction to chronic diarrhea and outlines the pathophysiology, including osmotic, secretory, inflammatory, and motility disorders. Common causes are then reviewed including infections, malignancies, celiac disease, tropical sprue, and short bowel syndrome. Management involves fluid/electrolyte replacement, treating the underlying cause, and symptomatic relief. Malabsorption syndrome and its specific etiologies like celiac disease, Whipple's disease, and tropical sprue are also summarized. The document stresses the importance of a thorough clinical evaluation to identify the cause and guide appropriate investigations and therapy.
This document provides a literature review on myasthenia gravis (MG). MG is an autoimmune disease that affects the neuromuscular junction. Some key points:
- The first accounts of MG were in the late 1800s and early 1900s by researchers like Erb, Goldman, and Jolly. The immunological nature was established in the 1970s.
- Prevalence is about 20 per 100,000 people. It is more common in women under 40 and men over 50. Thymic abnormalities like hyperplasia or tumors are associated with age of onset.
- MG causes fluctuating muscle weakness that worsens with activity. Common early symptoms include ptosis, diplopia,
Infective endocarditis is a bacterial or fungal infection of the heart valves or inner lining of the heart. It typically presents with fever and evidence of infection on echocardiogram or blood cultures. Underlying heart valve abnormalities predispose individuals to the condition by allowing bacteria to attach. Common causes include Staphylococcus aureus and various streptococci. Left untreated, it can cause heart valve damage, systemic embolisms, and death. Diagnosis involves identifying symptoms of infection along with testing like echocardiography and blood cultures to detect the infecting organism.
This patient likely has constrictive pericarditis based on the following:
1) Refractory edema despite diuretics suggesting impaired cardiac filling
2) History consistent with an etiology of post-pericarditis from RA
3) Clear lung fields on CXR rule out heart failure as cause of edema
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
2. 2 Child Kidney Dis • 2019;23:1-6 www.chikd.org
ofchildren.GlomerularlesionsassociatedwithINSinclude
multiple histologic types, such as minimal change NS
(MCNS), focal segmental glomerulosclerosis, membrano
proliferative glomerulonephritis, and membranous ne
phropathy1,5)
. All these types of morphology share a com
mon feature with podocyte foot process effacement and
structural disorganization of the glomerular filtration bar
rier leading to proteinuria. These ultrastructural abnor
malities typically resolve with corticosteroid-induced cli
nicalremissions5)
.However,themechanismsofthisacquired
and reversible abnormality in glomerular ultrastructure
and filtration barrier permeability are incompletely under
stood.
Shalhoub, in 1974, proposed that the increased glome
rular permeability to plasma protein in MCNS is due to a
circulating factor released by T-cells; however, until date
the search for the circulating factor has been unsuccessful.
In addition, advances in the knowledge of podocyte patho
biology in the mechanism underlying proteinuria have led
to NS being recognized as a podocytopathy. Based on this
knowledge, several hypotheses have been proposed to
explain the role of podocytes and related molecules in the
mechanism underlying proteinuria in INS. Although the
pathophysiology of NS has not been completely explained
until now, it is considered a complex multifactorial disease
with an immunological component. In this review, we dis
cussrecentresearchfindingsinthepathogenesisofMCNS.
Pathogenesis of MCNS
Podocyte foot process effacement is the ultrastructural
hallmark in MCNS, however, the pathogenesis leading to
podocyteeffacementisnotclear.Systemicfactors,immune
mediated or circulating, and local factors can contribute
to podocyte effacement, but there is no single unifying
hypothesis (Fig 1).
Immune dysregulation
As immunosuppression with corticosteroids is the main
stay of NS therapy, it is logical to suspect immune dysregu
lation as a pathogenic factor in disease development. In
1974,ShalhoubpostulatedthatMCNSisadisorderofT-cell
function, resulting in increased plasma levels of lympho
Minimal Change Nephrotic Syndrome
Systemic Glomerular
T and B cell dysfunction Podocyte dysfunction
Angplt4, CD80
Cytokines (e.g. IL-8, IL-13)
and
other circulating factors
(e.g. hemopexin, Angplt4)
Glomerular filtration barrier damage
(Podocyte foot process effacement, GBM charge loss etc.)
Treg
Fig 1. Pathogenetic pathways leading to minimal change nephrotic syndrome
Fig 1. Pathogenetic pathways leading to minimal change nephrotic syndrome. Angplt4, angio
poitin-like 4;Treg, regulatoryT-cell;GBM, glomerular basement membrane.
3. Yang EM • Pathogenesis of MCNS 3
www.chikd.org
cyte-derived permeability factor6)
. This hypothesis was
based on the following clinical observations: [1] remission
is commonly accompanied by measles infection whereby
cell-mediated immunity is suppressed; [2] MCNS is asso
ciated with Hodgkin’s disease, which is a known T-cell dis
order; [3] patients show good response to corticosteroids
and cyclophosphamide, which are inhibitors of T-cell func
tion; [4] humoral component deposition (immunoglobulin
and components) is absent in glomeruli, which is unlike
that in other glomerular disorders. Therefore, the massive
proteinuria and hypoalbuminemia that characterize NS
were thought to result from increased glomerular capillary
wall permeability due to T-cell activation triggered by
several stimuli, such as viral infection or allergens.
1.Roleofcytokines
Investigators have made attempts, based on Shalhoub’s
hypothesis,toidentifythecirculatingfactorsreleasedfrom
T-cells that increase glomerular permeability to serum
proteins, and some studies have confirmed that capillary
permeability factor is detectable in patients with NS7,8)
. Of
the various factors presumed to increase glomerular per
meability to serum proteins, the most likely pathogenic
factors are considered to be cytokines, which are small pro
teins secreted by the cells of both the innate and adaptive
immune systems that transfer information within the im
mune system9,10)
. Patients who suffered relapses were found
to have elevated serum or urine levels of various cytokines,
including interleukin (IL)-211,12)
, soluble IL-2 receptor11,13)
,
interferon-gamma11,12)
, IL-814-16)
, IL-1317-19)
, tumor necrosis
factor-α20)
, and vascular endothelial growth factor21)
. Of
the many known cytokines, IL-8 and IL-13 in particular
have been proposed to be most likely to be circulating
factors. IL-8 may play a role in proteinuria by affecting the
metabolism of glomerular basement membrane (GBM)
components15)
. Additionally, urinary IL-8 levels were
higher in patients who suffered relapses and had a positive
correlation with the degree of proteinuria16)
. However, rat
podocytes incubated in vitro with high concentrations of
human IL-8 showed no difference in GBM permeability22)
.
IL-13 has been revealed to stimulate intracellular podocyte
protein trafficking and proteolysis in vitro17)
. IL-13-trans
fectedratsdevelopedsevereproteinuriaandshowedMCNS-
like nephropathy18)
. Increased IL-13 also induced the over
expression in podocytes of CD80, recently identified as a
possible molecular mechanism underlying proteinuria in
NS23)
. However, not all patient with MCNS present serum
IL-13 elevation during relapse, and serum IL-13 is also
knowntobeincreasedinclinicalconditionsnotassociated
with proteinuria, such as allergy including asthma and
atopy24, 25)
. Studies conducted over the last 40 years have
reported conflicting results regarding the role of cytokines
in MCNS.
2.RoleofregulatoryT-cells(Tregs)andB-cells
Historically, MCNS has been considered a T-cell disease;
however, advances in the study of basic immunology have
contributed to a more articulated understanding of its pa
thogenesistakingintoaccountTregsandB-cells.Normally,
cytokine release by T-cells is transient owing to the activa
tion of Tregs that interact with T effector cells to suppress
cytokine production. Tregs have been suggested to consti
tute a second step in an MCNS cascade, of which the first
remains unclear26,27)
. The induction of Treg led to a marked
reduction in proteinuria in animal models, and most pa
tients with MCNS showed decreased levels of Treg28,29)
.
Shimada et al. reported that abnormal censoring of podo
cyte CD80 expression could underlie Treg dysfunction or
impaired autoregulation by podocytes. Treg dysfunction
could lead to transient massive proteinuria becoming per
sistent, following which podocyte injury, and eventually,
MCNS,occur27)
.UnlikeroleofT-cellsinMCNS,whichhas
been extensively studied, the role of B-cells is currently not
well understood. Clinical trials have been conducted that
demonstratedMCNSremissionafterB-celldepletionusing
the anti-CD20 monoclonal antibody rituximab30,31)
. The
recent successful use of anti-CD20 monoclonal antibodies
forthetreatmentofsteroidsensitiveNSraisesthepossibility
of B-cells either influencing T-cells or themselves being
primaryplayersinNS.CD80isexpressedbybothactivated
B- and T- cells, and increased nitric oxide production by
B-cells observed in NS patients with relapse further sup
ports the possibility of B-cell involvement10,32)
. Altogether,
these results revealed that not only T-cells, but also B-cells
or B-cell products might be implicated in the causal me
chanism of MCNS via the abnormal regulation of T-cell
function by circulating B-cells or by communication bet
ween B- and T-cells33)
. However, information on the role of
4. 4 Child Kidney Dis • 2019;23:1-6 www.chikd.org
B-cells is currently limited.
Systemic circulating factors
1.Hemopexin
Hemopexinisanabundantplasmaproteinthateffectively
scavengesheme.Ithasbeenproposedthatvariousisoforms
ofhemopexinexist10)
.Undernormalconditions,circulating
hemopexin is inactive, but under certain conditions, it be
comes activated as a serine protease34)
. The active isoform
of hemopexin has been reported to be implicated in the
pathogenesis of MCNS. Infusion of human plasma hemo
pexin in rats induces reversible proteinuria accompanied
by podocyte foot process effacement and loss of the nega
tive charge of the GBM35)
. Furthermore, hemopexin in
duces nephrin-dependent cytoskeletal rearrangement in
podocytes and affects permeability of the glomerular filtra
tion barrier by reduction in glycocalyx. The effects of he
mopexin were inhibited by pretreatment with normal
human plasma and serine protease inhibitors36)
. Hemo
pexinissuspectedtobeacirculatingfactorcausingMCNS,
although the mechanism of hemopexin activation and the
inhibitory factors that activate hemopexin under normal
conditions is unclear.
2.Angiopoietin-like4(Angptl4)
Angptl4isaglycoproteinsecretedmainlyintheliverand
adipose tissue. Angptl4 is minimally expressed in normal
glomeruli, but it is highly upregulated in the serum and
podocytes in experimental models of MCNS and in the
human disease10,37,38)
. There are two isoforms of podocyte-
secreted Angptl4: the hyposialylated form secreted by po
docytes (podocyte-secreted form), and the sialylated form
secreted by skeletal muscles, heart, and adipose tissue (cir
culating form)39)
. Podocyte-secreted Angtpl4 is glucocorti
coid sensitive and has been proposed to be a mediator of
proteinuria. It was observed that its upregulation induced
massive proteinuria, loss of negative charge in the GBM,
and foot process effacement in vivo models of NS, and that
its conversion into sialylated Angptl437)
. In addition, circu
lating Angptl4 was secreted in response to an elevated
plasma free fatty acid to albumin ratio when proteinuria
reached the nephrotic range, subsequently resulting in
hypertriglyceridemia38)
. This indicates that Angptl4 can
be developed as a biomarker of MCNS in feature studies.
Co-stimulatory molecule CD80
CD80,alsoknownasB7-1,isatransmembranemolecule
present on the surface of both antigen presenting cells and
activated B-cells, and acts as a co-stimulatory signal for T-
cell activation10)
. CD80, present on the surface of antigen
presentingcells,bindsCD28oneffectorT-cellsorcytotoxic
T lymphocyte-associated protein 4 (CTLA4) in regulator
T-cells, determining T-cell activation (CD28) or inhibition
(CTLA4)40)
.In2004,Reiseretal.reportedthatundercertain
conditions,podocytescanexpressCD80,anditsexpression
results in the development of a proteinuric condition23)
.
Proteinuria was not induced in CD80 knockout mice by
lipopolysaccharides administration, but it was induced in
SCID mice, which are deficient in T- and B-cell functions,
showing that CD80 plays a key role independent of T- and
B-cells23)
. Increased CD80 levels in urine are observed in
patients with MCNS with relapse compared to those in
remission and with other glomerular diseases (lupus, focal
segmental glomerulosclerosis)41,42)
. A recent study has re
ported that high urinary CD80 excretion might be a bio
marker for steroid responsiveness and a predictor for good
prognosis in NS43)
. In addition, polyinosinic:polycytidylic
acid(polyI:C),aligandofToll-likereceptor3whichmimics
viral infection, promotes podocyte CD80 expression44)
.
This offers a possible reasoning to explain the frequent re
lapse of MCNS after upper respiratory virus infection.
Because PolyI:C induces only transient proteinuria, im
paired regulatory mechanisms after CD80 induction were
postulated as a second hit cause of MCNS27)
. Suppression
of CD80 expression could be a novel therapeutic strategy
for MCNS; however, more evidence is required to support
this idea.
Conclusions
The pathophysiology of NS is still far from being fully
explained, although recent advances in podocyte biology
haveprovidednovelinsightsintothepossibilityofNSbeing
5. Yang EM • Pathogenesis of MCNS 5
www.chikd.org
a podocytopathy. MCNS is regarded as a multifactorial
disease. It is hypothesized that MCNS is a podocytopathy
and that CD80 or other circulatory factors are the triggers
for proteinuria. Recent and future research will lead to
new therapeutic targets in MCNS.
Conflict of interest
This study was funded by Individual Basic Science &
Engineering Research Program through the Ministry of
Education of the Republic of Korea and National Research
Foundation of Korea (NRF-2016R1D1A1B03933207)
ORCID
Eun Mi Yang http://orcid.org/0000-0001-9410-5855
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