Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Case report
Year : 2008 | Month : February | Volume : 2 | Issue : 1 | Page : 648 - 650

Idiopathic Carpal Tunnel Syndrome Presenting with Raynaud’s Phenomenon: Neurophysiological Evaluation

SHARMA V K

Division of Neurology, National University Hospital, Singapore.

Correspondence Address :
Dr. Vijay Sharma, Division of Neurology, National University Hospital, Singapore-119074. Email: drvijay@singnet.com.sg

Abstract

Carpal tunnel syndrome and Raynaud’s phenomena are common diseases and coexist in some patients while in others Raynaud’s phenomenon may be a clinical feature of carpal tunnel syndrome. I describe an interesting case with Raynaud’s phenomenon as a predominant presenting clinical feature due to an underlying mild carpal tunnel syndrome with preferential involvement of the autonomic fibers. Nocturnal wrist splinting, a common treatment for carpal tunnel syndrome, resulted in marked improvement in the symptoms.

Keywords

carpal tunnel syndrome, Raynaud’s phenomenon, autonomic tests

Case Report

A 51 year’s old woman, staff nurse by profession, presented with repeated transient episodes of blenching of the left hand for about a week. These episodes lasted for 2-3 minutes and were followed by dull aching in whole of the affected hand. She denied history of cold sensitivity, emotional stress, joint pain, finger ulcerations or any other significant medical illness in the past. She was not taking any medications prior to these episodes. She did not complain of any weakness in the hands, neck pain or radicular pain. She did not sustain any trauma to the upper extremities or neck in past. There was no history of any actions with a repetitive use or an abnormal and prolonged abnormal positioning of the hands. She denied any previous history of diabetes mellitus, thyroid disorders, rheumatoid arthritis or osteoarthritis of upper extremities. She was not taking any medications prior to this presentation.
She was a right-handed averagely built woman with an unremarkable general examination. Both the brachial and radial pulses were equally palpable. Motor and sensory examination of both upper limbs did not reveal any abnormality. Tinel’s sign was absent bilaterally while mildly positive Phalen’s test was noted over the left hand. Rest of the neurological examination was unremarkable. No reproducible sensitivity to cold or vibrations was noted.

Routine blood tests, serum markers for connective tissue diseases, electrolytes and thyroid functions were within normal limits. X-rays of the chest and cervical spine were negative for a cervical rib or any other significant pathology. Vascular sonography of the root of neck for the subclavian artery was normal. Nerve conduction tests demonstrated normal motor and sensory latencies as well as conduction velocities, both in the median as well as ulnar nerves in both upper extremities. However, a mildly prolonged second lumbrical-interossei latency difference (0.7ms; normal <0.4 ms) was noticeable in the left upper limb.

Normal Sympathetic skin responses (SSR) could be obtained from both hands. Autonomic studies showed significant differences between the two hands. Vasomotor studies, using gasp induced vasoconstriction and measuring the flow changes in the capillaries of finger pulps by laser Doppler, revealed a 30% change in the flow in the left hand as compared to a 60% change in the right. Water immersion testing revealed a skin wrinkling of grade 1(skin surface not smooth any more) in the left in comparison to a grade 3 (3 or more lines on the digit tip due to wrinkling) in the other hand.
Later, she confirmed a history of developing some mild and vaguely defined numbness and clumsiness of the hands, especially while carrying weights. She was awakened from sleep on a couple of occasions by the pain in the left hand, which was relieved by some shaking.

A diagnosis of Raynaud’s phenomenon in the left hand due to a mild grade carpal tunnel syndrome was made and splinting of the left hand was advised during the nights. A remarkable improvement was noted in her symptoms after about a week. On a follow-up visit about 2 months later, she was noted to be asymptomatic despite continuing her previous usual daily routine.

Discussion

This case describes the Raynaud's phenomenon as the presenting complaint in a patient with carpal tunnel syndrome. George Phalen described ‘since the median nerve carried with it most of the sympathetic supply of the hand, it seems logical to anticipate certain vasomotor changes arising from the irritation or compression of the nerve’.(1) Carpal tunnel syndrome (CTS) remains mainly a clinical diagnosis. (2) Numbness or pain especially in the first 3 digits, precipitated by a particular action or position of the hand, with nocturnal awakening and relief by changing the position or shaking of the wrist are the commonest clinical features. Although most patients with CTS will exhibit some of these primary clinical features, the clinician should be aware of the variability of CTS symptoms. Nerve conduction studies are fundamental in supporting a diagnosis of CTS, but depending on which parameters are used, 10-50% of patients may have normal motor and sensory conduction values.(3) Ultrasonography(4), MRI(5) and direct measurement of intracarpal pressure(6) have been evaluated as additional parameters for CTS diagnosis with variable accuracy parameters.

Both idiopathic CTS and Raynaud’s phenomenon (RP) are common and may have some similar clinical symptoms. Additionally, these two may even co-exist. Chung et al found 60% of their idiopathic CTS patients diagnosed clinically and electrophysiologically, having Raynaud’s phenomenon. (7) Similar association has been noted in various other studies. (8), (9)
Autonomic dysfunctions are common in CTS and may be seen in up to 55% cases(10) and their presence may correlate with worsening symptoms and electrophysiological findings. Campero et al found that median nerve provides vasomotor innervation to the hand.(11) The pathogenesis of Raynaud’s phenomenon in CTS remains unclear. The local or systemic sympathetic nervous system has been considered to play a significant role in the constriction of the digital arteries, thus invoking a Raynaud’s phenomenon.(12) However, exact role played by the sympathetic nerve fibers in causing Raynaud’s phenomenon is not known. It is said that the sympathetic axons may remain unaltered even in patients with long standing profound sensory impairment(13) and the testing of sympathetic fibers does not help in the diagnosis of CTS.(14) Moreover release of CTS does not affect the symptoms and signs of Raynaud’s phenomena.(15) Loebe et al(16) studied 40 patients of CTS with Raynaud’s phenomena. They found a poor correlation between CTS and Raynaud’s phenomena and concluded that CTS can not be regarded as a disease underlying Raynaud’s phenomenon.

Investigations for the assessment of autonomic nerve fibres are not routinely performed in the evaluation of carpal tunnel syndrome. Autonomic nerve fibres are basically important for sudomotor, vasomotor and pilomotor functions. My patient had normal sympathetic skin response (SSR), which indicates the integrity of the sudomotor fibers. The presenting complaints from the patient were only suggestive of Raynaud’s phenomenon. Her electrophysiological studies showed only a mildly abnormal second-lumbrical interossei latency difference, consistent with a possible minimal grade carpal tunnel syndrome. Measurement of the Second Lumbrical-Interossei latency difference has been found to be a sensitive test (sensitivity of 95-98%) for the diagnosis of CTS, both in mild as well as severe cases.(17)

However, the vasomotor studies and the skin wrinkling testin

References

1.
Phalen GS. The carpal tunnel syndrome; seventeen years’ experience in the diagnosis and treatment of six hundred forty four hands. J Bone Joint Surg 1966; 48: 218-428.
2.
Bland JD. Carpal tunnel syndrome. Curr Opin Neurol 2005;18: 581–585.
3.
 White JC, Hansen SR, Johnson RK. A comparison of EMG procedures in the carpal tunnel syndrome with clinical-EMG correlation. Muscle & Nerve 1988; 11:1177-1182.
4.
Wong SM, Griffith JF, Hui AC, Lo SK, Fu M, Wong KS. Carpal tunnel syndrome: diagnostic usefulness of sonography. Radiology 2004;232:93-99.
5.
Jarvik JG, Yuen E, Kliot M. Diagnosis of carpal tunnel syndrome: electrodiagnostic and MR imaging evaluation. Neuroimaging Clin N Am 2004 ;14:93-102.
6.
Schuind F. Canal pressures before, during, and after endoscopic release for idiopathic carpal tunnel syndrome. J Hand Surg [Am] 2002;27: 1019–1025.
7.
Chung MS, Gong HS, Baek GH. Prevalence of Raynaud’s phenomena in patients with idiopathic carpal tunnel syndrome. J Bone Joint Surg Br. 1999; 81:1017-1019.
8.
Pal B, Keenan J, Misra HN, Moussa K, Morris J. Raynaud’s phenomena in idiopathic carpal tunnel syndrome. Scan J Rheumatol 1996;25:143-145.
9.
Waller DG, Dathan JR. Raynaud’s syndrome and carpal tunnel syndrome Postgrad Med J 1985; 61:161-162.
10.
Verghese J, Galanopoulou AS, Herskovitz S. Autonomic dysfunctions in idiopathic carpal tunnel syndrome. Muscle & Nerve 2000; 23: 1209-1213.
11.
Campero M, Verdingo RJ, Ochoa JL. Vasomotor innervation of the skin of the hand: a contribution to the study of human anatomy. J Anat 1993;2:361-368.
12.
Harada N, Kondo H, Kimura K. Assessment of autonomic nervous function in patients with Raynaud’s phenomenon of the hand. J Vasc Surg 1986;3: 456-461.
13.
Ramieri G, Stella M, Calcagni M, Cellino G, Penzica GC. An immuno-histochemical study on cutaneous sensory receptors after chronic median nerve compression in man. Acta Anat Basel 1995;152:

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