1.column:Serum short-chain fatty acid levels and their association with atopic dermatitis in pediatric patients
Zhenxiang WANG ; Lele CHEN ; Liping DONG ; Sheng WANG ; Jinlei XU ; Xinying CAI ; Fengli XIAO
Acta Universitatis Medicinalis Anhui 2026;61(4):763-769
ObjectiveTo investigate the metabolic alterations of serum short chain fatty acids (SCFAs) in pediatric patients with atopic dermatitis (AD) and their correlation with different clinical phenotypes using targeted metabolomics. MethodsThis study enrolled 87 AD patients and 67 healthy controls (HC). Serum levels of eight SCFAs were quantified by ultra-high-performance liquid chromatography-mass spectrometry. The associations between SCFAs and AD were assessed using various statistical methods. ResultsCompared with the HC group, levels of acetic acid (AA), propionic acid (PA), and caproic acid (CA) (P=0.002,P=0.002,P=0.043) decreased in the AD group. Logistic regression analysis identified AA (OR=0.449, 95% CI: 0.289–0.698) and PA (OR = 0.487, 95% CI: 0.324–0.732) as protective factors against AD. The combination of AA and PA yielded an area under the curve (AUC) greater than 0.7, indicating good diagnostic efficacy. Age-stratified analysis revealed that AA reduction was predominant in childhood, whereas PA reduction was predominant in adolescence. Pathway enrichment analysis showed significant enrichment of fatty acid biosynthesis (FDR=0.341, P=0.003) and vitamin K metabolism (FDR=1, P=0.039) pathways. Furthermore, subgroup analyses based on disease severity, personal/family history of atopy, and sex revealed no significant differences in SCFAs levels among the groups. ConclusionDifferential serum SCFAs and their enriched metabolic pathways may be implicated in the pathogenesis of AD.
2.Benvitimod attenuates atopic dermatitis by regulating the NRF2/ROS/NLRP3 signaling pathway
Yun Lu ; Liping Dong ; Maoxin Huang ; Yu Wang ; Tingyue Deng ; Fengli Xiao
Acta Universitatis Medicinalis Anhui 2025;60(8):1490-1497,1505
Objective :
To investigate the mechanism of action of benvitimod (BVM) in the treatment of atopic der- matitis (AD) .
Methods :
HaCaT cells were stimulated by TNF-α and IFN-γ , and the cells were grouped into NC group , TNF-α/IFN-γ group , TNF-α/IFN-γ BVM group , and TNF-α/IFN-γ BVM ML385 group. The AD model of DNCB-induced Balb/c mice was divided into CON group , DNCB group , DNCB + BVM group , and DNCB + TAC group. The efficacy of BVM and its roles in antioxidant and pyroptosis regulation were evaluated.
Results:
Compared with the control group , BVM inhibited the inflammatory response of HaCaT cells stimulated by TNF-α and IFN-γ , and ameliorated the skin lesions and inflammation in the DNCB-induced AD mouse model ; at the same time , it significantly increased the expression of nuclearfactorerythroid-2-relatedfactor2 (NRF2)-related anti-oxida- tive stress proteins , and significantly reduced the expression of cellular reactive oxygen species (ROS) levels and pyroptosis proteins. At the same time , the levels of NRF2-related antioxidative stress proteins significantly in- creased , and the levels of ROS and pyroptosis proteins significantly decreased.
Conclusion
BVM activates the NRF2/ROS/NLRP3 pathway to inhibit pyroptosis , thereby reducing the inflammatory response in AD.
3.Diagnostic value of immunohistochemical and molecular markers in diffuse pleural mesothelioma
Shaoling LI ; Chunyan WU ; Liping ZHANG ; Likun HOU ; Zhengwei DONG ; Huikang XIE ; Wei WU ; Wei ZHANG ; Yan HUANG
Chinese Journal of Clinical and Experimental Pathology 2025;41(6):706-712
Purpose To investigate the diagnostic value of immunohistochemical(IHC)and molecular markers in diffuse pleural mesothelioma(DPM).Methods A total of 114 cases of DPM were retrospectively analyzed for clinical and imaging manifestations,histologic subtype and tumor grade.The positivity rates of Calretinin,WT-1,CK5/6,MC,D2-40,UPK3B,and GATA3 were assessed by IHC,and the loss rates of BAP-1 and MTAP were determined.The concordance between MTAP IHC and p16 gene fluorescence in situ hybridization(FISH)status was calculated,a-long with the sensitivity and specificity of MTAP IHC relative to p16 FISH.Results Among the 114 DPM patients,66(57.9%)were male and 48(42.1%)were female,with a mean age of 58.1 years(range 16-85 years).Imaging predominantly demonstrated pleural effusion and multiple pleural nodules(55.3%,63/114).Histologically,epitheli-oid,sarcomatoid and biphasic subtypes accounted for 88(77.2%),17(14.9%)and 9(7.9%)cases,respectively.Within the epithelioid group,low and high-grade tumors numbered 69(78.4%)and 19(21.6%),respectively.In epithelioid DPM,the highest IHC positivity rates were observed for Calretinin(92.4%,81/88),D2-40(90.0%,79/88)and WT-1(90.0%,79/88).In sarcomatoid DPM,D2-40(76.5%,13/17),WT-1(64.7%,11/17),and Cal-retinin(29.4%,5/17)showed the greatest positivity.UPK3B was positive in epithelioid(59.1%,39/66)and bi-phasic cases(66.7%,4/6),but was absent in sarcomatoid tumors(0/12).Among all DPM cases,loss rates were 47.3%(53/112)for BAP-1 and 19.2%(20/104)for MTAP by IHC,p16 gene deletion by FISH was 31.5%(34/108);Concordance between MTAP IHC and p16 FISH was 81.0%(81/100);MTAP IHC had a specificity of 95.5%(64/67)and sensitivity of 51.5%(17/33)relative to p16 FISH.Additionally,GATA3 was highly expressed in sarco-matoid DPM(76.5%,13/17).UPK3B positivity differed significantly between thoracoscopic DPM(59.2%,32/54)and percutaneous biopsy samples(36.7%,11/30)in epithelioid DPM(P<0.05).WT-1 positivity was higher in thoracoscopic than percutaneous samples of sarcomatoid DPM(90.0% vs 28.6%,P=0.009).Conclusion Calreti-nin,D2-40,and WT-1 are highly sensitive mesothelial markers and should serve as first-line IHC stains in DPM diag-nosis.UPK3B is diagnostically valuable in epithelioid DPM,GATA3 may complement the diagnosis of sarcomatoid DPM,and MTAP IHC can be used as a surrogate or adjunct to p16 FISH.
4.Comparison and application of grading and classification methods for nuclear medicine workplaces
Yong YANG ; Xiang GAO ; Zhihao JU ; Haiyang DONG ; Fan BAI ; Liping ZENG
Chinese Journal of Radiological Health 2025;34(6):800-804
Objective To analyze the differences and connections between the current grading and classification methods for nuclear medicine workplaces, and to provide technical guidance for environmental impact assessments and technical reviews. Methods By comparing the objects, purposes, and computational approaches between the two methods, this article illustrates the usage of both methods through specific examples and analyzes the relationship between them. Results The two methods differed in objects, purposes, and computational approaches. The A, B, and C grading scheme was primarily used to establish the level of administrative supervision for an entire nuclear medicine workplace. In contrast, the I, II, and III classification system specifies the hardware facilities and engineering protection requirements of internal places or rooms. Conclusion These two methods are complementary and collectively provide a complete framework for the assessment of nuclear medicine workplaces.
5.Diagnostic value of plasma IL-2, IL-6 and IFN-γ in non-Hodgkin lymphoma
Qiong WU ; Liping KONG ; Yuan DONG ; Li LI ; Siyu ZONG ; Jinge XU ; Qingyun WU
Journal of Leukemia & Lymphoma 2025;34(2):80-84
Objective:To investigate the diagnostic value of plasma cytokines such as interleukin (IL)-2, IL-6 and interferon (IFN)-γ in non-Hodgkin lymphoma (NHL).Methods:A retrospective case-control study was conducted. A total of 48 NHL patients admitted to the Second Affiliated Hospital of Xuzhou Medical University between January 2020 and December 2022 were selected as NHL group, and another 34 healthy people who underwent physical examimation during the same period were selected as the healthy control group. The levels of IL-2, IL-4, IL-6, IL-10, IL-17, tumor necrosis factor (TNF) - α and IFN-γ in the plasma of patients at first admission and healthy subjects during physical examination were detected by using flow cytometry. The differences in general data and all cytokines levels of both groups were compared. The collinearity stepwise screening was made in 7 cytokines levels, and the screened variables were included in multivariate binary logistic regression model. Plasma cytokines with independent effects on the pathogenesis of NHL were screened. Taking local biopsy, histopathological examination or immunohistochemical examination as the gold standard, the receiver operating characteristic (ROC) curves of individual and combined diagnosis of NHL based on the selected cytokines were drawn to judge the diagnostic effect of all indicators on NHL.Results:There were 32 males (66.7%) and 16 females (33.3%) in NHL group, with the median age [ M ( Q1, Q3)] of 56.50 (45.75, 67.50) years; there were 28 males (82.4%) and 6 females (17.6%) in the healthy control group, with the median age of 52.00 (47.50, 55.50) years. There were no statistically significant differences in age and gender composition between the 2 groups (all P > 0.05). The levels of IL-2 [1.44 (1.36, 1.85) pg/ml vs. 1.19 (0.86, 1.68) pg/ml] and TNF-α [3.46 (2.68, 4.06) pg/ml vs. 2.23 (1.52, 3.46) pg/ml] in NHL group were higher than those in the healthy control group, and the differences were statistically significant (all P < 0.05). There were no statistically significant differences in IL-4, IL-6, IL-10, IL-17, IFN-γ levels (all P > 0.05). According to collinear stepwise screening of independent variables, IL-4 and TNF-α were excluded from 7 cytokines, and the other 5 cytokines were included in multivariate logistic regression model, and the result showed that the decreased level of IL-2 ( OR = 0.20, 95% CI: 0.08-0.53, P = 0.001) and the increased levels of IL-6 ( OR = 1.18, 95% CI: 1.04-1.33, P = 0.009) and IFN-γ ( OR = 1.26, 95% CI: 1.08-1.46, P = 0.003) were independent risk factors for the onset of NHL. The results showed that the area under the curve of IL-2, IL-6, IFN-γ and the combination of 3 indexes for the diagnosis of NHL was 0.760 (95% CI: 0.651-0.870), 0.595 (95% CI: 0.468-0.722), 0.508 (95% CI: 0.373-0.642), 0.847 (95% CI: 0.763-0.930), and the optimal cut-off value of the combination of 3 indexes was 0.730 which was calculated by logistic regression model formula; the corresponding sensitivity and specificity were 70.2% and 94.1%, respectively. Conclusions:The decreased level of IL-2 and increased levels of IL-6 and IFN-γ at initial diagnosis are risk factors for the onset of NHL. The combined detection of the 3 indexes shows a good value in the diagnosis of NHL.
6.A preliminary study on the application of one-stage clotting assay in Emicizumab laboratory testing
Dong PENG ; Ying WANG ; Liping LUO ; Meizhu LUO ; Qiuyue DUAN ; Guichi ZHOU ; Xiaoying FU
Chinese Journal of Laboratory Medicine 2025;48(11):1432-1438
Objective:To establish a modified one-stage clotting assay (mOSA) based on the STA-R Evolution coagulation analyzer for quantifying emicizumab (EMI) concentration and to preliminarily evaluate its analytical performance; meanwhile to explore the clinical utility of the standard one-stage clotting assay (sOSA) in indirectly predicting EMI levels through surrogate factor Ⅷ (FⅧ) activity.Methods:A total of 30 pediatric patients with hemophilia A (HA) treated with EMI in the Hemophilia Treatment Center of Shenzhen Children′s Hospital from January 2023 to March 2025 were enrolled, and 48 post-treatment plasma samples were collected. EMI standards (2.5~100 μg/ml) were prepared using FⅧ-deficient plasma to establish the mOSA detection system. The linearity, accuracy, and precision of the method were evaluated. Surrogate FⅧ activity was measured by sOSA to estimate EMI concentrations, and its correlation with mOSA-derived EMI concentrations was analyzed using Spearman correlation analysis. The equivalent FⅧ activity in patient plasma samples was measured using a human chromogenic substrate assay-based FⅧ activity detection reagent, and Spearman correlation analysis was employed to evaluate its correlations with both the EMI concentrations measured by the mOSA method and estimated by the sOSA method respectively.Results:The established mOSA method for EMI detection showed excellent linearity in the range of 2.5?100 μg/ml ( Y=1.047 X?1.033, R 2=0.995, P<0.001). Average spike recovery rates at 25, 50, and 75 μg/ml were 101.55%(25.39/25.00), 105.31%(52.66/50.00), and 98.20%(73.65/75.00), respectively. Coefficients of variations of within-and inter-batch were 3.47%?4.80% and 6.30%?8.96%, respectively. A prediction model for EMI concentration was established as follows: estimated EMI concentration (μg/ml)=0.095×[alternative FⅧ activity (%) measured by sOSA]+2.652 ( R2=0.999, P<0.001). Validation demonstrated a strong correlation between the EMI concentration measured by the mOSA method and the EMI concentration estimated by the sOSA method ( r=0.989, P<0.001), with good consistency ( Y=1.014 X+0.684, R2=0.972, P<0.001). Both the EMI concentration measured by the mOSA method and the EMI concentration estimated by the sOSA method showed extremely strong correlations with the equivalent FⅧ activity ( r=0.986 and 0.987, respectively; P<0.001 for both). Conclusions:The mOSA system established on the STA-R Evolution analyzer demonstrates robust linearity, accuracy, and reproducibility, fulfilling clinical requirements for therapeutic drug monitoring of EMI. The sOSA method provides reliable indirect estimation of EMI concentrations through surrogate FⅧ activity, offering critical support for emergency decision-making.
7.The performance of long non-coding rnas in the differential diagnosis of elderly pulmonary tuberculosis
Xiuxiu JI ; Siyu YAO ; Jing DONG ; Qiuyue LIU ; Yingchao WANG ; Xuetian SHANG ; Hongyan JIA ; Lanyue ZHANG ; Chuanzhi ZHU ; Zongde ZHANG ; Liping PAN
Chinese Journal of Geriatrics 2025;44(6):801-807
Objective:To detect the expression levels of long non-coding RNAs(lncRNA)in elderly patients with pulmonary tuberculosis(PTB)and those with non-tuberculous lung diseases(non-TB), and to assess the performance of these lncRNA in the differential diagnosis of PTB.Methods:A total of 300 elderly patients with suspected PTB were recruited from Beijing Chest Hospital between January 2024 and September 2024, and were further divided into the PTB group and the non-TB lung disease group based on the results of mycobacterium tuberculosis(MTB)pathogenicity testing.Peripheral blood mononuclear cells were isolated using a lymphocyte separation solution, and RNA was extracted using the TRIzol method.Nine lncRNAs, previously identified as differentially expressed in PTB through our group's microarray analysis, were selected and detected by real-time fluorescence quantitative polymerase chain reaction to evaluate the expression levels of these lncRNAs between the PTB and non-TB lung disease groups.The overall patients were randomly divided into training and validation sets in a 7∶3 ratio.Lasso regression was employed to select the characteristic variables, and a random forest algorithm was then used to construct the lncRNA diagnostic portfolio.Receiver operating characteristic(ROC)curves were generated to evaluate the diagnostic performance of individual lncRNAs and the combined panel in differentiating elderly patients with PTB from those with other non-TB lung diseases.Results:A total of 201 cases were included, with 105 confirmed elderly patients diagnosed with PTB(52.2%)and 96 elderly patients suffering from non-TB lung disease(47.8%).Compared to the elderly patients with non-TB lung disease, the expression levels of ENST00000417346.1, ENST00000620744.1, lncRNA PWP1, ENST00000583184.1, lncRNA ABHD17B, ENST00000607464.1, ENST00000516057.1, and NR_003000 were significantly downregulated in the PTB patients, whereas the expression level of lncRNA BCL2L10 was significantly upregulated in the PTB patients.ROC analysis revealed that the area under the curve(AUC)for each lncRNA ranged from 0.659 to 0.848.The diagnostic panel, which included NR_003000, ENST00000607464.1, ENST00000583184.1, and ENST00000620744.1 as determined by Lasso analysis, exhibited AUC values of 0.917 and 0.906 in the training and validation sets, respectively.The performance of this panel was superior to that of each individual lncRNA.Conclusions:The random forest model, which incorporates NR_003000, ENST00000607464.1, ENST00000583184.1, and ENST00000620744.1, demonstrates potential in differentiating between PTB and non-TB lung diseases.
8.Serum lipidomic profiling in patients with dermatomyositis based on ultra-performance liquid chromatography-mass spectrometry
Tongchuan MA ; Xinying CAI ; Rui WANG ; Liping DONG ; Lele CHEN ; Fengli XIAO
Chinese Journal of Dermatology 2025;58(8):736-743
Objective:To investigate differences in serum lipid profiles between patients with dermatomyositis (DM) and healthy controls.Methods:A retrospective analysis was conducted on the clinical data and serum samples collected from 51 patients with DM who visited the First Affiliated Hospital, Anhui Medical University from September 2020 to January 2022. Serum samples were also collected from 66 healthy controls during the same period. Serum lipid profiles were analyzed using ultra-performance liquid chromatography-mass spectrometry in both groups. Differential lipids were screened using principal component analysis and orthogonal partial least squares-discriminant analysis. The predictive value of these differential lipids for DM was evaluated by receiver operating characteristic (ROC) curve analysis, and their correlations with clinical indicators were also evaluated.Results:A total of 51 patients with DM were enrolled, including 27 males and 24 females, with ages ( M[ Q1, Q3]) of 55.00 (47.00, 66.00) years and body mass index (BMI) values of 22.64 (19.79, 24.75) . The control group included 66 healthy individuals (33 males and 33 females) , with ages of 51.00 (43.75, 56.00) years and BMI values of 23.60 (21.18, 25.19) . No significant differences were observed between the two groups in terms of sex, age, or BMI (all P > 0.05) . A total of 341 lipid metabolites were identified, and 16 lipid metabolites such as ceramides (Cer) , sphingomyelins, phosphatidylcholines (PC) , phosphatidylethanolamines, lysophosphatidylcholines (LPC) , and triglycerides (TG) significantly differed between the DM group and the control group, of which 8 were upregulated and 8 were downregulated in the DM group. ROC curve analysis identified 7 differential lipids with area under the curve (AUC) values of > 0.9, of which 2 were Cer, 3 were TG, 1 was phosphatidylethanolamine, and 1 was LPC. In the DM patients, serum LPC (22∶1) levels were negatively correlated with creatine kinase isoenzyme MB levels ( r = -0.276, P < 0.05) , serum PC (15∶1/16∶0) levels were negatively correlated with aspartate aminotransferase levels ( r = -0.305, P < 0.05) , and serum Cer (d18∶1/18∶0) levels were positively correlated with C-reactive protein levels ( r = 0.283, P < 0.05) . Significant differences in serum lipid levels were observed between some DM subgroups (all P < 0.05) : sphingomyelin (d24∶0) levels significantly differed between anti-Sj?gren syndrome type A/Ro52 antibody-positive and -negative DM patients; LPC (17∶1) levels significantly differed between anti-PM-SCL75 antibody-positive and -negative DM patients; LPC (20∶0) and PC (32∶1p) levels significantly differed between anti-Mi-2 antibody-positive and -negative DM patients; LPC (22∶1) and TG (9∶0/9∶0/9∶0) levels significantly differed between anti-TIF1-γ antibody-positive and -negative DM patients; Cer (d18∶1/18∶0) levels significantly differed between DM patients with and without Heliotrope's sign. Conclusion:Lipid profiles were significantly altered in DM patients compared with healthy controls, and some lipids showed potential diagnostic value for DM.
9.Nitazoxanide protects against heart failure with preserved ejection and metabolic syndrome induced by high-fat diet (HFD) plus L-NAME "two-hit" in mice.
Jiahui CHEN ; Liping ZHANG ; Ting XIE ; Xiao ZHANG ; Congcong PAN ; Fangli SUN ; Wenfeng LI ; Zhijie SUN ; Deli DONG
Acta Pharmaceutica Sinica B 2025;15(3):1397-1414
The clinical antiprotozoal drug nitazoxanide has been demonstrated to improve the experimental diabetes mellitus, lipid metabolism disorders, atherosclerosis and inhibit inflammation. Since the pathogenesis of heart failure with preserved ejection (HFpEF) is multifactorial and closely associated with the aforementioned diseases, we aim to study the effect of nitazoxanide on high-fat diet (HFD) plus L-NAME (N ω-nitro-l-arginine methyl ester)-induced HFpEF and metabolic syndrome in mice. We found that oral nitazoxanide improved cardiac hypertrophy, cardiac fibrosis, cardiac diastolic dysfunction, increased blood pressure, impaired exercise tolerance, impaired glucose handling, serum lipid disorders, hepatic steatosis, increased weight of white adipose tissues and kidney fibrosis in HFD + L-NAME-treated mice. In the established HFD + L-NAME-induced HFpEF and metabolic syndrome mouse model, therapeutic treatment with nitazoxanide rescued HFD + L-NAME-induced pathological phenotypes as mentioned above. The in vitro experiments revealed that tizoxanide, the active metabolite of nitazoxanide, increased the basal mitochondria metabolism of cardiomyocytes, inhibited cardiomyocyte hypertrophy and collagen secretion from cardiac fibroblasts, and relaxed phenylephrine- and U46619-induced constriction of rat mesenteric arteries, indicating that the direct effect of tizoxanide might partly contribute to the protective effect of nitazoxanide against HFpEF in vivo. The present study suggests that nitazoxanide might be a potential drug for HFpEF and metabolic syndrome therapy.
10.Compound Centella asiatica formula alleviates Schistosoma japonicum-induced liver fibrosis in mice by inhibiting the inflammation-fibrosis cascade via regulating the TLR4/MyD88 pathway.
Liping GUAN ; Yan YAN ; Xinyi LU ; Zhifeng LI ; Hui GAO ; Dong CAO ; Chenxi HOU ; Jingyu ZENG ; Xinyi LI ; Yang ZHAO ; Junjie WANG ; Huilong FANG
Journal of Southern Medical University 2025;45(6):1307-1316
OBJECTIVES:
To explore the therapeutic mechanism of compound Centella asiatica formula (CCA) for alleviating Schistosoma japonicum (Sj)-induced liver fibrosis in mice.
METHODS:
The active components and targets of CCA were identified using the TCMSP database with cross-analysis of Sj-related liver fibrosis targets. A "drug-component-target-pathway-disease" network was constructed using Cytoscape 3.9.1. Functional enrichment analysis (GO/KEGG) was performed using DAVID. Molecular docking study was carried out to validate interactions between the core targets and the key compounds. For experimental validation of the results, 36 mice were divided into control group, Sj-infected model group, and CCA-treated groups. In the latter two groups, liver fibrosis was induced via abdominal infection with Sj cercariae for 8 weeks, followed by 8 weeks of daily treatment with CCA decoction or saline. Hepatic pathology of the mice was assessedwith HE and Masson staining, and hepatic expressions of collagen-I and collagen-III were detected using immunohistochemistry; serum IL-6 and TNF-α levels were determined with ELISA. Hepatic expressions of TLR4 and MyD88 proteins were analyzed with Western blotting.
RESULTS:
We identified a total of 107 bioactive CCA components and 791 targets, including 37 intersection targets linked to Sj-induced fibrosis. The core targets included TNF, TP53, JUN, MMP9, and CXCL8, involving the IL-17 signaling, lipid metabolism, TLR4/MyD88 axis, and cancer pathways. Molecular docking study confirmed strong binding affinity between quercetin (a primary CCA component) and TNF/TP53/JUN/MMP9. In Sj-infected mouse models, CCA treatment significantly attenuated hepatic inflammatory cell infiltration, reduced collagen-I and collagen-III deposition, improved tissue architecture, reduced serum IL-6 and TNF-α levels, and downregulated TLR4 and MyD88 expressions in the liver.
CONCLUSIONS
CCA mitigates Sj-induced liver fibrosis by targeting TNF, TP53, JUN, and MMP9 to modulate the TLR4/MyD88 pathway, thereby suppressing pro-inflammatory cytokine release, inhibiting hepatic stellate cell activation, reducing collagen deposition, and preventing granuloma formation in the liver.
Animals
;
Toll-Like Receptor 4/metabolism*
;
Mice
;
Myeloid Differentiation Factor 88/metabolism*
;
Schistosoma japonicum
;
Liver Cirrhosis/parasitology*
;
Schistosomiasis japonica
;
Signal Transduction
;
Molecular Docking Simulation
;
Inflammation
;
Centella/chemistry*
;
Drugs, Chinese Herbal/pharmacology*
;
Tumor Necrosis Factor-alpha/metabolism*


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