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Vector distribution is extensive &#40;<span class="elsevierStyleItalic">Aedes aegypti</span> and <span class="elsevierStyleItalic">Aedes albopictus</span>&#41; and since the end of 2013 infections by CHIK have spread from the Southern states of the United States to the north of Argentina&#46; These are the same mosquitoes responsible for the transmission of dengue fever&#44; yellow fever&#44; Zika fever&#44; West Nile fever&#44; Japanese encephalitis and Eastern equine encephalitis virus&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The standard initial disease symptoms are high fever from 3 to 10 days&#44; with half of patients also suffering from joint pain and&#47;or effusion<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> which starts 2&#8211;5 days after the fever and usually includes the involvement of over 10 joints symmetrically&#44; with hands&#44; followed by wrists&#44; and ankles being the most commonly affected&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2&#44;3</span></a> Participation of the axial skeleton is observed in less than half of the patients depending on the series&#46; The anti-CCP antibodies and the rheumatoid factor &#40;RF&#41; typically test negative&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Due to its low prevalence in Europe and North America up until now this disease has not been a regular pathology in the everyday clinical practice of rheumatologists in these areas&#46; However&#44; the increase in its incidence in our environment due to greater international travel and global warming suggests that cases should now be reviewed in greater detail&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical Case</span><p id="par0025" class="elsevierStylePara elsevierViewall">A 40 year-old woman presented at our centre in mid-December 2014&#46; She had been on a trip to Cartagena de Indias at the beginning of December that same year&#46; On the third day after her arrival in Colombia she suffered from low mucosa secretion and gingivitis&#44; and right carpal monoarthralgia on the fifth day which one day later developed into symmetrical and distal bilateral polyarthralgias affecting both wrists and ankles&#46; Later proximal and distal interphalangeal arthalgias were added to the first and fourth finger&#46; She did not suffer from myalgias&#46; On the eighth day&#44; on her return to Spain she had a fever of 37&#46;1<span class="elsevierStyleHsp" style=""></span>&#176;<span class="elsevierStyleSmallCaps">C</span> with a nonconfluent maculopapular rash which respected palms of hands and feet&#46; Analysis highlighted a reactive C protein of 1&#46;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; lymphopenia and monocytosis&#46; Treatment with nonsteroid anti-inflammatory drugs &#40;NSAIDS&#41; and paracetamol were prescribed&#46; On the twelfth day she presented with synovitis and effusion in both wrists and ankles which were confirmed by the rheumatology department&#46; The patient stated she no longer had a fever but did have night diaphoresis&#46; On the eighteenth day the patient suffered from carpal tunnel syndrome&#44; mostly in her right hand&#46; A positive IgM antibody for CHIK was then confirmed serologically and treatment with 30<span class="elsevierStyleHsp" style=""></span>mg of prednisone was initiated&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In May 2015&#44; functional limitation persisted&#44; with no synovitis&#44; but with serious pain in right wrists&#46; Nuclear magnetic resonance &#40;NMR&#41; imaging of the right wrist in October 2015&#44; 11 months after initiation of symptoms&#44; showed two erosions on the articular side of the right radial epiphysis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; In our case&#44; the patient continued to suffer for 18 months with arthritis controlled with corticosteroids&#44; initially at a fixed dose and later with a progressively lower dose until it was resolved&#46; Due to the patient&#39;s express desire to conceive&#44; we ruled out initiation of standard synthetic disease-modifying anti-rheumatic drugs &#40;DMARDs&#41;&#46; After one and a half years of clinical symptoms with the presence of articular effusion&#44; the corticoid treatment was withdrawn&#46; The patient currently has no clinical or ultrasound signs of arthritis in any joint although she continues to have pain on extreme flexion of the right wrist&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0035" class="elsevierStylePara elsevierViewall">The possibility of erosive polyarthritis of wrists&#44; hands and ankles has been described in the literature&#44;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#44;4&#44;5</span></a> with participation from uncommon joints on occasions&#44; such as the sternoclavicular or temporomandibular joints&#46; The severity of symptoms in the initial stages of the infection by CHIK could determine time of resolution and risk of development of a long-term arthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> Chronic progression of arthritis should be taken into consideration for a differential diagnosis to prevent persistence over time of an arthritis which could result in joint destruction&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">The mechanisms that may lead to chronification of arthritis have not been well established&#46; At the moment&#44; the presence of CHIK RNA in synovial fluid in the acute phase has only been demonstrated in animal models&#46; Furthermore it has been demonstrated that macrophage activation in synovial fluid plays a central role in persistent joint inflammation&#46; A study sponsored by the George Washington University is currently trying to show the presence of the virus in human synovial fluid and to assess its role in arthritis chronification&#44; in addition to the presence or nonpresence of the virus in serum&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> The prolonged persistence of IgM in serum could indicate the presence of the virus in tissues&#46; However&#44; there is no evidence that the persistence of the virus would be necessary for the development of a chronic inflammation or that there is a clear relationship between with the severity of the illness&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">One hypothesis is that&#44; through the mechanisms of molecular mimicry and individual genetic conditioning&#44; the infection triggers off an autoimmune reaction which conditions the appearance of a chronic arthritis&#46; Indian scientists concluded significantly in 2014 that the frequency of the allele HLA-DRB1&#42;11 and the haplotype DRB1&#42;11&#47;DQB1&#42;03 was lower in patients than in controls&#44; conferring resistance&#46; They also proved that the haplotype DRB1&#42;04&#47;DQB1&#42;03 was significantly higher in patients with arthritis chronification&#44; and found the allele HLA DQB1&#42;04 solely in this patient group&#46; In 2010&#44; the same work group&#44; from the longitudinal follow-up of a cohort of 203 patients for 10 months&#44; confirmed that only 51&#37; of patients were cured at the end of nine months&#46; They observed that of those who had joint pain &#40;74&#37;&#41;&#44; 36&#37; met the American College of Rheumatology criteria to classify them as having rheumatoid arthritis and tested 20 of these for RF and anti-CCP&#46; All serologies were negative except for one patient who tested positive for anti-CCP positive and who showed signs of joint destruction by NMR&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1&#44;8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">If we review data from the 2006 outbreak on Reunion Island&#44; we see that the majority of young patients recovered&#44; with prevalence of persistence clearly higher in people over 60&#44; who also had a higher viral load&#46; Rapid establishment of an innate response was shown with an increase in the activation of NK cells and CD4 lymphocytes&#44; followed by a weak response of the cytokins Th1&#47;Th2&#44; and high levels of IFN-alpha&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Cases have been described in the literature where chronic arthritis follows an infection by CHIK&#46; Some of these patients despite post-infectious origin&#44; were treated with DMARDs due to the chronic nature of the condition&#44; with favourable outcome&#46; We should highlight that the efficacy of the DMARDs in this indication has not been accurately assessed&#46; French researchers have postulated that the resistance or dependence of corticoids beyond 3 months would be highly suggestive of chronification&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">At present&#44; treatment is essentially one of support&#44; including anti-inflammatory drugs&#46; Antiviral drugs and chloroquine have not proven to be effective and there is currently no available vaccine&#46; For selected chronic patients&#44; the corticosteroids methotrexate and other immunomodulatory agents may be of use&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">10&#44;11</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conclusion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Scientific production aimed at this issue is limited and the evidence in all aspects is scarce&#46; Although arthritis by CHIK are self-limiting and mild in somewhat more than half of the occasions&#44; in several of the series up to 49&#37; of patients chronic progression took over 9 months&#44; sometimes causing joint destructions&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> It is unknown whether early establishment of treatment would lead to reduction of the probability of suffering from erosions&#46; Diagnosis is serological&#46; IgM presents from day one to day twelve of symptom initiation and IgG from the second month onwards although it is possible that raised levels will last for years&#46; It should be noted that possible laboratory cross-reactivity exists or a co-infection may occur since the vector is shared with the dengue&#46; Serological and clinical evolution is highly variable and genetic conditioning may play an essential role in the etiopathogenesis of chronification&#46; The infection generates antibodies which protect the person throughout their life&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding</span><p id="par0070" class="elsevierStylePara elsevierViewall">No financing sources exist&#44; all the information was obtained during standard clinical practice&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of Interests</span><p id="par0075" class="elsevierStylePara elsevierViewall">All the authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Chikungunya virus infection &#40;CHIKV&#41; is associated with joint involvement in half of the cases&#46; This can lead to erosive arthritis which&#44; given the high intervariability of clinical and serological presentations&#44; and the probable role of genetic conditioning in the severity and chronification of the condition&#44; represents a great diagnostic and therapeutic challenge&#46; There is an important lack of scientific evidence that would enable us to characterize the variability of the patient and choose the most appropriate approach&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La infecci&#243;n por virus Chikungunya &#40;CHIKV&#41; presenta afectaci&#243;n articular en la mitad de las ocasiones&#46; Esta afectaci&#243;n puede derivar en una artritis erosiva que&#44; dada la elevada intervariabilidad en la presentaci&#243;n tanto cl&#237;nica como serol&#243;gica y el probable papel del condicionamiento gen&#233;tico en la gravedad y cronificaci&#243;n del cuadro&#44; supone un gran reto diagn&#243;stico y terap&#233;utico&#46; Existe una importante falta de evidencia cient&#237;fica que nos permita caracterizar la variabilidad del paciente y decidir el abordaje m&#225;s adecuado&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Castro-Dom&#237;nguez F&#44; Salman-Monte TC&#44; Ojeda F&#44; Corzo P&#44; Carri&#243;n-Barber&#225; I&#44; Garcia-Duitama IC&#44; et al&#46; Artritis erosiva por virus Chikungunya&#44; caso y revisi&#243;n de la literatura&#46; Reumatol Clin&#46; 2019&#59;15&#58;e119&#8211;e121&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">NMR imaging enhanced in T1 &#40;A&#58; coronal slice&#44; B&#58; axial plane&#41; and proton density with fat suppression in sagittal plane &#40;C&#41;&#46; Erosion in the distal articular surface of the radium &#40;arrows&#41; may be observed with no clear spinal oedema in the underlying bone&#46;</p>"
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      "seccion" => array:1 [
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          "bibliografiaReferencia" => array:11 [
            0 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical progression of chikungunya fever during acute and chronic arthritic stages and the changes in joint morphology as revealed by imaging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;P&#46; Manimunda"
                            1 => "P&#46; Vijayachari"
                            2 => "R&#46; Uppoor"
                            3 => "A&#46;P&#46; Sugunan"
                            4 => "S&#46;S&#46; Singh"
                            5 => "S&#46;K&#46; Rai"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.trstmh.2010.01.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Trans R Soc Trop Med Hyg"
                        "fecha" => "2010"
                        "volumen" => "104"
                        "paginaInicial" => "392"
                        "paginaFinal" => "399"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20171708"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chikungunya infection&#58; an emerging rheumatism among travelers returned from Indian Ocean islands&#46; Report of 47 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "F&#46; Simon"
                            1 => "P&#46; Parola"
                            2 => "M&#46; Grandadam"
                            3 => "S&#46; Fourcade"
                            4 => "M&#46; Oliver"
                            5 => "P&#46; Brouqui"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MD/0b013e31806010a5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Medicine"
                        "fecha" => "2007"
                        "volumen" => "86"
                        "paginaInicial" => "123"
                        "paginaFinal" => "137"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17505252"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical features and molecular diagnosis of Chikungunya fever from South India"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Lakshmi"
                            1 => "M&#46; Neeraja"
                            2 => "M&#46;V&#46; Subbalaxmi"
                            3 => "M&#46; Parida"
                            4 => "P&#46; Dash"
                            5 => "S&#46; Santhosh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/529444"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2008"
                        "volumen" => "46"
                        "paginaInicial" => "1436"
                        "paginaFinal" => "1442"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18419449"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Destructive arthritis in a patient with chikungunya virus infection with persistent specific IgM antibodies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Malvy"
                            1 => "K&#46; Ezzedine"
                            2 => "M&#46; Mamani-Matsuda"
                            3 => "B&#46; Autran"
                            4 => "H&#46; Tolou"
                            5 => "M&#46;C&#46; Receveur"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2334-9-200"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Infect Dis"
                        "fecha" => "2009"
                        "volumen" => "9"
                        "paginaInicial" => "200"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20003320"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chikungunya virus &#40;CHIKV&#41;&#58; what can be expected after the acute phase&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "V&#46;J&#46; Khoury"
                            1 => "P&#46;R&#46; Camilo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.reuma.2015.12.002"
                      "Revista" => array:6 [
                        "tituloSerie" => "Reumatol Clin"
                        "fecha" => "2016"
                        "volumen" => "12"
                        "paginaInicial" => "1"
                        "paginaFinal" => "3"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26781826"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Post-chikungunya chronic arthritis&#44; our experience with DMARDs over two year follow up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;A&#46; Ganu"
                            1 => "A&#46;S&#46; Ganu"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Assoc Physicians India"
                        "fecha" => "2011"
                        "volumen" => "59"
                        "paginaInicial" => "83"
                        "paginaFinal" => "86"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21751641"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0049017213002163"
                          "estado" => "S300"
                          "issn" => "00490172"
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "A pilot study of the pathogenesis of chikungunya arthritis in the Americas&#46; Available from&#58; <a target="_blank" href="https://clinicaltrials.gov/ct2/show/NCT02463968?term=chikungunya+synovial%26rank=1">https&#58;&#47;&#47;clinicaltrials&#46;gov&#47;ct2&#47;show&#47;NCT02463968&#63;term&#61;chikungunya&#43;synovial&#38;rank&#61;1</a> &#91;accessed 26&#46;05&#46;16&#93;&#46;"
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              ]
            ]
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              "identificador" => "bib0095"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of human leukocyte antigen class II allele and haplotypes in chikungunya viral infection in a western Indian population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Thanapati"
                            1 => "A&#46; Hande"
                            2 => "R&#46; Das"
                            3 => "Y&#46; Gurav"
                            4 => "A&#46;S&#46; Tripathy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/trstmh/tru030"
                      "Revista" => array:6 [
                        "tituloSerie" => "Trans R Soc Trop Med Hyg"
                        "fecha" => "2014"
                        "volumen" => "108"
                        "paginaInicial" => "277"
                        "paginaFinal" => "282"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24699361"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A report of 21 cases of rheumatoid arthritis following Chikungunya fever&#46; A mean follow-up of two years"
                      "autores" => array:1 [
                        0 => array:2 [
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