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Vaginal cesarean delivery: operative technique.

Video Author: Sophie Delplanque, MD and Krystel Nyangoh Timoh, MD, PhD
Published on: 01.09.2020

This video is a step-by-step operative technique for educational purposes. The current pregnancy was complicated by severe preeclampsia, the medical team decided to perform a vaginal cesarean delivery for maternal salvage. The operative technique consists of 4 steps. Step 1 is the sagittal and vertical incision of the cervix then the bladder with the anterior vaginal wall pushed upwards. Step 2 is the exposing the lower uterine segment and making a vertical segment incision up to the highest part of the lower uterine segment. Step 3 is the extraction of the fetus and the step 4 is the reconstruction of the lower uterine segment by separate sutures.

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Creator: Dr. Matthew Romagano

Duration: 2:28

Dr. Matthew Romagano summarizes his case report on catecholaminergic polymorphic ventricular tachycardia in pregnancy in the April, 2016 issue of the Obstetrics & Gynecology.

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Modified open laparoscopy using a 5-mm laparoscope

Creator: William W. Hurd, MD

Duration: 2:08

Demonstration of a 5-mm modified open laparoscopic entry technique that minimizes some of the disadvantages of conventional 10-mm open techniques while avoiding blind placement of sharp instruments. See the related article by Pryor and Hurd (March 2016 issue). Video courtesy of William W. Hurd, MD.

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Cystoscopy with dextrose as the distension medium

Creator: Deepa M. Narasimhulu, MD

Duration: 0:32

Cystoscopy video using dextrose as the distension medium with the view focused on the left ureteric orifice showing a good ureteric jet. See the related article by Narasimhulu et al (January 2016 issue). Video courtesy of Deepa M. Narasimhulu, MD.

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Removal of deeply inserted etonogestrel implant with modified vasectomy clamp

Creator: Melissa J. Chen, MD, MPH

Duration: 1:01

After making a skin incision over the implant, the straight hemostat clamp is used to divide the subcutaneous tissue until the level of the implant, as determined by the preprocedure ultrasonography study. The modified vasectomy clamp grasps around the implant and brings it to the skin surface. A scalpel is used to clear any overlying fibrotic tissue to free the implant for removal. See the related article by Chen and Creinin (November 2015 issue). Video courtesy of Melissa J. Chen, MD, MPH

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Video Abstract: A Pregnant Patient With Ebola Virus Disease

Creator: Titilope Oduyebo, MD, MPH

Duration: 4:16

Ebola: Dr. Titilope Oduyebo presents a case of a pregnant woman with Ebola virus disease and stillbirth in Sierra Leone. See the related article by Oduyebo et al (http://journals.lww.com/greenjournal/Abstract/publishahead/A_Pregnant_Patient_With_Ebola_Virus_Disease_.98946.aspx). Video courtesy of Titilope Oduyebo, MD, MPH. Used with permission.

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Video Abstract: Alcoholic Pancreatitis Masquerading as Preeclampsia

Creator: Dr. Tara A. Lynch

Duration: 3:01

Pancreatitis: Dr. Tara A. Lynch summarizes her case report of alcoholic pancreatitis masquerading as preeclampsia. See the related article by Lynch and Dexter (http://journals.lww.com/greenjournal/Abstract/publishahead/Alcoholic_Pancreatitis_Masquerading_as.98948.aspx). Video courtesy of Dr. Tara A. Lynch.

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Whirlpool sign in a case of ovarian torsion

Creator: Ron Bardin, MD

Duration: 0:30

Real-time ultrasound images of the whirlpool sign in a case of ovarian torsion. The study demonstrates blood flow in a clockwise direction around a central axis. See the related article by Ashwal et al (September 2015 issue). Video courtesy of Dr. Yoav Peled.

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Minilaparoscopic single site total hysterectomy.

Creator: Dr. Stefano Uccella, MD, PhD

Duration: 1:34

The technique for minilaparoscopic single site hysterectomy is here shown. A uterine manipulator is placed transvaginally and two 3-mm trocars are inserted at the umbilical level. Standard steps for total laparoscopic hysterectomy are followed. The entire operation is accomplished using only reusable instruments and all the uterine vascular pedicles are coagulated using 3-mm bipolar coagulation. Colpotomy is performed using monopolar cautery and the specimen is extracted through the vagina. The cuff is sutured transvaginally. The operation is terminated leaving only a very small umbilical incision. See the related article by Uccella et al (July 2015 issue).

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Laparoscopic enclosed power morcellation using a surgical glove

Creator: Ali Akdemir, MD

Duration: 7:30

The specimen is placed into the glove within the abdomen. Glove opening and thumb are exteriorized through the umbilical and left lower incisions, respectively. The trocar and optic are inserted into the glove, which is then insufflated. The thumb tip is cut, and a power morcellator is inserted through this finger. The morcellation is accomplished within the glove. The thumb tip is closed, and the glove, containing residuals, is removed through the umbilical incision. Thus, the risks of bag piercing and leakage during contained power morcellation are eliminated. See the related article by Akdemir et al (May 2015 issue).

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Video Abstract: Bowel Perforation after Placement of Tubal Occlusion Contraceptive

Creator: Dr. Kristin Riley

Duration: 3:02

Video Abstract: Bowel Perforation after Placement of Tubal Occlusion Contraceptive Dr. Kristin Riley summarizes her case report of a bowel perforation after placement of tubal occlusion contraceptive appearing in the April, 2015 issue of the Obstetrics & Gynecology.

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Sodium fluorescein use during intraoperative cystoscopy

Creator: Paula Doyle, MD and Ronald Wood, PhD

Duration: 0:20

Use of 0.25 mL of 10% sodium fluorescein intravenously during intraoperative cystoscopy for visualization of ureteral efflux. See the related article by Doyle et al (March 2015 issue).

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Endometrial aspiration at time of saline infusion sonohysterography

Creator: Ohad Rotenberg, MD

Duration: 0:10

Video depiction of endometrial aspiration at the conclusion of a saline-infusion sonohysterography procedure. Initially, the catheter edge is seen at the fundus. After negative pressure is applied by using a 20cc syringe, the catheter is slowly withdrawn pulling endometrial tissue with it. A thinner endometrium is seen at the end of the aspiration. See the related article by Rotenberg et al (February 2015 issue).

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Modified McIndoe procedure (part II)

Creator: Aubrey Rauktys, MD

Duration: 4:55

This video gives a detailed view of the steps including the harvesting of a split-thickness graft from the patient's pannus, suturing of this graft onto an obstetric balloon, and its placement inside the space created at the proximal end of the foreshortened vagina is presented. See the related article by Rauktys et al (January 2015 issue).

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Transcervical intralesional vasopressin injection and its effects during hysteroscopic myomectomy

Creator: Alyssa Sze Wai Wong, MD

Duration: 00:50

Vasopressin injection was performed with an ovum aspiration needle through the operating channel of a diagnostic hysteroscope to exert local vasoconstrictive effect. After cervical dilatation, a resectoscope is then used to complete the hysteroscopic myomectomy. See the related article by Wong et al (November 2014 issue).

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Laparoscopically Assisted Myomectomy

Creator: Ceana Nezhat, MD

Duration: 0:27

This video illustrates a hybrid approach specimen removal with myomectomy or hysterectomy. See the related article by Kho et al (October 2014 issue).

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Enclosed Transvaginal Morcellation of an Enlarged Uterus after Total Laparoscopic Hysterectomy and Bilateral Salpingo-oophorectomy

Creator: Ceana Nezhat, MD

Duration: 4:09

In this video we demonstrate transvaginal extracorporeal morcellation of a large uterus within an enclosed endoscopic bag. See the related article by Kho et al (October 2014 issue).

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Contained Power Morcellation at Laparoendoscopic Single Site Hysterectomy within an Insufflated Isolation Bag

Creator: KA Shibley

Duration: 6:47

Demonstrates the single-site technique for use of an insufflated isolation bag at time of power morcellation of uterine tissue See the related article by Cohen et al (September 2014 issue).

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Real-time ultrasound of fetal diphallia

Creator: Jin-Chung Shih, MD, PhD

Duration: 0:12

The urethras of these two phalluses seem to separately connect with the distal portion of the bladder. See the related article by Tu et al (August 2014 issue).

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High-Resolution Anoscopy

Creator: Adam C. ElNaggar, MD, Wendy Likes PhD, DNSc, APRN-Bc, Dianne Robbins, RN, Edwin Thorpe, MD

Duration: 2:58

High-resolution anoscopy is used for the detection of anal intraepithelial neoplasia. This video depicts important landmarks of the anal canal and pathologic features of anal intraepithelial neoplasia. Video courtesy of Dr. Adam ElNaggar. Used with permission. See the related article by ElNaggar and Santoso, Obstet Gynecol 2013;122:218-23.

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The Office Visceral Slide Test

Creator: Erica C. Dun, MD, MPH

Duration: 1:30

The office visceral slide test is an outpatient ultrasound test used to preoperatively predict intra-abdominal adhesions. This short video clip will explain the equipment needed, how to perform, and how to interpret the visceral slide test. An example of a normal test and an abnormal ultrasound visceral slide test are illustrated, including a laparoscopic view of the patient with an abnormal test. Video courtesy of Erica C. Dun, MD, MPH. Used with permission. See the related article by Nezhat et al (May 2014 issue).

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Removal of a large fundal polyp using a hysteroscopic morcellator.

Creator: Paul P. Smith, MBChB (hons)

Duration: 3:52

A large fundal polyp is removed under direct vision using a hysteroscopic morcellator. Video courtesy of Paul P. Smith, MBChB (hons). Used with permission. See the related article by Smith et al (April 2014 issue).

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Demonstration of protocol for measuring cervical length

Creator: Video courtesy of Nir Melamed, Liran Hiersch, Noam Domniz, Akiva Maresky, Ron Bardin, and Yariv Yogev

Duration: 0:30

Demonstration of protocol for measuring cervical length. Video courtesy of Nir Melamed, Liran Hiersch, Noam Domniz, Akiva Maresky, Ron Bardin, and Yariv Yogev.

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Michigan Four-Wall Sacrospinous Ligament Suspension for Vaginal Vault Prolapse

Creator: Kindra Larson, Daniel Morgan, and John O.L. DeLancey

Duration: 9:00

The operative technique of a Michigan four-wall sacrospinous ligament suspension for vaginal vault prolapse. © 2009 Kindra Larson, Daniel Morgan, and John O.L. DeLancey. Used with permission.

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Ovarian abnormalities followed with serial transvaginal ultrasonography

Creator: Dr. Edward J. Pavlik

Duration: 5:27

In the first part of the video, examples of ultrasonographic abnormalities are presented. In the second part, the authors show examples of the last abnormal morphologies before resolving to normal ovarian morphologies.

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Pelvic organ support changes during pregnancy.

Creator: Jette Stær-Jensen, MD

Duration: 0:44

Pelvic organ support changes during pregnancy. During Valsalva maneuver an increase of the levator hiatus area of up to 21.4% is seen. The video demonstrates the same primiparous woman at 21weeks of gestation and again at 37 weeks of gestation performing Valsalava maneuver. Video courtesy of Jette Stær-Jensen, MD. See the related article by Stær-Jensen et al.

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Three-dimensional endovaginal ultrasound imaging of the levator ani muscles

Creator: S. Abbas Shobeiri, MD

Duration: 4:08

Three-dimensional endovaginal ultrasound imaging of the levator ani muscles. See the related article by Rostaminia et al in the May issue.

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Colposcopic signs for detection of high-grade cervical intraepithelial neoplasia

Creator: Prof. Dr. Achim Schneider

Duration: 4:26

Demonstration of the inner border, ridge, and rag signs shown at colposcopic evaluation of women with high-grade cervical intraepithelial neoplasia. See the related article by Vercellino et al.

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LeFort Colpocleisis

Creator: Dr. Leon N. Plowright and Dr. G. Willy Davila

Duration: 9:31

LeFort colpocleisis. See the related article by Zebede et al.

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Outpatient Vaginal Hysterectomy: Tactics to Facilitate Same-Day Discharge

Creator: Dr. Mark Zakaria and Dr. Barbara Levy

Duration: 2:10

Outpatient vaginal hysterectomy: tactics to help facilitate same-day discharge. See the related article by Zakaria and Levy.

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Endometrial polypectomy using a 16-French resectoscope

Creator: Dr. Maurizio Guido

Duration: 4:40

Endometrial and endocervical polypectomy using a 16-French resectoscope equipped with a monopolar loop electrode. See the related article by Ricciardi et al.

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Robotic Surgical Management of Endometrial Cancer, Part 1 of 2

Creator: Drs. Susie Lau and Walter H. Gotlieb

Duration: 3:43

Robotic surgical treatment of a patient with endometrial cancer. See the related article by Lau et al.

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Pessary Position

Creator: Patrick J. Culligan, M.D.

Duration: 0:16

Ring with support pessary and Gellhorn pessary shown in “realistic” position with the patient upright. Animation courtesy of Tim Peters & Co. See the related Clinical Expert Series article by Culligan.

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Part 1: Laparoscopic techniques for excision of endometriosis

Creator: Tommaso Falcone, MD

Duration: 7:00

Minimally invasive conservative surgical treatment of endometriosis. Video courtesy of Dr. Tommaso Falcone. See the related article by Falcone and Lebovic in the September 2011 issue.

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Part 2: Laparoscopic techniques for excision of endometriosis

Creator: Tommaso Falcone, MD

Duration: 6:43

Minimally invasive conservative surgical treatment of endometriosis. Video courtesy of Dr. Tommaso Falcone. See the related article by Falcone and Lebovic in the September 2011 issue.

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Single-Port Laparoscopic-Assisted Vaginal Hysterectomy

Creator: Dr. Yi-Jen Chen and co-authors

Duration: 2:57

A demonstration of the insertion of the retractor and ports, hysterectomy, and dissection of cul de sac adhesions. Video courtesy of Dr. Yi-Jen Chen and co-authors.

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Robotic Myomectomy for Intramural Leiomyomata

Creator: Gouri Diwadkar, MD, and Tommaso Falcone, MD

Duration: 7:45

A demonstration of the technique of robotic myomectomy for intramural leiomyomata. Video courtesy of Drs. Gouri Diwadkar and Tommaso Falcone.

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Laparoscopic treatment of torsion of an accessory ovary

Creator: Dr. SF Ngu et al.

Duration: 0:57

A demonstration of laparoscopic treatment of torsion of an accessory ovary containing a cystic mass. Video courtesy of Drs. SF Ngu, HLT Wan, YS Tam, and VYT Cheung.

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Laparoscopic Salpingostomy for Ectopic Pregnancy

Creator: Dr. Demetrio Larrain, Dr. Benoit Rabischong et al.

Duration: 3:39

Demonstration of laparoscopic salpingostomy for ectopic pregnancy. Video courtesy of Dr. Demetrio Larrain, Dr. Benoit Rabischong, and co-authors.

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Use of FloSeal in postpartum hemorrhage due to placenta previa

Creator: Dr. Lai Wa Law

Duration: 1:00

Demonstration of the use of FloSeal hemostatic gel for intraoperative management of postpartum hemorrhage due to placenta previa. Video courtesy of Dr. Lai Wa Law and co-authors.

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Using Middle Cerebral Artery Peak Systolic Velocity to Time In Utero Transfusions

Creator: Prof. Bruno Carbonne

Duration: 2:05

Middle cerebral artery peak systolic velocity was used to time in utero transfusions in fetomaternal hemorrhage. Video courtesy of Prof. Carbonne. See the related article by Friszer et al.

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Office Hysteroscopic Sterilization

Creator: Scott Chudnoff, MD

Duration: 5:58

A demonstration of hysteroscopic sterilization in an office setting. Video courtesy of Drs. Chudnoff and Levie. See the related article by Chudnoff et al (Obstet Gynecol 2010;115:26-34).

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2008 Stump the Professors Scientific Session: "A Simple Case of Pre-Eclampsia?"

Creator: Lindsay B. Killingsworth, MD.

Duration: 19:13

2008 Stump the Professors presentation by Lindsay B. Killingsworth, MD.

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Laser Treatment of Placental Vascular Anastomoses

Creator: Dr. Dick Oepkes

Duration: 00:21

Laser treatment of placental vascular anastomoses.

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Ductus Venosus Doppler

Creator:

Duration: 2:22

The first segment of the video shows animated anatomy of the fetal circulation, highlighting the ductus venosus. The next segment shows a sonographic view of ductus venosus blood flow in a first-trimester fetus. The third segment shows normal ductus venosus blood flow velocity waveforms. The last segment shows reversed a-wave blood flow. Video courtesy of the Fetal Medicine Foundation. See the related article by Maiz et al (Obstet Gynecol 2009;113:860-5).

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Botox Bladder Injections

Creator:

Duration: 0:31

Cystoscopic intradetrusor injection of botulinum neurotoxin type A for treatment of non-neurogenic overactive bladder. Video courtesy of Dr. Thomas Kessler. See the related article by Kessler et al (Obstet Gynecol 2009;113:1046-51).

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Vaginal Surgical Skills

Creator: Gouri B. Diwadkar, MD

Duration: 1:37

Assessment of vaginal surgical skills using video motion analysis. Video courtesy of Dr. Gouri B. Diwadkar. See the related article by Diwadkar et al (Obstet Gynecol 2009;114:244-52).

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Weight, Weight—Don’t Tell Me!

Creator: The American College of Obstetricians and Gynecologists.

Duration: 18:56

2009 Stump the Professors presentation by Brian M. Burton, MD of the University of Arkansas for Medical Sciences, Little Rock, AR. See the related editorial by James R. Scott, MD (Obstet Gynecol 2009;114:413-4).

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Hysteroscopy preformed with both setups.

Creator: Nikolaos Kathopoulis, PhD

Duration: 3:10

Video created by Nikolaos Kathopoulis, PhD. Used with permission.

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A novel laparoscopic simulation platform

Creator: Amanda Ulrich, MD, Maureen Cho, MD, and Veronica Lerner, MD

Duration: 5:53

This video illustrates the creation of a reusable laparoscopic simulation platform, set up with a colpotomy model, and demonstration of the usability. Created by Amanda Ulrich, MD, Maureen Cho, MD, and Veronica Lerner, MD. Used with permission.

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The Shoulder Shrug Maneuver

Creator: Ricardo Leante, MS

Duration: 1:39

The video highlights a new technique to facilitate delivery during shoulder dystocia. See the related article by Sancetta et al (June 2019 issue). Video created by Ricardo Leante, MS. Used with permission.

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Positive sliding sign

Creator: Ori Shen, MD

Duration: 0:08

This clip demonstrates motion between the maternal abdominal and anterior uterine walls. See the related article by Drukker et al (March 2018 issue). Video created by Ori Shen, MD. Used with permission.

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Vaginal hysterectomy.

Creator: Dr. Karl Jallad

Duration: 12:13

Vaginal hysterectomy is the preferred route of hysterectomy for benign disease. It is associated with a shorter recovery, fewer complications, less cost and better cosmetic results than other types of hysterectomy. The objective of this video is to make vaginal hysterectomy approachable by showing the key procedural steps. Courtesy of Karl Jallad. Used with permission.

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Michigan Four-Wall Sacrospinous Ligament Suspension for Vaginal Vault Prolapse

Creator: Kindra Larson, Daniel Morgan, and John O.L. DeLancey

Duration: 9:00

The operative technique of a Michigan four-wall sacrospinous ligament suspension for vaginal vault prolapse. © 2009 Kindra Larson, Daniel Morgan, and John O.L. DeLancey. Used with permission.

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LeFort Colpocleisis

Creator: Dr. Leon N. Plowright and Dr. G. Willy Davila

Duration: 9:31

LeFort colpocleisis. See the related article by Zebede et al.

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