867 results match your criteria Imaging in Twin-to-Twin Transfusion Syndrome


Role of Imaging in Obstetric Interventions: Criteria, Considerations, and Complications.

Radiographics 2021 Jun 11:200163. Epub 2021 Jun 11.

From the Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, Box 0628, San Francisco, CA 94143-0628 (P.J., V.A.F.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (M.V.R.); Department of Radiology, Winthrop University Hospital, Mineola, NY (D.S.K.); and Department of Radiology, University of Washington, Seattle, Wash (M.M.).

US has an established role in the prenatal detection of congenital and developmental disorders. Many pregnant women undergo US at 18-20 weeks of gestation for assessment of fetal anatomy and detection of structural anomalies. With advances in fetoscopy and minimally invasive procedures, in utero fetal interventions can be offered to address some of the detected structural and physiologic fetal abnormalities. Read More

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From a Disposable Ureteroscope to an Active Lightweight Fetoscope-Characterization and Usability Evaluation.

IEEE Robot Autom Lett 2018 Oct 20;3(4):4359-4366. Epub 2018 Aug 20.

Sebastien Ourselin is with the Department of Imaging and Biomedical Engineering, King's College London, London WC2R 2LS, U.K.

The twin-to-twin transfusion syndrome is a severe fetal anomaly appearing in up to 15% of identical twin pregnancies. This anomaly occurs when twins share blood vessels from a common placenta. The complication leads to an unbalanced blood transfusion between both fetuses. Read More

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October 2018

Complicated Monochorionic-Diamniotic Twins in a Pregnant Woman with COVID-19 in the Second Trimester.

Am J Perinatol 2021 06 14;38(7):747-752. Epub 2021 Apr 14.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, Los Angeles, California.

Objective: A majority of studies evaluating the risk of vertical transmission and adverse outcomes in pregnancies with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are mostly based on third-trimester infections. There is limited data available on pregnancy sequelae of maternal infection in the first or second trimester.

Study Design: We present a patient with monochorionic-diamniotic twins that develops coronavirus disease 2019 infection at 15 weeks of gestation. Read More

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Twin-to-Twin Transfusion Syndrome: Diagnostic Imaging and Its Role in Staving Off Malpractice Charges and Litigation.

Diagnostics (Basel) 2021 Mar 4;11(3). Epub 2021 Mar 4.

Department of Anatomical, Histological, Forensic, and Orthopedic Sciences, Sapienza University of Rome, 00161 Rome, Italy.

The study aims to expound upon the imaging-based diagnostic methodologies aimed at identifying twin-to-twin transfusion syndrome (TTTS), a serious, somewhat rare prenatal condition that takes place in pregnancies where identical twins, or other multiples, share a placenta (monochorionic placenta), highlighting how medico-legal outcomes can be affected by provable compliance with consolidated diagnostic guidelines or best practices. It is of utmost importance to produce a prompt identification of TTTS instances; an early diagnosis is in fact critical in order to effectively treat and manage TTTS. By virtue of TTTS being a highly progressive condition, a delay in diagnosis can result in disastrous outcomes; just a few weeks delay in the diagnosis of TTTS can turn out fatal for one or both twins. Read More

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Intrafetal laser therapy in a monochorionic diamniotic triplet pregnancy with two acardiac fetuses: a case report and literature review.

BMC Pregnancy Childbirth 2021 Mar 23;21(1):245. Epub 2021 Mar 23.

Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, Sichuan, 610041, Chengdu, China.

Background: Monochorionic diamniotic triplet pregnancies are rare. Twin reversed arterial perfusion sequence in monochorionic triplet pregnancies is extremely rare, and it is associated with high perinatal morbidity and mortality rates in the "pump fetus."

Case Presentation: We reported a case of monochorionic diamniotic triplet pregnancy with twin reversed arterial perfusion sequence, including two acardiac fetuses sharing a single amniotic sac and a normal fetus in another amniotic sac. Read More

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Fetal surgery.

Authors:
K Sampat P D Losty

Br J Surg 2021 Jun;108(6):632-637

Department of Paediatric Surgery, Alder Hey Children's Hospital, Liverpool, UK.

Fetal medicine is a super-specialty enterprise and a technology-driven field. The growth and interest in fetal surgery can be largely attributed to advances in fetal imaging and bespoke instruments for in utero intervention. Previously fatal fetal conditions are now being treated using open surgery, minimally invasive procedures, and percutaneous fetal technologies. Read More

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Double inferior vena cava in a monochorionic twin pregnancy with selective fetal growth restriction.

BMJ Case Rep 2021 Mar 10;14(3). Epub 2021 Mar 10.

Department for Obstetrics and Gynecology, Inselspital Bern Universitätsklinik für Frauenheilkunde, Bern, BE, Switzerland.

Congenital anomalies of the infrarenal inferior vena cava (IVC) are well described in adult life, however, little information exists on their associations in fetal life. Here, we describe a case of a monochorionic diamniotic (MCDA) twin pregnancy complicated by selective fetal growth restriction (sFGR) with an incidental finding of a double IVC in one child. In fetal life, variants of the infrarenal IVC are strongly associated with heart defects, which might suggest haemodynamic alterations or genetic causes, even more so in our case with MCDA twins complicated by sFGR. Read More

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A shape-constraint adversarial framework with instance-normalized spatio-temporal features for inter-fetal membrane segmentation.

Med Image Anal 2021 05 19;70:102008. Epub 2021 Feb 19.

Department of Advanced Robotics, Istituto Italiano di Tecnologia, Genoa, Italy.

Background And Objectives: During Twin-to-Twin Transfusion Syndrome (TTTS), abnormal vascular anastomoses in the monochorionic placenta can produce uneven blood flow between the fetuses. In the current practice, this syndrome is surgically treated by closing the abnormal connections using laser ablation. Surgeons commonly use the inter-fetal membrane as a reference. Read More

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Twin pregnancies.

Ultraschall Med 2021 Jun 23;42(3):246-269. Epub 2021 Feb 23.

Department of Obstetrics, University Hospital Zürich and University of Zurich, Zurich, Switzerland.

Twin pregnancies, resulting in 2-3 % of all deliveries, are high risk pregnancies which need specialized care. A correct dating of pregnancy and the assessment of the chorionicity/amnionicity in the first trimester (< = 13 + 6 gestational weeks, GW) is essential for further monitoring. During first trimester risk stratification of monochorionic pregnancies includes evaluation of discordance of crown-rump-lengths, nuchal translucencies and amniotic fluid. Read More

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Renal artery Doppler studies in the assessment of monochorionic, diamniotic twin pregnancies with and without twin-twin transfusion syndrome.

Am J Obstet Gynecol MFM 2020 08 1;2(3):100167. Epub 2020 Jul 1.

Columbia University Irving Medical Center, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York, NY.

Background: In monochorionic, diamniotic twin pregnancies complicated by twin-twin transfusion syndrome, imbalanced fetofetal blood shunting and discordant activation of the renin-angiotensin system result in a hypovolemic, oliguric donor twin and a hypervolemic, polyuric recipient twin. Renal artery Doppler assessments have been reported to predict oligohydramnios in singleton pregnancies; however, their value in assessing monochorionic, diamniotic twin gestations, including pregnancies complicated by twin-twin transfusion syndrome, remains unstudied.

Objective: This investigation evaluated whether renal artery Doppler parameters are different between sets of monochorionic, diamniotic twins with and without twin-twin transfusion syndrome. Read More

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Intrauterine fetoscopic laser surgery versus expectant management in stage 1 twin-to-twin transfusion syndrome: an international randomized trial.

Am J Obstet Gynecol 2021 05 26;224(5):528.e1-528.e12. Epub 2020 Nov 26.

Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, AP-HP and EA7328, Université de Paris, Paris, France.

Background: Selective fetoscopic laser coagulation of the intertwin anastomotic chorionic vessels is the first-line treatment for twin-twin transfusion syndrome. However, in stage 1 twin-twin transfusion syndrome, the risks of intrauterine surgery may be higher than those of the natural progression of the condition.

Objective: This study aimed to compare immediate surgery and expectant follow-up in stage 1 twin-twin transfusion syndrome. Read More

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The prevalence of brain lesions after in utero surgery for twin-to-twin transfusion syndrome on third-trimester MRI: a retrospective cohort study.

Eur Radiol 2021 Jun 19;31(6):4097-4103. Epub 2020 Nov 19.

Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium.

Objective: Due to the increased risk of antenatal brain lesions, we offer a third-trimester magnetic resonance imaging (MRI) scan to all patients who underwent an in utero intervention for twin-twin transfusion syndrome (TTTS). However, the usefulness of such a policy has not been demonstrated yet. Therefore, we determined the prevalence of antenatal brain lesions detected on third-trimester MRI and the proportion of lesions detected exclusively on MRI. Read More

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The spectrum of brain malformations and disruptions in twins.

Am J Med Genet A 2020 Nov 18. Epub 2020 Nov 18.

Department of Pediatrics, Division of Genetics and Metabolism, University of Minnesota, Minneapolis, Minnesota, USA.

Twins have an increased risk for congenital malformations and disruptions, including defects in brain morphogenesis. We analyzed data on brain imaging, zygosity, sex, and fetal demise in 56 proband twins and 7 less affected co-twins with abnormal brain imaging and compared them to population-based data and to a literature series. We separated our series into malformations of cortical development (MCD, N = 39), cerebellar malformations without MCD (N = 13), and brain disruptions (N = 11). Read More

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November 2020

Fetal neurodevelopmental recovery in donors after laser surgery for twin-twin transfusion syndrome.

Prenat Diagn 2021 01 26;41(2):190-199. Epub 2020 Nov 26.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.

Background: Fetal magnetic resonance imaging (MRI) and spectroscopy (MRS) provide a unique opportunity to non-invasively measure markers of neurodevelopment in survivors of twin-twin transfusion syndrome (TTTS).

Objective: To characterize fetal brain maturation after laser surgery for TTTS by measuring brain volumes and cerebral metabolite concentrations using fetal MRI + MRS.

Study Design: Prospective study of dual surviving fetuses treated with laser surgery for TTTS. Read More

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January 2021

A donor twin discordant with Peters anomaly in a twin-twin transfusion syndrome case: a case report.

BMC Pregnancy Childbirth 2020 Sep 23;20(1):558. Epub 2020 Sep 23.

Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan.

Background: Peters anomaly is a rare form of anterior segment ocular dysgenesis, the antenatal image of Peters anomaly had not been reported. We herein showcased a discordant finding of Peters anomaly in a monozygotic twin complicated with twin-twin transfusion syndrome (TTTS) and exhibited its antenatal sonographic images, CASE PRESENTATION: A 38-year-old gravida 2 para 1 pregnant woman visited our clinic at the gestational age of 18 weeks where TTTS stage III was diagnosed and the following laser therapy was done successfully. Ten days after the surgery, the follow-up ultrasound detected the opacity of both fetal eyeballs in the donor twin and thus congenital cataract was suspected initially. Read More

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September 2020

The incidence, maternal, fetal and neonatal consequences of single intrauterine fetal death in monochorionic twins: A prospective observational UKOSS study.

PLoS One 2020 21;15(9):e0239477. Epub 2020 Sep 21.

Fetal Medicine Centre, Birmingham Women's and Children's NHS Foundation Trust, Birmingham Women's Hospital, Mindelsohn Way, Edgbaston, United Kingdom.

Objective: Report maternal, fetal and neonatal complications associated with single intrauterine fetal death (sIUFD) in monochorionic twin pregnancies.

Design: Prospective observational study.

Setting: UK. Read More

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November 2020

Fetoscopic Release of Amniotic Band Syndrome: An Update.

J Ultrasound Med 2021 May 20;40(5):1039-1048. Epub 2020 Sep 20.

Department of Maternal Fetal Medicine, Strasbourg University Hospital, France.

Amniotic band syndrome is a rare condition. There have been few cases reported of fetoscopic band dissection. The aim of this case series is to report 3 cases of fetoscopic treatment for amniotic band syndrome, including indication for surgery, technical aspects, complications and outcomes. Read More

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Segmentation of the placenta and its vascular tree in Doppler ultrasound for fetal surgery planning.

Int J Comput Assist Radiol Surg 2020 Nov 19;15(11):1869-1879. Epub 2020 Sep 19.

Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, Spain.

Purpose: Twin-to-twin transfusion syndrome (TTTS) is a serious condition that occurs in about 10-15% of monochorionic twin pregnancies. In most instances, the blood flow is unevenly distributed throughout the placenta anastomoses leading to the death of both fetuses if no surgical procedure is performed. Fetoscopic laser coagulation is the optimal therapy to considerably improve co-twin prognosis by clogging the abnormal anastomoses. Read More

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November 2020

Double Trouble: Complications in Twin Pregnancies.

Ultrasound Q 2020 Sep;36(3):240-246

Department of Radiology, University of Washington, Seattle, WA.

With the increasing rate of twin pregnancies due to increase in maternal age and use of assisted reproduction, it is important to be aware of unique diseases which occur specifically to twin pregnancies, especially in monochorionic twin pregnancies. These entities include twin to twin transfusion syndrome, twin anemia polycythemia sequence, twin reversed arterial perfusion, cotwin demise, and conjoined twins. Early evaluation and documentation are imperative to guide management which ultimately leads to better patient outcomes. Read More

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September 2020

Society for Maternal-Fetal Medicine Special Statement: Updated checklists for management of monochorionic twin pregnancy.

Am J Obstet Gynecol 2020 11 27;223(5):B16-B20. Epub 2020 Aug 27.

Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.

Approximately 20% of twin pregnancies are monochorionic. The management of monochorionic twin pregnancy involves several additional interventions beyond the routine management of singletons or dichorionic twins. In 2015, the Society for Maternal-Fetal Medicine posted checklists for monochorionic/diamniotic twins and monochorionic/monoamniotic twins. Read More

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November 2020

Cerebral Oxygenation in Preterm Infants With Necrotizing Enterocolitis.

Pediatrics 2020 09;146(3)

Homerton University Hospital National Health Service Foundation Trust, London, United Kingdom;

Background And Objectives: Preterm infants with necrotizing enterocolitis (NEC) are known to have worse neurodevelopmental outcomes, but there is no substantial evidence to support an underlying pathophysiology. We aimed to examine whether cerebral oxygenation differs in those infants who develop NEC compared to cerebral oxygenation in those who do not.

Methods: We examined 48 infants <30 weeks' gestation admitted to a tertiary level NICU from October 2016 to May 2018. Read More

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September 2020

Deep learning-based fetoscopic mosaicking for field-of-view expansion.

Int J Comput Assist Radiol Surg 2020 Nov 17;15(11):1807-1816. Epub 2020 Aug 17.

Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) and Department of Computer Science, University College London, London, UK.

Purpose: Fetoscopic laser photocoagulation is a minimally invasive surgical procedure used to treat twin-to-twin transfusion syndrome (TTTS), which involves localization and ablation of abnormal vascular connections on the placenta to regulate the blood flow in both fetuses. This procedure is particularly challenging due to the limited field of view, poor visibility, occasional bleeding, and poor image quality. Fetoscopic mosaicking can help in creating an image with the expanded field of view which could facilitate the clinicians during the TTTS procedure. Read More

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November 2020

Intestinal volvulus in the pump twin of a twin reversed arterial perfusion (TRAP) sequence after laser therapy at 18 weeks: a case report.

J Med Case Rep 2020 Aug 8;14(1):123. Epub 2020 Aug 8.

Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP), Ciudad del Saber, Panamá, Panamá.

Background: Twin reversed arterial perfusion sequence is a rare and potentially lethal condition affecting approximately 1% of monochorionic twin pregnancies and 1 in 35,000 pregnancies overall. An apparently normal (pump) twin perfuses its severely malformed cotwin with deoxygenated blood via retrograde flow in direct arterioarterial anastomoses between the umbilical arteries of each twin. Fetal intestinal volvulus is a rare condition usually manifesting after birth. Read More

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TTTS-STgan: Stacked Generative Adversarial Networks for TTTS Fetal Surgery Planning Based on 3D Ultrasound.

IEEE Trans Med Imaging 2020 11 28;39(11):3595-3606. Epub 2020 Oct 28.

Twin-to-twin transfusion syndrome (TTTS) is characterized by an unbalanced blood transfer through placental abnormal vascular connections. Prenatal ultrasound (US) is the imaging technique to monitor monochorionic pregnancies and diagnose TTTS. Fetoscopic laser photocoagulation is an elective treatment to coagulate placental communications between both twins. Read More

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November 2020

Umbilical Artery Doppler Patterns and Right Ventricular Outflow Abnormalities in Twin-Twin Transfusion Syndrome.

J Ultrasound Med 2021 Jan 10;40(1):71-78. Epub 2020 Jul 10.

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.

Objectives: To evaluate the association of abnormal Doppler velocimetric patterns in the umbilical arteries (UAs) and right ventricular outflow tract abnormalities (RVOTAs) in twin- twin transfusion syndrome (TTTS) cases.

Methods: This retrospective study involved women who had laser surgery for TTTS between January 2012 and May 2018 at a single institution. The prevalence of an RVOTA in either twin was compared among TTTS cases in which both twins had positive end-diastolic flow (EDF) in the UA and those in which either twin had intermittent or persistent absent/reversed UA EDF. Read More

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January 2021

Reversible parenchymal ischemic injury on fetal brain MRI following fetoscopic laser coagulation-Implication on parental counseling.

Radiol Case Rep 2020 Aug 27;15(8):1369-1372. Epub 2020 Jun 27.

Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

We present a case of reversible extensive ischemic injury seen on fetal-brain MRI in a fetus following laser coagulation performed for treatment of severe twin-twin transfusion syndrome twin-twin transfusion syndrome. A 32-year-old pregnant mother presented with twin-twin transfusion syndrome. Following fetoscopic laser coagulation, intrauterine fetal death of the donor fetus was diagnosed. Read More

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Non-invasive dynamic observation of placental vascular anastomoses in monochorionic twins: Assessment using three-dimensional sonography combined with tomographic ultrasound imaging.

Placenta 2020 06 4;95:84-90. Epub 2020 May 4.

Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China. Electronic address:

Introduction: Three-dimensional (3D) sonography combined with tomographic ultrasound imaging (TUI) to observe placental vascular anastomoses in monochorionic diamniotic (MCDA) twin pregnancies was evaluated.

Methods: Women with MCDA twin pregnancies at a gestational age of 16-32 weeks were enrolled in this retrospective study. Placental anastomoses were detected using two-dimensional (2D) and 3D sonography. Read More

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Neurodevelopmental impairment at 3 years of age after fetoscopic laser surgery for twin-to-twin transfusion syndrome.

Prenat Diagn 2020 07 13;40(8):1013-1019. Epub 2020 May 13.

Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.

Background: Data on neurodevelopmental outcomes of children surviving after fetoscopic laser surgery (FLS) for twin-to-twin transfusion syndrome (TTTS) are scarce.

Methods: We retrospectively investigated children surviving after FLS for TTTS at 16 to 26 weeks' gestation between 2003 and 2014. Children were evaluated by standardized neurologic examinations using the Kyoto Scale 2001 at a corrected age of 3 years ± 6 months. Read More

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Magnetic resonance imaging of the fetal brain in monochorionic diamniotic twin gestation: correlation of cerebral injury with ultrasound staging and survival outcomes.

Pediatr Radiol 2020 07 2;50(8):1131-1138. Epub 2020 May 2.

Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229, USA.

Background: The current staging system of twin-twin transfusion syndrome (TTTS) is based on the ultrasound criteria and does not consider the cerebral injury.

Objective: To assess the incidence of cerebral damage on fetal MRI and correlate abnormal cerebral diffusion-weighted imaging (DWI) findings with survival outcome and the ultrasound staging of TTTS.

Materials And Methods: We conducted a retrospective review of MRI/DWI of fetal brains and the electronic medical records in monochorionic diamniotic twin gestations. Read More

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Deep learning-based monocular placental pose estimation: towards collaborative robotics in fetoscopy.

Int J Comput Assist Radiol Surg 2020 Sep 30;15(9):1561-1571. Epub 2020 Apr 30.

Department of Mechanical Engineering, KU Leuven, Leuven, Belgium.

Purpose: Twin-to-twin transfusion syndrome (TTTS) is a placental defect occurring in monochorionic twin pregnancies. It is associated with high risks of fetal loss and perinatal death. Fetoscopic elective laser ablation (ELA) of placental anastomoses has been established as the most effective therapy for TTTS. Read More

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September 2020