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The inflammatory profile of exacerbations in patients with severe refractory eosinophilic asthma receiving mepolizumab (the MEX study): a prospective observational study.

Lancet Respir Med 2021 May 7. Epub 2021 May 7.

Centre for Experimental Medicine, School of Medicine, Dentistry, and Biological Sciences, Queen's University, Belfast, UK. Electronic address:

Background: Clinical trials with mepolizumab, a humanised monoclonal antibody against interleukin-5, show a 50% reduction in severe asthma exacerbations in people with severe eosinophilic asthma. Exacerbations in patients treated with mepolizumab seem to be different to exacerbations in those given placebo, as patients treated with mepolizumab report fewer symptoms, have a lower sputum eosinophil count, and smaller fall in peak expiratory flow. We aimed to investigate the inflammatory phenotype and physiological characteristics of exacerbation events in patients with severe eosinophilic asthma who were treated with mepolizumab. Read More

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Diabetes: Pharmacotherapy for Type 2 Diabetes.

Erin St Onge

FP Essent 2021 May;504:22-27

University of Florida College of Pharmacy Department of Pharmacotherapy and Translational Research, 1225 Center Drive, Gainesville, FL 32610.

For most patients with type 2 diabetes, the American Diabetes Association (ADA) recommends an A1c goal of less than 7%. However, this goal may be adjusted depending on certain patient factors. Metformin should be used as a first-line treatment in all patients with type 2 diabetes unless contraindicated. Read More

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Efficacy of tight control strategy in the treatment of adult-onset Still disease.

Clin Rheumatol 2021 May 10. Epub 2021 May 10.

Connective Tissue Diseases Research Center, Imam-Reza Hospital, Tabriz University of Medical Sciences, Flat 1, Golgasht St, P.O. Box 5166614756, Tabriz, Iran.

Background: Adult-onset Still's disease (AOSD) characterized by a high spiking fever, skin rash, arthritis, and leukocytosis. The aim of the present study was considering the long-term outcomes of patients with AOSD who were treated with tight control strategy with disease modifying anti-rheumatic drugs (DMARDs).

Methods: Fifty-six patients with AOSD treated with tight control strategy were included. Read More

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Selecting β-thalassemia Patients for Gene Therapy: A Decision-making Algorithm.

Hemasphere 2021 May 29;5(5):e555. Epub 2021 Apr 29.

Centro della Microcitemia e Anemie Congenite, E.O. Ospedali Galliera, Genova, Italy.

This expert opinion originally developed by a panel of the Italian Society of Thalassemias and Hemoglobinopathies (SITE), reviewed and adopted by the European Hematology Association (EHA) through the EHA Scientific Working Group on Red Cells and Iron, has been developed as priority decision-making algorithm on evidence and consensus with the aim to identify which patients with transfusion-dependent beta-thalassemia (TDT) could benefit from a gene therapy (GT) approach. Even if the wide utilized and high successful allogeneic hematopoietic stem-cell transplantation provides the possibility to cure several patients a new scenario has been opened by GT. Therefore, it is important to establish the patients setting for whom it is priority indicated, particularly in the early phase of the diffuse use outside experimental trials conducted in high selected centers. Read More

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Standardization of critical care management of non-critically ill patients with COVID-19.

World J Clin Cases 2021 Apr;9(12):2696-2702

Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China.

The large global outbreak of coronavirus disease 2019 (COVID-19) has seriously endangered the health care system in China and globally. The sudden surge of patients with severe acute respiratory syndrome coronavirus 2 infection has revealed the shortage of critical care medicine resources and intensivists. Currently, the management of non-critically ill patients with COVID-19 is performed mostly by non-intensive care unit (ICU) physicians, who lack the required professional knowledge, training, and practice in critical care medicine, especially in terms of continuous monitoring of the respiratory function, intervention, and feedback on treatment effects. Read More

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Impact of phytoestrogens on treatment of urogenital menopause symptoms: A systematic review of randomized clinical trials.

Eur J Obstet Gynecol Reprod Biol 2021 Apr 20. Epub 2021 Apr 20.

Faculty of Health, Ilam University of Medical Sciences, Ilam, Iran.

Objective: Menopause symptoms affect the various dimensions of women's lives and they can lead to reduction of their quality of life. Phytoestrogens can be used as an approach to diminish these symptoms. The aim of this systematic review was to investigate the effect of phytoestrogens on the treatment of urogenital menopause symptoms. Read More

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Hydroxychloroquine reduces interleukin-6 levels after myocardial infarction: The randomized, double-blind, placebo-controlled OXI pilot trial.

Int J Cardiol 2021 May 4. Epub 2021 May 4.

Heart and Lung Center, Helsinki University Hospital, Helsinki University, Helsinki, Finland. Electronic address:

Objectives: To determine the anti-inflammatory effect and safety of hydroxychloroquine after acute myocardial infarction.

Method: In this multicenter, double-blind, placebo-controlled OXI trial, 125 myocardial infarction patients were randomized at a median of 43 h after hospitalization to receive hydroxychloroquine 300 mg (n = 64) or placebo (n = 61) once daily for 6 months and, followed for an average of 32 months. Laboratory values were measured at baseline, 1, 6, and 12 months. Read More

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Drug survival of anakinra and canakinumab in monogenic autoinflammatory diseases: observational study from the International AIDA Registry.

Rheumatology (Oxford) 2021 May 7. Epub 2021 May 7.

Research Center of Systemic Auto inflammatory Diseases and Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy.

Objectives: To investigate survival of interleukin (IL)-1 inhibitors in monogenic autoinflammatory disorders (mAID) through drug retention rate (DRR) and identify potential predictive factors of drug survival from a real-life perspective.

Patients And Methods: Multicentre retrospective study analyzing patients affected by the most common mAID treated with anakinra or canakinumab. Survival curves were analyzed with the Kaplan-Meier method. Read More

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Efficacy and Safety of Qingpeng Ointment for Subacute and Chronic Eczema: A Systematic Review and Meta-Analysis.

Biomed Res Int 2021 15;2021:5594953. Epub 2021 Apr 15.

Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.

Objective: To evaluate the efficacy and safety of Qingpeng ointment for the treatment of subacute and chronic eczema.

Method: Randomized controlled trials (RCTs) on Qingpeng ointment for subacute and chronic eczema were searched on PubMed, the Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang Database, Chinese Biomedical Literature Database, and Chinese Science and Technology Periodical Journal from their inception to 30 November 2020. Quality assessment and data analysis were performed by Review Manager 5. Read More

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Platelet Reactivity and Response to Aspirin and Clopidogrel in Patients with Platelet Count Disorders.

Cardiol Res Pract 2021 17;2021:6637799. Epub 2021 Apr 17.

Department of Hematology, Blood Neoplasms, and Bone Marrow Transplantation, Wroclaw Medical University, Wrocław, Poland.

Background: Platelet reactivity and response to antiplatelet drugs, acetylsalicylic acid (ASA) and clopidogrel, in patients with thrombocytopenia and thrombocythemia can have a potentially important effect on the outcome. The effectiveness and safety of antiplatelet drugs in such patients has not been well examined. Measuring the effect of ASA and clopidogrel on platelets could help guide the therapy. Read More

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The Role of Health Care Quality in Hypertension Self-Management: A Qualitative Study of the Experience of Patients in a Public Hospital, North-West Ethiopia.

Integr Blood Press Control 2021 27;14:55-68. Epub 2021 Apr 27.

School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.

Purpose: Hypertension is becoming a global epidemic in all population groups. For its effective management and control, patients should have enhanced self-management skills and get adequate support from care providers. Although the quality of health care is critical in enhancing self-management behaviors of patients with hypertension, the issue has not been fully explored in the Ethiopian context. Read More

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Pertuzumab Plus High-Dose Trastuzumab in Patients With Progressive Brain Metastases and HER2-Positive Metastatic Breast Cancer: Primary Analysis of a Phase II Study.

J Clin Oncol 2021 May 4:JCO2002822. Epub 2021 May 4.

Northwestern University, Chicago, IL.

Purpose: Effective therapies are needed for the treatment of patients with human epidermal growth factor receptor-2 (HER2)-positive metastatic breast cancer (MBC) with brain metastases. A trastuzumab radioisotope has been shown to localize in brain metastases of patients with HER2-positive MBC, and intracranial xenograft models have demonstrated a dose-dependent response to trastuzumab.

Methods: In the phase II PATRICIA study (ClinicalTrials. Read More

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Thirst distress in outpatients with heart failure in a Mediterranean zone of Spain.

ESC Heart Fail 2021 May 3. Epub 2021 May 3.

Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.

Aims: This study aimed to evaluate psychometric properties of the Spanish version of the Thirst Distress Scale for patients with Heart Failure (TDS-HF) and to describe thirst distress-associated factors in outpatients at a heart failure (HF) clinic in Spain. Thirst is common in patients with HF, but thirst distress has rarely been addressed and may significantly decrease quality of life.

Methods And Results: A cross-sectional study was performed assessing perceived thirst distress by patients with HF during the preceding 3 days, with the TDS-HF (scores 8 to 40). Read More

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Effect of a single intra-articular high molecular weight hyaluronan in a naturally occurring canine osteoarthritis model: a randomized controlled trial.

J Orthop Surg Res 2021 May 3;16(1):290. Epub 2021 May 3.

Faculty of Veterinary Medicine, University of Lisbon (FMV/ULisboa), Lisbon, Portugal.

Background: Osteoarthritis (OA) is a complex joint disease and chronic pain source, affecting a patient's quality of life and posing a financial burden. As the dog is considered a nearly ideal species for translation research of human OA and the most used model for research, exploring spontaneous dog OA under the One Health/One Medicine concept can improve both humans and dogs' health and well-being.

Methods: In a clinical treatment experiment, forty (N=40) joints were selected and randomly assigned to a control group (CG), which received 0. Read More

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Impact of Molecular Classification on Treatment Paradigms in Uterine Cancers.

Curr Oncol Rep 2021 May 3;23(7):75. Epub 2021 May 3.

Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, The James Cancer Hospital and Solove Research Institute, M-210 Starling-Loving, 320 West 10th Avenue, Columbus, OH, 43210-3078, USA.

Purpose Of Review: This article will discuss the recent data on the prognostic significance of molecular classification of endometrial carcinoma, as well as its impact on directing treatment decisions.

Recent Findings: Molecular classification has emerged as a complement to the current paradigm of endometrial cancer (EC) risk stratification. POLE mutations appear to portend favorable prognoses, but data are insufficient to indicate withholding treatment based on this signature. Read More

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The safety of echo contrast-enhanced ultrasound in high-intensity focused ultrasound ablation for abdominal wall endometriosis: a retrospective study.

Quant Imaging Med Surg 2021 May;11(5):1751-1762

Department of Gynecologic Minimally Invasive Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China.

Background: We aimed to investigate the efficacy and safety of echo contrast-enhanced ultrasound (CEUS) during high-intensity focused ultrasound (HIFU) ablation therapy for abdominal wall endometriosis (AWE).

Methods: A total of 67 patients with AWE were treated with HIFU ablation, and their demographic characteristics were retrospectively analysed. Blood perfusion of the focal lesion was assessed before the operation, during ablation and after the operation with the use of an ultrasound contrast agent, and the effect of the ultrasound contrast agent on treatment was assessed over a 1-year follow-up period. Read More

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Tracheomediastinal Fistula Formation After Endobronchial Ultrasound Transbronchial Needle Aspiration While on Bevacizumab Treatment.

Cureus 2021 Mar 30;13(3):e14189. Epub 2021 Mar 30.

Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA.

A 63-year-old male with non-small-cell lung cancer (NSCLC) developed a tracheomediastinal fistula after endobronchial ultrasound transbronchial needle aspiration while on treatment with bevacizumab. This vascular endothelial growth factor-specific angiogenesis inhibitor is a first-line treatment for unresectable or metastatic NSCLC and has been reported to cause fatal non-gastrointestinal fistulas. Respiratory tract fistulas are a known rare complication after bevacizumab therapy characterized by a high mortality rate. Read More

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Safety, Tolerability, and Effect of Nusinersen in Non-ambulatory Adults With Spinal Muscular Atrophy.

Front Neurol 2021 16;12:650532. Epub 2021 Apr 16.

Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, OH, United States.

Investigation of the safety, tolerability, and treatment effect of nusinersen treatment in non-ambulatory adults with spinal muscular atrophy (SMA). Non-ambulatory individuals, aged 18 years or older with genetically confirmed 5q SMA were enrolled. In participants with spinal fusion, fluoroscopy guided cervical C1-C2 lateral approach was used. Read More

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Brain reactivity during aggressive response in women with premenstrual dysphoric disorder treated with a selective progesterone receptor modulator.

Neuropsychopharmacology 2021 Apr 29. Epub 2021 Apr 29.

Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.

Premenstrual dysphoric disorder (PMDD) is a psychiatric condition characterized by late luteal phase affective, cognitive, and physical impairment. The disorder causes significant suffering in about 5% of women in their reproductive age. Altered sensitivity of cognitive-affective brain circuits to progesterone and its downstream metabolite allopregnanolone is suggested to underlie PMDD symptomatology. Read More

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Favorable Effects of Voriconazole Trough Concentrations Exceeding 1 μg/mL on Treatment Success and All-Cause Mortality: A Systematic Review and Meta-Analysis.

J Fungi (Basel) 2021 Apr 16;7(4). Epub 2021 Apr 16.

Department of Infection Control and Prevention, Hyogo College of Medicine, Hyogo 663-8501, Japan.

This systematic review and meta-analysis examined the optimal trough concentration of voriconazole for adult patients with invasive fungal infections. We used stepwise cutoffs of 0.5-2. Read More

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Irreversible Electroporation (IRE) in Locally Advanced Pancreatic Cancer: A Review of Current Clinical Outcomes, Mechanism of Action and Opportunities for Synergistic Therapy.

J Clin Med 2021 Apr 10;10(8). Epub 2021 Apr 10.

Centre of Surgical Innovation, Organ Regeneration and Transplantation, University College London (UCL), London NW3 2QG, UK.

Locally advanced pancreatic cancer (LAPC) accounts for 30% of patients with pancreatic cancer. Irreversible electroporation (IRE) is a novel cancer treatment that may improve survival and quality of life in LAPC. This narrative review will provide a perspective on the clinical experience of pancreas IRE therapy, explore the evidence for the mode of action, assess treatment complications, and propose strategies for augmenting IRE response. Read More

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Photodynamic Therapy as an Oxidative Anti-Tumor Modality: Negative Effects of Nitric Oxide on Treatment Efficacy.

Pharmaceutics 2021 Apr 21;13(5). Epub 2021 Apr 21.

Department of Integrative Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada.

Anti-tumor photodynamic therapy (PDT) is a unique oxidative stress-based modality that has proven highly effective on a variety of solid malignancies. PDT is minimally invasive and generates cytotoxic oxidants such as singlet molecular oxygen (O). With high tumor site-specificity and limited off-target negative effects, PDT is increasingly seen as an attractive alternative or follow-up to radiotherapy or chemotherapy. Read More

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Recent Progress and Challenges for Drug-Resistant Tuberculosis Treatment.

Pharmaceutics 2021 Apr 21;13(5). Epub 2021 Apr 21.

Bioinformatics Research Group, Department of Chemistry, Faculty of Mathematics and Natural Sciences, Universitas Indonesia, Depok 16424, Indonesia.

Control of infection continues to be an issue, particularly in countries with a high tuberculosis (TB) burden in the tropical and sub-tropical regions. The effort to reduce the catastrophic cost of TB with the WHO's End TB Strategy in 2035 is still obstructed by the emergence of drug-resistant TB (DR-TB) cases as result of various mutations of the MTB strain. In the approach to combat DR-TB, several potential antitubercular agents were discovered as inhibitors for various existing and novel targets. Read More

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Impact of Platelet Reactivity in ACS Patients on Clinical Outcomes with Triple Antithrombotic Therapy.

J Clin Med 2021 Apr 8;10(8). Epub 2021 Apr 8.

Department of Cardiology, ARCHANTEC, School of Medicine, Aix Marseille University, 13007 Marseille, France.

Optimal antithrombotic therapy after percutaneous coronary intervention (PCI) in patients on oral anticoagulants (OAC) remains a clinical conundrum. In fact, combining an OAC with dual antiplatelet therapy (triple antithrombotic therapy, TAT) increases the risk of bleeding. Clopidogrel is the only thienopyridine recommended in TAT patients. Read More

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Rhinofacial conidiobolomycosis: Clinical and microbiological characterisation and shift in the management of a rare disease.

Mycoses 2021 Apr 29. Epub 2021 Apr 29.

Department of Infectious Diseases, Christian Medical College, Vellore, India.

Background: Conidiobolomycosis is a rare tropical rhinofacial fungal infection which has not been well characterised. The available evidence in its management is sparse due to lack of clinical studies and the limited data on antifungal susceptibility patterns.

Objective: To analyse the clinical manifestations, antifungal treatment and outcomes of patients with conidiobolomycosis and to determine antifungal susceptibility profiles of the isolates. Read More

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Service user experiences of community services for complex emotional needs: A qualitative thematic synthesis.

PLoS One 2021 29;16(4):e0248316. Epub 2021 Apr 29.

Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, United Kingdom.

Background: There is a recognised need to develop clear service models and pathways to provide high quality care in the community for people with complex emotional needs, who may have been given a "personality disorder" diagnosis. Services should be informed by the views of people with these experiences.

Aims: To identify and synthesise qualitative studies on service user experiences of community mental health care for Complex Emotional Needs. Read More

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Study of clinical characteristics, risk factors and outcomes for tuberculosis post allogeneic stem cell transplant: never count it out.

Ther Adv Infect Dis 2021 Jan-Dec;8:20499361211008674. Epub 2021 Apr 12.

Department of Hematology and Bone Marrow Transplant Unit, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, Delhi 110085, India.

Background: Allogeneic stem cell transplant (AlloSCT) recipients remain at a higher risk of developing tuberculosis (TB), especially in endemic populations. We conducted a retrospective study to identify the incidence, clinical presentation, and risk factors for active TB among our alloSCT recipients.

Methods: Records of all patients transplanted between 1 January 2012 and 31 July 2020 were reviewed. Read More

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Cou Cou, flying fish and a whole exome please... lessons learned from genetic testing in Barbados.

Pan Afr Med J 2021 3;38:111. Epub 2021 Feb 3.

Departments of Pediatrics and Clinical Neuroscience, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Millions of patients, with suspected complex neurogenetic disorders, living in resource limited regions around the world have no access to genetic testing despite the rapidly expanding availability and decreasing costs of genetic testing in first world nations. The barriers to increasing availability of genetic testing in resource limited nations are multifactorial but can be attributed, in large part, to a lack of awareness of the power of genetic testing to lead to a rapid, cost-effective, diagnosis that potentially will have profound clinical implications on treatment and patient outcomes. We report our experience with whole exome sequencing (WES) done for the first time in 5 patients of African descent with a suspected neurogenetic disorder living in a resource limited setting on the Eastern Caribbean island of Barbados. Read More

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Umeclidinium/Vilanterol Compared with Fluticasone Propionate/Salmeterol, Budesonide/Formoterol, and Tiotropium as Initial Maintenance Therapy in Patients with COPD Who Have High Costs and Comorbidities.

Int J Chron Obstruct Pulmon Dis 2021 22;16:1149-1161. Epub 2021 Apr 22.

US Value Evidence and Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA.

Background: Comorbidities in patients with chronic obstructive pulmonary disease (COPD) are associated with increased medical costs and risk of exacerbations. This study compared COPD-related medical costs and exacerbations in high-cost, high-comorbidity patients with COPD receiving initial maintenance treatment (IMT) with umeclidinium/vilanterol (UMEC/VI) versus fluticasone propionate/salmeterol (FP/SAL), budesonide/formoterol (B/F), or tiotropium (TIO).

Methods: This retrospective, matched cohort study identified patients from Optum's de-identified Clinformatics Data Mart database who initiated UMEC/VI, FP/SAL, B/F, or TIO between January 1, 2014 and December 31, 2018 (index date defined as date of the first fill). Read More

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Cyclooxygenase inhibitor use is associated with increased COVID-19 severity.

medRxiv 2021 Apr 20. Epub 2021 Apr 20.

Background: Cyclooxygenase (COX) inhibitors including non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce pain, fever, and inflammation but have been associated with complications in community acquired pneumonia and other respiratory tract infections (RTIs). Conclusive data are not available about potential beneficial or adverse effects of COX inhibitors on COVID-19 patients.

Methods: We conducted a retrospective, multi-center observational study by leveraging the harmonized, high-granularity electronic health record data of the National COVID Cohort Collaborative (N3C). Read More

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