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Failure of the Ottawa Score to Predict the Risk of Recurrent Venous Thromboembolism in Cancer Patients: The Prospective PREDICARE Cohort Study.

Thromb Haemost 2021 Apr 20. Epub 2021 Apr 20.

Georges Pompidou European Hosp, Paris, France.

Introduction: Recurrent venous thromboembolism (VTE) despite curative anticoagulation is frequent in patients with cancer. Identifying patients with a high risk of recurrence could have therapeutic implications. A prospective study was designed to validate the Ottawa risk score of recurrent VTE in cancer patients. Read More

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Validity of the 6-Minute Walk Test in Patients with End-Stage Lung Diseases Wearing an Oronasal Surgical Mask in Times of the COVID-19 Pandemic.

Respiration 2021 Apr 20:1-6. Epub 2021 Apr 20.

Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.

Background And Objectives: The 6-minute walk test (6MWT), as a clinical assessment tool for functional exercise capacity, is an integral component of lung allocation scores (LASs). In times of the coronavirus disease (COVID-19) pandemic, patients underwent 6MWTs wearing a surgical mask in ambulatory care. We investigated the impact of wearing a mask on 6-minute walk distances (6MWDs). Read More

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Early and Midtreatment Mortality in Palliative Radiotherapy: Emphasizing Patient Selection in High-Quality End-of-Life Care.

J Natl Compr Canc Netw 2021 Apr 20:1-9. Epub 2021 Apr 20.

1Department of Radiation Oncology, and.

Background: Palliative radiotherapy (RT) is effective, but some patients die during treatment or too soon afterward to experience benefit. This study investigates end-of-life RT patterns to inform shared decision-making and facilitate treatment consistent with palliative goals.

Materials And Methods: All patients who died ≤6 months after initiating palliative RT at an academic cancer center between 2015 and 2018 were identified. Read More

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Bone Metastases, Skeletal-Related Events, and Survival in Patients With Metastatic Non-Small Cell Lung Cancer Treated With Immune Checkpoint Inhibitors.

J Natl Compr Canc Netw 2021 Apr 20:1-7. Epub 2021 Apr 20.

3Division of Medical Oncology, and.

Background: Bone metastases and skeletal-related events (SREs) are a frequent cause of morbidity in patients with metastatic non-small cell lung cancer (mNSCLC). Data are limited on bone metastases and SREs in patients with mNSCLC treated using immune checkpoint inhibitors (ICIs), and on the efficacy of bone-modifying agents (BMAs) in this setting. Here we report the incidence, impact on survival, risk factors for bone metastases and SREs, and impact of BMAs in patients with mNSCLC treated with ICIs in a multi-institutional cohort. Read More

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TORS elective lingual tonsillectomy has less acute morbidity than therapeutic base of tongue TORS.

Oral Oncol 2021 Apr 16;117:105294. Epub 2021 Apr 16.

Department of Radiation Oncology, Emory University School of Medicine, Atlanta, GA, United States.

Objective: To determine the impact of diagnostic TORS lingual tonsillectomy (DTLT) on objective swallowing measures for carcinoma of unknown primary (CUP).

Methods: Between 10/2016-1/2020, 27 patients with p16+ squamous cell carcinoma (SCC) level 2a nodal disease underwent DTLT and ipsilateral neck dissection for CUP. No patient had a history of cutaneous SCC. Read More

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Tuberculosis in Myasthenia Gravis patients on immunosuppressive therapy in a high-risk area: Implications for preventative therapy.

J Neurol Sci 2021 Apr 17;425:117447. Epub 2021 Apr 17.

Division of Neurology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Neurology Research Group, UCT Neuroscience Institute, University of Cape Town, Cape Town, South Africa. Electronic address:

Data regarding the risk of tuberculosis (TB) in myasthenia gravis (MG) patients receiving immunosuppressive therapy is limited, and the benefit of TB preventative therapy in these patients is uncertain. We audited observational data collected at an MG clinic in South Africa over a ~ 10-year period, of cases who received immunosuppressive therapy. The total time that the cohort was at risk (patient-years) was used as the denominator to calculate TB incidence after immunosuppressive therapy initiation. Read More

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Association between long-term exposure to fine particulate matter and diabetic retinopathy among diabetic patients: A national cross-sectional study in China.

Environ Int 2021 Apr 17;154:106568. Epub 2021 Apr 17.

Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin 300052, China; Tianjin Medical University, Tianjin 300070, China. Electronic address:

Background: While the relationship between ambient air pollution and diabetes mellitus has recently been reported, data on the association between fine particulate matter (PM) and diabetic complications are limited, especially in microvascular diseases such as diabetic retinopathy.

Objectives: To investigate the associations between long-term exposure to PM and the prevalence of diabetic retinopathy in adult diabetic patients in rural China.

Methods: The study population was based on the Rural Epidemiology for Glaucoma in China (REG-China), a national cross-sectional survey conducted in rural China. Read More

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Survival outcomes after breast-conserving therapy compared with mastectomy for patients with early-stage metaplastic breast cancer: a population-based study of 2412 patients.

Breast 2021 Apr 1;58:10-17. Epub 2021 Apr 1.

Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China; Shantou University Medical College, Shantou, 515041, China. Electronic address:

Background: Previous studies revealed that patients with early-stage metaplastic breast cancer (MBC) underwent mastectomy more often than breast-conserving therapy (BCT) mainly due to the larger tumor size. This study was performed to compare the survival outcomes following BCT versus mastectomy for patients with early-stage MBC.

Methods: Surveillance, Epidemiology, and End Results (SEER) database was used to identify women diagnosed with early-stage MBC (T1-3N0-3M0) between 2001 and 2016, who were treated with either BCT or mastectomy. Read More

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Early Clinical and Patient-Reported Outcomes of a New Hybrid Mesh for Incisional Hernia Repair.

J Surg Res 2021 Apr 17;265:49-59. Epub 2021 Apr 17.

Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address:

Introduction: Consensus on the safety and efficacy of various types of mesh in reconstructing the abdomen has yet to be reached. Hybrid mesh products have been designed to address the need for a cost-effective mesh leveraging the tensile strength of a synthetic mesh while minimizing the prosthetic footprint within the abdominal wall through resorbable materials. In this study we evaluate early clinical outcomes and health related quality of life (HR-QOL) of a new Hybrid mesh, Synecor, for Ventral Hernia Repair (VHR). Read More

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Alberta Stroke Program Early CT Score Calculation Using the Deep Learning-Based Brain Hemisphere Comparison Algorithm.

J Stroke Cerebrovasc Dis 2021 Apr 17;30(7):105791. Epub 2021 Apr 17.

Department of Neurology, Saiseikai Kumamoto Hospital, Chikami 5-3-1, Minami-ku, Kumamoto, Japan. Electronic address:

Objectives: The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is a promising tool for the evaluation of stroke expansion to determine suitability for reperfusion therapy. The aim of this study was to validate deep learning-based ASPECTS calculation software that utilizes a three-dimensional fully convolutional network-based brain hemisphere comparison algorithm (3D-BHCA).

Materials And Methods: We retrospectively collected head non-contrast computed tomography (CT) data from 71 patients with acute ischemic stroke and 80 non-stroke patients. Read More

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A simple and easy-to-perform liquid chromatography-mass spectrometry method for the quantification of tacrolimus and its metabolites in human whole blood. Application to the determination of metabolic ratios in kidney transplant patients.

J Chromatogr B Analyt Technol Biomed Life Sci 2021 Apr 8;1173:122698. Epub 2021 Apr 8.

Laboratory of Pharmacology-pharmacogenetics and Toxicology- Grenoble-Alpes University Hospital, F-38043 Grenoble, France; Univ. Grenoble Alpes, F-38041 Grenoble, France; INSERM U1300, HP2, F-38041 Grenoble, France. Electronic address:

Tacrolimus is the cornerstone of immunosuppressive therapy in solid organ transplantation and its blood concentrations are routinely monitored. Tacrolimus is extensively metabolized into metabolites that are supposed to be nephrotoxic. Yet, few analytical methods have been described to simultaneously quantify tacrolimus and its main metabolites. Read More

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Continuous renal replacement therapy in intensive care patients with COVID-19; survival and renal recovery.

J Crit Care 2021 Apr 16;64:125-130. Epub 2021 Apr 16.

Dept of Perioperative Medicine and Intensive Care, Karolinska University Hospital, 171 76, Stockholm, Sweden. Electronic address:

Background: Outcome for critically ill patients with COVID-19 treated with continuous renal replacement therapy (CRRT) is largely unknown. We describe mortality and renal outcome in this group.

Methods: This observational study was conducted at a university hospital in Sweden. Read More

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Neutrophil-to-Lymphocyte Ratio is superior to other leucocyte-based ratios as a prognostic predictor in radiosurgically treated non-small cell lung cancer brain metastases patients under immunotherapy or targeted therapy.

World Neurosurg 2021 Apr 17. Epub 2021 Apr 17.

Department of Neurosurgery, Medical University of Vienna, Vienna, Austria. Electronic address:

Objective: The predictive value of pre-radiosurgery leucocyte-based prognostic ratios was investigated in a selected cohort of non-small cell lung cancer patients (NSCLC) patients with radiosurgically treated brain metastases (BM) and concomitant immunotherapy (IT) or targeted therapy (TT).

Methods: We performed a retrospective analysis of 166 NSCLC BM patients treated with Gamma Knife Radiosurgery. The Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR), and Lymphocyte-to-Monocyte Ratio (LMR) were assessed within 14 days prior to radiosurgical treatment. Read More

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Epidemiological and Clinical Presentations of Hospitalized COVID-19 patients in Libya: an initial report from Africa.

Travel Med Infect Dis 2021 Apr 17:102064. Epub 2021 Apr 17.

Faculty of Medicine, University of Tripoli, Tripoli, Libya. Electronic address:

Background: The first case of the novel coronavirus disease 2019 (COVID-19) in Libya was diagnosed in March 2020. We aimed to determine the epidemiological, clinical, and laboratory characteristics of COVID-19 in Libya.

Method: In this retrospective descriptive study, we analyzed the demographics, initial clinical presentation, history, comorbidities, laboratory findings, complications, and outcomes of hospitalized patients with COVID-19 at several centers in the Western part of Libya between March 24, 2020, and December 3, 2020. Read More

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Association between coronary artery calcium score and stent expansion in percutaneous coronary intervention.

Int J Cardiol 2021 Apr 17. Epub 2021 Apr 17.

Department of Cardiovascular Medicine, Miyazaki Prefectural Nobeoka Hospital, Miyazaki, Japan.

Background: Measurement of the coronary artery calcification score using multidetector computed tomography (MDCT) is a useful noninvasive test for the diagnosis of coronary artery disease. However, whether pre-intervention assessment of the target vessel coronary artery calcification (TV-CAC) score is associated with stent expansion failure and future target lesion revascularization (TLR), remains unknown. This study aimed to determine the association between the TV-CAC score measured by MDCT and stent expansion rate in patients who underwent IVUS-guided PCI for stable angina. Read More

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A pre-specified analysis of the DAPA-CKD trial indicates effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathy.

Kidney Int 2021 Apr 17. Epub 2021 Apr 17.

Department Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.

Immunoglobulin A (IgA) nephropathy is a common form of glomerulonephritis, which despite use of renin-angiotensin-aldosterone-system blockers and immunosuppressants, often progresses to kidney failure. In the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease trial, dapagliflozin reduced risk of kidney failure and prolonged survival in participants with chronic kidney disease with and without type 2 diabetes, including those with IgA nephropathy. Here we randomized participants with estimated glomerular filtration rate (eGFR) 25-75 mL/min/1. Read More

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Testicular tumor markers in the spermatic vein - correlation to pathology, stage and outcome.

Urology 2021 Apr 17. Epub 2021 Apr 17.

Department of Urology, Klinik Favoriten, Vienna, AUSTRIA. Electronic address:

Objective: To report our findings in patients with determination of testicular tumor markers from the vena spermatica during inguinal orchiectomy.

Methods: In a retrospective setting, data of patients who underwent inguinal orchiectomy between January 2004 and December 2014 were analyzed. Cubital and testicular vein tumor markers were assessed and correlated to histology, clinical stage and outcome. Read More

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Long-term cognitive outcome after radiosurgery in epileptic hypothalamic hamartomas and review of the literature.

Epilepsia 2021 Apr 20. Epub 2021 Apr 20.

Department of Functional and Stereotactic Neurosurgery and Gamma Knife Radiosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France.

Objective: Epileptic patients with hypothalamic hamartoma (HH) frequently present cognitive impairments. Surgical techniques aiming at HH can be very efficient for epilepsy relief and cognitive improvement but are also demonstrated to carry a significant risk of additional reduction in memory function in these already disabled patients. Gamma knife radiosurgery (GKS) offers an efficient minimally invasive procedure. Read More

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A matter of size? Health-related quality of life after radical prostatectomy for patients with giant prostates.

Prostate 2021 Jun;81(8):443-451

Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany.

Background: Evidence regarding the impact of giant prostate volume (PV) on outcome after radical prostatectomy (RP) is controversial with a lack of evidence on the impact of PV on health-related quality of life (HRQOL). We aimed to assess the impact of giant PV on HRQOL and functional outcomes for men with prostate cancer (PC) undergoing RP.

Methods: Giant PV was defined based on the 95th percentile of PV measured by specimen weight of 3929 patients that underwent RP between 2013 and 2018 in a large tertiary care center. Read More

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Thyroid immune-related adverse events following immune checkpoint inhibitor treatment.

J Clin Endocrinol Metab 2021 Apr 20. Epub 2021 Apr 20.

Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.

Background: Thyroid dysfunction occurs commonly following immune checkpoint inhibition. The etiology of thyroid immune-related adverse events (irAEs) remains unclear and clinical presentation can be variable. This study sought to define thyroid irAEs following immune checkpoint inhibitor (ICI) treatment and describe their clinical and biochemical associations. Read More

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Association of adalimumab trough concentrations and treatment response in patients with Juvenile Idiopathic Arthritis.

Rheumatology (Oxford) 2021 Apr 20. Epub 2021 Apr 20.

Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands.

Objective: To assess the relationship of adalimumab trough concentrations and treatment response in paediatric patients with juvenile idiopathic arthritis (JIA).

Methods: Monocentric cohort study of JIA patients treated with adalimumab. Clinical data and samples were collected during routine follow-up. Read More

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NAFLD and liver fibrosis are not associated with reduced femoral bone mineral density in the general US population.

J Clin Endocrinol Metab 2021 Apr 20. Epub 2021 Apr 20.

Department of Medicine and Rehabilitation, Policlinico di Monza.

Context: It is still debated whether nonalcoholic fatty liver disease (NAFLD) may be a risk factor for reduced bone mineral density (BMD), and it is not known whether liver fibrosis, which is the major predictor of future development of liver-related events in patients with NAFLD, has an influence on BMD.

Objective: To assess whether liver steatosis and fibrosis are associated with reduced BMD in the general US population.

Design: Cross-sectional analysis of the population-based 2017-2018 cycle of the National Health and Nutrition Examination Survey (NHANES), in which vibration controlled transient elastography (VCTE) and dual-energy x-ray absorptiometry (DXA) of the femoral neck were simultaneously available. Read More

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AAV9-mediated FIG4 delivery prolongs life span in Charcot Marie Tooth disease type 4J mouse model.

J Clin Invest 2021 Apr 20. Epub 2021 Apr 20.

Genetic Resource Science, The Jackson Laboratory, Bar Harbor, United States of America.

Charcot-Marie-Tooth disease type 4J (CMT4J) is caused by recessive, loss-of-function mutations in FIG4, encoding a phosphoinositol(3,5)P2-phosphatase. CMT4J patients have both neuron loss and demyelination in the peripheral nervous system, with vacuolization indicative of endosome/lysosome trafficking defects. Although the disease is highly variable, the onset is often in childhood and FIG4 mutations can dramatically shorten lifespan. Read More

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The yield of upper gastrointestinal endoscopy in patients below 60 years and without alarm symptoms presenting with dyspepsia.

Scand J Gastroenterol 2021 Apr 20:1-7. Epub 2021 Apr 20.

Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.

Background And Aims: Upper gastrointestinal (GI) endoscopy is frequently performed in patients with upper abdominal symptoms. Although guidelines recommend withholding an endoscopy in the absence of alarm symptoms, dyspeptic symptoms remain a predominant indication for endoscopy. We aimed to investigate the yield of upper GI endoscopy in patients with low-risk dyspeptic symptoms. Read More

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A first pregnancy seems associated with a positive effect on the course of inflammatory bowel disease: data from a prospective pregnancy cohort.

Scand J Gastroenterol 2021 Apr 20:1-6. Epub 2021 Apr 20.

Department of Gastroenterology and Hepatology, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.

The effect of pregnaSSncy on the course of inflammatory bowel disease (IBD) remains controversial. We aimed to describe the disease course before and after a first pregnancy in IBD patients. We analyzed data from a prospectively followed-up pregnancy cohort (minimal follow-up of 7 years), with clinical, biochemical and endoscopic characteristics obtained pre-pregnancy, during pregnancy and post-pregnancy. Read More

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Opioid Prescribing at Discharge in Opioid-Naïve Trauma Patients.

Am Surg 2021 Apr 20:31348211011105. Epub 2021 Apr 20.

Department of Pharmacy, 6473St. Joseph's University Medical Center, Paterson, NJ, USA.

Background: Opioid analgesics remain mainstay of treatment for trauma-related pain despite growing concerns for opioid dependency or misuse. The purpose of this study was to evaluate opioid prescribing at hospital discharge after traumatic injury.

Methods: This is a single-center, retrospective analysis of patients ≥18 years of age admitted for ≥24 hours with a primary diagnosis of traumatic injury. Read More

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The Association of the Affordable Care Act With Medicaid Enrollment Status and Costs of Care at a Level I Trauma Center in a Medicaid Non-expansion State.

Am Surg 2021 Apr 20:31348211011144. Epub 2021 Apr 20.

22442Carolinas Medical Center, Charlotte, NC, USA.

Introduction: The intended purpose of the Patient Protection and Affordable Care Act (ACA) was to expand access to health care insurance for all Americans. In our study, we examine the association of Medicaid enrollment status, health care outcomes, and financial outcomes for trauma patients at a level I urban trauma center in a state that did not expand Medicaid coverage under the ACA.

Methods: We retrospectively reviewed trauma admissions from 2011 to 2016, via the trauma registry (n = 36,250). Read More

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SLL-PEEP Ventilation to Improve Exposure in Minimally Invasive Right Anterolateral Minithoracotomy Aortic Valve Replacement.

Innovations (Phila) 2021 Apr 20:15569845211004265. Epub 2021 Apr 20.

14929 Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany.

Objective: An accepted landmark to assess feasibility of surgical aortic valve replacement (SAVR) via right anterolateral minithoracotomy (RALT) is the aortic-midpoint to right-sternal-edge distance. We aimed to evaluate single left lung positive-end-expiratory-pressure (SLL-PEEP) ventilation inducing an intraoperative rightward shift of the ascending aorta to improve exposure.

Methods: Nineteen patients with aortic stenosis undergoing SAVR via RALT were prospectively analyzed. Read More

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Implementation and Monitoring of a Telemedicine Model in Acromegalic Outpatients in a Low-Income Country During the COVID-19 Pandemic.

Telemed J E Health 2021 Apr 20. Epub 2021 Apr 20.

Service of Endocrinology, University Hospital, Faculty of Medicine, University of Brasilia, Brasilia, Brazil.

Telemedicine is a resource to provide health care to patients social distancing and prevent their exposure to the risk of contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in medical-hospital settings. This study evaluated a virtual model of care in acromegalic patients. We recruited 78 acromegalic patients, 65% female, median age 63 years. Read More

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ROCK2 Inhibition With Belumosudil (KD025) for the Treatment of Chronic Graft-Versus-Host Disease.

J Clin Oncol 2021 Apr 20:JCO2002754. Epub 2021 Apr 20.

Fred Hutchinson Cancer Research Center, Seattle, WA.

Purpose: The rho-associated coiled-coil-containing protein kinase-2 (ROCK2) signaling pathway regulates the Th17/regulatory T cells balance and controls profibrotic pathways. Selective ROCK2 inhibition with belumosudil (KD025) may offer a novel approach to the management of chronic graft-versus-host disease (cGVHD).

Patients And Methods: A phase IIa, open-label, dose-finding study of belumosudil enrolled 54 patients with cGVHD who had received one to three prior lines of therapy (LOTs). Read More

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