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Shapiro R, Jordan ML, Scantlebury VP, Vivas CA, Jain A, Chakrabarti P, McCauley J, Johnston J, Randhawa P, Rao A, Fung JJ, Corry RJ. Simultaneous pancreas-kidney transplantation at the University of Pittsburgh. CLINICAL TRANSPLANTS 2001:217-21. [PMID: 11038640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Analysis of the SPK program at the University of Pittsburgh has led to a number of observations: 1. Under tacrolimus-based immunosuppression, without antibody induction, it has been possible to achieve (a) One- and 3-year actuarial patient survival rates of 98% and 95% (b) One- and 3-year actuarial kidney survival rates of 95% and 87% (c) One- and 3-year actuarial pancreas survival rates of 86% and 80% 2. Steroid withdrawal has been achieved in over half of the successfully transplanted recipients, with excellent outcomes and a low rate (4.7%) of subsequent rejection. 3. Bone marrow augmentation has been associated with (a) less rejection (b) less pancreatic graft loss to rejection (c) an increased ability to withdraw steroids 4. Rejection has been associated with a rising serum lipase. 5. Renal allograft rejection in SPK patients with elevated serum lipase levels has been seen in the setting of normal renal function. 6. Enteric drainage has been associated with a reasonably low complication rate. 7. SPK transplantation is a successful therapeutic option in selected type I diabetics with end-stage renal disease.
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Miki T, Sun H, Lee Y, Tandin A, Kovscek AM, Subbotin V, Fung JJ, Valdivia LA. Blockade of tryptophan catabolism prevents spontaneous tolerogenicity of liver allografts. Transplant Proc 2001; 33:129-30. [PMID: 11266740 DOI: 10.1016/s0041-1345(00)02792-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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53
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Liang X, Lu L, Zhang H, Vickers T, Fung JJ, Qian S. Phenotype and allostimulatory function of dendritic cells treated with antisense oligodeoxyribonucleotides targeting CD80 or CD86 mRNA. Transplant Proc 2001; 33:235. [PMID: 11266796 DOI: 10.1016/s0041-1345(00)01991-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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54
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Metes D, Morel PA, Nellis J, Fung JJ, Rao AS. FcgammaRllc 13Q/STP polymorphism influences the antibody-dependent cytotoxicity levels triggered by natural killer cells against pig aortic endothelial cells. Transplant Proc 2001; 33:333. [PMID: 11266847 DOI: 10.1016/s0041-1345(00)02034-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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55
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Tandin A, Miki T, Metes D, Lee Y, Kovscek AM, Subbotin V, Fung JJ, Valdivia LA. Immune complex disease in immunosuppressed rat recipients of hamster liver xenografts. Transplant Proc 2001; 33:778. [PMID: 11267066 DOI: 10.1016/s0041-1345(00)02250-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Chakrabarti P, Wong HY, Toyofuku A, Scantlebury VP, Jordan ML, Vivas C, Jain AB, McCauley J, Johnston J, Randhawa PS, Hakala TR, Simmons RL, Fung JJ, Starzl TE, Shapiro R. Outcome after steroid withdrawal in adult renal transplant patients receiving tacrolimus-based immunosuppression. Transplant Proc 2001; 33:1235-6. [PMID: 11267274 PMCID: PMC2972654 DOI: 10.1016/s0041-1345(00)02402-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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57
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Li W, Lu L, Wang L, Wang Z, Thomson AW, Fung JJ, Qian S. Neutralization of IL-12 reverses rejection of mouse liver allografts from Flt3-ligand-treated donors and is associated with suppression of both cellular and humoral responses. Transplant Proc 2001; 33:525. [PMID: 11266939 DOI: 10.1016/s0041-1345(00)02123-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sun H, Subbotin V, Woodward J, Valdivia L, Fung JJ, Rao AS. Role of MHC class I and CD8(+) T cells in the pathogenesis of chronic rejection. Transplant Proc 2001; 33:319. [PMID: 11266839 DOI: 10.1016/s0041-1345(00)02027-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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59
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Tang JL, Woodward JE, Subbotin V, Logar AJ, Sun H, Valdivia LA, Schaefer AT, Zottola LB, Peach R, Fung JJ, Rao AS. Presentation of MHC-disparate donor antigens predominantly by the indirect pathway results in the development of posttransplant vasculopathy: salutary effects of perioperative costimulatory blockade. Transplant Proc 2001; 33:307. [PMID: 11266831 DOI: 10.1016/s0041-1345(00)02020-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Metes D, Storkus WJ, Zeevi A, Watkins S, Patterson K, Nellis J, Logar A, Fung JJ, Rao AS. Use of autologous dendritic cells loaded with apoptotic LCL for ex vivo generation of specific CTL from the PBMC of EBV(-) individuals. Transplant Proc 2001; 33:441. [PMID: 11266900 DOI: 10.1016/s0041-1345(00)02084-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Qian S, Wang Z, Li W, Chen Z, Zhang H, Vickers T, Fung JJ, Lu L. Administration of antisense oligodeoxyribonucleotides against mRNA of CD80 or CD86 prolongs survival of cardiac allografts by inhibition of CTL activity. Transplant Proc 2001; 33:551. [PMID: 11266953 DOI: 10.1016/s0041-1345(00)02137-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Koike C, Friday R, Fung JJ, Starzl TE, Trucco M. Comparison of the regulatory regions of the alpha1,3galactosyltransferase gene between murine and porcine species. Transplant Proc 2001; 33:710-1. [PMID: 11267031 PMCID: PMC2962605 DOI: 10.1016/s0041-1345(00)02216-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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63
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Tang JL, Woodward JE, Subbotin V, Logar AJ, Sun H, Valdivia LA, Schaefer AT, Zottola LB, Peach R, Fung JJ, Rao AS. Blockade of the CD28/B7 and CD40/CD40L costimulatory pathways does not ameliorate chronic rejection in a mouse aortic allograft model of direct antigen presentation. Transplant Proc 2001; 33:382. [PMID: 11266872 DOI: 10.1016/s0041-1345(00)02058-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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64
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Chen Z, Lu L, Li J, Li W, Fung JJ, Xiao X, Qian S. Transfection with genes encoding CTLA4Ig mediated by adenoassociated virus vectors prolongs survival of heart allografts. Transplant Proc 2001; 33:604. [PMID: 11266978 DOI: 10.1016/s0041-1345(00)02162-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kuddus R, Patzer JF, Lopez R, Mazariegos GV, Meighen B, Kramer DJ, Fung JJ, Rao AS. Valuation of transmission of porcine endogenous retrovirus into patients subjected to hemoperfusion using an extracorporeal bioartificial liver support system. Transplant Proc 2001; 33:1976. [PMID: 11267594 DOI: 10.1016/s0041-1345(00)02760-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Molmenti EP, Jain AB, Shapiro R, Scantlebury V, Lee R, Totsuka E, Flohr J, Rakela J, Fung JJ. Kidney transplantation for end-stage renal failure in liver transplant recipients with hepatitis C viral infection. Transplantation 2001; 71:267-71. [PMID: 11213072 DOI: 10.1097/00007890-200101270-00018] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND End-stage renal failure after successful liver transplantation (LTx) has been described in up to 5% of patients. Kidney transplantation (KTx) has been the treatment of choice in these cases. However, in recipients infected with hepatitis C virus (HCV), the augmentation of immunosuppression after KTx may result in an increased viral load. This, in turn, may adversely affect the liver allograft. METHOD The present study retrospectively examined the outcome in 17 patients (3 females and 14 males, mean age 51.1+/-11.3 years) who received KTx after LTx. The mean interval from LTx to KTx was 57.6+/-32.1 months. The mean follow-up was 41.7+/-20.5 months after KTx, and 99.6+/-37.7 months after LTx. Sixteen of the 17 patients received tacrolimus-based immunosuppression at the time of KTx. RESULTS During the follow-up period, one patient underwent combined liver and kidney retransplantation 3.7 years after KTx and 12.7 years after LTx. She subsequently died secondary to primary nonfunction. Four other patients died, two of lung cancer, one of pancreatitis/sepsis, and one of severe depression leading to noncompliance. A total of 29 episodes of biopsy-proven acute renal allograft rejection (1.7 episodes/ patient) were encountered and treated with steroids. Seven patients experienced a rise in liver function tests during the period of increased steroid dosage. Four patients received no treatment, and their liver function returned to baseline. The remaining three were treated with interferon. Overall 1- and 3-year actuarial patient and liver allograft survival was 88% and 71% (after renal transplantation); corresponding 1- and 3-year actuarial graft survival was 88% and 61%. Twelve patients are alive with normal liver function. One patient is on dialysis, because of renal allograft loss to noncompliance. CONCLUSION In this series, LTx recipients with HCV infection were able to undergo KTx with a reasonable degree of success. KTx should be offered for end-stage renal failure after LTx, even in the presence of HCV infection, to individuals with stable liver function and no signs of liver failure.
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Torbenson MS, Wang J, Nichols L, Jain AB, Fung JJ, Nalesnik MA. Occult nonhematopoietic malignancies present at autopsy in solid organ transplant patients who died within 100 days. Transplantation 2001; 71:64-9. [PMID: 11211197 DOI: 10.1097/00007890-200101150-00011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients are at an increased risk for developing malignancies after transplantation. Lymphomas, skin malignancies, Kaposi's sarcomas, and cervical/vulvar neoplasms are the most common, but visceral malignancies are also well documented, with a reported frequency ranging from 1% to 6%. These visceral tumors represent a mix of neoplasms that were clinically occult at the time of transplantation and those that arise de novo after transplantation. Little information, however, is available on the frequency of clinically occult malignancies at the time of transplantation and their contribution to the number of posttransplant malignancies. METHODS A retrospective study was performed of all patients who received an organ transplant from January 1981 to June 1997 and died within 100 days, a time interval in which epithelial malignancies found at autopsy were presumed to have been present, but clinically occult, at the time of transplantation. RESULTS A total of 375 patients were studied who received the following organ transplants: 231 liver, 52 heart, 26 heart and lung, 32 lung, and 34 kidney. Eleven malignancies were identified for an overall frequency of 2.9% and included three thyroid carcinomas, three carcinoids of the small bowel, two lung carcinomas, one laryngeal carcinoma, one renal cell carcinoma, and one seminoma. CONCLUSION The 2.9% frequency of malignancies seen in this study suggests that a small, but significant, number of patients have occult malignancies at the time of transplantation and that these occult tumors contribute substantially to the number of malignancies that present clinically after transplantation.
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Jain A, Kashyap R, Kramer D, Dodson F, Hamad I, Starzl TE, Fung JJ. Prospective randomized trial of tacrolimus and prednisone versus tacrolimus, prednisone, and mycophenolate mofetil: complete report on 350 primary adult liver transplantations. Transplant Proc 2001; 33:1342-4. [PMID: 11267319 PMCID: PMC3184833 DOI: 10.1016/s0041-1345(00)02502-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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69
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Kashyap R, Jain A, Reyes J, Demetris AJ, Elmagd KA, Dodson SF, Marsh W, Madariaga V, Mazariegos G, Geller D, Bonham CA, Cacciarelli T, Fontes P, Starzl TE, Fung JJ. Causes of death after liver transplantation in 4000 consecutive patients: 2 to 19 year follow-up. Transplant Proc 2001; 33:1482-3. [PMID: 11267383 PMCID: PMC2953259 DOI: 10.1016/s0041-1345(00)02561-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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70
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Rao AS, Dvorchik I, Dodson F, Abu-Elmagd K, Schaefer AT, Ostrowski L, Valenti M, Zeevi A, Kuddus R, Starzl TE, Fung JJ. Donor bone marrow infusion in liver recipients: effect on the occurrence of acute cellular rejection. Transplant Proc 2001; 33:1352. [PMID: 11267323 PMCID: PMC2964064 DOI: 10.1016/s0041-1345(00)02506-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kashyap R, Jain A, Reyes J, Demetris AJ, Elmagd KA, Dodson SF, Marsh W, Madariaga V, Mazariegos G, Geller D, Bonham CA, Cacciarelli T, Fontes P, Starzl TE, Fung JJ. Causes of retransplantation after primary liver transplantation in 4000 consecutive patients: 2 to 19 years follow-up. Transplant Proc 2001; 33:1486-7. [PMID: 11267385 PMCID: PMC2987633 DOI: 10.1016/s0041-1345(00)02563-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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73
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Shapiro R, Rao AS, Corry RJ, Valenti M, Zeevi A, Jordan ML, Scantlebury VP, Vivas CA, Jain A, McCauley J, Randhawa P, Gray EA, Dvorchik I, McMichael J, Fung JJ, Starzl TE. Kidney transplantation with bone marrow augmentation: five-year outcomes. Transplant Proc 2001; 33:1134-5. [PMID: 11267224 PMCID: PMC2978658 DOI: 10.1016/s0041-1345(00)02461-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Murase N, Ye Q, Nalesnik MA, Demetris AJ, Abu-Elmagd K, Reyes J, Ichikawa N, Okuda T, Fung JJ, Starzl TE. Immunomodulation for intestinal transplantation by allograft irradiation, adjunct donor bone marrow infusion, or both. Transplantation 2000; 70:1632-41. [PMID: 11152226 PMCID: PMC2972579 DOI: 10.1097/00007890-200012150-00016] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The passenger leukocytes in the intestine have a lineage profile that predisposes to graft-versus-host disease (GVHD) in some animal models and have inferior tolerogenic qualities compared with the leukocytes in the liver, other solid organs, and bone marrow. Elimination by ex vivo irradiation of mature lymphoid elements from the bowel allografts is known to eliminate the GVHD risk. We hypothesized that infusion of donor bone marrow cells (BMC) in recipients of irradiated intestine would improve tolerogenesis without increasing the risk of GVHD. METHODS Orthotopic small intestine transplantation was performed with the GVHD-prone Lewis (LEW)-to-Brown Norway (BN) combination and the reverse GVHD-resistant BN-to-LEW model under a short course of tacrolimus treatment (1 mg/kg/day, days 0-13, 20, 27). Grafts were irradiated ex vivo, using a 137Cs source. In selected experimental groups, donor BMC (2.5 x 10(8)) were infused on the day of small intestine transplantation. RESULTS The unmodified LEW intestine remained intact, whether transplanted alone or with adjunct donor BMC infusion, but all of the BN recipients died of GVHD after approximately 2 months. Intestinal graft irradiation (10 Gy) effectively prevented the GVHD and prolonged survival to 92.5 days, but all of the BN recipients died with chronic rejection of the LEW grafts, which was prevented by infusion of adjunct donor BMC without causing GVHD. In the GVHD-resistant reverse strain direction (BN-->LEW), all intestinal recipients treated for 27 days with tacrolimus survived > or =150 days without regard for graft irradiation or adjunct BMC, but chronic rejection was severe in the irradiated intestine, moderate in the unaltered graft, and least in the irradiated intestine transplanted with adjunct BMC. Mild arteritis in the 150 day allografts of both strain combinations (i.e., LEW--> BN and BN-->LEW) may have been irradiation associated, but this was prevented when weekly doses of tacrolimus were continued for the duration of the experiment rather than being stopped at 27 days. CONCLUSIONS Recipients are protected from GVHD by irradiating intestinal allografts, but the resulting leukocyte depletion leads to chronic rejection of the transplanted bowel. The chronic rejection is prevented with adjunct donor BMC without causing GVHD. Although application of the strategy may be limited by the possibility of radiation injury, the results are consistent with the paradigm that we have proposed to explain organ-induced graft acceptance, tolerance, and chronic rejection.
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Nardo B, Valdivia LA, Catena F, Cavallari G, Demetris AJ, Rao AS, Fung JJ, Starzl TE, Cavallari A. Evidence of microchimerism after pretransplant blood transfusion and FK 506 in liver xenograft. Transplant Proc 2000; 32:2710-2. [PMID: 11134771 DOI: 10.1016/s0041-1345(00)01851-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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