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Gary JB, Gallagher L, Joseph PV, Reed D, Gudis DA, Overdevest JB. Qualitative Olfactory Dysfunction and COVID-19: An Evidence-Based Review with Recommendations for the Clinician. Am J Rhinol Allergy 2023; 37:95-101. [PMID: 35957578 PMCID: PMC9379596 DOI: 10.1177/19458924221120117] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Nearly 40% of patients who experience smell loss during SARS-CoV-2 infection may develop qualitative olfactory dysfunction, most commonly parosmia. Our evidence-based review summarizes the evolving literature and offers recommendations for the clinician on the management of patients experiencing parosmia associated with COVID-19. METHODS We performed a systematic search using independent queries in PubMed, Embase, Ovid, and Cochrane databases, then categorized articles according to themes that emerged regarding epidemiology, effect on quality of life, disease progression, prognosis, pathophysiology, diagnosis, and treatment of parosmia. RESULTS We identified 123 unique references meeting eligibility and performed title and abstract review with 2 independent reviewers, with 74 articles undergoing full-text review. An inductive approach to thematic development provided 7 central themes regarding qualitative olfactory dysfunction following COVID-19. CONCLUSIONS While other respiratory viruses are known to cause qualitative olfactory disturbances, the incidence of parosmia following COVID-19 is notable, and correlates negatively with age. The presence of parosmia predicts persistent quantitative olfactory dysfunction. Onset can occur months after infection, and symptoms may persist for well over 7 months. Affected patients report increased anxiety and decreased quality of life. Structured olfactory training with essential oils is the preferred treatment, where parosmia predicts recovery of aspects of quantitative smell loss when undergoing training. There is limited evidence that nasal corticosteroids may accelerate recovery of olfactory function. Patients should be prepared for the possibility that symptoms may persist for years, and providers should guide them to resources for coping with their psychosocial burden.
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Affiliation(s)
- Joseph B. Gary
- Vagelos College of Physicians and
Surgeons, Columbia University, New York, NY, USA
| | - Liam Gallagher
- Vagelos College of Physicians and
Surgeons, Columbia University, New York, NY, USA
| | - Paule V. Joseph
- National Institute on Alcohol Abuse and
Alcoholism, Bethesda, MD, USA
- National Institute of Nursing Research,
Bethesda, MD, USA
| | - Danielle Reed
- Monell Chemical Senses
Center, Philadelphia, PA, USA
| | - David A. Gudis
- Vagelos College of Physicians and
Surgeons, Columbia University, New York, NY, USA
- Department of Otolaryngology–Head and
Neck Surgery, Columbia University Irving Medical
Center, New York–Presbyterian Hospital, New York, NY, USA
| | - Jonathan B. Overdevest
- Vagelos College of Physicians and
Surgeons, Columbia University, New York, NY, USA
- Department of Otolaryngology–Head and
Neck Surgery, Columbia University Irving Medical
Center, New York–Presbyterian Hospital, New York, NY, USA
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Altundag A. Parosmia and Phantosmia: Managing Quality Disorders. CURRENT OTORHINOLARYNGOLOGY REPORTS 2023; 11:19-26. [PMID: 36721659 PMCID: PMC9880375 DOI: 10.1007/s40136-023-00441-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 01/28/2023]
Abstract
Purpose of Review The purpose of this review was to summarize the current knowledge on parosmia and phantosmia and introduce support and treatment algorithms for the two qualitative olfactory disorders. Recent Findings Recent literature regarding parosmia has revealed that patients with the disorder are mainly triggered by certain substances, including thiols and pyrazines. In 2015, the existing "olfactory training" regimen was improved to more effectively treat post-infectious olfactory loss and was named "modified olfactory training" (MOT). It was also found in 2022 that MOT is also effective against COVID-19-induced parosmia. Summary Parosmia, the distortion of smells, is a symptom in qualitative olfactory disorders that severely affects patients' mental well-being and enjoyment of their everyday lives. The condition was first documented in 1895 and can affect up to 5% of the general population. Etiologies of parosmia include sinonasal diseases, viruses, surgeries, traumatic brain injury, neurological and psychiatric conditions, toxic chemicals, and medications. Parosmia has seen a surge in cases since the onset of the COVID-19 pandemic and is linked to changes in brain structure following an infection. The evaluation of the symptom is done using surveys, smell identification tests, fMRI, MRI, PET/CT, and gas chromatography. Treatment for parosmia can vary in duration, which makes it essential to focus not only on helping the patients regain normosmia, but also on supporting the patient through the recovery journey. Parosmia should not be confused with phantosmia, in which the distortion of smells occurs in the absence of olfactory stimuli. The etiology of phantosmia can vary from infections and traumatic brain injury to psychiatric disorders like schizophrenia. Unlike parosmia, the treatment of phantosmia is less straightforward, with an emphasis on determining the etiology and providing symptomatic relief.
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Affiliation(s)
- Aytug Altundag
- Otorhinolaryngology Department, Biruni University School of Medicine, Istanbul, Turkey
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Ijichi C, Kondo K, Kobayashi M, Shirasawa A, Shimbo K, Nakata K, Maruyama Y, Ihara Y, Kawato Y, Mannen T, Takeshita R, Kikuchi Y, Saito Y, Yamasoba T. Lipocalin 15 in the olfactory mucus is a biomarker for Bowman's gland activity. Sci Rep 2022; 12:9984. [PMID: 35750866 PMCID: PMC9232505 DOI: 10.1038/s41598-022-13464-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/24/2022] [Indexed: 12/04/2022] Open
Abstract
Olfactory mucus contributes to the specific functions of the olfactory mucosa, but the composition and source of mucus proteins have not been fully elucidated. In this study, we used comprehensive proteome analysis and identified lipocalin 15 (LCN15), a human-specific lipocalin family protein, as an abundant component of the olfactory mucus. Western blot analysis and enzyme-linked immunosorbent assay (ELISA) using a newly generated anti-LCN15 antibody showed that LCN15 was concentrated in olfactory mucus samples, but not in respiratory mucus samples. Immunohistochemical staining using anti-LCN15 antibody revealed that LCN15 localized to the cytokeratin 18-positive Bowman's glands of the olfactory cleft mucosa. Quantitative image analysis revealed that the area of LCN15 immunoreactivity along the olfactory cleft mucosa significantly correlated with the area of neuron-specific Protein-Gene Product 9.5 (PGP9.5) immunoreactivity, suggesting that LCN15 is produced in non-degenerated areas of the olfactory neuroepithelium. ELISA demonstrated that the concentration of LCN15 in the mucus was lower in participants with normal olfaction (≥ 50 years) and also tended to be lower in patients with idiopathic olfactory loss (≥ 50 years) than in participants with normal olfaction (< 50 years). Thus, LCN15 may serve as a biomarker for the activity of the Bowman’s glands.
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Affiliation(s)
- Chiori Ijichi
- Food Products Division, Technology & Solution Development Center, Institute of Food Science and Technologies, Ajinomoto Co., Inc., Kawasaki, 210-8681, Japan.
| | - Kenji Kondo
- Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan.
| | - Masayoshi Kobayashi
- Department of Otorhinolaryngology-Head and Neck Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Ayaka Shirasawa
- Research Institute for Bioscience Products & Fine Chemicals, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Kazutaka Shimbo
- Research Institute for Bioscience Products & Fine Chemicals, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Kunio Nakata
- Research Institute for Bioscience Products & Fine Chemicals, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Yutaka Maruyama
- Food Products Division, Technology & Solution Development Center, Institute of Food Science and Technologies, Ajinomoto Co., Inc., Kawasaki, 210-8681, Japan
| | - Yusuke Ihara
- Food Products Division, Technology & Solution Development Center, Institute of Food Science and Technologies, Ajinomoto Co., Inc., Kawasaki, 210-8681, Japan
| | - Yayoi Kawato
- Food Products Division, Technology & Solution Development Center, Institute of Food Science and Technologies, Ajinomoto Co., Inc., Kawasaki, 210-8681, Japan
| | - Teruhisa Mannen
- Research Institute for Bioscience Products & Fine Chemicals, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Rie Takeshita
- Research Institute for Bioscience Products & Fine Chemicals, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Yoshimi Kikuchi
- Research Institute for Bioscience Products & Fine Chemicals, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Yuki Saito
- Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
| | - Tatsuya Yamasoba
- Department of Otorhinolaryngology-Head and Neck Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, 113-8655, Japan
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Ijichi C, Wakabayashi H, Sugiyama S, Hayashi K, Ihara Y, Nishijima H, Touhara K, Kondo K. Odorant metabolism of the olfactory cleft mucus in idiopathic olfactory impairment patients and healthy volunteers. Int Forum Allergy Rhinol 2021; 12:293-301. [PMID: 34637187 DOI: 10.1002/alr.22897] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND It remains unclear whether the metabolic activity of nasal mucus in the olfactory and respiratory areas is different. Moreover, age- and olfaction-related changes may affect metabolism. METHODS Hexanal, octanal, and 2-methylbutanal were selected for in vitro metabolism analysis and compared between the olfactory cleft and respiratory mucus of participants < 50-year-old with normal olfaction using gas chromatography mass spectrometry. The metabolic activity of hexanal in the olfactory cleft mucus was further compared between three groups, (1) normal olfaction, age < 50 years old, (2) normal olfaction, age ≥50 years old, and (3) idiopathic olfactory impairment. To characterize the enzyme(s) responsible for aldehyde reduction, we also tested if epalr22897estat and 3,5-dichlorosalicylic acid, types of reductase inhibitors, affect metabolism. RESULTS Conversion of aldehydes to their corresponding alcohols was observed in the olfactory cleft and respiratory mucus. The metabolic production of hexanol, octanol, and 2-methybutanol was significantly higher in the olfactory cleft mucus than in the respiratory mucus (p < 0.01). The metabolic conversion of hexanal to hexanol in the mucus of the idiopathic olfactory impairment group was significantly lower than that in the age-matched normal olfaction group. Excluding the nicotinamide adenine dinucleotide phosphate (NADPH) regenerating system from the reaction mixture inhibited metabolism. The addition of either epalr22897estat or 3,5-dichlorosalicylic acid did not inhibit this metabolic conversion. CONCLUSIONS The enzymatic metabolism of odorants in the olfactory cleft mucus is markedly higher than in the respiratory mucus and decreases in patients with idiopathic olfactory impairment.
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Affiliation(s)
- Chiori Ijichi
- Technology and Solution Development Center, Institute of Food Science and Technologies, Food Products Division, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Hidehiko Wakabayashi
- Technology and Solution Development Center, Institute of Food Science and Technologies, Food Products Division, Ajinomoto Co., Inc., Kawasaki, Japan.,College of Bioresource Sciences, Nihon University, Kameino, Fujisawa, Japan
| | - Shingo Sugiyama
- Technology and Solution Development Center, Institute of Food Science and Technologies, Food Products Division, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Kazuhiro Hayashi
- Technology and Solution Development Center, Institute of Food Science and Technologies, Food Products Division, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Yusuke Ihara
- Technology and Solution Development Center, Institute of Food Science and Technologies, Food Products Division, Ajinomoto Co., Inc., Kawasaki, Japan
| | - Hironobu Nishijima
- Department of Otolaryngology-Head and Neck Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Kazushige Touhara
- Department of Applied Biological Chemistry, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Kenji Kondo
- Department of Otolaryngology-Head and Neck Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Relationship between cognitive impairment and olfactory function among older adults with olfactory impairment. Auris Nasus Larynx 2020; 48:420-427. [PMID: 33293191 DOI: 10.1016/j.anl.2020.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/19/2020] [Accepted: 11/27/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Understanding the relationships among aging, cognitive function, and olfaction may be useful for diagnosing olfactory decline in older adults. Olfactory function declines in the early stage of neurodegenerative diseases, including Alzheimer's and Parkinson's diseases. Aging and cognitive impairment are associated with olfactory decline. Moreover, the assessment of hyposmia and anosmia is paramount to the diagnosis of neurodegenerative diseases. We aimed to assess the relationships among aging, cognitive function, and olfaction in patients with olfactory impairment. METHODS This observational study included 141 patients with olfactory deterioration who presented with dementia, mild cognitive impairment (MCI), age-related hyposmia, or postviral olfactory dysfunction (PVOD). The patients underwent T&T olfactometry, a self-administered odor questionnaire (SAOQ), a visual analog scale (VAS), and a Mini-Mental State Examination. RESULTS T&T odor recognition thresholds decreased with aging (p < 0.01) and cognitive impairment (p < 0.08). The average T&T recognition thresholds were 5.1,4.6,4.2, and 3.7 in dementia, MCI, age-related hyposmia, and PVOD, respectively. Moreover, the average differences between the detection and recognition thresholds were 3.7, 2.8, 2.3, and 2.0 in dementia, MCI, age-related hyposmia, and PVOD, respectively. Hyposmia with dementia presented the highest recognition thresholds (p < 0.05) and the largest differences between the T&T detection and recognition thresholds, compared with age-related hyposmia and PVOD (p < 0.05). Hyposmia with dementia had the highest SAOQ and VAS scores compared with the other groups (p < 0.05). CONCLUSION The possibility of dementia should be investigated in patients with hyposmia, including those with high T&T recognition thresholds, a large difference between the T&T detection and recognition thresholds, and high SAOQ and VAS scores.
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Shiga H, Wakabayashi H, Washiyama K, Noguchi T, Hiromasa T, Miyazono S, Kumai M, Ogawa K, Taki J, Kinuya S, Miwa T. Thallium-201 Imaging in Intact Olfactory Sensory Neurons with Reduced Pre-Synaptic Inhibition In Vivo. Mol Neurobiol 2020; 57:4989-4999. [PMID: 32820461 PMCID: PMC7541386 DOI: 10.1007/s12035-020-02078-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/14/2020] [Indexed: 11/30/2022]
Abstract
In this study, we determined whether the 201Tl (thallium-201)-based olfactory imaging is affected if olfactory sensory neurons received reduced pre-synaptic inhibition signals from dopaminergic interneurons in the olfactory bulb in vivo. The thallium-201 migration rate to the olfactory bulb and the number of action potentials of olfactory sensory neurons were assessed 3 h following left side nasal administration of rotenone, a mitochondrial respiratory chain complex I inhibitor that decreases the number of dopaminergic interneurons without damaging the olfactory sensory neurons in the olfactory bulb, in mice (6–7 animals per group). The migration rate of thallium-201 to the olfactory bulb was significantly increased following intranasal administration of thallium-201 and rotenone (10 μg rotenone, p = 0.0012; 20 μg rotenone, p = 0.0012), compared with that in control mice. The number of action potentials was significantly reduced in the olfactory sensory neurons in the rotenone treated side of 20 μg rotenone-treated mice, compared with that in control mice (p = 0.0029). The migration rate of thallium-201 to the olfactory bulb assessed with SPECT-CT was significantly increased in rats 24 h after the left intranasal administration of thallium-201 and 100 μg rotenone, compared with that in control rats (p = 0.008, 5 rats per group). Our results suggest that thallium-201 migration to the olfactory bulb is increased in intact olfactory sensory neurons with reduced pre-synaptic inhibition from dopaminergic interneurons in olfactory bulb glomeruli.
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Affiliation(s)
- Hideaki Shiga
- Department of Otorhinolaryngology, Kanazawa Medical University, Uchinadamachi, Kahokugun, Ishikawa, 920-0293, Japan.
| | - Hiroshi Wakabayashi
- Department of Nuclear Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, 920-8640, Japan
| | - Kohshin Washiyama
- Advanced Clinical Research Center, Fukushima Global Medical Science Center, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Tomohiro Noguchi
- Department of Sensory Physiology, Asahikawa Medical University, Asahikawa, 078-8510, Japan
| | - Tomo Hiromasa
- Department of Nuclear Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, 920-8640, Japan
| | - Sadaharu Miyazono
- Department of Sensory Physiology, Asahikawa Medical University, Asahikawa, 078-8510, Japan
| | - Masami Kumai
- Department of Otorhinolaryngology, Kanazawa Medical University, Uchinadamachi, Kahokugun, Ishikawa, 920-0293, Japan
| | - Kazuma Ogawa
- Institute for Frontier Science Initiative, Kanazawa University, Kanazawa, Ishikawa, 920-1192, Japan
| | - Junichi Taki
- Department of Nuclear Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, 920-8640, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Ishikawa, 920-8640, Japan
| | - Takaki Miwa
- Department of Otorhinolaryngology, Kanazawa Medical University, Uchinadamachi, Kahokugun, Ishikawa, 920-0293, Japan
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Zhang L. Evolving management of upper airway diseases: focus on Asia. Int Forum Allergy Rhinol 2020; 9:1233-1235. [PMID: 31682333 DOI: 10.1002/alr.22470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Shiga H, Okuda K, Taki J, Watanabe N, Tonami H, Kinuya S, Miwa T. Nasal thallium-201 uptake in patients with parosmia with and without hyposmia after upper respiratory tract infection. Int Forum Allergy Rhinol 2019; 9:1252-1256. [PMID: 31356735 PMCID: PMC6899886 DOI: 10.1002/alr.22395] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/30/2019] [Accepted: 07/04/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND In this study, we aimed to determine whether nasal thallium-201 uptake of the olfactory cleft and olfactory bulb (OB) differs between patients with parosmia with and without hyposmia after upper respiratory tract infection (URTI). METHODS Twenty patients with parosmia after URTI were enrolled in this study (15 women and 5 men, 28 to 76 years old). Nasally administered thallium-201 migration to the OB, nasal thallium-201 uptake ratio in the olfactory cleft, and OB volume were determined in 10 patients with normal T&T olfactometry (Daiichi Yakuhin Sangyo, Tokyo, Japan) odor recognition thresholds (≤2.0) who still complained of parosmia (parosmia group), and 10 patients with T&T odor recognition thresholds >2.0 (parosmia and hyposmia group). RESULTS The nasal thallium-201 uptake ratio in the olfactory cleft was significantly higher in the parosmia group than in the parosmia and hyposmia group (p = 0.0015). Thallium-201 migration to the OB was not significantly different between the 2 groups (p = 0.31). The OB volume was significantly larger in the parosmia group than that in the parosmia and hyposmia group (p = 0.029); however, the mean OB volume in both the groups was lower than the normal threshold value in healthy individuals. CONCLUSION Our results signify the recovery of the olfactory epithelium; however, the olfactory neural projections to the OB and regeneration of OB were not complete in patients with parosmia with normal T&T recognition thresholds after URTI.
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Affiliation(s)
- Hideaki Shiga
- Department of Otorhinolaryngology, Kanazawa Medical University, Ishikawa, Japan
| | - Koichi Okuda
- Department of Physics, Kanazawa Medical University, Ishikawa, Japan
| | - Junichi Taki
- Department of Nuclear Medicine, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - Naoto Watanabe
- Department of Diagnostic and Therapeutic Radiology, Kanazawa Medical University, Ishikawa, Japan
| | - Hisao Tonami
- Department of Diagnostic and Therapeutic Radiology, Kanazawa Medical University, Ishikawa, Japan
| | - Seigo Kinuya
- Department of Nuclear Medicine, Graduate School of Medical Science, Kanazawa University, Ishikawa, Japan
| | - Takaki Miwa
- Department of Otorhinolaryngology, Kanazawa Medical University, Ishikawa, Japan
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