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Bruner MM, Bazan C, Liu B, Cheng C, Chad M, Sievert C, Edwards L, Solomon GM. Effects of High Frequency Chest Wall Oscillation (HFCWO) on Clinical Symptoms in COPD. RESEARCH SQUARE 2024:rs.3.rs-4165729. [PMID: 38659871 PMCID: PMC11042428 DOI: 10.21203/rs.3.rs-4165729/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Background Mucociliary clearance plays a critical role in pulmonary host defense. Abnormal mucociliary clearance contributes to the pathogenesis of pulmonary disorders, including COPD. In bronchiectasis, treatments targeting mucus obstruction in the airways include the use of high frequency chest wall oscillation (HFCWO) therapy. This prospective outcome based study was designed to investigate the changes in symptoms and quality of life (QOL) to measure the effect of adjunctive HFCWO therapy to standard of care therapy for patients with COPD. Research Question When HFCWO is indicated and used as intended, will the quality of life for those patients with COPD improve and sustain improvement. Study Design and Methods We conducted a prospective, openl-label, observational study in COPD patients without concomitant bronchiectasis. Participants had assessments of QOL at baseline (day 0) and then at 30 and 90 days after initiation of HFCWO therapy. The St. George's Respiratory Questionnaire for COPD Patients (SGRQ-C) was employed and longitudinally followed at each timepoint. Paired t-tests were used to compare means between each time points adjusted for multiple comparisons. A linear mixed model for the analysis of longitudinal data was then constructed to determine the simultaneous contribution of race, gender, ethnicity, time, and selected interactions in the primary outcome of change in SGRQ-C across 0, 30, and 90 days. Results The cohort of patients (n=102) demonstrated a significant reduction in the SGRQ-C at 30 and sustained at 90 days compared to baseline. In addition, two component scores of the SGRQ-C questionnaire ("Symptoms" and Impacts") were significantly reduced at 30 and 90 days. Interpretation This prospective, observational study demonstrates statistically significant and clinically favorable responses to HFCWO as an adjunctive therapy for patients with a primary diagnosis of COPD without concomitant bronchiectasis. Results of this study inform the design of additional additional studies of HFCWO to prove efficacy inCOPD patients.
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Affiliation(s)
| | | | - Bo Liu
- University of Alabama at Birmingham
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Uzundurukan A, Poncet S, Boffito DC, Micheau P. CT-FEM of the human thorax: Frequency response function and 3D harmonic analysis at resonance. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 246:108062. [PMID: 38359553 DOI: 10.1016/j.cmpb.2024.108062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND AND OBJECTIVE High-frequency chest wall compression (HFCC) therapy by airway clearance devices (ACDs) acts on the rheological properties of bronchial mucus to assist in clearing pulmonary secretions. Investigating low-frequency vibrations on the human thorax through numerical simulations is critical to ensure consistency and repeatability of studies by reducing extreme variability in body measurements across individuals. This study aims to present the numerical investigation of the harmonic acoustic excitation of ACDs on the human chest as a gentle and effective HFCC therapy. METHODS Four software programs were sequentially used to visualize medical images, decrease the number of surfaces, generate and repair meshes, and conduct numerical analysis, respectively. The developed methodology supplied the validation of the effect of HFCC through computed tomography-based finite element analysis (CT-FEM) of a human thorax. To illustrate the vibroacoustic characteristics of the HFCC therapy device, a 146-decibel sound pressure level (dBSPL) was applied on the back-chest surface of the model. Frequency response function (FRF) across 5-100 Hz was analyzed to characterize the behaviour of the human thorax with the state-space model. RESULTS We discovered that FRF pertaining to accelerance equals 0.138 m/s2N at the peak frequency of 28 Hz, which is consistent with two independent experimental airway clearance studies reported in the literature. The state-space model assessed two apparent resonance frequencies at 28 Hz and 41 Hz for the human thorax. The total displacement, kinetic energy density, and elastic strain energy density were furthermore quantified at 1 µm, 5.2 µJ/m3, and 140.7 µJ/m3, respectively, at the resonance frequency. In order to deepen our understanding of the impact on internal organs, the model underwent simulations in both the time domain and frequency domain for a comprehensive analysis. CONCLUSION Overall, the present study enabled determining and validating FRF of the human thorax to roll out the inconsistencies, contributing to the health of individuals with investigating gentle but effective HFCC therapy conditions with ACDs. This innovative finding furthermore provides greater clarity and a tangible understanding of the subject by simulating the responses of CT-FEM of the human thorax and internal organs at resonance.
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Affiliation(s)
- Arife Uzundurukan
- Centre de Recherche Acoustique-Signal-Humain, Université de Sherbrooke, 2500 Bd de l'Université, Sherbrooke, QC J1K 2R1, Canada.
| | - Sébastien Poncet
- Centre de Recherche Acoustique-Signal-Humain, Université de Sherbrooke, 2500 Bd de l'Université, Sherbrooke, QC J1K 2R1, Canada
| | - Daria Camilla Boffito
- Department of Chemical Engineering, École Polytechnique de Montréal, 2500 Chem. de Polytechnique, Montréal, QC H3T 1J4, Canada
| | - Philippe Micheau
- Centre de Recherche Acoustique-Signal-Humain, Université de Sherbrooke, 2500 Bd de l'Université, Sherbrooke, QC J1K 2R1, Canada
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Zhang Z, Wang C, Li Z, Liu Y, Nie Y, Zhang J, Li D. Efficacy of respiratory rehabilitation in patients with COVID-19: a retrospective study. BMC Pulm Med 2024; 24:152. [PMID: 38532376 DOI: 10.1186/s12890-024-02969-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/18/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has resulted in millions of confirmed cases and deaths globally. The purpose of this study was to investigate the therapeutic effect of airway clearance technology combined with prone ventilation on patients infected with COVID-19. METHODS 38 patients with COVID-19 (severe) who were treated in the intensive rehabilitation group of Shengli Oilfield Central Hospital. They were randomly divided into a control group and an observation group. The control group received prone position ventilation intervention, and the observation group received airway clearance technology combined with prone position ventilation intervention. The changes of oxygen and index, procalcitonin (PCT), interleukin-6 (IL-6) and chest X-ray image indexes were compared between the two groups. RESULT There was no significant difference in age, gender and other general data between the control group and the observation group. The results showed that oxygen index, PCT, IL-6 and chest X-ray image index in the observation group were better than that indexes in the control group. CONCLUSION Airway clearance technology combined with prone ventilation intervention in patients with COVID-19 can improve the total effective rate and oxygenation index, improve the inflammatory indicators and respiratory function of patients. And it may be widely promoted and used in the treatment of patients with COVID-19 (severe).
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Affiliation(s)
- Zhiyou Zhang
- Department of Neurorehabilitation, Shengli Oilfield Central Hospital, No. 31 Jinan Road, 257000, Dongying, Shandong, China
| | - Congcong Wang
- Department of Neurorehabilitation, Shengli Oilfield Central Hospital, No. 31 Jinan Road, 257000, Dongying, Shandong, China
| | - Zhendong Li
- Department of Neurorehabilitation, Shengli Oilfield Central Hospital, No. 31 Jinan Road, 257000, Dongying, Shandong, China
| | - Yueyang Liu
- Department of Neurorehabilitation, Shengli Oilfield Central Hospital, No. 31 Jinan Road, 257000, Dongying, Shandong, China
| | - Yutong Nie
- Department of Neurorehabilitation, Shengli Oilfield Central Hospital, No. 31 Jinan Road, 257000, Dongying, Shandong, China
| | - Jianwei Zhang
- Department of Neurorehabilitation, Shengli Oilfield Central Hospital, No. 31 Jinan Road, 257000, Dongying, Shandong, China
| | - Dawei Li
- Department of Neurorehabilitation, Shengli Oilfield Central Hospital, No. 31 Jinan Road, 257000, Dongying, Shandong, China.
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Pestelli MT, Grecchi B, Vottero E, Galli A, Nicolini A, Compalati E, Banfi P, Diaz DE Teran T, Gonzales M, D'Abrosca F, Lippi L, Ferraioli G, Sheridan S, Dimabuyu-Francisco M, Solidoro P. Effectiveness of a new "focused pulse" high-frequency chest wall oscillation in patients with moderate to severe COPD. Minerva Med 2024; 115:4-13. [PMID: 38261298 DOI: 10.23736/s0026-4806.23.08874-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Chest physiotherapy plays a crucial role in the treatment of COPD, although the optimal techniques for airway clearance have not been definitively established. Among the different techniques, high-frequency chest wall oscillation (HFCWO) has gained attention for its potential to create a widespread lung percussion, facilitating the removal of secretions and potentially clearing the peripheral bronchial tree. This study aims to assess the effectiveness of a novel "focused pulse" HFCWO in patients with moderate to severe COPD. METHODS Sixty patients were randomized to three groups: a group treated with the PEP technique, a group with "focused pulse "HFCWO" and a group with pharmacological therapy alone (control group). The primary outcomes were changes in respiratory function parameters, changes in dyspnea and quality of life scores as well as daily life activity and health status assessment. The secondary outcomes were the number of exacerbations and the number of practitioner or emergency department (ED) visits after 1, 3, and 6 months. RESULTS Sixty patients concluded the study with 20 patients allocated to each group. The two devices improved respiratory function tests, quality of life and health scores and dyspnea compared to the control group. Maximal expiratory pressure and diffusing lung carbon oxide were significantly improved in the focused pulse HFCWO group compared to the PEP group. Only pulse-focused HFCWO showed a statistically significant lower number of exacerbations and visits to ED or practitioner compared to the control group. CONCLUSIONS The focused pulse HFCWO technique improves daily life activities and lung function in patients with stable COPD. The device demonstrated significantly greater effectiveness in lowering COPD exacerbations as well as visits to ED or practitioner.
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Affiliation(s)
- Maria T Pestelli
- Physical Medicine and Rehabilitation, General Hospital, Sestri Levante, Genoa, Italy
| | - Bruna Grecchi
- Physical Medicine and Rehabilitation, General Hospital, Sestri Levante, Genoa, Italy
| | - Erica Vottero
- Physical Medicine and Rehabilitation, General Hospital, Sestri Levante, Genoa, Italy
| | - Alice Galli
- Physical Medicine and Rehabilitation, General Hospital, Sestri Levante, Genoa, Italy
| | - Antonello Nicolini
- Cardio-Pulmonary Rehabilitation Unit, IRCCS Don Gnocchi Foundation, Milan, Italy -
| | - Elena Compalati
- Cardio-Pulmonary Rehabilitation Unit, IRCCS Don Gnocchi Foundation, Milan, Italy
| | - Paolo Banfi
- Cardio-Pulmonary Rehabilitation Unit, IRCCS Don Gnocchi Foundation, Milan, Italy
| | - Teresa Diaz DE Teran
- Sleep and Ventilation Unit, Department of Pneumology, Marqués de Valdecilla University Hospital, Cantabria University, Santander, Spain
| | - Monica Gonzales
- Sleep and Ventilation Unit, Department of Pneumology, Marqués de Valdecilla University Hospital, Cantabria University, Santander, Spain
| | - Francesco D'Abrosca
- Department of Physical and Rehabilitative Medicine, University of Eastern Piedmont, Novara, Italy
- Infrastruttura Ricerca Formazione Innovazione (IRFI), SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Lorenzo Lippi
- Department of Physical and Rehabilitative Medicine, University of Eastern Piedmont, Novara, Italy
- Infrastruttura Ricerca Formazione Innovazione (IRFI), SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Gianluca Ferraioli
- Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Genoa, Italy
| | | | | | - Paolo Solidoro
- Unit of Pneumology, Cardiovascular and Thoracic Department, Molinette Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
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Kim MJ, Kim SH, Yun SU, Kim GH, Nam KW. In vitro comparative study of wall portbased high-frequency chest wall oscillation device and internal air-pulse generator device. Proc Inst Mech Eng H 2024; 238:45-54. [PMID: 38044662 DOI: 10.1177/09544119231214620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Owing to environmental and disease issues, the use of high-frequency chest wall oscillation (HFCWO) devices in hospitals is consistently increasing. This study proposes a cost-effective actuator-less HFCWO device that utilizes an external wall port utility in hospitals to generate the positive and negative pneumatic pressures required for HFCWO treatment instead of an embedded mechanical actuator. The manufactured prototype with the no-amplification (NO-AMP) setting contained an electric pressure regulator to enable intensity level adjustment and two solenoid valves to enable vibration frequency adjustment, whereas the prototype with the pre-amplification (PRE-AMP) setting contained an additional air reservoir and an air-pressure booster. The prototype device was tuned to output average local maximum values in the pressure waveform similar to a commercial VEST-205 device at an 8-12 Hz frequency and 2-4 pressure intensity levels. In vitro comparative experiments demonstrated that the prototype device showed similar local maximum pressures to those of the VEST-205 (mean absolute pressure difference, <3 mmH2O); in contrast, the proposed device showed significantly higher local minimum pressures than those of the VEST-205 (mean absolute pressure difference, >8 mmH2O). Additionally, the driving sound of the proposed device was 17.0-17.8 dB higher than that of VEST-205. We conclude that the proposed device has the potential to substitute for conventional HFCWO devices under the limited but most frequently used operating conditions, although more detailed modifications are necessary in future studies to improve its performance and clinical usability.
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Affiliation(s)
- Min Jae Kim
- Department of Biomedical Engineering, School of Medicine, Pusan National University, Yangsan, Korea
| | - Soo Hong Kim
- Department of Biomedical Engineering, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung Uk Yun
- Department of Biomedical Engineering, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Gun Ho Kim
- Department of Biomedical Engineering, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kyoung Won Nam
- Department of Biomedical Engineering, School of Medicine, Pusan National University, Yangsan, Korea
- Department of Biomedical Engineering, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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Lee CS, Li M, Lou Y, Abbasi QH, Imran MA. Acoustic Lung Imaging Utilized in Continual Assessment of Patients with Obstructed Airway: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:6222. [PMID: 37448069 DOI: 10.3390/s23136222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
Smart respiratory therapy is enabled by continual assessment of lung functions. This systematic review provides an overview of the suitability of equipment-to-patient acoustic imaging in continual assessment of lung conditions. The literature search was conducted using Scopus, PubMed, ScienceDirect, Web of Science, SciELO Preprints, and Google Scholar. Fifteen studies remained for additional examination after the screening process. Two imaging modalities, lung ultrasound (LUS) and vibration imaging response (VRI), were identified. The most common outcome obtained from eleven studies was positive observations of changes to the geographical lung area, sound energy, or both, while positive observation of lung consolidation was reported in the remaining four studies. Two different modalities of lung assessment were used in eight studies, with one study comparing VRI against chest X-ray, one study comparing VRI with LUS, two studies comparing LUS to chest X-ray, and four studies comparing LUS in contrast to computed tomography. Our findings indicate that the acoustic imaging approach could assess and provide regional information on lung function. No technology has been shown to be better than another for measuring obstructed airways; hence, more research is required on acoustic imaging in detecting obstructed airways regionally in the application of enabling smart therapy.
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Affiliation(s)
- Chang-Sheng Lee
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK
- Global Technology and Innovation Department, Hill-Rom Services Pte Ltd., Singapore 768923, Singapore
| | - Minghui Li
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK
| | - Yaolong Lou
- Global Technology and Innovation Department, Hill-Rom Services Pte Ltd., Singapore 768923, Singapore
| | - Qammer H Abbasi
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK
| | - Muhammad Ali Imran
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK
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Ge J, Ye Y, Tan Y, Liu F, Jiang Y, Lu J. High-frequency chest wall oscillation multiple times daily can better reduce the loss of pulmonary surfactant and improve lung compliance in mechanically ventilated patients. Heart Lung 2023; 61:114-119. [PMID: 37247538 DOI: 10.1016/j.hrtlng.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND High-frequency chest wall oscillation (HFCWO) has been widely recognized for its airway secretion clearance effectiveness in critically ill ICU patients. OBJECTIVES The purpose of this randomized controlled trial is to validate and compare the effects of different frequencies of HFCWO on oxygenation, lung compliance, and pulmonary surfactant proteins (SPs) in critically ill patients admitted to the intensive care unit (ICU). METHODS Sixty patients with severe craniocerebral injury treated with a tracheostomy and mechanical ventilation were randomized into three groups (20 patients in each group): a single group (treated with 30 minutes of HFCWO once daily) and a double group (treated with 30 minutes of HFCWO twice daily), and a blank group (treated without HFCWO). Primary outcome measures included results on several specific proteins (SP-A, SP-B, SP-C, and SP-D) in serum and alveolar lavage fluid. Secondary outcome measures were lung static compliance test and oxygenation. RESULTS Patients in both the single and double groups exhibited significant oxygenation and static compliance improvement. Similar results were observed in changes in SPs concentrations in the alveolar lavage fluid. However, a significant reduction of SPs levels was observed in the serum. In the group comparison analysis for the same variables between the single and double group, twice daily HFCWO treatments showed a significantly better result. CONCLUSION Compared with HFCWO once daily, HFCWO twice daily is advantageous in patients with tracheostomy and prolonged ventilation, which demonstrated significantly greater effectiveness in improving oxygenation and lung static compliance linked to the increase of and SPs contents in the airways as well as a reduction of SPs shift from airways to the blood.
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Affiliation(s)
- Jiaqi Ge
- Department of Critical Care Medicine, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu, PR China; Jiangsu University, Zhenjiang, Jiangsu, PR China.
| | - Yinjie Ye
- Department of Critical Care Medicine, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu, PR China.
| | - Yongfei Tan
- Cardiothoracic intensive care unit, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu, PR China; Cardiac-Thoracic Surgery, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu, PR China.
| | - Fang Liu
- Department of Critical Care Medicine, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu, PR China.
| | - Yan Jiang
- Department of Critical Care Medicine, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu, PR China.
| | - Junjie Lu
- Department of Critical Care Medicine, The Affiliated Yixing Hospital of Jiangsu University, Wuxi, Jiangsu, PR China.
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Abstract
BACKGROUND Cystic fibrosis (CF) is an inherited progressive life-limiting disease characterised by the build-up of abnormally thick, sticky mucus affecting mostly the lungs, pancreas, and digestive system. Airway clearance techniques (ACTs), traditionally referred to as chest physiotherapy, are recommended as part of a complex treatment programme for people with CF. The aim of an ACTs is to enhance mucociliary clearance and remove viscous secretions from the airways within the lung to prevent distal airway obstruction. This reduces the infective burden and associated inflammatory effects on the airway epithelia. There are a number of recognised ACTs, none of which have shown superiority in improving short-term outcomes related to mucus transport. This systematic review, which has been updated regularly since it was first published in 2000, considers the efficacy of ACTs compared to not performing any ACT in adults and children with CF. It is important to continue to review this evidence, particularly the long-term outcomes, given the recent introduction of highly effective modulator therapies and the improved health outcomes and potential changes to CF management associated with these drugs. OBJECTIVES To determine the effectiveness and acceptability of airway clearance techniques compared to no airway clearance techniques or cough alone in people with cystic fibrosis. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, which comprises references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings, to 17 October 2022. We searched ongoing trials registers (Clinicaltrials.gov and the WHO International Clinical Trials Registry Platform) to 7 November 2022. SELECTION CRITERIA We included randomised or quasi-randomised studies that compared airway clearance techniques (chest physiotherapy) with no airway clearance techniques or spontaneous cough alone in people with CF. DATA COLLECTION AND ANALYSIS Both review authors independently assessed study eligibility, extracted data, and assessed the risk of bias of the included studies. We used GRADE methodology to assess the certainty of the evidence. MAIN RESULTS We included 11 cross-over studies (153 participants) and one parallel study (41 participants). There were differences between studies in how the interventions were delivered, with several intervention groups combining more than one ACT. One study used autogenic drainage; five used conventional chest physiotherapy; nine used positive expiratory pressure (PEP), with one study varying the water pressure between arms; three studies used oscillating PEP; two used exercise; and two used high-frequency chest wall oscillation (HFCWO). Of the 12 included studies, 10 were single-treatment studies, and two delivered the intervention over two consecutive days (once daily in one study, twice daily in the second). This substantial heterogeneity in the treatment interventions precluded pooling of data for meta-analysis. Blinding of participants, caregivers, and clinicians is impossible in airway clearance studies; we therefore judged all studies at unclear risk of performance bias. Lack of information in eight studies made assessment of risk of bias unclear for most other domains. We rated the certainty of evidence as low or very low due to the short-term cross-over trial design, small numbers of participants, and uncertain risk of bias across most or all domains. Six studies (84 participants) reported no effect on pulmonary function variables following intervention; but one study (14 participants) reported an improvement in pulmonary function following the intervention in some of the treatment groups. Two studies reported lung clearance index: one (41 participants) found a variable response to treatment with HFCWO, whilst another (15 participants) found no effect on lung clearance index with PEP therapy (low-certainty evidence). Five studies (55 participants) reported that ACTs, including coughing, increased radioactive tracer clearance compared to control, while a further study (eight participants) reported no improvement in radioactive tracer clearance when comparing PEP to control, although coughing was discouraged during the PEP intervention. We rated the certainty of evidence on the effect of ACTs on radioactive tracer clearance as very low. Four studies (46 participants) investigated the weight of mucus cleared from the lungs and reported greater secretions during chest physiotherapy compared to a control. One study (18 participants) reported no differences in sputum weight (very low-certainty evidence). AUTHORS' CONCLUSIONS The evidence from this review shows that ACTs may have short-term effects on increasing mucus transport in people with CF. All included studies had short-term follow-up; consequently, we were unable to draw any conclusions on the long-term effects of ACTs compared to no ACTs in people with CF. The evidence in this review represents the use of airway clearance techniques in a CF population before widespread use of cystic fibrosis transmembrane conductance regulator (CFTR) modulators. Further research is needed to determine the effectiveness and acceptability of airway clearance in those treated with highly effective CFTR modulators.
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Affiliation(s)
- Louise Warnock
- Oxford Adult Cystic Fibrosis Centre, Oxford Centre for Respiratory Medicine, The Churchill Hospital, Oxford, UK
| | - Alison Gates
- Oxford Adult Cystic Fibrosis Centre, Oxford Centre for Respiratory Medicine, The Churchill Hospital, Oxford, UK
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Early physiotherapy and chest wall oscillation in patients with COVID-19 disease at the intensive care unit: a pilot clinical trial. JOURNAL OF COMPLEXITY IN HEALTH SCIENCES 2022. [DOI: 10.21595/chs.2022.23037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Over the past few years, the early mobilization and rehabilitation of patients in the intensive care unit (ICU) has drawn a lot of interest from the clinical and scientific communities. An interdisciplinary team treating patients suffering from serious conditions should include physiotherapy. Additionally, physiotherapy is utilized to treat and prevent the side effects of extended immobility or sleep, as well as to improve respiratory function. The purpose is to improve residual functionality; to avoid new and repeated hospitalizations; to improve health and quality of life. Exercises for the entire body (including early in-bed cycling), specialized breathing exercises, chest mobilization, relief help, drainage postures, vibration, verticalization, and passive movements are all crucial components of COVID-19 physiotherapy. Our goal was to evaluate the changes of functional condition of patients with COVID-19 in the acute stage using different physiotherapy methods: complex measures against mono therapy. In the research, 28 subjects (15 men and 13 women) were involved. A total of 84 physiotherapy procedures were performed. In the first group, breathing exercises and chest wall oscillation were applied, in the second group – only chest wall oscillation. Respiratory physiotherapy (breathing exercises) plays an important role in reducing and preventing respiratory complications in COVID-19 patients treated at ICU. Early mobilization and chest wall oscillation are beneficial in COVID-19 patients. We note that we are the first to conduct an evidence-based study of physiotherapy in intensive care with COVID-19 patients. We hope that our pilot clinical trial gives opportunity to future researches.
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Bokov P, Gerardin M, Brialix G, Da Costa Noble E, Juif R, Foucher AV, Le Clainche L, Houdouin V, Mauroy B, Delclaux C. Beneficial short-term effect of autogenic drainage on peripheral resistance in childhood cystic fibrosis disease. BMC Pulm Med 2022; 22:241. [PMID: 35729620 PMCID: PMC9210656 DOI: 10.1186/s12890-022-02039-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background Airway clearance techniques are supposed to be a necessary adjunct for the enhancement of impaired peripheral clearance in cystic fibrosis (CF). The objective was to assess the effect of one physiotherapy session (autogenic drainage: AD) on mucus clearance (sputum wet weight) and impulse oscillometry system (IOS) indices, including those obtained from extended Resistance-Inertance-Compliance (eRIC) modelling, considering the degree of bronchial congestion. Methods Thirty children with CF (median age: 12.7 years) in a stable condition prospectively underwent IOS measurements at baseline and after AD. They were divided in two groups: with (visual analog scale of bronchial congestion by the physiotherapist ≥ 5/10) and without (scale < 5/10) bronchial congestion. Paired-comparison of the effects of AD on airway resistance measurements was done with Wilcoxon test. Results The congestion scale correlated with the wet weight of sputum production during the session (Pearson test: p < 0.0001, R = 0.66). Ten children had bronchial congestion and 20 were without congestion. In the whole group, R5–20 Hz significantly decreased after AD (P = 0.049), which was related to a decrease in the children with congestion (P = 0.025), whereas it was not significantly modified in the children without congestion (P = 0.327). The eRIC model allowed the calculation of the peripheral resistance of the respiratory system, which also decreased in the children with congestion (P = 0.037), however, not modified in the children without congestion (P = 0.390). Conclusion One session of autogenic drainage has the ability to decrease peripheral resistance obtained from IOS measurements, more specifically in children with CF with moderate to severe bronchial congestion. Trial registration ClinicalTrials.gov Identifier: NCT04094441.
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Affiliation(s)
- Plamen Bokov
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, Université de Paris, Hôpital Robert Debré, AP-HP, 48, boulevard Sérurier, 75019, Paris, France
| | - Michèle Gerardin
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Géraldine Brialix
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Emmanuelle Da Costa Noble
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Romain Juif
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Antonia Vital Foucher
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Laurence Le Clainche
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Véronique Houdouin
- Service de Pneumopédiatrie, Centre de Ressources et de Compétences de la Mucoviscidose, Hôpital Robert Debré, AP-HP, 75019, Paris, France
| | - Benjamin Mauroy
- Laboratoire JA Dieudonné, CNRS, Université Nice Côte d'Azur, 06108, Nice, France
| | - Christophe Delclaux
- Service de Physiologie Pédiatrique-Centre du Sommeil, INSERM NeuroDiderot, Université de Paris, Hôpital Robert Debré, AP-HP, 48, boulevard Sérurier, 75019, Paris, France.
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11
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Audag N, Dubus JC, Combret Y. [Respiratory physiotherapy in pediatric practice]. Rev Mal Respir 2022; 39:547-560. [PMID: 35738979 DOI: 10.1016/j.rmr.2022.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/03/2022] [Indexed: 01/11/2023]
Abstract
Congestion of the upper (URT) and lower respiratory tracts (LRT) is a common symptom in several acute and chronic respiratory diseases that occur in childhood. To eliminate these secretions, airway clearance techniques (ACT) directed to the URT and LRT are frequently prescribed. The rationale for the application of these techniques is the same as in adults, but they need to be adapted to be transposed to children. The physiotherapist will be able to choose among a wide range of techniques, of which the most adequate will depend not only on the age of the child and the indication, but also on the basis of his preferences or habits, as well as those of the child. Upper airway clearance, including nasal irrigation, is now recommended for acute and chronic rhinosinusitis in children. It is also one of the symptomatic treatments recommended for infants with acute bronchiolitis. For LRT clearance, several indications, such as cystic fibrosis, primary ciliary dyskinesia and neuromuscular disease, are now widely advocated. Conversely, other indications, such as for infants with acute viral bronchiolitis, are highly controversial. Thoughtful application of these techniques is lacking in robust and precise tools to objectively assess the presence of bronchial congestion, and to treat it accordingly. Similarly, no precise and reliable evaluation of the effectiveness of these ACTs is available to date. This review is designed to explore the ACTs used by physiotherapists, to provide an overview of their current indications, and to consider complementary approaches.
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Affiliation(s)
- N Audag
- Institut de recherche expérimentale et clinique, pôle de pneumologie, ORL & dermatologie, groupe recherche en kinésithérapie respiratoire, université Catholique de Louvain, Bruxelles, Belgique; Secteur de kinésithérapie et ergothérapie, cliniques universitaires Saint-Luc, avenue Hippocrate 10, Bruxelles 1200, Belgique.
| | - J-C Dubus
- Service de médecine infantile et pneumologie pédiatrique, CHU Timone-Enfants, Marseille, France; Aix-Marseille université, IRD, AP-HM, MEPHI, IHU Méditerranée-infection, Marseille, France
| | - Y Combret
- Secteur de kinésithérapie, Groupe Hospitalier du Havre, 76600 Le Havre, France
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12
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Antos NJ, Savant AP. Cystic fibrosis year in review 2020: Section 2 pulmonary disease, infections, and inflammation. Pediatr Pulmonol 2022; 57:347-360. [PMID: 34033706 DOI: 10.1002/ppul.25459] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 12/20/2022]
Abstract
The outlook for those with cystic fibrosis (CF) has never been brighter with ever increasing life expectancy and the approval of the highly effective CFTR modulators, such as elexacaftor/tezacaftor/ivacaftor. With that being said, the progressive pulmonary decline and importance of lung health, infection, and inflammation in CF remains. This review is the second part in a three-part CF Year in Review 2020. Part one focused on the literature related to CFTR modulators while part three will feature the multisystem effects related to CF. This review focuses on articles from Pediatric Pulmonology, including articles from other journals that are of particular interest to clinicians. Herein, we highlight studies published during 2020 related to CF pulmonary disease, infection, treatment, and diagnostics.
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Affiliation(s)
- Nicholas J Antos
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Department of Pediatric Pulmonology, Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Adrienne P Savant
- Department of Pediatrics, Children's Hospital of New Orleans, New Orleans, Louisiana, USA.,Department of Pediatrics, Tulane University, New Orleans, Louisiana, USA
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13
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Methods Used to Evaluate the Immediate Effects of Airway Clearance Techniques in Adults with Cystic Fibrosis: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:jcm10225280. [PMID: 34830562 PMCID: PMC8625729 DOI: 10.3390/jcm10225280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/01/2021] [Accepted: 11/08/2021] [Indexed: 12/17/2022] Open
Abstract
This review reports on methods used to evaluate airway clearance techniques (ACT) in adults with CF and examined data for evidence of any effect. Sixty-eight studies described ACT in adequate detail and were included in this review. Frequently reported outcomes were sputum expectoration (72%) and spirometric lung function (60%). Compared with cough alone, following any ACT, there was a trend for greater sputum wet weight, however FEV1 was not different. The mean (95% CI) within-group effect for sputum wet weight following any ACT was 12.43 g (9.28 to 15.58) (n = 30 studies) and for FEV1 was 0.03 L (−0.17 to 0.24) (n = 14 studies). Meta-regression demonstrated that, when compared with cough alone, greater sputum wet weight was reported in groups that received additional ACT by between 2.45 and 3.94 g (F3,66 = 2.97, p = 0.04). These data suggest the addition of ACT to cough alone may optimise sputum clearance; however, FEV1 lacked sensitivity to detect this change. Importantly, this review highlights the lack of appropriate measures to assess ACT efficacy.
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14
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Lauwers E, Snoeckx A, Ides K, Van Hoorenbeeck K, Lanclus M, De Backer W, De Backer J, Verhulst S. Functional respiratory imaging in relation to classical outcome measures in cystic fibrosis: a cross-sectional study. BMC Pulm Med 2021; 21:256. [PMID: 34348676 PMCID: PMC8336350 DOI: 10.1186/s12890-021-01622-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/29/2021] [Indexed: 12/17/2022] Open
Abstract
Background Functional Respiratory Imaging (FRI) combines HRCT scans with computational fluid dynamics to provide objective and quantitative information about lung structure and function. FRI has proven its value in pulmonary diseases such as COPD and asthma, but limited studies have focused on cystic fibrosis (CF). This study aims to investigate the relation of multiple FRI parameters to validated imaging parameters and classical respiratory outcomes in a CF population. Methods CF patients aged > 5 years scheduled for a chest CT were recruited in a cross-sectional study. FRI outcomes included regional airway volume, airway wall volume, airway resistance, lobar volume, air trapping and pulmonary blood distribution. Besides FRI, CT scans were independently evaluated by 2 readers using the CF-CT score. Spirometry and the 6-Minute Walk Test (6MWT) were also performed. Statistical tests included linear mixed-effects models, repeated measures correlations, Pearson and Spearman correlations. Results 39 CT scans of 24 (17M/7F) subjects were analyzed. Patients were 24 ± 9 years old and had a ppFEV1 of 71 ± 25% at the time of the first CT. All FRI parameters showed significant low-to-moderate correlations with the total CF-CT score, except for lobar volume. When considering the relation between FRI parameters and similar CF-CT subscores, significant correlations were found between parameters related to airway volume, air trapping and airway wall thickening. Air trapping, lobar volume after normal expiration and pulmonary blood distribution showed significant associations with all spirometric parameters and oxygen saturation at the end of 6MWT. In addition, air trapping was the only parameter related to the distance covered during 6MWT. A subgroup analysis showed considerably higher correlations in patients with mild lung disease (ppFEV1 ≥ 70%) compared to patients with moderate to severe lung disease (ppFEV1 < 70%) when comparing FRI to CF-CT scores. Conclusions Multiple structural characteristics determined by FRI were associated with abnormalities determined by CF-CT score. Air trapping and pulmonary blood distribution appeared to be the most clinically relevant FRI parameters for CF patients due to their associations with classical outcome measures. The FRI methodology could particularly be of interest for patients with mild lung disease, although this should be confirmed in future research. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01622-3.
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Affiliation(s)
- Eline Lauwers
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2160, Wilrijk, Belgium. .,Infla-Med Research Consortium of Excellence, University of Antwerp, Antwerp, Belgium.
| | - Annemiek Snoeckx
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kris Ides
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2160, Wilrijk, Belgium.,Infla-Med Research Consortium of Excellence, University of Antwerp, Antwerp, Belgium.,Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium.,CoSys Research Lab, Faculty of Applied Engineering, University of Antwerp, Antwerp, Belgium.,Flanders Make Strategic Research Center, Lommel, Belgium
| | - Kim Van Hoorenbeeck
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2160, Wilrijk, Belgium.,Infla-Med Research Consortium of Excellence, University of Antwerp, Antwerp, Belgium.,Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | | | - Wilfried De Backer
- FLUIDDA NV, Kontich, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Stijn Verhulst
- Laboratory of Experimental Medicine and Pediatrics, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2160, Wilrijk, Belgium.,Infla-Med Research Consortium of Excellence, University of Antwerp, Antwerp, Belgium.,Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
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Leemans G, Belmans D, Van Holsbeke C, Becker B, Vissers D, Ides K, Verhulst S, Van Hoorenbeeck K. The effectiveness of a mobile high-frequency chest wall oscillation (HFCWO) device for airway clearance. Pediatr Pulmonol 2020; 55:1984-1992. [PMID: 32320537 PMCID: PMC7496233 DOI: 10.1002/ppul.24784] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/07/2020] [Accepted: 04/11/2020] [Indexed: 12/04/2022]
Abstract
INTRODUCTION High-frequency chest wall oscillation (HFCWO) is a commonly prescribed airway clearance technique (ACT) for patients whose ability to expectorate sputum is compromised. This study aimed to assess the effectiveness of a newly developed mobile ACT device (mHFCWO-The Monarch Airway Clearance System) in patients with cystic fibrosis (CF). A standard nonmobile HFCWO device (sHFCWO) was used as a comparator. METHODOLOGY This was a randomized, open-label, crossover pilot study. CF patients were treated with each device. Sputum was collected during and after each therapy session, while spirometry tests, Brody score assessment and functional respiratory imaging were performed before and after treatments. RESULTS Wet weight of sputum collected during and after treatment was similar for mHFCWO and sHFCWO (6.53 ± 8.55 vs 5.80 ± 5.82; P = .777). Interestingly, the mHFCWO treatment led to a significant decrease in specific airway volume (9.55 ± 9.96 vs 8.74 ± 9.70 mL/L; P < .001), while increasing specific airway resistance (0.10 ± 0.16 vs 0.16 ± 0.23 KPA*S; P < .001). These changes were heterogeneously-distributed throughout the lung tissue and were greater in the distal areas, suggesting a shift of mucus. Changes were accompanied by an overall improvement in the Brody index (57.71 ± 16.55 vs 55.20 ± 16.98; P = .001). CONCLUSION The newly developed mobile device provides airway clearance for CF patients comparable to a nonmobile sHFCWO device, yielding a change in airway geometry and patency by the shift of mucus from the more peripheral regions to the central airways.
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Affiliation(s)
- Glenn Leemans
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | | | - Brian Becker
- Department of Medical Affairs, Hillrom Company Inc., St. Paul, Minnesota
| | - Dirk Vissers
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Kris Ides
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Stijn Verhulst
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Kim Van Hoorenbeeck
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
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