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MacDonald MR, Zarriello S, Swanson J, Ayoubi N, Mhaskar R, Mirza AS. Secondary prevention among uninsured stroke patients: A free clinic study. SAGE Open Med 2020; 8:2050312120965325. [PMID: 33110604 PMCID: PMC7564623 DOI: 10.1177/2050312120965325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 09/18/2020] [Indexed: 01/03/2023] Open
Abstract
Objectives: Free clinics manage a diversity of diseases among the uninsured. We sought to assess the medical management of stroke in a population of uninsured patients. Methods: A retrospective chart review was conducted to collect chronic disease statistics from 6558 electronic medical records and paper charts at nine free clinics in Tampa, Florida, from January 2016 to December 2017. Demographics and risk factors were compared between stroke patients and non-stroke patients. Medication rates for several comorbidities were also assessed. Results: Two percent (107) of patients had been diagnosed with a stroke. Stroke patients were older (mean (M) = 56.0, standard deviation (SD) = 11.2) than the rest of the sample (M = 43.3, SD = 15.4), p < 0.001 and a majority were men (n = 62, 58%). Of the stroke patients with hypertension (n = 79), 81% (n = 64) were receiving anti-hypertensive medications. Of the stroke patients with diabetes (n = 43), 72% (n = 31) were receiving diabetes medications. Among all stroke patients, 44% were receiving aspirin therapy (n = 47). Similarly, 39% of all stroke patients (n = 42) were taking statins. Conclusions: Uninsured patients with a history of stroke may not be receiving adequate secondary prevention highlighting the risk and vulnerability of uninsured patients. This finding identifies an area for improvement in secondary stroke prevention in free clinics.
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Affiliation(s)
| | - Sydney Zarriello
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Justin Swanson
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Noura Ayoubi
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA
| | - Abu-Sayeef Mirza
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA
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Zhao W, Xiao ZJ, Zhao SP. The Benefits and Risks of Statin Therapy in Ischemic Stroke: A Review of the Literature. Neurol India 2020; 67:983-992. [PMID: 31512619 DOI: 10.4103/0028-3886.266274] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Statins are effective cholesterol-lowering drugs for reducing the risks of mortality and morbidity of cardiovascular diseases. Increasing evidence has shown that statin use is associated with a significant beneficial effect in patients with ischemic stroke. Both pre-stroke and post-stroke statin use has been found to be beneficial in ischemic stroke. Furthermore, good adherence is associated with a better clinical outcome, and statin withdrawal is associated with a poor functional outcome in patients with ischemic stroke. High-intensity statin therapy is advocated for the treatment of ischemic stroke. However, there are concerns regarding the adverse effects associated with statin use in ischemic stroke such as intracranial hemorrhage. In this review, we summarize the beneficial effect of statin use in ischemic stroke and discuss the potential risks associated with statin therapy.
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Affiliation(s)
- Wang Zhao
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Zhi-Jie Xiao
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
| | - Shui-Ping Zhao
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, P.R. China
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Bian Y, Li X, Li X, Ju J, Liang H, Hu X, Dong L, Wang N, Li J, Zhang Y, Yang B. Daming capsule, a hypolipidaemic drug, lowers blood lipids by activating the AMPK signalling pathway. Biomed Pharmacother 2019; 117:109176. [DOI: 10.1016/j.biopha.2019.109176] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/18/2019] [Accepted: 06/25/2019] [Indexed: 02/01/2023] Open
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Luan D, Wu ZY, Zhang YX, Yuan LL, Xu Y, Chu ZH, Ma LS, Wang YP, Zhao SC. Effect of dl-3-n-butylphthalide on infarction volume in animal models of ischemic stroke: A meta-analysis. World J Meta-Anal 2019; 7:358-372. [DOI: 10.13105/wjma.v7.i7.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/27/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ischemic stroke is a frequently-occurring disease in the elderly and characterized by high morbidity and mortality. Dl-3-n-butylphthalide (NBP), a synthetic compound based on natural celery seeds, has potential therapeutic effects on cerebral ischemia, brain trauma, memory impairment, and epilepsy.
AIM To evaluated the effect of NBP on infarct volume in experimental ischemic stroke.
METHODS Twenty one relevant literatures were included from the PubMed, EMBASE, Web of Science, Chinese National Knowledge Infrastructure, VIP information database, and Wanfang database, and data on the effect of dl-3-n-butylphthalide on infarction volume in the middle cerebral artery occlusion model were extracted. Statistical analysis was performed using standard mean difference with random effects model of Revman 5.3.
RESULTS The data of meta-analysis of the 21 studies had suggested that NBP reduced the cerebral infarction volume of middle cerebral artery occlusion model animals compared to the control group significantly [SMD: -3.97, 95%CI: -4.71 to -3.23, P < 0.01; heterogeneity: χ2 = 59.09, df = 20 (P < 0.01); I2 = 66 %].
CONCLUSION NBP was effective in experimental ischemic stroke.
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Affiliation(s)
- Di Luan
- Department of Neurology, Yijishan Hospital affiliated to Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Zheng-Yu Wu
- Department of Clinical Pharmacy, Yijishan Hospital affiliated to Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Yuan-Xiang Zhang
- Department of Clinical Pharmacy, Yijishan Hospital affiliated to Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Li-Li Yuan
- Department of Neurology, Yijishan Hospital affiliated to Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Yang Xu
- Department of Neurology, Yijishan Hospital affiliated to Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Zhao-Hu Chu
- Department of Neurology, Yijishan Hospital affiliated to Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Ling-Song Ma
- Department of Neurology, Yijishan Hospital affiliated to Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Ya-Ping Wang
- Department of Neurology, Yijishan Hospital affiliated to Wannan Medical College, Wuhu 241000, Anhui Province, China
| | - Shou-Cai Zhao
- Department of Neurology, Yijishan Hospital affiliated to Wannan Medical College, Wuhu 241000, Anhui Province, China
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Güntekin Ü, Gümrükçüoğlu HA, Yaman M, Öztürk F, Akyol A, Gümrükçüoğlu FN, Okudan YE, Tosun V, Kandemir YB. Compliance With Dyslipidemia Guidelines in Daily Practice: How Effective Is Cardiovascular Risk Prevention? Clin Ther 2018; 40:2031-2040. [PMID: 30392816 DOI: 10.1016/j.clinthera.2018.10.002] [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: 04/19/2018] [Revised: 09/25/2018] [Accepted: 10/04/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Cardiovascular disease (CVD) due to atherosclerosis is the leading cause of early mortality and morbidity. The current European guidelines on CVD prevention in clinical practice recommend the use of the Systematic Coronary Risk Estimation (SCORE) system. The current American Heart Association guidelines recommend the use of the new pooled cohort risk assessment equations to estimate the 10-year atherosclerotic CVD risk. The purpose of this article was to investigate the compliance of dyslipidemia guidelines in daily practice in patients with dyslipidemia or who have risk factors for CVD. METHODS The study group consisted of 500 outpatients who had dyslipidemia or risk factors for CVD. The risk level was computed according to the European and American Heart Association guidelines. Therapeutic LDL-C targets were identified based on the calculated risk level. Therapeutic target levels were compared based on the dosage of statins used and achievement of the LDL-C goal in daily practice according to the risk levels. FINDINGS According to the European dyslipidemia guidelines, 231 patients were in the very-high/high-risk group, and 106 patients (45.9%) achieved the LDL-C target (<100 mg/dL); 210 patients were in the moderate-risk group, and 156 (74.3%) patients achieved the LDL-C target (<115 mg/dL); and 59 patients were in the low-risk group, and 55 (93.2%) patients achieved the LDL-C target (<155 mg/dL). Univariate and multivariate logistic regression analyses revealed that the LDL-C level and presence of coronary artery disease were significantly reverse associated with achievement of the LDL-C goal (both, P < 0.001). IMPLICATIONS Our results showed that the majority of patients were in the very-high/high-risk group in daily practice. Although the European dyslipidemia guidelines are more likely to be used in daily practice, achievement of the guidelines-recommended treatment goals was low.
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Affiliation(s)
- Ünal Güntekin
- Department of Cardiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | | | - Mehmet Yaman
- Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Fatih Öztürk
- Department of Cardiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Aytaç Akyol
- Department of Cardiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | | | - Yunus Emre Okudan
- Department of Cardiology, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey
| | - Veysel Tosun
- Department of Cardiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Vavlukis M, Vavlukis A. Adding ezetimibe to statin therapy: latest evidence and clinical implications. Drugs Context 2018; 7:212534. [PMID: 30023003 PMCID: PMC6044319 DOI: 10.7573/dic.212534] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 12/13/2022] Open
Abstract
Background Statins are the hypolipemic treatment of choice for hyperlipidemia with confirmed atherosclerotic cardiovascular disease (ASCVD) protective effect, proven even in normolipemic patients. But in rare situations, even with a high-dose treatment regimen, or maximally tolerated statin dose treatment, treatment targets of low-density lipoprotein cholesterol (LDL-C), according to the risk profile of the patient, cannot be achieved. Combination therapy with ezetimibe is an effective treatment choice, as it is one of the few hypolipemic drugs with proven ASCVD protective effect. Aim In this review, we address the question of therapeutic efficacy and safety of ezetimibe in combination therapy with statins, as expressed through its hypolipemic and vasoprotective effects and its potential side effects. Methods We conducted a literature review of English articles through PubMed, PubMed Central, and Cochrane for randomized clinical trials, retrospective analyses, meta-analyses, and review articles by using key words: ezetimibe, statins, combination therapy, adverse effects. We analyzed data on ezetimibe–statin combination therapy in terms of hypolipemic efficacy, ASCVD risk reduction, and adverse effects. Results Statins have been proven to be very effective in reducing ASCVD risk, with no apparent threshold at which LDL-C lowering is not associated with reduced risk. Yet, a significant on-treatment residual risk of major cardiovascular (CV) events still exists according to meta-analyses of statin trials. Findings like this point to the unmet needs of the patients on statin treatment. The unmet needs in terms of LDL-C targets and ASCVD risk reduction raise the question of statin combination therapy. Ezetimibe is a cholesterol-lowering drug from the class of cholesterol absorption inhibitors, with the potency to decrease LDL-C by about 10–18% and Apo B by 11–16%, while in combination therapy with statins, an additional LDL-C lowering of 25% or total LDL-C lowering of 34–61% is observed. The effects on LDL-C and other lipoprotein (LP) fractions are translated by ASCVD risk reduction. Ezetimibe is one of the few hypolipemic medications that leads to additional ASCVD risk reduction when added to statin therapy. Present data on ezetimibe support the existence of pleotropic anti-inflammatory and antioxidative effects, in addition to its hypolipemic effect, which are responsible for this added ASCVD risk reduction on top of statin monotherapy. Ezetimibe, in combination therapy with a maximal or maximally tolerated statin therapy, is used in patients who fail to achieve target LDL-C levels with statin monotherapy. In combination with low-to-moderate statin dose treatment, or with second- or third-line statins, ezetimibe is used in situations of statin-associated muscle symptoms. The combination therapy is relatively safe. Conclusion Ezetimibe add-on to statin combination therapy is an effective treatment option that leads to additional LDL-C lowering – recommended in situations where, with a maximal or maximally tolerated statin monotherapy treatment regimen, LDL-C targets cannot be achieved. It leads to additional ASCVD risk reduction, without raising significant safety concerns.
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Affiliation(s)
- Marija Vavlukis
- University Clinic of Cardiology, Vodnjanska St. no 17, Medical Faculty, Ss' Cyril and Methodius University, 1000, Skopje, Republic of Macedonia
| | - Ana Vavlukis
- Faculty of Pharmacy, Ss' Cyril and Methodius University, 1000, Skopje, Republic of Macedonia
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Cacho-Díaz B, Lorenzana-Mendoza NA, Spínola-Maroño H, Reyes-Soto G, Cantú-Brito C. Comorbidities, Clinical Features, and Prognostic Implications of Cancer Patients with Cerebrovascular Disease. J Stroke Cerebrovasc Dis 2018; 27:365-371. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/01/2017] [Accepted: 09/07/2017] [Indexed: 12/12/2022] Open
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Ju W, Ji M, Li X, Li Z, Wu G, Fu X, Yang X, Gao X. Relationship between higher serum selenium level and adverse blood lipid profile. Clin Nutr 2017; 37:1512-1517. [PMID: 28943111 DOI: 10.1016/j.clnu.2017.08.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/24/2017] [Accepted: 08/28/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND As the key component of glutathione peroxidase with unique antioxidant properties, selenium has been considered to play an important part on lipid metabolism. However, the associations of serum selenium concentrations with lipid concentrations and dyslipidemia are still controversial. METHODS We analyzed cross-sectional data including serum selenium levels, lipid concentrations and other related indexes of 8198 rural Chinese. Serum selenium was measured by inductively coupled plasma mass spectrometry, and total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-c) and low density lipoprotein-cholesterol (LDL-c) of serum were measured with kits. RESULTS Overall, mean serum selenium was 120 μg/l. Multivariate liner regression revealed that selenium concentrations were positively correlated with TC (P < 0.001), HDL-c (P < 0.001), TG (P < 0.001) and LDL-c (P < 0.001). Compared with the lowest quintile of serum selenium, participants in quintile 3, 4 and 5 had higher risks of High-TC dyslipidemia (P ≤ 0.02) and High-LDLC dyslipidemia (P < 0.02) after adjusting for covariates. In the stratified analyses, we found that the selenium-dyslipidemia associations were significantly stronger in post-menopausal women (OR: 2.72; 95% CI: 1.97, 4.17) and diabetics (OR: 9.40; 95% CI: 3.02, 29.26). CONCLUSION Elevated serum selenium levels were correlated with the increased concentrations of TC, LDL-c, HDL-c and TG, and increased the risk of High-TC and High-LDLC dyslipidemia among rural Chinese. However, the real associations between serum selenium and lipid profile should be verified in specifically designed randomized trials in future.
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Affiliation(s)
- Wen Ju
- Department of Public Health, Shandong University, Jinan 250012, Shandong, China
| | - Mei Ji
- Laboratory of Physical and Chemical Inspection, Jinan Municipal Railway Center for Disease Control and Prevention, Jinan 250119, Shandong, China
| | - Xia Li
- Department of Public Health, Shandong University, Jinan 250012, Shandong, China
| | - Zhe Li
- Department of Public Health, Shandong University, Jinan 250012, Shandong, China
| | - Guanrui Wu
- Department of Public Health, Shandong University, Jinan 250012, Shandong, China
| | - Xiaofeng Fu
- Department of Public Health, Shandong University, Jinan 250012, Shandong, China
| | - Xiaomei Yang
- Department of Public Health, Shandong University, Jinan 250012, Shandong, China
| | - Xibao Gao
- Department of Public Health, Shandong University, Jinan 250012, Shandong, China.
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Ren XM, Zuo GF, Wu W, Luo J, Ye P, Chen SL, Hu ZY. Atorvastatin Alleviates Experimental Diabetic Cardiomyopathy by Regulating the GSK-3β-PP2Ac-NF-κB Signaling Axis. PLoS One 2016; 11:e0166740. [PMID: 27851811 PMCID: PMC5112957 DOI: 10.1371/journal.pone.0166740] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 11/02/2016] [Indexed: 01/17/2023] Open
Abstract
Recent studies reported that atorvastatin (ATOR) alleviated progression of experimental diabetic cardiomyopathy (DCM), possibly by protecting against apoptosis. However, the underlying mechanisms of this protective effect remain unclear. Therefore, our study investigated the role of the glycogen synthase kinase (GSK)-3β-protein phosphatase 2A(PP2A)-NF-κB signaling pathway in the anti-apoptotic and cardioprotective effects of ATOR on cardiomyocytes cultured in high glucose (HG) and in DCM. Our results showed that, in HG-cultured cardiomyocytes, phosphorylation of GSK-3β was decreased, while that of the PP2A catalytic subunit C (PP2Ac) and IKK/IкBα was increased, followed by NF-кB nuclear translocation and apoptosis. IKK/IкBα phosphorylation and NF-кB nuclear translocation were also increased by treatment of cells with okadaic acid (OA), a selective PP2A inhibitor, or by silencing PP2Ac expression. The opposite results were obtained by silencing GSK-3β expression, which resulted in PP2Ac activation. Furthermore, IKK/IкBα phosphorylation and NF-кB nuclear translocation were markedly inhibited and apoptosis attenuated in cells treated with ATOR. These effects occurred through inactivation of GSK-3β and subsequent activation of PP2Ac. They were abolished by treatment of cells with OA or PP2Ac siRNA. In mice with type 1 diabetes mellitus, treatment with ATOR, at 10 mg-kg−1-d−1, significantly suppressed GSK-3β activation, IKK/IкBα phosphorylation, NF-кB nuclear translocation and caspase-3 activation, while also activating PP2Ac. Finally, improvements in histological abnormalities, fibrosis, apoptosis and cardiac dysfunction were observed in diabetic mice treated with ATOR. These findings demonstrated that ATOR protected against HG-induced apoptosis in cardiomyocytes and alleviated experimental DCM by regulating the GSK-3β-PP2A-NF-κB signaling pathway.
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Affiliation(s)
- Xiao-min Ren
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Qinhuai, Nanjing 210006, P.R. China
| | - Guang-feng Zuo
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Qinhuai, Nanjing 210006, P.R. China
| | - Wen Wu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Qinhuai, Nanjing 210006, P.R. China
| | - Jie Luo
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Qinhuai, Nanjing 210006, P.R. China
| | - Peng Ye
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Qinhuai, Nanjing 210006, P.R. China
| | - Shao-liang Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Qinhuai, Nanjing 210006, P.R. China
- * E-mail: (SLC); (ZYH)
| | - Zuo-ying Hu
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Qinhuai, Nanjing 210006, P.R. China
- * E-mail: (SLC); (ZYH)
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Li JM, Zhang C. Value of serum OPN levels in patients with acute cerebral hemorrhage for assessment of nerve function impairment. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2016.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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