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Zhang L, Chen X, Jia L, Dong L, Wang J, Liu P, Lv M. Case Report: Persistent Primitive Hypoglossal Artery Accompanied by a Basilar Bifurcation Aneurysm Treated by Y-Stent-Assisted Coil Embolization. Front Neurol 2021; 12:621610. [PMID: 33746878 PMCID: PMC7966712 DOI: 10.3389/fneur.2021.621610] [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: 10/28/2020] [Accepted: 01/26/2021] [Indexed: 12/03/2022] Open
Abstract
Successful embolization of a basilar bifurcation aneurysm associated with a persistent primitive hypoglossal artery (PPHA) using Y-stent-assisted coiling.
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Affiliation(s)
- Longhui Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiheng Chen
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Luqiong Jia
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linggen Dong
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiejun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Yabuki R, Baba EI, Shirokane K, Tsuchiya A, Nomura M. Persistent Primitive Hypoglossal Artery Associated With Multiple Cerebral Aneurysms. J Clin Med Res 2018; 11:72-75. [PMID: 30627281 PMCID: PMC6306131 DOI: 10.14740/jocmr3649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Accepted: 10/22/2018] [Indexed: 11/21/2022] Open
Abstract
Persistent primitive hypoglossal artery is a rare anastomosis between the carotid and basilar arteries, and sometimes associated with cerebral aneurysms. However, association of persistent primitive hypoglossal artery with aneurysms located on arteries other than persistent primitive hypoglossal artery itself or posterior circulation is very rare. An 80-year-old woman suffered from subarachnoid hemorrhage, whose angiography demonstrated aneurysms on the left middle cerebral artery and anterior communicating artery, and the left persistent primitive hypoglossal artery. The middle cerebral artery aneurysm was the origin of hemorrhage. Although repeated craniotomy was necessary for the left middle cerebral artery aneurysm, both aneurysms were successfully clipped. In our case, neither aneurysm was located on an artery related to the persistent primitive hypoglossal artery. There is a possibility that cases of persistent primitive hypoglossal artery are accompanied by cerebral aneurysms on arteries other than the persistent primitive hypoglossal artery or in the posterior circulation.
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Affiliation(s)
- Rikako Yabuki
- Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan
| | - Ei-Ichi Baba
- Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan
| | | | | | - Motohiro Nomura
- Department of Neurosurgery, Kanto Rosai Hospital, Kawasaki, Japan
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Saito N, Tanikawa R, Tsuboi T, Noda K, Ota N, Miyata S, Matsukawa H, Yanagisawa T, Sakakibara F, Kinoshita Y, Miyazaki T, Kamiyama H, Tokuda S. Posterior Inferior Cerebellar Artery Thrombosed Aneurysm Associated with Persistent Primitive Hypoglossal Artery Successfully Treated with Condylar Fossa Approach. NMC Case Rep J 2017; 4:93-96. [PMID: 28840087 PMCID: PMC5566692 DOI: 10.2176/nmccrj.cr.2016-0233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/23/2017] [Indexed: 11/20/2022] Open
Abstract
A 68-year-old woman presented with generalized seizure due to the left internal carotid artery (ICA) aneurysmal compression of the ipsilateral medial temporal lobe. Computed tomography angiography (CTA) revealed multiple aneurysms of the right persistent primitive hypoglossal artery (PPHA), the right ICA, and the right anterior cerebral artery (ACA). The right PPHA originated from the ICA at the level of the C1 and C2 vertebral bodies and passed through the hypoglossal canal (HC). The PPHA aneurysm was large and thrombosed, which was located at the bifurcation of the right PPHA and the right posterior inferior cerebellar artery (PICA), projecting medially to compress the medulla oblongata. Since this patient had no neurological deficits, sequential imaging studies were performed to follow this lesion, which showed gradual growth of the PPHA aneurysm with further compression of the brain stem. Although the patient remained neurologically intact, considering the growing tendency clipping of the aneurysm was performed. Drilling of the condylar fossa was necessary to expose the proximal portion of the PPHA inside the HC. The key of this surgery was the preoperative imaging studies to fully understand the anatomical structures. The PPHA was fully exposed from the dura to the corner its turning inferiorly without damaging the occipital condylar facet. Utilizing this technique, the neck ligation of the aneurysm was safely achieved without any surgical complications.
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Affiliation(s)
- Norihiro Saito
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Rokuya Tanikawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Toshiyuki Tsuboi
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Kosmo Noda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Nakao Ota
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Shirou Miyata
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hidetoshi Matsukawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Takeshi Yanagisawa
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Fumihiro Sakakibara
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Yu Kinoshita
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Takanori Miyazaki
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Hiroyasu Kamiyama
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Sadahisa Tokuda
- Department of Neurosurgery, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
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Baltsavias GM, Chourmouzi D, Tasianas N, Drevelengas A, Damianovski D, Jovkovski S. Ruptured aneurysm of a persistent primitive hypoglossal artery treated by endovascular approach—case report and literature review. ACTA ACUST UNITED AC 2007; 68:338-43; discussion 343. [PMID: 17719985 DOI: 10.1016/j.surneu.2006.10.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 10/10/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND A persistent PHA is the second most common of the embryonic carotid-basilar anastomoses that fail to regress in the embryo. The fact that PHA often is functionally a single artery providing blood to the posterior circulation poses challenging therapeutic problems in case of an aneurysm located on the PHA. CASE DESCRIPTION A 46-year-old woman presented with SAH due to a large ruptured aneurysm of the left PHA. Identification of such an artery by CT angiogram is the proposed cold standard. The aneurysm was obliterated by coil embolization. To our knowledge, this is the first reported case of aneurysm located on a primitive persistent hypoglossal artery that was endovascularly treated. CONCLUSION Aneurysms located on a persistent PHA can be treated safely and effectively via an endovascular approach.
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Affiliation(s)
- Gerasimos M Baltsavias
- Neuroendovascular Department, Interbalkan European Medical Centre, 57001 Thessaloniki, Greece.
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Gupta AK. Cerebral Arteriovenous Malformation Embolized through Persistent Primitive Hypoglossal Artery: A Case Report. Interv Neuroradiol 2005; 11:241-6. [PMID: 20584481 DOI: 10.1177/159101990501100307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2005] [Accepted: 08/25/2005] [Indexed: 11/17/2022] Open
Abstract
SUMMARY Carotid-vertebral anastomoses are commonly detected as incidental findings. But sometimes these channels are important for the clinical condition of the patient. Here a case of right thalamo- capsular arteriovenous malformation is described where a persistent primitive hypoglossal artery was the only route for embolization of the arteriovenous malformation.
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Affiliation(s)
- A K Gupta
- Department of Radiology Sree Chitra Tirunal Institute for Medical Sciences and Technology; Trivandrum, India -
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Huynh-Le P, Matsushima T, Muratani H, Hikita T, Hirokawa E. Persistent primitive hypoglossal artery associated with proximal posterior inferior cerebellar artery aneurysm. ACTA ACUST UNITED AC 2004; 62:546-51; discussion 551. [PMID: 15576127 DOI: 10.1016/j.surneu.2004.03.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2003] [Accepted: 03/22/2004] [Indexed: 11/25/2022]
Abstract
BACKGROUND A persistent primitive hypoglossal artery (PPHA) is a rare anomaly. The association of PPHA with intracranial aneurysms of the artery has also been rarely reported. We surgically treated a case of PPHA associated with a ruptured saccular aneurysm at the proximal posterior inferior cerebellar artery (PICA). CASE DESCRIPTION The patient was admitted because of subarachnoid hemorrhaging. Angiography and three-dimensional computed tomography (CT) angiography (3D-CTA) demonstrated a left PPHA entering the posterior fossa through the left large hypoglossal canal. The left vertebral artery was absent. A saccular aneurysm was found at the junction of the PPHA and the proximal PICA. 3D-CTA showed not only the aneurysm itself but also the anatomical relationship between the aneurysm and the surrounding structures. Therefore, 3D-CTA was very useful in planning the surgery. The neck of the aneurysm was clipped through a far lateral approach associated with a C1 laminectomy, because this case had a large posterior condylar emissary vein and the aneurysm was located just posteroinferior to the hypoglossal canal. CONCLUSIONS A case of PPHA associated with an aneurysm at the proximal PICA is reported. This case not only had a large hypoglossal canal but also had a huge posterior condylar emissary vein in the large posterior condylar canal. Anomalous structures associated with PPHA are also discussed. Finally, 3D-CTA proved to be very useful in planning the optimal surgical modality around the lateral portion of the foramen magnum.
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Affiliation(s)
- Phuong Huynh-Le
- Department of Neurosurgery, Neurological Institute, Kyushu University, Japan
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Megyesi JF, Findlay JM, Sherlock RA. Carotid Endarterectomy in the Presence of a Persistent Hypoglossal Artery: Case Report. Neurosurgery 1997. [DOI: 10.1227/00006123-199709000-00032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Megyesi JF, Findlay JM, Sherlock RA. Carotid endarterectomy in the presence of a persistent hypoglossal artery: case report. Neurosurgery 1997; 41:669-72. [PMID: 9310986 DOI: 10.1097/00006123-199709000-00032] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE AND IMPORTANCE A persistent hypoglossal artery, one of the embryonic carotid-basilar anastomoses that can fail to regress in the embryo and can be observed past birth, is one of the only congenital anatomic variations of the internal carotid artery (ICA) that can complicate the performance of carotid endarterectomy. When associated with atherosclerotic carotid artery disease, the recognition and intraoperative management of a persistent hypoglossal artery is important. CLINICAL PRESENTATION A 72-year-old man presented with a symptom of transient right hemisphere ischemia, and although ultrasonography indicated a right ICA stenosis (and no other abnormality), angiography also demonstrated that the atherosclerotic plaque extended into the origin of a large right persistent hypoglossal artery arising 1.5 cm from the origin of the ICA. In this patient, the persistent hypoglossal artery was the only arterial supply to the basilar artery. INTERVENTION The patient underwent a right ICA endarterectomy, and intraoperative angiography was necessary to ensure that the persistent hypoglossal artery was the vessel shunted during the arterial repair. CONCLUSION Recognition of the primitive carotid-basilar anastomoses is important to surgeons who perform carotid endarterectomy and is not possible with ultrasonography alone. Intraoperative angiography enables the surgeon to accurately catheterize a persistent hypoglossal artery with a carotid shunt.
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Affiliation(s)
- J F Megyesi
- Division of Neurosurgery, University of Alberta, Edmonton, Canada
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Kato S, Yamasita T, Nomura S, Kashiwagi S, Ito H, Yamashita H. Giant intracranial aneurysms in two sisters: case report. SURGICAL NEUROLOGY 1996; 46:240-6. [PMID: 8781593 DOI: 10.1016/0090-3019(96)00072-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND It is rare for intracranial aneurysms to present with cranial nerve palsy caused by the space-occupying effect of the lesion. Herein we discuss two sisters with familial intracranial aneurysms, both of whom presented with cranial nerve palsy. CASE DESCRIPTION Two female siblings presented with ocular movement and facial sensory disturbances caused by the space-occupying effect of giant aneurysms at the cavernous portion of the internal carotid arteries. The aneurysms were located at the identical site in both patients. Proximal occlusion of the internal carotid artery was effective in both cases, resulting in the promotion of thrombosis within the aneurysms in order to reduce their space-occupying effect. CONCLUSION This is considered to be the first known case of siblings, both suffering from giant internal carotid artery aneurysms.
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Affiliation(s)
- S Kato
- Department of Neurosurgery, Yamaguchi University, School of Medicine, Japan
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Schievink WI, Michels VV, Piepgras DG. Neurovascular manifestations of heritable connective tissue disorders. A review. Stroke 1994; 25:889-903. [PMID: 8160237 DOI: 10.1161/01.str.25.4.889] [Citation(s) in RCA: 200] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Heritable disorders of connective tissue are recognized in a small minority of patients with neurovascular diseases. In this report, we review the neurovascular manifestations of four heritable connective tissue disorders: Ehlers-Danlos syndrome, Marfan's syndrome, osteogenesis imperfecta, and pseudoxanthoma elasticum, as well as two other systemic disorders with potential vascular manifestations: neurofibromatosis and polycystic kidney disease. SUMMARY OF REVIEW Typical neurovascular complications of Ehlers-Danlos syndrome are carotid-cavernous fistulae, intracranial aneurysms, and cervical artery dissections. Arterial dissections and intracranial aneurysms cause the majority of neurovascular symptoms in Marfan's syndrome. Neurovascular disease is uncommon in osteogenesis imperfecta, although carotid-cavernous fistulae and vertebral artery dissections have been reported. Neurovascular disease in pseudoxanthoma elasticum is characterized by intracranial aneurysms and cerebral ischemia caused by premature arterial occlusive disease. Intracranial occlusive arterial disease is the most common neurovascular manifestation of neurofibromatosis, followed by cervical arteriovenous fistulae and aneurysms and intracranial aneurysms. Intracranial aneurysms are the hallmark of polycystic kidney disease. CONCLUSIONS Recognition of an underlying generalized connective tissue disorder may be of considerable importance, although marked phenotypic heterogeneity often complicates the diagnosis of these disorders. Conversely, the association of certain neurovascular anomalies with generalized connective tissue disorders and recognition of their basic molecular defect may offer clues to the etiology and pathogenesis of these neurovascular diseases in general.
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Affiliation(s)
- W I Schievink
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minn. 55905
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Chapman AB, Johnson AM, Gabow PA. Intracranial aneurysms in patients with autosomal dominant polycystic kidney disease: how to diagnose and who to screen. Am J Kidney Dis 1993; 22:526-31. [PMID: 8213791 DOI: 10.1016/s0272-6386(12)80924-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- A B Chapman
- Department of Medicine, University of Colorado Health Sciences Center, Denver 80262
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Chapman AB, Rubinstein D, Hughes R, Stears JC, Earnest MP, Johnson AM, Gabow PA, Kaehny WD. Intracranial aneurysms in autosomal dominant polycystic kidney disease. N Engl J Med 1992; 327:916-20. [PMID: 1513348 DOI: 10.1056/nejm199209243271303] [Citation(s) in RCA: 240] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND METHODS Intracranial aneurysms are a feature of autosomal dominant polycystic kidney disease, but their prevalence is uncertain. We studied 92 subjects with autosomal dominant polycystic kidney disease who had no symptoms or signs of any neurologic disorder. To determine the prevalence of intracranial aneurysms, we performed high-resolution computed tomography (CT) in 60 subjects, four-vessel cerebral angiography in 21, and both procedures in 11. RESULTS Four of the 88 subjects in whom the radiologic studies were successfully completed had intracranial aneurysms (4 percent; 95 percent confidence interval, 0.1 to 9 percent), as compared with the prevalence of 1 percent reported for an angiographic study of the general population. Three of the four subjects had multiple aneurysms. Seven subjects for whom the results of CT studies were suspicious underwent cerebral angiography: two had aneurysms, and five had normal vascular structures that accounted for the suspicious results of tomography. Four subjects who had normal CT imaging studies also had normal angiographic examinations. Eight of the 32 subjects who underwent angiography (25 percent) had transient complications, as compared with 22 of 220 control subjects (10 percent) who did not have polycystic kidney disease (P less than 0.05). We could not identify any risk factor in these subjects that was related to the occurrence of aneurysm. CONCLUSIONS Asymptomatic intracranial aneurysms appear to be more frequent in people with polycystic kidney disease than in the general population, although our 95 percent confidence interval includes the possibility of no difference. Because cerebral angiography is associated with increased morbidity in people with polycystic kidney disease, we recommend high-resolution CT as a screening test.
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Affiliation(s)
- A B Chapman
- Department of Medicine, University of Colorado School of Medicine, Denver
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Franz M, Berlit P, Tornow K. General dysplasia of the cerebral arteries with persistent primitive acoustic artery and giant aneurysm. EUROPEAN ARCHIVES OF PSYCHIATRY AND NEUROLOGICAL SCIENCES 1989; 238:196-8. [PMID: 2759152 DOI: 10.1007/bf00381464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A case of cerebrovascular systemic dysplasia is presented. The anomalies were: persistent primitive acoustic artery, giant aneurysm of the left internal carotid artery, aneurysm of the basilar artery, and an arteriovenous fistula. A review of the literature shows that the association of multiple malformations of cerebral vessels with a persistent primitive acoustic artery has not previously been described. Impairment of embryonic development is suggested as the origin of the malformations.
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Affiliation(s)
- M Franz
- Neurologische Klinik im Klinikum Mannheim, Universität Heidelberg, Federal Republic of Germany
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