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Liu Y, Tian S, Jia G, Han Z, Guo C, Shang Y, Han Y. Symptoms Burden and Health-related Quality of Life in Chinese Patients with Primary Biliary Cholangitis. J Clin Transl Hepatol 2021; 9:860-867. [PMID: 34966649 PMCID: PMC8666377 DOI: 10.14218/jcth.2020.00119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 03/04/2021] [Accepted: 04/09/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND AIMS Primary biliary cholangitis (PBC) is a chronic liver disease that negatively affects the health-related quality of life (HRQoL) of patients. Furthermore, the HRQoL of Chinese patients has been neglected for a long time. The present study aimed to assess the HRQoL of Chinese patients with PBC and explore the clinical variables correlating to the improvement of itch and fatigue. METHODS This was an observational, cross-sectional study. The PBC-40 and itch numerical rating scales were used to evaluate the symptoms and HRQoL of patients. RESULTS A total of 383 patients were recruited, and 86.4% were female, with a median age of 55 years (range: 49-63 years). We found that females had significantly higher scores than males in symptoms (p=0.033) and cognitive domains (p=0.021), and the fatigue domain was higher in elderly patients (p=0.007). Meanwhile, patients whose body mass index was <18.5 had the highest scores in the symptoms (p=0.009), fatigue (p=0.010), and cognitive (p=0.019) domains. Age at participation (odds ratio [OR]=1.068, p=0.015) and albumin level at 12 months after ursodeoxycholic acid treatment (OR=208.807, p=0.025) were independent factors that affected the improvement of the itch and fatigue domains, respectively. CONCLUSIONS The HRQoL of Chinese patients with PBC was significantly impaired depending on sex, age, and body mass index. Age and albumin level were significantly associated with the improvement of itch and fatigue, respectively. Therefore, treatment and support aimed at these two factors can be provided to improve the HRQoL of patients.
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Affiliation(s)
| | | | | | | | | | - Yulong Shang
- Correspondence to: Ying Han and Yulong Shang, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Air Force Military Medical University, Xi’an, Shaanxi 710032, China. ORCID: https://orcid.org/0000-0003-3046-9507 (YH) and https://orcid.org/0000-0002-8576-3175 (YS). Tel: +86 29 84771509; Fax: +86 29 82539041; E-mail: (YH) or (YS)
| | - Ying Han
- Correspondence to: Ying Han and Yulong Shang, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Xijing Hospital, Air Force Military Medical University, Xi’an, Shaanxi 710032, China. ORCID: https://orcid.org/0000-0003-3046-9507 (YH) and https://orcid.org/0000-0002-8576-3175 (YS). Tel: +86 29 84771509; Fax: +86 29 82539041; E-mail: (YH) or (YS)
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Milovanovic T, Popovic D, Stojkovic Lalosevic M, Dumic I, Dragasevic S, Milosavljević T. Quality of Life in Patients with Primary Biliary Cholangitis: A Single-Center Experience in Serbia. Dig Dis 2020; 38:515-521. [PMID: 32135537 DOI: 10.1159/000506980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 03/04/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Primary biliary cholangitis (PBC) is a chronic cholestatic autoimmune disease, predominantly affecting middle-aged women, which may progress to end-stage liver disease. We aimed to assess the quality of life (QoL) in patients with PBC given that social, economic, and geographical factor also influence QoL. METHODS This study included patients with diagnosed PBC according to the European Association for the Study of the Liver guidelines, who were treated for at least 6 months in order to allow adequate time for the initial burden of symptoms to subside. We used the PBC-40 questionnaire validated in the Serbian language. RESULTS The mean total PBC-40 score was 89.4 ± 29.3. The overall frequency of moderate and severe involvement in each domain was as follows: 84.9% (n = 107) in "Symptoms," 29.3% (n = 36) in "Itch," 76.4% (n = 97) in "Fatigue," 58.1% (n = 72) in "Cognitive," 77.2% (n = 98) in "Social," and 70.9% (n = 90) in "Emotional." There was a statistically significant negative correlation of disease duration and albumin score with the Emotional domain score. Furthermore, this domain showed a significant positive correlation with the Mayo score. CONCLUSION The present study demonstrates that patients with PBC have significant impairment in QoL with fatigue being the most prevalent symptom. The Social and Emotional domains were also significantly affected in these individuals, particularly in patients with peripheral edema who exhibited worse QoL that those who were euvolemic.
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Affiliation(s)
- Tamara Milovanovic
- School of Medicine, University of Belgrade, Belgrade, Serbia, .,Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia,
| | - Dusan Popovic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia
| | - Milica Stojkovic Lalosevic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia
| | - Igor Dumic
- Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Sanja Dragasevic
- School of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Gastroenterology and Hepatology, Clinical Center of Serbia, Belgrade, Serbia
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Corrigan M, Hirschfield G, Greenfield S, Parry J. Barriers to implementation of stratified care in primary biliary cholangitis: a scoping exercise. BMJ Open Gastroenterol 2019; 6:e000226. [PMID: 31321066 PMCID: PMC6596962 DOI: 10.1136/bmjgast-2018-000226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/31/2018] [Accepted: 09/07/2018] [Indexed: 01/29/2023] Open
Abstract
Patients with primary biliary cholangitis (PBC) can be stratified into low-risk and high-risk groups based on their response to treatment. Newly published guidelines from the British Society of Gastroenterology suggest low-risk patients can be managed substantially in primary care. This represents a shift from existing practice and makes assumptions about service capacity and the willingness of both patients and health care practitioners (HCPs) to make this change. The aim of this paper is to identify possible barriers to the implementation of these new care pathways through review of the PBC-specific literature and by identifying the experiences of patients and HCPs managing a different condition with comparable patients and disease characteristics. Searches of MEDLINE, CINAHL and EMBASE were undertaken. Within the existing PBC literature there is little data surrounding stakeholder perspectives on place of care. Review of the breast cancer literature highlights a number of barriers to change including primary care practitioner knowledge and work load, communication between healthcare settings, and the significance of the established doctor-patient relationship. Further research is needed to establish the extent to which these barriers may surface when changing PBC care pathways, and the actions required to overcome them.
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Affiliation(s)
- Margaret Corrigan
- University of Birmingham, NIHR Birmingham Biomedical Research Centre, Centre for Liver Research, Birmingham, UK
- Department of Liver medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gideon Hirschfield
- University of Birmingham, NIHR Birmingham Biomedical Research Centre, Centre for Liver Research, Birmingham, UK
- Department of Liver medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sheila Greenfield
- University of Birmingham, Institute of Applied Health Research, Birmingham, UK
| | - Jayne Parry
- University of Birmingham, Institute of Applied Health Research, Birmingham, UK
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Health-related quality of life and survival in Chinese patients with chronic liver disease. Health Qual Life Outcomes 2013; 11:131. [PMID: 23902894 PMCID: PMC3734055 DOI: 10.1186/1477-7525-11-131] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 07/30/2013] [Indexed: 12/20/2022] Open
Abstract
Background To investigate the relationship between health-related quality of life (HRQOL) and survival in Chinese patients with chronic liver disease (CLD). Methods HRQOL was measured with the Chinese version of Short Form 36 (SF-36). SF-36 scores, demographic and clinical data were collected at baseline and after 18 months follow-up. Kaplan-Meier and Cox Proportional Hazard Regression survival analyses were used for interpretation of data. Surviving patients were censored in the analyses. Results A total of 415 Chinese patients with CLD and 86 healthy controls were enrolled. During the follow-up period 50 patients died. SF-36 scores in healthy controls and surviving patients were higher compared with those in deceased patients. Scores of physical component summary (PCS) in healthy controls, surviving and deceased patients were 54.1 ± 5.2, 48.9 ± 7.7 and 33.5 ± 8.2 respectively (p < 0.001). Scores of mental component summary (MCS) in healthy controls, surviving and deceased patients were 56.6 ± 8.2, 53.0 ± 5.6 and 37.1 ± 12.1 (p < 0.001) respectively. Survival was significantly associated with PCS and MCS scores, and the presence of ascites. Conclusions HRQOL was associated with survival in patients with CLD. PCS and MCS scores were predictors of survival.
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TRAF1-C5 affects quality of life in patients with primary biliary cirrhosis. Clin Dev Immunol 2013; 2013:510547. [PMID: 23710202 PMCID: PMC3655458 DOI: 10.1155/2013/510547] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/06/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Previous studies reported associations between specific alleles of non-HLA immunoregulatory genes and higher fatigue scores in patients with primary biliary cirrhosis (PBC). AIM To study the relationship between variables of health-related quality of life (HRQoL) and single nucleotide polymorphisms of TRAF1-C5, a member of the tumor necrosis factor receptor family. PATIENTS AND METHODS TRAF1-C5 gene polymorphisms, rs2900180 and rs3761847, were analysed in 120 Caucasian PBCs. The HRQoL was assessed with SF-36, PBC-40, and PBC-27 questionnaires. RESULTS We found a negative association between TT genotype of rs2900180 and SF-36's domains vitality (P < 0.05), mental health (P < 0.05), and mental component summary score (P < 0.05). GG homozygotes of rs3761847 had lower vitality (P < 0.05), mental health (P < 0.05), mental component summary score (P < 0.05) and impairment of social functioning (P < 0.01). Allelic analysis has shown that T allele of rs2900180 and G allele of rs3761847 related to SF-36's vitality (P < 0.05 and P < 0.01), social functioning (P < 0.05 and P < 0.05), mental health (P < 0.01 and P < 0.05), and mental component summary score (P < 0.01 and P < 0.05), respectively. Genotyping and allelic analysis did not reveal correlation with PBC-40 and PBC-27 domains. CONCLUSION The association between rs2900180 and rs3761847 polymorphisms and HRQoL variables indicates that TRAF1 is involved in the induction of impaired QoL in PBC.
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Health-related quality of life in chinese patients with chronic liver disease. Gastroenterol Res Pract 2012; 2012:516140. [PMID: 22701477 PMCID: PMC3371692 DOI: 10.1155/2012/516140] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 04/09/2012] [Accepted: 04/11/2012] [Indexed: 12/17/2022] Open
Abstract
Aim. To investigate the factors contributing to health-related quality of life (HRQOL) in Chinese patients with chronic liver disease (CLD). Methods. HRQOL was measured with SF-36v2 Chinese version. Demographic and clinical data were collected, and patients with liver cirrhosis were divided into Child's Class A, B, and C according to Child-Turcotte-Pugh scoring system. Results. A total of 392 Chinese patients with CLD and 91 healthy controls were enrolled. HRQOL in patients with CLD was lower than that in healthy controls. Score of PCS in healthy controls was 54.6 ± 5.5 and in CLD was 47.8 ± 8.8 (P = 0.000). Score of MCS in healthy controls was 56.4 ± 8.1 and in CLD was 51.7 ± 7.4 (P = 0.000). Increasing severity of CLD from no cirrhosis to advanced cirrhosis was associated with a decrease on all domains of the SF-36 (P < 0.05). Stepwise linear regression analysis showed that severity of disease, age, present ascites, present varices, and prothrombin time had significant effect on physical health area. Severity of disease, female, present varices, total bilirubin, prothrombin time, and hemoglobin had significant effect on mental health area.
Conclusions. Patients with CLD had impaired HRQOL. Increasing severity of CLD was associated with a decrease on HRQOL. Old age, female gender, advanced stage of CLD, present ascites, hyperbilirubinemia, and prolonging prothrombin time were important factors reducing HRQOL.
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Wong GLH, Wong VWS. Medical therapy for primary sclerosing cholangitis. Aliment Pharmacol Ther 2011; 34:1135-6; discussion 1136-7. [PMID: 21981734 DOI: 10.1111/j.1365-2036.2011.04845.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- G L-H Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
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Tillmann HL, Wiese M, Braun Y, Wiegand J, Tenckhoff S, Mössner J, Manns MP, Weissenborn K. Quality of life in patients with various liver diseases: patients with HCV show greater mental impairment, while patients with PBC have greater physical impairment. J Viral Hepat 2011; 18:252-61. [PMID: 20337922 DOI: 10.1111/j.1365-2893.2010.01292.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Little is known comparing and contrasting quality of life (QoL) in patients with hepatitis C, compared to patients with other liver diseases. We performed two independent prospective cross-sectional studies including 511 and 284 patients with different forms of liver diseases. SF-36 was used in both studies. Fatigue Impact Score, WHO-BREF and Hospital Anxiety and Depression Scale (HADS) were used in either study only. In both studies, HCV-positive patients scored worse in the mental aspects of health-related QoL compared to other liver diseases, except for HBV in one study. Surprisingly, in both studies, quality of life was also significantly impaired in patients with viral clearance after interferon therapy but not after spontaneous clearance. Furthermore, patients with primary biliary cirrhosis showed significantly better mental health but significantly worse physical well-being. Liver diseases differ in their form of impaired QoL. In HCV, this impairment might not always return to normal after treatment-induced viral clearance. This may suggest that HCV either may not be involved in QoL impairment or may induce a process which persists after viral clearance in some patients.
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Affiliation(s)
- H L Tillmann
- Medizinische Hochschule Hannover, Abteilung für Gastroenterologie, Hepatologie und Endokrinologie, Hannover, Germany.
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Liu H, Liu Y, Wang L, Xu D, Lin B, Zhong R, Gong S, Podda M, Invernizzi P. Prevalence of primary biliary cirrhosis in adults referring hospital for annual health check-up in Southern China. BMC Gastroenterol 2010; 10:100. [PMID: 20815889 PMCID: PMC2944334 DOI: 10.1186/1471-230x-10-100] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 09/03/2010] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary biliary cirrhosis (PBC) is an autoimmune liver disease characterized by the presence of anti-mitocondrial autoantibodies (AMA) which has an essential role also for diagnosis. In addition, also some anti-nuclear antibodies (ANA) have been shown to be highly specific PBC. The purpose of this study was to assess the prevalence of PBC among the adults referring hospital for annual health check-up in Southern China by screening sera for PBC-specific autoantibodies. METHODS AMA and ANA were screened in 8,126 adults (mean age 44 ± 15 years, 48% females) by indirect immunofluorenscence (IIF). Positive sera were tested by ELISA/immunoblotting for AMA-M2, anti-sp100 and anti-gp210. A diagnosis of PBC was re-assessed six months after the initial testing. RESULTS Out of 8,126 individuals 35 were positive for AMA and 79 positive for ANA. Nineteen, 4, and 3 of the subjects positive for AMA and/or ANA showed reactivity for AMA-M2, anti-sp100 or gp210, respectively, further tested with ELISA/immunoblotting. Fourteen in the 39 individuals positive for AMA at IIF, AMA-M2, anti-gp210, or anti-sp100 had abnormal cholestatic liver functional indices. One definite and 3 probable PBC diagnosis could be made in 4 cases including 3 females and 1 male after half a year. CONCLUSIONS We found a point prevalence rate of PBC among Southern Chinese adults attending for yearly health check-up of 492 cases per million (95% CI, 128 to 1,093) and 1,558 cases per million (95% CI, 294 to 3,815) for women over 40, a finding similar to prevalence reported in other geographical areas.
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Affiliation(s)
- Haiying Liu
- Clinical Laboratory, Guangzhou Women and Children’s Medical Center, 9 Jinsui Road, Guangzhou 510623, China
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Health-related quality of life and emotional status of anophthalmic patients in Korea. Am J Ophthalmol 2010; 149:1005-1011.e1. [PMID: 20231012 DOI: 10.1016/j.ajo.2009.12.036] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 12/19/2009] [Accepted: 12/21/2009] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate the health-related quality of life and emotional status of anophthalmic patients. DESIGN Prospective, cross-sectional study. METHODS The study included 134 monocular anophthalmic patients and 48 healthy volunteers who visited the department of Ophthalmology at the Yonsei University College of Medicine, Seoul, Korea, between July and December 2008. Surveys were administered to participants to evaluate their sociodemographic characteristics and disease-related factors. Data collected from the Short-Form 36-Item Health Survey (SF-36) and the Hospital Anxiety and Depression Scale survey instruments were analyzed to identify significant differences and correlations between categories. RESULTS Anophthalmic patients scored lower in all categories of SF-36 compared with controls. Married females and participants with children generally had lower scores on the SF-36, and some of the differences were statistically significant. There were significant negative correlations between all SF-36 scores and participant self-evaluations on whether they had negative feelings regarding their social interpersonal relationships as a result of wearing prostheses. Those who scored higher on the Hospital Anxiety and Depression Scale anxiety and depression scales tended to evade social interrelations significantly. CONCLUSIONS Anophthalmic patients had lower health-related quality-of-life scores than healthy individuals. This finding was particularly evident in terms of the patients' own perceptions of their social relationships, which were negatively affected by their use of prosthetic eyes. Such perceptions reduced their quality of life and heightened their anxiety and depression. Therefore, it is important to evaluate both the physical and emotional well-being of anophthalmic patients to identify those patients who will need additional physical and mental support.
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Lee H, Roh HS, Yoon JS, Lee SY. Assessment of quality of life and depression in Korean patients with Graves' ophthalmopathy. KOREAN JOURNAL OF OPHTHALMOLOGY 2010; 24:65-72. [PMID: 20379454 PMCID: PMC2851004 DOI: 10.3341/kjo.2010.24.2.65] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 03/08/2010] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess quality of life and depressive status in Korean patients with Graves' ophthalmopathy. Methods A cross-sectional study of 49 patients (mean age, 41 years; sex ratio, M:F=11:38) with Graves' ophthalmopathy (referred to as the Graves' group) and 48 age-matched and sex-matched controls (mean age, 40.2 years; sex ratio, M:F=11:37) was performed using the Korean version of the 36-item Short-Form General Health Survey (SF-36) questionnaire and the Beck Depression Inventory (BDI). Survey data was compared among patients with mild, moderately severe, and sight-threatening Graves' ophthalmopathy and between patients with low (0 or 1) or high (2 or 3) Gorman scores. Results Those in the Graves' group scored significantly lower on all categories of the SF-36, as compared to the control group (p<0.05). The 4 patients with sight-threatening Graves' had significantly lower scores for physical functioning, role limitations due to physical health, and the physical component summary of the SF-36, when compared with the 28 patients with mild Graves' and the 17 patients with moderately severe Graves' (p<0.05). The 17 patients in the high Gorman score group had lower physical component summary scores than the 32 patients in the low Gorman score group (p=0.03). The 16 patients with BDI scores ≥16 had significantly lower scores on the SF-36 and higher clinical activity scores, as compared to the 33 patients with BDI scores <16 (p<0.05). Conclusions Patients with Graves' ophthalmopathy had reduced health-related quality of life and were more likely to be depressed, especially those with a sight threatening condition or significant diplopia. It is important to identify these patients to provide the necessary psychological support.
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Affiliation(s)
- Hun Lee
- Department of Ophthalmology, Institute of Vision Research, Yonsei University College of Medicine, Seoul, Korea
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