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Mohammedi K, Cordon A, Rigalleau V, Foussard N, Bairras-Martin C, Couffinhal T, Bezin J, Benard A. Cost-effectiveness of screening of coronary artery disease in patients with type 2 diabetes at a very high cardiovascular risk (SCADIAB) study. Updated study design: emulation of a randomised target trial using electronic health records. Cardiovasc Diabetol 2023; 22:329. [PMID: 38017442 PMCID: PMC10685710 DOI: 10.1186/s12933-023-02069-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023] Open
Affiliation(s)
- Kamel Mohammedi
- Univ. Bordeaux, INSERM, BMC, U1034, 33600, Pessac, France.
- Department of Endocrinology, Diabetes and Nutrition, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France.
| | - Audrey Cordon
- Clinical Epidemiology Unit (USMR), CIC-EC 14-01, Bordeaux University Hospital, Bordeaux, France
| | - Vincent Rigalleau
- Univ. Bordeaux, INSERM, BMC, U1034, 33600, Pessac, France
- INSERM U1219-Bordeaux Population Health Research Center, Bordeaux, France
| | - Ninon Foussard
- Univ. Bordeaux, INSERM, BMC, U1034, 33600, Pessac, France
- Department of Endocrinology, Diabetes and Nutrition, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France
| | | | - Thierry Couffinhal
- Univ. Bordeaux, INSERM, BMC, U1034, 33600, Pessac, France
- Department of Cardiology, Bordeaux University Hospital, Hôpital Haut-Lévêque, Pessac, France
| | - Julien Bezin
- INSERM, Bordeaux Population Health Research Center, U1219, Team Pharmacoepidemiology, Bordeaux, France
- Department of Pharmacology, Bordeaux University Hospital, Bordeaux, France
| | - Antoine Benard
- Clinical Epidemiology Unit (USMR), CIC-EC 14-01, Bordeaux University Hospital, Bordeaux, France
- INSERM, Bordeaux Population Health Research Center, U1219, Team EMOS, Bordeaux, France
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Hinton W, Ansari AS, Whyte MB, McGovern AP, Feher MD, Munro N, de Lusignan S. Sodium-glucose co-transporter-2 inhibitors in type 2 diabetes: Are clinical trial benefits for heart failure reflected in real-world clinical practice? A systematic review and meta-analysis of observational studies. Diabetes Obes Metab 2023; 25:501-515. [PMID: 36239122 DOI: 10.1111/dom.14893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 02/02/2023]
Abstract
AIM To determine the absolute risk reduction (ARR) of heart failure events in people treated with sodium-glucose co-transporter-2 (SGLT2) inhibitors. MATERIALS AND METHODS We searched PubMed, EMBASE, CINAHL and ISI Web of Science for observational studies published to 9 May 2022 that explored the association between SGLT2 inhibitors and any indication for heart failure (including new diagnosis or hospitalization for heart failure) in type 2 diabetes. Identified studies were independently screened by two reviewers and assessed for bias using the Newcastle-Ottawa scale. Eligible studies with comparable outcome data were pooled for meta-analysis using random-effects models, reporting hazard ratios (HRs) with 95% confidence intervals (CIs). The ARR per 100 person-years was determined overall, and in subgroups with and without baseline cardiovascular disease (CVD). RESULTS From 43 eligible studies, with a total of 4 818 242 participants from 17 countries, 21 were included for meta-analysis. SGLT2 inhibitors were associated with a reduced risk of hospitalization for heart failure (HR 0.65, 95% CI 0.59-0.72) overall and both in those with CVD (HR 0.78, 95% CI 0.68-0.89) and without CVD (HR 0.53, 95% CI 0.39-0.71). Risk reduction for hospitalization for heart failure in people with a history of CVD (ARR 1.17, 95% CI 0.78-1.55) was significantly greater than for those without CVD (ARR 0.39, 95% CI 0.32-0.47). The number-needed-to-treat to prevent one event of hospitalization for heart failure was 86 (95% CI 65-128) person-years of treatment for the CVD group and 256 (95% CI 215-316) person-years for those without CVD. CONCLUSIONS Real-world SGLT2 inhibitor use supports randomized trial data for the size effect of reduced hospitalization for heart failure in type 2 diabetes, although with a much lower ARR in people without CVD.
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Affiliation(s)
- William Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Abdus Samad Ansari
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Martin B Whyte
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Andrew P McGovern
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Michael D Feher
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Neil Munro
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), London, UK
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Mohammedi K, Préaubert N, Cariou T, Rigalleau V, Foussard N, Piazza L, Bairras-Martin C, Couffinhal T, Bezin J, Benard A. Cost-effectiveness of screening of coronary artery disease in patients with type 2 DIABetes at a very high cardiovascular risk (SCADIAB study) rational and design. Cardiovasc Diabetol 2021; 20:63. [PMID: 33714278 PMCID: PMC7955624 DOI: 10.1186/s12933-021-01253-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 12/14/2022] Open
Abstract
Background Screening for coronary artery disease (CAD) remains broadly performed in patients with type 2 diabetes (T2DM), although the lack of evidence. We conduct a real-world evidence (RWE) study to assess the risk of major clinical outcomes and economic impact of routine CAD screening in T2DM individuals at a very high cardiovascular risk. Methods SCADIAB is a comparative nationwide cohort study using data from the French National Health Data System. The main inclusion criteria are: age ≥ 40 years, DT2 diagnosed for ≥ 7 years, with ≥ 2 additional cardiovascular risk factors plus a history of microvascular or macrovascular disease, except CAD. We estimated ≥ 90,000 eligible participants for our study. Data will be extracted from 01/01/2008 to 31/12/2019. Eligible participants will be identified during a first 7-year selection period (2008–2015). Each participant will be assigned either in experimental (CAD screening procedure during the selection period) or control group (no CAD screening) on 01/01/2015, and followed for 5 years. The primary endpoint is the incremental cost per life year saved over 5 years in CAD screening group versus no CAD screening. The main secondary endpoints are: total 5-year direct costs of each strategy; incidence of major cardiovascular (acute coronary syndrome, hospitalization for heart failure, coronary revascularization or all-cause death), cerebrovascular (hospitalization for transient ischemic attack, stroke, or carotid revascularization) and lower-limb events (peripheral artery disease, ischemic diabetic foot, lower-limb revascularization or amputation); and the budget impact for the French Insurance system to promote the cost-effective strategy. Analyses will be adjusted for a high-dimension propensity score taking into account known and unknown confounders. SCADIAB has been funded by the French Ministry of Health and the protocol has been approved by the French ethic authorities. Data management and analyses will start in the second half of 2021. Discussion SCADIAB is a large and contemporary RWE study that will assess the economic and clinical impacts of routine CAD screening in T2DM people at a very high cardiovascular risk. It will also evaluate the clinical practice regarding CAD screening and help to make future recommendations and optimize the use of health care resources. Trial registration ClinicalTrials.gov Identifier: NCT04534530 (https://clinicaltrials.gov/ct2/show/NCT04534530)
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Affiliation(s)
- Kamel Mohammedi
- Department of Endocrinology, Diabetes and Nutrition, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France. .,Faculty of Medicine, University of Bordeaux, Bordeaux, France. .,INSERM Unit 1034, Biology of Cardiovascular Diseases, Pessac, France.
| | - Nathalie Préaubert
- Health Economics Unit, Clinical Research Department, Bordeaux University Hospital, Talence, France
| | - Tanguy Cariou
- Clinical Epidemiology Unit (USMR), CIC-EC 14-01, Bordeaux University Hospital, Bordeaux, France
| | - Vincent Rigalleau
- Department of Endocrinology, Diabetes and Nutrition, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France.,Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - Ninon Foussard
- Department of Endocrinology, Diabetes and Nutrition, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France
| | - Laurent Piazza
- Health Economics Unit, Clinical Research Department, Bordeaux University Hospital, Talence, France
| | | | - Thierry Couffinhal
- Faculty of Medicine, University of Bordeaux, Bordeaux, France.,INSERM Unit 1034, Biology of Cardiovascular Diseases, Pessac, France.,Department of Cardiology, Bordeaux University Hospital, Hôpital Haut-Lévêque, Bordeaux, Pessac, France
| | - Julien Bezin
- Faculty of Medicine, University of Bordeaux, Bordeaux, France.,INSERM, Bordeaux Population Health Research Center, U1219, Team Pharmacoepidemiology, Bordeaux, France.,Department of Pharmacology, Bordeaux University Hospital, Bordeaux, France
| | - Antoine Benard
- Clinical Epidemiology Unit (USMR), CIC-EC 14-01, Bordeaux University Hospital, Bordeaux, France.,INSERM, Bordeaux Population Health Research Center, U1219, Team EMOS0, Bordeaux, France
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Muhlestein JB, Moreno FL. Coronary Computed Tomography Angiography for Screening in Patients with Diabetes: Can Enhanced Detection of Subclinical Coronary Atherosclerosis Improve Outcome? Curr Atheroscler Rep 2016; 18:64. [DOI: 10.1007/s11883-016-0620-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Um T, Lee DH, Kang JW, Kim EY, Yoon YH. The Degree of Diabetic Retinopathy in Patients with Type 2 Diabetes Correlates with the Presence and Severity of Coronary Heart Disease. J Korean Med Sci 2016; 31:1292-9. [PMID: 27478342 PMCID: PMC4951561 DOI: 10.3346/jkms.2016.31.8.1292] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 05/11/2016] [Indexed: 11/20/2022] Open
Abstract
Both diabetic retinopathy (DR) and coronary heart disease (CHD) are clinically significant in diabetic patients. We investigated the correlation between the severity of DR and the presence and severity of CHD among type 2 diabetic patients. A total of 175 patients who were examined at the DR clinic and underwent dual-source computed tomography (DSCT) angiography within 6 months were included. The degree of DR was graded as no DR, nonproliferative DR (NPDR), and proliferative DR (PDR). The severity of CHD and the numbers of significant stenotic coronary artery on DSCT angiography according to DR grade were assessed. The mean Agatston Calcium Score (ACS) in patients with PDR was significantly higher than other groups (P < 0.001). The overall odds of an ACS increase were about 4.7-fold higher in PDR group than in no DR group (P < 0.001). In PDR group, in comparison with in no DR, the odds of having 1 or 2 arterial involvement were 3-fold higher (P = 0.044), and those of having 3 were 17-fold higher (P = 0.011). The c-index, one of the predictability values in regression analysis model, was not significantly increased when PDR was added to classical CHD risk factors (0.671 to 0.706, P = 0.111). Conclusively, patients with PDR develop a greater likelihood of not only having CHD, but being more severe nature. PDR has no additional effect to classical CHD risk factors for predicting CHD.
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Affiliation(s)
- Taewoong Um
- Department of Ophthalmology, 38th Fighter Group Medical Station, Gunsan, Korea
| | - Dong Hoon Lee
- Department of Ophthalmology, Yonsei Eagle Eye Hospital, Seongnam, Korea
| | - Joon-Won Kang
- Department of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Eun Young Kim
- Department of Radiology, Chonbuk National University Medical School and Hospital, Research Institute of Clinical Medicine, Jeonju, Korea
| | - Young Hee Yoon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
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Tsujimoto T, Sugiyama T, Yamamoto-Honda R, Kishimoto M, Noto H, Morooka M, Kubota K, Kamimura M, Hara H, Kajio H, Kakei M, Noda M. Beneficial effects through aggressive coronary screening for type 2 diabetes patients with advanced vascular complications. Medicine (Baltimore) 2016; 95:e4307. [PMID: 27537556 PMCID: PMC5370783 DOI: 10.1097/md.0000000000004307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Glycemic control alone does not reduce cardiovascular events in patients with type 2 diabetes (T2D), and routine screening of all T2D patients for asymptomatic coronary artery disease (CAD) is not effective for preventing acute cardiac events. We examined the effectiveness of an aggressive screening protocol for asymptomatic CAD in T2D patients with advanced vascular complications.We designed a 3-year cohort study investigating the effectiveness of the aggressive coronary screening for T2D patients with advanced vascular complications and no known coronary events using propensity score adjusted analysis at a national center in Japan. Eligibility criteria included T2D without known coronary events and with any 1 of the following 4 complications: advanced diabetic retinopathy, advanced chronic kidney disease, peripheral artery disease, or cerebrovascular disease. In the aggressive screening group (n = 122), all patients received stress single photon emission computed tomography and those exhibiting myocardial perfusion abnormalities underwent coronary angiography. In the conventional screening group (n = 108), patients were examined for CAD at the discretion of their medical providers. Primary endpoint was composite outcome of cardiovascular death and nonfatal cardiovascular events.Asymptomatic CAD with ≥70% stenosis was detected in 39.3% of patients completing aggressive screening. The proportions achieving revascularization and receiving intensive medical therapy within 90 days after the screening were significantly higher in the aggressive screening group than in the conventional screening group [19.7% vs 0% (P < 0.001) and 48.4% vs 9.3% (P < 0.001), respectively]. The cumulative rate of primary composite outcome was significantly lower in the aggressive screening group according to a propensity score adjusted Cox proportional hazards model (hazard ratio, 0.35; 95% confidence interval, 0.12-0.96; P = 0.04).Aggressive coronary screening for T2D patients with advanced vascular complications reduced cardiovascular death and nonfatal cardiovascular events.
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Affiliation(s)
- Tetsuro Tsujimoto
- Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo
- Division of General Medicine, Jichi Medical University Graduate School of Medicine, Shimotsuke
| | - Takehiro Sugiyama
- Department of Clinical Study and Informatics, Center for Clinical Sciences, National Center for Global Health and Medicine
- Department of Public Health/Health Policy, the University of Tokyo
| | - Ritsuko Yamamoto-Honda
- Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo
- Department of Diabetes Research, Diabetes Research Center
| | - Miyako Kishimoto
- Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo
- Department of Diabetes Research, Diabetes Research Center
| | - Hiroshi Noto
- Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo
- Department of Diabetes Research, Diabetes Research Center
| | | | | | - Munehiro Kamimura
- Department of Cardiovascular Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo
| | - Hisao Hara
- Department of Cardiovascular Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo
| | - Hiroshi Kajio
- Department of Diabetes, Endocrinology, and Metabolism, Center Hospital, National Center for Global Health and Medicine, Tokyo
| | - Masafumi Kakei
- Division of General Medicine, Jichi Medical University Graduate School of Medicine, Shimotsuke
- First Department of Comprehensive Medicine, Saitama Medical Center, Jichi Medical University School of Medicine
| | - Mitsuhiko Noda
- Department of Diabetes Research, Diabetes Research Center
- Department of Endocrinology and Diabetes, Saitama Medical University, Saitama, Japan
- Correspondence: Mitsuhiko Noda, Department of Endocrinology and Diabetes, Saitama Medical University, 38 Moro-hongo, Moroyama, Iruma-gun, Saitama 350-0495, Japan (e-mail: )
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Armstrong EJ, Waldo SW. Determining the Most Appropriate Mode of Coronary Artery Revascularisation in Patients With Diabetes. Interv Cardiol 2016; 11:44-46. [PMID: 29588704 DOI: 10.15420/icr.2016:4:2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Obstructive coronary artery disease is a common cause of morbidity and mortality among patients with diabetes mellitus (DM). Previous research has demonstrated that the clinical sequelae of coronary artery disease remains the most common cause of death in this population. As a result numerous observational studies and randomised clinical trials have evaluated the timing and mode of coronary artery revascularisation within this population. In this review, we survey the currently available data informing the indications and optimal method of coronary revascularisation for diabetic patients.
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Affiliation(s)
- Ehrin J Armstrong
- Veterans Affairs Eastern Colorado Healthcare System, University of Colorado, Denver, CO, USA
| | - Stephen W Waldo
- Veterans Affairs Eastern Colorado Healthcare System, University of Colorado, Denver, CO, USA
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Rong J, Yu CQ, Yang P, Chen J. Association of retinopathy with coronary atherosclerosis determined by coronary 64-slice multidetector computed tomography angiography in type 2 diabetes. Diab Vasc Dis Res 2013; 10:161-8. [PMID: 22906861 DOI: 10.1177/1479164112454755] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although there are substantial analyses for association of coronary artery disease (CAD) with diabetic retinopathy (DR), which was recognized as an indicator of risk for CAD in diabetes mellitus (DM), there is as yet little rigorous evaluation of the relationship between DR and subclinical coronary atherosclerosis (CAS) determined by coronary 64-slice multidetector computed tomography angiography (MDCTA) in persons with type 2 DM. In this article, we found that CAS associated with DR was independent of the traditional risk factors for CAD [odds ratio (OR): 5.1; 95% confidence interval (CI): 2.6-10.1; p < 0.001], and the severity and extent of CAS were significantly increased with the incidence and progression of DR (all p < 0.001). An independent association between hypertension, obesity, renal dysfunction and DR was also found (all p < 0.05). The relationship of CAS with DR was relatively continuous and graded under the diabetes status. Therefore, much of CAS and DR could be still multifactorial with common pathway.
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Affiliation(s)
- Jian Rong
- Geriatric Department, Military General Hospital of Chengdu PLA, Chengdu, Sichuan, People's Republic of China.
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Abstract
CLINICAL CONTEXT Sensitive tools are available to diagnose occult ischemic and atherosclerotic coronary disease, yet screening for coronary artery disease (CAD) has not been shown to reduce cardiac events in patients with type 2 diabetes mellitus (T2DM). Professional guidelines are inconsistent regarding CAD screening recommendations, but it is suggested that those at highest risk (10-yr risk ≥20%) for cardiac events may benefit. EVIDENCE ACQUISITION We reviewed bibliographies of professional CAD screening guidelines, review articles, and clinical trials published within the last 10 yr, although we have included relevant older studies. We excluded studies that did not focus on T2DM or explicitly analyze that subgroup. EVIDENCE SYNTHESIS Although screening for coronary ischemia or atherosclerosis does provide incremental prognostic information in patients with T2DM and previously undiagnosed CAD, this has not been found to significantly impact outcomes. This appears to result from comparable efficacy of revascularization and optimal medical therapy in stable CAD. Limited evidence supports the hypothesis that those with more severe CAD (three-vessel, left main, proximal left anterior descending) amenable to bypass surgery may be potential beneficiaries of screening. However, the low prevalence of such candidates in the asymptomatic population, continuing advances with percutaneous intervention, and the lack of prospective trials makes such a recommendation currently unsupportable. CONCLUSIONS Findings to date do not support widespread screening for CAD in patients with T2DM. A future strategy identifying those at highest risk as screening candidates may ultimately be effective, but the optimal method for selecting those subjects or subsequent treatment is unknown.
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Affiliation(s)
- Charles T Upchurch
- University of Virginia School of Medicine, Charlottesville, Virginia 22908, USA.
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