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Holland SA, Wellwood I, Kuys S. Effect of abnormal body weight on mortality and functional recovery in adults after stroke: An umbrella review. Int J Stroke 2024; 19:397-405. [PMID: 37897100 DOI: 10.1177/17474930231212972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
BACKGROUND Several published systematic reviews have drawn conflicting conclusions on the effect of abnormal body weight (i.e. being underweight, overweight or obese) on outcomes following stroke. The 'obesity paradox' seen in several diseases (wherein obesity, often associated with mortality and morbidity, appears to be protective and improve outcomes) may be evident after stroke, but inconsistent results of existing reviews, and the issue of being underweight, are worth investigating further. AIMS To better understand the impact of body weight on prognosis after stroke, we aimed to answer the following research question: What is the effect of abnormal body weight (underweight, overweight, or obesity) on mortality and functional recovery in adults after stroke? SUMMARY OF REVIEW We conducted an umbrella review to synthesize existing evidence on the effects of abnormal body weight on stroke outcomes. We searched Cumulated Index to Nursing and Allied Health Literature (CINAHL) Complete, COCHRANE Database of Systematic Reviews, PubMed, Medline, PEDro, and EMBASE Classic + EMBASE, from inception until 28 February 2023. Seven systematic reviews (1,136,929 participants) from 184 primary studies (counting duplicates) were included. While the risk of mortality increases with being underweight (body mass index (BMI) < 18.5 kg/m2), excess body weight (being overweight (BMI = 25-29.9 kg/m2) or obese (BMI > 30 kg/m2)) is associated with reduced mortality. The impact of abnormal body weight on functional recovery is less clear; data from studies of being underweight are associated with poor functional outcomes while those from studies of excess body weight are inconclusive. CONCLUSION Abnormal body weight effects post-stroke outcomes and should be considered in clinical decision-making, prognostic research, and clinical trials of rehabilitation interventions. The "obesity paradox" is evident after stroke, and excess body weight is associated with reduced mortality compared to normal body weight. It is recommended that body weight is routinely recorded for stroke patients, and further research, including well-designed cohort studies with reliable weight data, is needed to further investigate the impact of body weight and distribution on post-stroke outcomes.
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Affiliation(s)
- Stephanie A Holland
- Department of Physiotherapy, Sunshine Hospital, Western Health, Saint Albans, VIC, Australia
| | - Ian Wellwood
- Australian Catholic University, Ballarat, VIC, Australia
| | - Suzanne Kuys
- Australian Catholic University, Banyo, QLD, Australia
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Liu M, Kang N, Wang D, Mei D, Wen E, Qian J, Chen G. Analysis of Lower Extremity Motor Capacity and Foot Plantar Pressure in Overweight and Obese Elderly Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3112. [PMID: 36833807 PMCID: PMC9965343 DOI: 10.3390/ijerph20043112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/03/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Overweight, obesity and falls are major public health problems and old people are the biggest group suffering falls. METHODS 92 females were divided into the overweight or obesity (O) group (68.85 ± 3.85) and regular-weight (R) group (67.90 ± 4.02). Lower extremity motor capacity and plantar pressure were compared between the two groups. The IRB approval number is 20190804. RESULTS (1) Functional Movement Screen and Fugl-Meyer Assessment scores in the O group were significantly lower than in the R group. The time to complete the Timed Up and Go test in the O group was significantly longer than in the R group. (2) Foot flat phase, double support distance, and left foot axis angle in the O group were significantly higher than in the R group. Distance and velocity, left-foot minimum subtalar joint angle and right-foot maximum subtalar joint angle in the O group were significantly shorter than in the R group. (3) Peak force, average force and pressure of metatarsal 1-4, mid-foot, heel medial and lateral, peak pressure of metatarsal l, midfoot, heel medial and lateral in the O group were significantly higher than in the R group. (p < 0.05). CONCLUSIONS Overweight and obese elderly women have a lower sensorimotor function, flexibility and stability in functional movements, but higher loads on the foot.
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Affiliation(s)
- Min Liu
- Institute of Population Research, Peking University, Beijing 100871, China
| | - Ning Kang
- Institute of Population Research, Peking University, Beijing 100871, China
| | - Dongmin Wang
- Department of Physical Education, Peking University, Beijing 100871, China
| | - Donghui Mei
- College of Psychology, Capital Normal University, Beijing 100048, China
| | - Erya Wen
- Department of Physical Education, Peking University, Beijing 100871, China
| | - Junwei Qian
- Department of Physical Education, Peking University, Beijing 100871, China
| | - Gong Chen
- Institute of Population Research, Peking University, Beijing 100871, China
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Weidman M, MacDonald SL. The Impact of Body Mass Index Classification on Outcomes After Stroke Rehabilitation: A Retrospective Study. Am J Phys Med Rehabil 2022; 101:714-717. [PMID: 35067556 DOI: 10.1097/phm.0000000000001966] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
ABSTRACT With improving stroke mortality rates, more individuals are living with the consequences of stroke. Obesity is a known risk factor for stroke, but its effect on functional outcomes poststroke is less clear. The aim of this study was to determine the association between body mass index classification (underweight, normal weight, overweight, and obese) and functional outcomes, as measured by Functional Independence Measure change, Functional Independence Measure efficiency, and rehabilitation length of stay after inpatient stroke rehabilitation. A retrospective cohort study of individuals with a diagnosis of stroke admitted to a high-intensity inpatient rehabilitation program was performed. Patients were divided into 4 groups based on body mass index category using normal body mass index as the reference. Overall, 34 individuals (4.5%) were classified as underweight, 303 (40.1%) had body mass indices within the normal range, 269 (35.6%) were overweight, and 149 (19.7%) were obese. Ischemic stroke was the most common stroke type across all body mass index categories. Patients in the overweight and obese groups tended to be younger. There were no statistically significant differences in rehabilitation length of stay, Functional Independence Measure change, or Functional Independence Measure efficiency with all groups demonstrating significant functional improvements. Based on these findings, patients admitted for inpatient rehabilitation after stroke can be expected to make similar functional improvements regardless of BMI class.
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Affiliation(s)
- Melissa Weidman
- From the Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada (MW, SLM); and Bridgepoint Active Healthcare, Sinai Health, Toronto, Canada (SLM)
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García-Rudolph A, Saurí J, Cegarra B, Madai VI, Frey D, Kelleher JD, Cisek K, Opisso E, Tormos JM, Bernabeu M. Long-term trajectories of motor functional independence after ischemic stroke in young adults: Identification and characterization using inpatient baseline assessments. NeuroRehabilitation 2022; 50:453-465. [DOI: 10.3233/nre-210293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Stroke is a major worldwide cause of serious long-term disability. Most previous studies addressing functional independence included only inpatients with limited follow-up. OBJECTIVE: To identify novel classes of patients having similar temporal patterns in motor functional independence and relate them to baseline clinical features. METHODS: Retrospective observational cohort study, data were obtained for n = 428 adult patients with ischemic stroke admitted to rehabilitation (March 2005–March 2020), including baseline clinical features and follow-ups of motor Functional Independence Measure (mFIM) categorized as poor, fair or good. Growth mixture models (GMMs) were fitted to identify classes of patients with similar mFIM trajectories. RESULTS: GMM identified three classes of trajectories (1,664 mFIM assessments): C1 (11.2 %), 97.9% having poor admission mFIM, at 4.93 years 61.1% still poor, with the largest percentage of hypertension, neglect, dysphagia, diabetes and dyslipidemia of all three classes. C2 (23.1%), 99% had poor admission mFIM, 25% poor discharge mFIM, the largest percentage of aphasia and greatest mFIM gain, at 4.93 years only 6.2% still poor. C3 (65.7%) the youngest, lowest NIHSS, 37.7% poor admission mFIM, 73% good discharge mFIM, only 4.6% poor discharge mFIM, 90% good at 4.93 years. CONCLUSIONS: GMM identified novel motor functional classes characterized by baseline features.
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Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònomade Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Joan Saurí
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònomade Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Blanca Cegarra
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònomade Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Vince Istvan Madai
- CLAIM Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health (BIH), Charité – Universitätsmedizin Berlin, Berlin, Germany
- School of Computing and Digital Technology, Faculty of Computing, Engineering and the Built Environment, Birmingham City University, Birmingham, United Kingdom
| | - Dietmar Frey
- CLAIM Charité Lab for AI in Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John D. Kelleher
- Information, Communication and Entertainment Research Institute, Technological University Dublin (TU Dublin), Dublin, Ireland
| | - Katryna Cisek
- Information, Communication and Entertainment Research Institute, Technological University Dublin (TU Dublin), Dublin, Ireland
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònomade Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep María Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònomade Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Montserrat Bernabeu
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Barcelona, Spain
- Universitat Autònomade Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
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Weight Change during the Early Phase of Convalescent Rehabilitation after Stroke as a Predictor of Functional Recovery: A Retrospective Cohort Study. Nutrients 2022; 14:nu14020264. [PMID: 35057445 PMCID: PMC8779388 DOI: 10.3390/nu14020264] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/30/2021] [Accepted: 01/05/2022] [Indexed: 01/27/2023] Open
Abstract
It has been reported that weight gain at discharge compared with admission is associated with improved activities of daily living in convalescent rehabilitation (CR) patients with low body mass index. Here, we investigated whether weight maintenance or gain during the early phase of CR after stroke correlates with a better functional recovery in patients with a wide range of BMI values. We conducted this retrospective cohort study in a CR ward of our hospital and included adult stroke patients admitted to the ward from January 2014 to December 2018. After ~1 month of hospitalization, the patients were classified into weight loss and weight maintenance or gain (WMG) groups based on the Global Leadership Initiative on Malnutrition criteria for weight. We adopted the motor functional independence measure (FIM) gain as the primary outcome. The motor FIM gain tended to be greater in the WMG group but without statistical significance. However, multiple regression analysis showed that WMG was significantly and positively associated with motor FIM gain. In conclusion, weight maintenance or gain in patients during the early phase of CR after stroke may be considered as a predictor of their functional recovery, and nutritional management to prevent weight loss immediately after the start of rehabilitation would contribute to this.
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Wolf VL, Ergul A. Progress and challenges in preclinical stroke recovery research. Brain Circ 2021; 7:230-240. [PMID: 35071838 PMCID: PMC8757504 DOI: 10.4103/bc.bc_33_21] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/16/2021] [Accepted: 10/22/2021] [Indexed: 01/29/2023] Open
Abstract
Significant innovations in the management of acute ischemic stroke have led to an increased incidence in the long-term complications of stroke. Therefore, there is an urgent need for improvements in and refinement of rehabilitation interventions that can lead to functional and neuropsychological recovery. The goal of this review is to summarize the current progress and challenges involved with preclinical stroke recovery research. Moving forward, stroke recovery research should be placing an increased emphasis on the incorporation of comorbid diseases and biological variables in preclinical models in order to overcome translational roadblocks to establishing successful clinical rehabilitation interventions.
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Affiliation(s)
- Victoria Lea Wolf
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
| | - Adviye Ergul
- Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
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Kokura Y, Nishioka S. Association Between Weight Loss and Activities of Daily Living in Obese and Overweight Patients after Stroke: A Cross-Sectional Study. J Stroke Cerebrovasc Dis 2021; 30:106052. [PMID: 34419833 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/27/2021] [Accepted: 08/08/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Whether weight loss during hospitalization is associated with improvement in activities of daily living (ADL) in overweight and obese stroke patients remains unclear. This study investigated the association between decreases in body mass index (BMI), fat-free mass (FFM), and fat mass (FM) and ADL improvement. MATERIALS AND METHODS In this cross-sectional study, we analyzed data of patients admitted to acute care hospitals with stroke. Patients were classified into two groups based on their change in BMI during their hospital stay (i.e. decreased or nondecreased group). To control and adjust for patient characteristics and confounders, we created an inverse probability-weighted (IPW) model using propensity scoring, which was used to compare the Functional Independence Measure Motor (FIM-M) efficacy between the two groups. We also compared FFM and FM between admission and discharge in each group. RESULTS A total of 556 patients were analyzed, among whom 391 (70.3%) had a decrease in BMI and 165 (29.7%) had a nondecrease. After IPW adjustment, efficiency of FIM-M was significantly higher in the nondecreased group as compared to that in the decreased group (median: 0.44 vs. 0.29, P < 0.001). FFM and FM were significantly decreased from admission to discharge in the decreased group, but there was no significanct difference observed in the nondecreased group. Preserving BMI during hospitalization was associated with a positive improvement in ADL in overweight and obese stroke patients undergoing rehabilitation. CONCLUSIONS Risks and benefits of weight loss should be balanced in nutritional care and rehabilitation for overweight and obese stroke patients.
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Affiliation(s)
- Yoji Kokura
- Department of Clinical Nutrition, Keiju Medical Center, 94 Tomioka chou, Nanao, Ishikawa 926-8605, Japan; Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, Osaka, Japan.
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
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García-Rudolph A, Kelleher JD, Cegarra B, Saurí Ruiz J, Nedumpozhimana V, Opisso E, Tormos JM, Bernabeu M. The impact of Body Mass Index on functional rehabilitation outcomes of working-age inpatients with stroke. Eur J Phys Rehabil Med 2020; 57:216-226. [PMID: 33263247 DOI: 10.23736/s1973-9087.20.06411-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Stroke is the most relevant cause of acquired persistent disability in adulthood. The relationship between patient's weight during rehabilitation and stroke functional outcome is controversial, previous research reported positive, negative and no effects, with scarce studies specifically addressing working-age patients. AIM To evaluate the association between Body Mass Index (BMI) and the functional progress of adult (<65 years) patients with stroke admitted to a rehabilitation hospital. DESIGN Retrospective observational cohort study. SETTING Inpatient rehabilitation center. POPULATION 178 stroke patients (ischemic or hemorrhagic). METHODS Point-biserial and Spearman's correlations, multivariate linear regressions and analysis of covariance were used to describe differences in functional outcomes after adjusting for age, sex, severity, dysphagia, depression and BMI category. Functional Independence Measure (FIM), FIM gain, efficiency and effectiveness were assessed. RESULTS Participants were separated in 3 BMI categories: normal weight (47%), overweight (33%) and obese (20%). There were no significant differences between BMI categories in any functional outcome (total FIM [T-FIM], cognitive [C-FIM]), motor [M-FIM]) at discharge, admission, gain, efficiency or effectiveness. In regression models BMI (as continuous variable) was not significant predictor of T-FIM at discharge after adjusting for age, sex, severity, dysphagia, depression and ataxia (R2=0.4813), significant predictors were T-FIM at admission (β=0.528) and NIHSS (β=-0.208). M-FIM efficiency did not significantly differ by BMI subgroups, neither did C-FIM efficiency. Length of stay (LOS) and T-FIM effectiveness were associated for normal (r=0.33) and overweight (r=0.43), but not for obese. LOS and T-FIM efficiency were strongly negatively associated only for obese (r=-0.50). CONCLUSIONS FIM outcomes were not associated to BMI, nevertheless each BMI category when individually considered (normal weight, overweight or obese) was characterized by different associations involving FIM outcomes and clinical factors. CLINICAL REHABILITATION IMPACT In subacute post-stroke working-age patients undergoing rehabilitation, BMI was not associated to FIM outcomes (no obesity paradox was reported in this sample). Distinctive significant associations emerged within each BMI category, (supporting their characterization) such as length of stay and T-FIM effectiveness were associated for normal weight and overweight, but not for obese. Length of stay and T-FIM efficiency were strongly negatively associated only for obese.
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Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Spain - .,Universitat Autònoma de Barcelona, Bellaterra, Spain - .,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain -
| | - John D Kelleher
- Information, Communication and Entertainment Research Institute, Technological University Dublin (TU), Dublin, Ireland
| | - Blanca Cegarra
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain.,Universitat de Barcelona, Barcelona, Spain
| | - Joan Saurí Ruiz
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Vasudevan Nedumpozhimana
- Information, Communication and Entertainment Research Institute, Technological University Dublin (TU), Dublin, Ireland
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Josep M Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
| | - Montserrat Bernabeu
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació Adscrit a la UAB, Badalona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
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