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Zheng X, Feng L, Xing C, Wang J, Zhao W, Zhang F. Renal impairment may indicate postoperative low vision in young patients with proliferative diabetic retinopathy undergoing vitrectomy. Front Endocrinol (Lausanne) 2024; 14:1321226. [PMID: 38274226 PMCID: PMC10808762 DOI: 10.3389/fendo.2023.1321226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Objective To innovatively evaluate the impact of renal impairment in young work age patients with proliferative diabetic retinopathy (PDR) on their visuality after vitrectomy. Methods To find out whether it is possible to better predict the improvement of visual acuity after vitrectomy in working-age people without adding additional preoperative testing. In view of the fact that diabetic retinopathy and diabetic nephropathy are common diabetic complications of microvascular damage, it is considered whether preoperative renal function can be used as this evaluation index. This paper studies the design under this theme. This retrospective study included 306 patients (306 eyes) diagnosed with PDR and undergoing vitrectomy in our hospital from January 2016 to June 2023. Relevant baseline data were collected, including age, history of kidney disease and clinical laboratory test results. According to the International Standard Logarithmic Visual Acuity Checklist, the best corrected visual acuity was tested on the first day of admission and one month after surgery, and the difference between the two was subtracted. A difference >0 was defined as "vision improved". Patients were classified as vision-improved group (n=245) and non-improved group (n=61). The differences in baseline serum urea nitrogen, creatinine, uric acid, Cystatin C, estimated glomerular filtration rate (eGFR) and urine protein distribution between the two groups were statistically analyzed, binary regression analysis was performed for meaningful parameters, and random forest model ranked the characteristics in importance. Results 1.A higher level of serum cystatin C [1.02(0.80,1.48) mg/L vs 0.86(0.67,1.12) mg/L, P<0.001] and a lower eGFR [82.3(50.33, 115.11) ml/(min/1.73m²) vs 107.69(73.9, 126.01) ml/(min/1.73m²), P=0.002] appeared in the non-(vision-)improved group compared with the vision-improved group. 2. The occurrence of preoperation proteinuria history of nephropathy take a larger proportion in non-improved group. 3. Univariate regression analysis showed history of nephrology (OR=1.887, P=0.028), preoperative serum urea nitrogen (OR=0.939, P=0.043), cystatin C (Cys-C) concentration (OR=0.75, P=0.024), eGFR (OR=1.011, P=0.003) and proteinuria (OR=3.128, P<0.001) were influencing factors to postoperative visual acuity loss in young working age PDR patients. Excluding other confounding factors, preoperative proteinuria is an independent risk factor for postoperative vision improvement in working-age PDR populations (OR=2.722, P=0.009). 4. The accuracy of the prediction random forst model is 0.81. The model appears to be superior in terms of positive prediction. Conclusion In young work aged PDR patients undergoing vitrectomy, preoperative urine protein can be an independent indicator of postoperative visual loss. Aggressive correction of kidney injury before surgery may help improve postoperative vision in patients with PDR.
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Affiliation(s)
- Xiaorong Zheng
- Clinical Laboratory, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Lin Feng
- Diabetic Eye Disease Ward, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Chen Xing
- Fundus Imaging and Laser Therapy Department, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Junlan Wang
- Internal Medicine Department, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Wei Zhao
- Medical Records Room, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, Xingtai, Hebei, China
| | - Fengmei Zhang
- Clinical Laboratory, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Clinical Research Center for Eye Diseases, Hebei Eye Hospital, Xingtai, Hebei, China
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Kameda Y. Commentary: Is preclinical diabetic retinopathy in diabetic nephropathy individuals more severe? Front Endocrinol (Lausanne) 2023; 14:1256555. [PMID: 37810877 PMCID: PMC10556869 DOI: 10.3389/fendo.2023.1256555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
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Guo H, Wang Z, Nie Z, Zhang X, Wang K, Duan N, Bai S, Li W, Li X, Hu B. Establishment and validation of a prognostic nomogram for long-term low vision after diabetic vitrectomy. Front Endocrinol (Lausanne) 2023; 14:1196335. [PMID: 37693349 PMCID: PMC10485701 DOI: 10.3389/fendo.2023.1196335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose We aimed to evaluate the risk factors and develop a prognostic nomogram of long-term low vision after diabetic vitrectomy. Methods This retrospective study included 186 patients (250 eyes) that underwent primary vitrectomy for proliferative diabetic retinopathy with a minimum follow-up period of one year. Patients were assigned to the training cohort (200 eyes) or validation cohort (50 eyes) at a 4:1 ratio randomly. Based on a cutoff value of 0.3 in best-corrected visual acuity (BCVA) measurement, the training cohort was separated into groups with or without low vision. Univariate and multivariate logistic regression analyses were performed on preoperative systemic and ocular characteristics to develop a risk prediction model and nomogram. The calibration curve and the area under the receiver operating characteristic curves (AUC) were used to evaluate the calibration and discrimination of the model. The nomogram was internally validated using the bootstrapping method, and it was further verified in an external cohort. Results Four independent risk factors were selected by stepwise forward regression, including tractional retinal detachment (β=1.443, OR=4.235, P<0.001), symptom duration ≥6 months (β=0.954, OR=2.595, P=0.004), preoperative BCVA measurement (β=0.540, OR=1.716, P=0.033), and hypertension (β=0.645, OR=1.905, P=0.044). AUC values of 0.764 (95% CI: 0.699-0.829) in the training cohort and 0.755 (95% CI: 0.619-0.891) in the validation cohort indicated the good predictive ability of the model. Conclusion The prognostic nomogram established in this study is useful for predicting long-term low vision after diabetic vitrectomy.
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Affiliation(s)
- Haoxin Guo
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Zhaoxiong Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
- Department of Ophthalmology, Tianjin Baodi Hospital, Tianjin, China
- Baodi Clinical College, Tianjin Medical University, Tianjin, China
| | - Zetong Nie
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xiang Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Kuan Wang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
- Department of Retinal Disease, Cangzhou Eye Hospital, Cangzhou, China
| | - Naxin Duan
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Siqiong Bai
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Wenbo Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xiaorong Li
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Bojie Hu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Zhao M, Chandra A, Xu J, Li J. Factors related to postoperative vitreous hemorrhage after small-gauge vitrectomy in proliferative diabetic retinopathy patients. BMC Ophthalmol 2023; 23:215. [PMID: 37189104 DOI: 10.1186/s12886-023-02940-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 04/23/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND The role of anticoagulation or antiplatelet on post-vitrectomy vitreous hemorrhage (POVH) in patients with proliferative diabetic retinopathy (PDR) is rarely investigated in the small-gauge vitrectomy era. We investigate the relationship between the long-term use of those medications and POVH in a group of PDR patients. METHODS A retrospective cohort study was carried out in a group of PDR patients who underwent small-gauge vitrectomy in our center. The baseline data on diabetes, diabetic complications, long-term use of anticoagulants and antiplatelet agents, ocular findings, and vitrectomy details were collected. The occurrence of POVH was recorded during at least three-month follow-up. Factors related to POVH were analyzed using logistic analysis. RESULTS During a median follow-up of 16 weeks, 5% (11/220) of patients had POVH, and 75 had received antiplatelet or anticoagulation agents before the operation. Factors related to persistent POVH were the use of antiplatelet or anticoagulation agents (5.98, 1.75-20.45, p = 0.004), the presence of myocardial revascularization (130.65, 3.53-4834.50, p = 0.008), the presence of coronary artery disease (CAD) treated with medicine (56.52, 1.99-1604.06, p = 0.018), and younger age (0.86, 0.77-0.96, p = 0.012). For those receiving preoperative antiplatelet or anticoagulation agents, the probability of developing POVH was higher in the patients whose previous therapy was adjusted compared to those with continued therapy (p = 0.02 by Log-rank test). CONCLUSIONS We identified long-term use of anticoagulation or antiplatelet medication, the presence of CAD, and younger age as three independent factors related to POVH. In PDR patients on long-term antiplatelet or anticoagulation medications, particular attention should be given to controlling intraoperative bleeding, and follow-up for POVH should be scheduled.
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Affiliation(s)
- Meng Zhao
- Department of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No1. Dongjiaominxiang street, Dongcheng District, Beijing, 100730, China
| | - Aman Chandra
- Mid & South Essex NHS Foundation Trust (Southend University Hospital) Prittlewell Chase Essex SS00RY, Anglia Ruskin University, Cambridge, UK
| | - Jun Xu
- Department of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No1. Dongjiaominxiang street, Dongcheng District, Beijing, 100730, China
| | - Jipeng Li
- Department of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Beijing Tongren Eye Center, Capital Medical University, No1. Dongjiaominxiang street, Dongcheng District, Beijing, 100730, China.
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Qu J, Chen X, Liu Q, Wang F, Li M, Zhou Q, Yao J, Li X. Prophylactic intravitreal injection of aflibercept for preventing postvitrectomy hemorrhage in proliferative diabetic retinopathy: A randomized controlled trial. Front Public Health 2023; 10:1067670. [PMID: 36711366 PMCID: PMC9875129 DOI: 10.3389/fpubh.2022.1067670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction The aim of this study was to assess the effects of preoperative intravitreal aflibercept (IVA) injection on the incidence of postoperative vitreous hemorrhage (VH) after vitrectomy for proliferative diabetic retinopathy (PDR). Methods This study involved a prospective, randomized clinical trial. One hundred twenty-eight eyes of 128 patients of PDR who underwent pars plana vitrectomy (PPV) were enrolled. Sixty-four eyes were assigned randomly to either the IVA group (IVA injection 1 to 5 days before PPV) or the control group (no IVA injection). The primary outcome was the incidence of VH at 1 month after PPV. Secondary outcome measures were best-corrected visual acuity (BCVA) changes from baseline to at 1 week, 1 month, 2 months, and 3 months after surgery. Results The VH incidences in the IVA group and the control group were 14.8 and 39.3% at week 1, 8.6 and 31.7% at month 1, 11.7 and 30.5% at month 2, and 8.6 and 30.5% at month 3, respectively. Intergroup differences showed a significantly decreased VH rate in the IVA group compared with that in the control group at week 1, month 1, and month 3 (p = 0.021, 0.006, and 0.047, respectively). Compared to the baseline, neither the mean BCVA nor the BCVA change in the Logarithm of the Minimum Angle of Resolution (logMAR) scale did differ significantly between the two groups at each visit point. There are a greater number of eyes with BCVA improvement of more than 2 logMAR in the IVA group than in the control group at week 1 (8 vs. 2, p = 0.048). Conclusions This study found that the adjunctive use of preoperative IVA reduces early and late postoperative VH in vitrectomy for PDR.
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Affiliation(s)
- Jinfeng Qu
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China
| | - Xiuju Chen
- Department of Ophthalmology, Xiamen Eye Center of Xiamen University, Xiamen, China
| | - Qinghuai Liu
- Department of Ophthalmology, Nanjing Medical University Affiliated Nanjing Hospital, Jiangsu, China
| | - Fang Wang
- Department of Ophthalmology, The Tenth Affiliated Hospital of Shanghai Tongji University, Shanghai, China
| | - Mingxin Li
- Department of Ophthalmology, The Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Qiong Zhou
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi, China
| | - Jin Yao
- Department of Ophthalmology, The Affiliated Eye Hospital of Nanjing Medical University, Jiangsu, China
| | - Xiaoxin Li
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China,Department of Ophthalmology, Xiamen Eye Center of Xiamen University, Xiamen, China,*Correspondence: Xiaoxin Li ✉
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Kameda Y, Suzuki Y, Sugai M, Ishinabe K, Fukuoka N. Comment on: Long-term hemodialysis improved and stabilized diabetic macular edema: two case reports. Int J Ophthalmol 2022; 15:1891-1892. [PMID: 36404974 PMCID: PMC9631177 DOI: 10.18240/ijo.2022.11.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/14/2022] [Indexed: 12/18/2022] Open
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Li S, Tang J, Han X, Wang Z, Zhang L, Zhao M, Qu J. Prospective Comparison of Surgery Outcome Between Preoperative and Intraoperative Intravitreal Injection of Ranibizumab for Vitrectomy in Proliferative Diabetic Retinopathy Patients. Ophthalmol Ther 2022; 11:1833-1845. [PMID: 35904708 PMCID: PMC9437166 DOI: 10.1007/s40123-022-00550-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/07/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION To compare the efficacy and safety of intravitreal injections of ranibizumab (IVR) before and at the end of vitrectomy in proliferative diabetic retinopathy (PDR) patients. METHODS A prospective comparative study was performed on 60 eyes of 52 PDR patients who received ranibizumab injection (0.5 mg/0.05 ml) 3-5 days before vitrectomy (preoperative group) and 55 eyes of 50 PDR patients who received ranibizumab injection (0.5 mg/0.05 ml) at the end of vitrectomy (intraoperative group). Intra- and postoperative indices were collected for further comparison. RESULTS Postoperative best-corrected visual acuity (BCVA) in preoperative group was better than in intraoperative group at 1 week after surgery (P < 0.05) but comparable at 1- and 3-month follow-up (P = 0.20 and P = 0.37, respectively). Central retinal thickness (CRT) in preoperative group was lower than in intraoperative group at 1 week postoperatively (P < 0.05), but comparable at 1- and 3-month follow-up (P = 0.39 and P = 0.77, respectively). The average surgery time was significantly shorter in preoperative group than in intraoperative group (61.50 ± 11.44 min vs. 74.49 ± 12.01 min, P < 0.01). The incidence of intraoperative bleeding was significant lower in preoperative group than in intraoperative group (21.7% vs. 40.0%, P < 0.05). Moreover, the incidence of intraocular electrocoagulation use, iatrogenic retinal breaks, relaxing retinotomy and silicone oil tamponade were all significantly lower in preoperative group than that in intraoperative group (P < 0.05, respectively). The incidences of postoperative vitreous hemorrhage (VH), neovascular glaucoma (NVG), recurrent retinal detachment, postoperative fibrovascular proliferation progression and reoperation showed no statistical differences between the two groups (P > 0.05, respectively). Both groups had no ocular or system adverse events during observation period. CONCLUSION In vitrectomy for PDR, preoperative IVR can significantly reduce surgery time and lower the incidence of intraoperative bleeding, intraocular electrocoagulation use, iatrogenic retinal breaks, relaxing retinotomy and silicone oil tamponade during surgery and gain short-term better postoperative BCVA and thinner CRT. TRIAL REGISTRATION ClinicalTrials.gov (identifier, NCT05408416).
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Affiliation(s)
- Siying Li
- Department of Ophthalmology, Peking University People's Hospital, No. 11 South Avenue of XiZhiMen, Xi Cheng District, Beijing, 100044, People's Republic of China
- Eye Diseases and Optometry Institute, Beijing, 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, 100044, China
| | - Jiyang Tang
- Department of Ophthalmology, Peking University People's Hospital, No. 11 South Avenue of XiZhiMen, Xi Cheng District, Beijing, 100044, People's Republic of China
- Eye Diseases and Optometry Institute, Beijing, 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, 100044, China
| | - Xinyao Han
- Department of Ophthalmology, Peking University People's Hospital, No. 11 South Avenue of XiZhiMen, Xi Cheng District, Beijing, 100044, People's Republic of China
- Eye Diseases and Optometry Institute, Beijing, 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, 100044, China
| | - Zongyi Wang
- Department of Ophthalmology, Peking University People's Hospital, No. 11 South Avenue of XiZhiMen, Xi Cheng District, Beijing, 100044, People's Republic of China
- Eye Diseases and Optometry Institute, Beijing, 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, 100044, China
| | - Linqi Zhang
- Department of Ophthalmology, Peking University People's Hospital, No. 11 South Avenue of XiZhiMen, Xi Cheng District, Beijing, 100044, People's Republic of China
- Eye Diseases and Optometry Institute, Beijing, 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, 100044, China
| | - Mingwei Zhao
- Department of Ophthalmology, Peking University People's Hospital, No. 11 South Avenue of XiZhiMen, Xi Cheng District, Beijing, 100044, People's Republic of China
- Eye Diseases and Optometry Institute, Beijing, 100044, China
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, 100044, China
| | - Jinfeng Qu
- Department of Ophthalmology, Peking University People's Hospital, No. 11 South Avenue of XiZhiMen, Xi Cheng District, Beijing, 100044, People's Republic of China.
- Eye Diseases and Optometry Institute, Beijing, 100044, China.
- Beijing Key Laboratory of Diagnosis and Therapy of Retinal and Choroid Diseases, College of Optometry, Peking University Health Science Center, Beijing, 100044, China.
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