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Jiménez-Blanco Bravo M, Pérez-Gómez L, Hernández-Pérez FJ, Arellano-Serrano C, Torres-Sanabria M, Gómez-Bueno M, Oteo-Domínguez JF, Mingo-Santos S, Segovia-Cubero J. Lack of Usefulness of Donor-Derived Cell-Free DNA as a Biomarker for Cardiac Allograft Vasculopathy: A Prospective Study. Front Cardiovasc Med 2022; 9:856600. [PMID: 35463750 PMCID: PMC9019134 DOI: 10.3389/fcvm.2022.856600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Cardiac allograft vasculopathy (CAV) remains a major cause of morbidity and mortality among long-term heart transplant recipients. There is an unmet need for a non-invasive biomarker of CAV that could obviate the need to perform surveillance coronary angiograms in these patients. Our aim was to evaluate the performance of Donor-derived Cell Free DNA (dd-cfDNA) as a biomarker of CAV. Methods We prospectively measured dd-cfDNA levels in all patients undergoing routine coronary angiography >1 year after heart transplant at a single center. Endpoints included the association between dd-cfDNA levels and the presence CAV, according to several prespecified criteria. Results We included 94 heart transplant recipients, a median of 10.9 years after transplant. Coronary angiogram revealed CAV0, CAV1, CAV2, and CAV3 in 61, 19, 14, and 6% of patients, respectively. Comparison of dd-cfDNA levels in patients with CAV0 and CAV1–2–3 (primary end-point) did not show significant differences (0.92%, IQR 0.46–2.0 vs. 0.46%, IQR 0.075–1.5, p = 0.059), nor did the comparison between patients with stable CAV (no new coronary lesions since previous angiogram, n = 77) and progressive CAV (n = 17); dd-cfDNA values 0.735% (IQR 0.195–2.0) vs. 0.9% (IQR 0.12–1.8), p = 0.76. However, we found an association between NTproBNP levels and CAV degree (p = 0.017). Dd-cfDNA levels did not correlate with NTproBNP (ρ = −0.095). Conclusion In this study, dd-cfDNA did not perform as a useful biomarker to avoid surveillance coronary angiograms for CAV diagnosis. Clinical Trial Notation Potential Role of Donor-derived Cell Free DNA as a Biomarker in Cardiac Allograft Vasculopathy, NCT 04791852.
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Affiliation(s)
- Marta Jiménez-Blanco Bravo
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Hospital Universitario Ramón y Cajal, Madrid, Spain
- Centro de Investigación Biomédica en Red CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
- *Correspondence: Marta Jiménez-Blanco Bravo,
| | - Laura Pérez-Gómez
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Manuel Gómez-Bueno
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Javier Segovia-Cubero
- Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
- Centro de Investigación Biomédica en Red CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain
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2
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Álvarez-Avello JM, Hernández-Pérez FJ, Herrero-Cano Á, López-Ibor JV, Aymerich M, Iranzo R, Vidal-Fernández M, Gómez-Bueno M, Gómez-Paratcha B, García-Suárez J, Martín CE, Forteza A, González-Román A, Segovia-Cubero J. Usefulness of severity scales for cardiogenic shock in-hospital mortality. Proposal for a new prognostic model. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:79-87. [PMID: 35177367 DOI: 10.1016/j.redare.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/31/2021] [Indexed: 06/14/2023]
Abstract
UNLABELLED Cardiogenic shock (CS) is a condition comprising multiple etiologies, which associates high mortality rates. Some scoring systems have been shown to be good predictors of hospital mortality in patients admitted to Critical Care Units (CCU). The main objective of this study is to analyze their usefulness and validity in a cohort of CS patients. METHODS Observational unicentric study of a cohort of CS patients. SOFA, SAPS II and APACHE II scores were calculated in the first 24 h of CCU admission. RESULTS 130 patients with CS were included. SOFA, SAPS II and APACHE II scores revealed good discrimination for hospital mortality: (AUC) ROC values (AUC: 0.711, 0.752 and 0.742 respectively; P = .6). Calibration, estimated by the Hosmer-Lemeshow test, was adequate in all cases. Acute coronary syndrome, lactate serum values, SAPS II score and vasoactive inotropic score (VIS) were found to be independent predictors for mortality, upon ICU admission. With these variables, a specific prognostic indicator was developed (SAPS-2-LIVE), which improved predictive capability for mortality in our series (AUC) ROC, 0.825 (95% CI 0.752-0.89). CONCLUSION In this contemporary CS cohort, the aforementioned scores have been shown to have good predictive ability for hospital mortality. These findings could contribute to a more accurate risk stratification in CS.
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Affiliation(s)
- J M Álvarez-Avello
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Departamento de Anestesiología y Cuidados Intensivos, Clínica Universidad de Navarra, Madrid, Spain.
| | - F J Hernández-Pérez
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Á Herrero-Cano
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - J V López-Ibor
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - M Aymerich
- Departamento de Anestesiología y Cuidados Intensivos, Clínica Universidad de Navarra, Madrid, Spain
| | - R Iranzo
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - M Vidal-Fernández
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - M Gómez-Bueno
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - B Gómez-Paratcha
- Departamento de Anestesiología y Cuidados Intensivos, Clínica Universidad de Navarra, Madrid, Spain
| | - J García-Suárez
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - C E Martín
- Servicio de Cirugía Cardiaca, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - A Forteza
- Servicio de Cirugía Cardiaca, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - A González-Román
- Servicio de Anestesiología y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - J Segovia-Cubero
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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3
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Villar-García S, Martín-López CE, Pérez-Redondo M, Hernández-Pérez FJ, Martínez-López D, de Villarreal-Soto JE, Ríos-Rosado EC, Vera-Puente B, Ospina-Mosquera VM, Serrano-Fiz S, Forteza-Gil A. Donación en asistolia controlada: cómo iniciar un programa. Cirugía Cardiovascular 2022. [DOI: 10.1016/j.circv.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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4
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López-Ibor JV, Krsnik I, Gómez-Bueno M, Hernández-Pérez FJ, Durante-López A, Mingo Santos S, Moñivas Palomero V, García-Izquierdo E, Sayago I, Royuela A, Segovia-Cubero J. Should We Expand Cardiac Response Criteria in Patients with Light Chain Cardiac Amyloidosis? J Am Soc Echocardiogr 2020; 34:318-322. [PMID: 33276078 DOI: 10.1016/j.echo.2020.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 11/21/2020] [Accepted: 11/22/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Jorge V López-Ibor
- Advanced Heart Failure and Heart Transplantation Unit, Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Isabel Krsnik
- Department of Hematology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Manuel Gómez-Bueno
- Advanced Heart Failure and Heart Transplantation Unit, Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Francisco J Hernández-Pérez
- Advanced Heart Failure and Heart Transplantation Unit, Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Alejandro Durante-López
- Advanced Heart Failure and Heart Transplantation Unit, Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Susana Mingo Santos
- Advanced Heart Failure and Heart Transplantation Unit, Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Vanessa Moñivas Palomero
- Advanced Heart Failure and Heart Transplantation Unit, Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Eusebio García-Izquierdo
- Advanced Heart Failure and Heart Transplantation Unit, Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Inés Sayago
- Advanced Heart Failure and Heart Transplantation Unit, Department of Cardiology, Hospital Virgen del Rocío, Sevilla, Spain
| | - Ana Royuela
- Biostatistics Unit, Puerta de Hierro Biomedical Research Institute, CIBERESP, Madrid, Spain
| | - Javier Segovia-Cubero
- Advanced Heart Failure and Heart Transplantation Unit, Department of Cardiology, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
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Rivas-Lasarte M, Sans-Roselló J, Collado-Lledó E, González-Fernández V, Noriega FJ, Hernández-Pérez FJ, Fernández-Martínez J, Ariza A, Lidón RM, Viana-Tejedor A, Segovia-Cubero J, Harjola VP, Lassus J, Thiele H, Sionis A. External validation and comparison of the CardShock and IABP-SHOCK II risk scores in real-world cardiogenic shock patients. Eur Heart J Acute Cardiovasc Care 2020; 10:2048872619895230. [PMID: 32004078 DOI: 10.1177/2048872619895230] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/26/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mortality from cardiogenic shock remains high and early recognition and risk stratification are mandatory for optimal patient allocation and to guide treatment strategy. The CardShock and the Intra-Aortic Balloon Counterpulsation in Acute Myocardial Infarction Complicated by Cardiogenic Shock (IABP-SHOCK II) risk scores have shown good results in predicting short-term mortality in cardiogenic shock. However, to date, they have not been compared in a large cohort of ischaemic and non-ischaemic real-world cardiogenic shock patients. METHODS The Red-Shock is a multicentre cohort of non-selected cardiogenic shock patients. We calculated the CardShock and IABP-SHOCK II risk scores in each patient and assessed discrimination and calibration. RESULTS We included 696 patients. The main cause of cardiogenic shock was acute coronary syndrome, occurring in 62% of the patients. Compared with acute coronary syndrome patients, non-acute coronary syndrome patients were younger and had a lower proportion of risk factors but higher rates of renal insufficiency; intra-aortic balloon pump was also less frequently used (31% vs 56%). In contrast, non-acute coronary syndrome patients were more often treated with mechanical circulatory support devices (11% vs 3%, p<0.001 for both). Both risk scores were good predictors of in-hospital mortality in acute coronary syndrome patients and had similar areas under the receiver-operating characteristic curve (area under the curve: 0.742 for the CardShock vs 0.752 for IABP-SHOCK II, p=0.65). Their discrimination performance was only modest when applied to non-acute coronary syndrome patients (0.648 vs 0.619, respectively, p=0.31). Calibration was acceptable for both scores (Hosmer-Lemeshow p=0.22 for the CardShock and 0.68 for IABP-SHOCK II). CONCLUSIONS In our cohort, both the CardShock and the IABP-SHOCK II risk scores were good predictors of in-hospital mortality in acute coronary syndrome-related cardiogenic shock.
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Affiliation(s)
- Mercedes Rivas-Lasarte
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Spain
| | - Jordi Sans-Roselló
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Spain
| | | | | | | | | | - Juan Fernández-Martínez
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Spain
| | - Albert Ariza
- Cardiology Service, Universitari Bellvitge Hospital-IDIBELL, Spain
| | - Rosa-Maria Lidón
- Cardiovascular Critical Care Unit, CIBER-CV Vall d'Hebron Hospital, Spain
| | | | - Javier Segovia-Cubero
- Advanced Heart Failure and Transplant Unit, Hospital Universitario Puerta de Hierro, Spain
| | | | - Johan Lassus
- Heart and Lung Centre, Helsinki University Hospital, Finland
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Germany
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, CIBERCV, Spain
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Hernández-Pérez FJ, Mirelis JG, Alonso-Pulpón L. Quiste cardiaco gigante: imagen singular de aneurisma ventricular. Rev Esp Cardiol (Engl Ed) 2014. [DOI: 10.1016/j.recesp.2013.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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7
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Hernández-Pérez FJ, Mirelis JG, Alonso-Pulpón L. Giant cardiac cyst: rare image of ventricular aneurysm. ACTA ACUST UNITED AC 2014; 67:406. [PMID: 24774735 DOI: 10.1016/j.rec.2013.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 09/12/2013] [Indexed: 10/25/2022]
Affiliation(s)
| | - Jesus G Mirelis
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Luis Alonso-Pulpón
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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8
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Hernández-Pérez FJ, Burgos-Lázaro RJ, Gómez-Bueno MF. A serious complication in a patient with a ventricular assist device. ACTA ACUST UNITED AC 2014; 67:322. [PMID: 24774596 DOI: 10.1016/j.rec.2013.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 08/02/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Francisco J Hernández-Pérez
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Raúl J Burgos-Lázaro
- Servicio de Cirugía Cardiovascular, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Manuel F Gómez-Bueno
- Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
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Hernández-Pérez FJ, Blasco-Lobo A, Goicolea L, Muñiz-Lozano A, Fernandez-Díaz JA, Domínguez JR, Goicolea-Ruigómez J. Use of the radial approach in primary angioplasty: results in 1029 consecutive patients and analyses in unfavorable subgroups. ACTA ACUST UNITED AC 2014; 67:45-51. [PMID: 24774263 DOI: 10.1016/j.rec.2013.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES The transradial approach is associated with a reduction in vascular access-related complications after primary percutaneous coronary interventions. The purpose of this study was to examine the feasibility of the routine use of transradial access in primary angioplasty and to evaluate how it affects subgroups with less favorable characteristics. METHODS We analyzed 1029 consecutive patients with an ST-segment elevation acute coronary syndrome treated with primary angioplasty. RESULTS Transradial access was the primary approach in 93.1% of the patients. The success rate of primary angioplasty was 95.9%, and 87.6% of the patients were event-free 30 days after the procedure. Crossover was required in 3.0% of the patients with primary transradial access, and this rate remained stable over the years. Predictors of the need for crossover were age older than 75 years (odds ratio=2.50, 95% confidence interval, 1.09-5.71; P=.03) and a history of ischemic heart disease (odds ratio=2.65; 95% confidence interval, 1.12-6.24; P=.02). Primary transfemoral access use was higher in women older than 75 years. Use of the transradial approach in this subgroup did not affect reperfusion time or the success of angioplasty, although there was a greater need for crossover (10.9% vs 2.6%; P=.006). Among patients in cardiogenic shock, the transradial approach was used in 51.5%; reperfusion times and angioplasty success rates were similar to those obtained with transfemoral access, but there was a greater need for crossover. CONCLUSIONS Transradial access can be used safely and effectively in most primary angioplasty procedures. In older women and in patients in cardiogenic shock, there is a higher crossover requirement, with no detriment to reperfusion time.
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Affiliation(s)
- Francisco J Hernández-Pérez
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
| | - Ana Blasco-Lobo
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Leire Goicolea
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Ana Muñiz-Lozano
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José A Fernandez-Díaz
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - José R Domínguez
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Javier Goicolea-Ruigómez
- Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
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Hernández-Pérez FJ, Blasco-Lobo A, Goicolea L, Muñiz-Lozano A, Fernandez-Díaz JA, Domínguez JR, Goicolea-Ruigómez J. El uso del acceso radial en la angioplastia primaria: resultados en 1.029 pacientes consecutivos y análisis en subgrupos desfavorables. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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