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Kruszka P, Addissie YA, McGinn DE, Porras AR, Biggs E, Share M, Crowley TB, Chung BHY, Mok GTK, Mak CCY, Muthukumarasamy P, Thong MK, Sirisena ND, Dissanayake VHW, Paththinige CS, Prabodha LBL, Mishra R, Shotelersuk V, Ekure EN, Sokunbi OJ, Kalu N, Ferreira CR, Duncan JM, Patil SJ, Jones KL, Kaplan JD, Abdul-Rahman OA, Uwineza A, Mutesa L, Moresco A, Obregon MG, Richieri-Costa A, Gil-da-Silva-Lopes VL, Adeyemo AA, Summar M, Zackai EH, McDonald-McGinn DM, Linguraru MG, Muenke M. 22q11.2 deletion syndrome in diverse populations. Am J Med Genet A 2017; 173:879-888. [PMID: 28328118 DOI: 10.1002/ajmg.a.38199] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [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: 01/05/2017] [Revised: 02/02/2017] [Accepted: 02/02/2017] [Indexed: 11/10/2022]
Abstract
22q11.2 deletion syndrome (22q11.2 DS) is the most common microdeletion syndrome and is underdiagnosed in diverse populations. This syndrome has a variable phenotype and affects multiple systems, making early recognition imperative. In this study, individuals from diverse populations with 22q11.2 DS were evaluated clinically and by facial analysis technology. Clinical information from 106 individuals and images from 101 were collected from individuals with 22q11.2 DS from 11 countries; average age was 11.7 and 47% were male. Individuals were grouped into categories of African descent (African), Asian, and Latin American. We found that the phenotype of 22q11.2 DS varied across population groups. Only two findings, congenital heart disease and learning problems, were found in greater than 50% of participants. When comparing the clinical features of 22q11.2 DS in each population, the proportion of individuals within each clinical category was statistically different except for learning problems and ear anomalies (P < 0.05). However, when Africans were removed from analysis, six additional clinical features were found to be independent of ethnicity (P ≥ 0.05). Using facial analysis technology, we compared 156 Caucasians, Africans, Asians, and Latin American individuals with 22q11.2 DS with 156 age and gender matched controls and found that sensitivity and specificity were greater than 96% for all populations. In summary, we present the varied findings from global populations with 22q11.2 DS and demonstrate how facial analysis technology can assist clinicians in making accurate 22q11.2 DS diagnoses. This work will assist in earlier detection and in increasing recognition of 22q11.2 DS throughout the world.
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Affiliation(s)
- Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Yonit A Addissie
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Daniel E McGinn
- Division of Human Genetics, 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Antonio R Porras
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, D.C
| | - Elijah Biggs
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, D.C
| | - Matthew Share
- Division of Human Genetics, 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - T Blaine Crowley
- Division of Human Genetics, 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brian H Y Chung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Gary T K Mok
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Christopher C Y Mak
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Premala Muthukumarasamy
- Faculty of Medicine, Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Meow-Keong Thong
- Faculty of Medicine, Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Nirmala D Sirisena
- Faculty of Medicine, Human Genetics Unit, University of Colombo, Sri Lanka
| | | | | | | | - Rupesh Mishra
- Faculty of Medicine, Human Genetics Unit, University of Colombo, Sri Lanka
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genetics, Faculty of Medicine, Department of Pediatrics, Chulalongkorn University, Bangkok, Thailand
| | - Ekanem Nsikak Ekure
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching, Lagos, Nigeria
| | | | - Nnenna Kalu
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching, Lagos, Nigeria
| | - Carlos R Ferreira
- Division of Genetics and Metabolism, Children's National Health System, Washington, D.C
| | - Jordann-Mishael Duncan
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | | | - Kelly L Jones
- Division of Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Julie D Kaplan
- Division of Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Omar A Abdul-Rahman
- Division of Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Annette Uwineza
- Center of Human Genetics/School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Leon Mutesa
- Center of Human Genetics/School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Angélica Moresco
- Servicio de Genética, Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | | | - Antonio Richieri-Costa
- Hospital for the Rehabilitation of Craniofacial Anomalies, São Paulo University, Bauru, Brazil
| | | | - Adebowale A Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Marshall Summar
- Division of Genetics and Metabolism, Children's National Health System, Washington, D.C
| | - Elaine H Zackai
- Division of Human Genetics, 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Donna M McDonald-McGinn
- Division of Human Genetics, 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington, D.C
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
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Kruszka P, Porras AR, Sobering AK, Ikolo FA, La Qua S, Shotelersuk V, Chung BHY, Mok GTK, Uwineza A, Mutesa L, Moresco A, Obregon MG, Sokunbi OJ, Kalu N, Joseph DA, Ikebudu D, Ugwu CE, Okoromah CAN, Addissie YA, Pardo KL, Brough JJ, Lee NC, Girisha KM, Patil SJ, Ng ISL, Min BCW, Jamuar SS, Tibrewal S, Wallang B, Ganesh S, Sirisena ND, Dissanayake VHW, Paththinige CS, Prabodha LBL, Richieri-Costa A, Muthukumarasamy P, Thong MK, Jones KL, Abdul-Rahman OA, Ekure EN, Adeyemo AA, Summar M, Linguraru MG, Muenke M. Down syndrome in diverse populations. Am J Med Genet A 2017; 173:42-53. [PMID: 27991738 DOI: 10.1002/ajmg.a.38043] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [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: 08/31/2016] [Accepted: 10/25/2016] [Indexed: 11/08/2022]
Abstract
Down syndrome is the most common cause of cognitive impairment and presents clinically with universally recognizable signs and symptoms. In this study, we focus on exam findings and digital facial analysis technology in individuals with Down syndrome in diverse populations. Photos and clinical information were collected on 65 individuals from 13 countries, 56.9% were male and the average age was 6.6 years (range 1 month to 26 years; SD = 6.6 years). Subjective findings showed that clinical features were different across ethnicities (Africans, Asians, and Latin Americans), including brachycephaly, ear anomalies, clinodactyly, sandal gap, and abundant neck skin, which were all significantly less frequent in Africans (P < 0.001, P < 0.001, P < 0.001, P < 0.05, and P < 0.05, respectively). Evaluation using a digital facial analysis technology of a larger diverse cohort of newborns to adults (n = 129 cases; n = 132 controls) was able to diagnose Down syndrome with a sensitivity of 0.961, specificity of 0.924, and accuracy of 0.943. Only the angles at medial canthus and ala of the nose were common significant findings amongst different ethnicities (Caucasians, Africans, and Asians) when compared to ethnically matched controls. The Asian group had the least number of significant digital facial biometrics at 4, compared to Caucasians at 8 and Africans at 7. In conclusion, this study displays the wide variety of findings across different geographic populations in Down syndrome and demonstrates the accuracy and promise of digital facial analysis technology in the diagnosis of Down syndrome internationally. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Antonio R Porras
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington DC
| | - Andrew K Sobering
- Department of Biochemistry, St. George's University, St. George's, Grenada, West Indies
| | - Felicia A Ikolo
- Department of Biochemistry, St. George's University, St. George's, Grenada, West Indies
| | - Samantha La Qua
- Department of Biochemistry, St. George's University, St. George's, Grenada, West Indies
| | - Vorasuk Shotelersuk
- Faculty of Medicine, Department of Pediatrics, Center of Excellence for Medical Genetics, Chulalongkorn University, Bangkok, Thailand
| | - Brian H Y Chung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong kong, China
| | - Gary T K Mok
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Hong kong, China
| | - Annette Uwineza
- Center of Human Genetics/ School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Leon Mutesa
- Center of Human Genetics/ School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Angélica Moresco
- Servicio de Genética Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | | | - Ogochukwu Jidechukwu Sokunbi
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria
| | - Nnenna Kalu
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria
| | - Daniel Akinsanya Joseph
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria
| | - Desmond Ikebudu
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria
| | - Christopher Emeka Ugwu
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria
| | - Christy A N Okoromah
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria
| | - Yonit A Addissie
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Katherine L Pardo
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - J Joseph Brough
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Ni-Chung Lee
- Department of Pediatrics and Medical Genetics, National Taiwan University Hospital, Taiwan
| | - Katta M Girisha
- Department of Medical Genetics, Kasturba Medical College, Manipal University, Manipal, India
| | | | - Ivy S L Ng
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | | | - Saumya S Jamuar
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | | | | | - Suma Ganesh
- Dr. Shroff Charity Eye Hospital, New Delhi, India
| | - Nirmala D Sirisena
- Faculty of Medicine, Human Genetics Unit, University of Colombo, Sri Lanka
| | | | | | | | | | - Premala Muthukumarasamy
- Faculty of Medicine, Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Meow-Keong Thong
- Faculty of Medicine, Department of Paediatrics, University of Malaya, Kuala Lumpur, Malaysia
| | - Kelly L Jones
- Division of Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Omar A Abdul-Rahman
- Division of Medical Genetics, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
| | - Ekanem Nsikak Ekure
- Department of Paediatrics College of Medicine, University of Lagos, Lagos University Teaching Hospital Idi-Araba, Lagos, Nigeria
| | - Adebowale A Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
| | - Marshall Summar
- Division of Genetics and Metabolism, Children's National Health System, Washington DC
| | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Health System, Washington DC
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute, The National Institutes of Health, Bethesda, Maryland
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Kruszka P, Addissie YA, McGinn DE, Porras AR, Biggs E, Share M, Crowley TB, Chung BHY, Mok GTK, Mak CCY, Muthukumarasamy P, Thong MK, Sirisena ND, Dissanayake VHW, Paththinige CS, Prabodha LBL, Mishra R, Shotelersuk V, Ekure EN, Sokunbi OJ, Kalu N, Ferreira CR, Duncan JM, Patil SJ, Jones KL, Kaplan JD, Abdul-Rahman OA, Uwineza A, Mutesa L, Moresco A, Obregon MG, Richieri-Costa A, Gil-da-Silva-Lopes VL, Adeyemo AA, Summar M, Zackai EH, McDonald-McGinn DM, Linguraru MG, Muenke M. Cover Image, Volume 173A, Number 4, April 2017. Am J Med Genet A 2017. [DOI: 10.1002/ajmg.a.38224] [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] [Indexed: 11/06/2022]
Affiliation(s)
- Paul Kruszka
- Medical Genetics Branch, National Human Genome Research Institute; The National Institutes of Health; Bethesda Maryland
| | - Yonit A. Addissie
- Medical Genetics Branch, National Human Genome Research Institute; The National Institutes of Health; Bethesda Maryland
| | - Daniel E. McGinn
- Division of Human Genetics; 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania
| | - Antonio R. Porras
- Sheikh Zayed Institute for Pediatric Surgical Innovation; Children's National Health System; Washington, D.C
| | - Elijah Biggs
- Sheikh Zayed Institute for Pediatric Surgical Innovation; Children's National Health System; Washington, D.C
| | - Matthew Share
- Division of Human Genetics; 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania
| | - T. Blaine Crowley
- Division of Human Genetics; 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania
| | - Brian H. Y. Chung
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Special Administrative Region Hong Kong China
| | - Gary T. K. Mok
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Special Administrative Region Hong Kong China
| | - Christopher C. Y. Mak
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine; The University of Hong Kong; Hong Kong Special Administrative Region Hong Kong China
| | | | - Meow-Keong Thong
- Faculty of Medicine, Department of Paediatrics; University of Malaya; Kuala Lumpur Malaysia
| | | | | | | | | | - Rupesh Mishra
- Faculty of Medicine, Human Genetics Unit; University of Colombo; Sri Lanka
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genetics; Faculty of Medicine, Department of Pediatrics, Chulalongkorn University; Bangkok Thailand
| | - Ekanem Nsikak Ekure
- Department of Paediatrics College of Medicine; University of Lagos, Lagos University Teaching; Lagos Nigeria
| | | | - Nnenna Kalu
- Department of Paediatrics College of Medicine; University of Lagos, Lagos University Teaching; Lagos Nigeria
| | - Carlos R. Ferreira
- Division of Genetics and Metabolism; Children's National Health System; Washington, D.C
| | - Jordann-Mishael Duncan
- Medical Genetics Branch, National Human Genome Research Institute; The National Institutes of Health; Bethesda Maryland
| | | | - Kelly L. Jones
- Division of Medical Genetics, Department of Pediatrics; University of Mississippi Medical Center; Jackson Mississippi
| | - Julie D. Kaplan
- Division of Medical Genetics, Department of Pediatrics; University of Mississippi Medical Center; Jackson Mississippi
| | - Omar A. Abdul-Rahman
- Division of Medical Genetics, Department of Pediatrics; University of Mississippi Medical Center; Jackson Mississippi
| | - Annette Uwineza
- Center of Human Genetics/School of Medicine and Pharmacy, College of Medicine and Health Sciences; University of Rwanda; Kigali Rwanda
| | - Leon Mutesa
- Center of Human Genetics/School of Medicine and Pharmacy, College of Medicine and Health Sciences; University of Rwanda; Kigali Rwanda
| | - Angélica Moresco
- Servicio de Genética; Hospital de Pediatría Garrahan; Buenos Aires Argentina
| | | | - Antonio Richieri-Costa
- Hospital for the Rehabilitation of Craniofacial Anomalies; São Paulo University; Bauru Brazil
| | | | - Adebowale A. Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute; The National Institutes of Health; Bethesda Maryland
| | - Marshall Summar
- Division of Genetics and Metabolism; Children's National Health System; Washington, D.C
| | - Elaine H. Zackai
- Division of Human Genetics; 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania
| | - Donna M. McDonald-McGinn
- Division of Human Genetics; 22q and You Center, and Clinical Genetics Center, The Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania; Philadelphia Pennsylvania
| | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation; Children's National Health System; Washington, D.C
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute; The National Institutes of Health; Bethesda Maryland
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Abstract
BACKGROUND Cleft palate is the commonest multifactorial epigenetic disorder with a prevalence of 0.43-2.45 per 1000. The objectives of this study were to evaluate the clinical features and identify the 22q11.2 deletion in patients with cleft palate in Sri Lanka. MATERIALS AND METHODS Cleft patients attending a Teaching Hospital in Sri Lanka were recruited for this study. The relevant data were obtained from review of case notes, interviews, and examination of patients according to a standard evaluation sheet. Quantitative multiplex polymerase chain reaction (PCR) was performed to identify the 22q11.2 deletion. A gel documentation system (Bio-Doc) was used to quantify the PCR product following electrophoresis on 0.8% agarose gel. RESULTS AND CONCLUSION There were 162 cleft palate patients of whom 59% were females. A total of 92 cleft palate subjects (56.2%) had other associated clinical features. Dysmorphic features (25.27%) and developmental delays (25.27%) were the commonest medical problems encountered. The cleft was limited to the soft palate in 125 patients, while in 25 patients it involved both the hard and the soft palate. There were seven subjects with bifid uvula and five subjects with submucous cleft palate. None of the patients had 22q11.2 deletion in this study population. A multicentered large population-based study is needed to confirm the results of this study and to develop guidelines on the appropriate use of 22q11.2 deletion testing, which are valid for cleft palate patients in Sri Lanka.
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Affiliation(s)
- L. B. Lahiru Prabodha
- Molecular Genetics Laboratory, Department of Anatomy, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | - Dayanath Kumara Dias
- Regional Cleft Centre & Maxillo-Facial Department, Teaching Hospital, Karapitiya, Galle, Sri Lanka
| | - B. Ganananda Nanayakkara
- Molecular Genetics Laboratory, Department of Anatomy, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
| | | | | | - Isurani Ileyperuma
- Molecular Genetics Laboratory, Department of Anatomy, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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