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Song SW, Yoo KY, Ro YS, Pyeon T, Bae HB, Kim J. Sugammadex is associated with shorter hospital length of stay after open lobectomy for lung cancer: a retrospective observational study. J Cardiothorac Surg 2021; 16:45. [PMID: 33757525 PMCID: PMC7987114 DOI: 10.1186/s13019-021-01427-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/12/2021] [Indexed: 11/28/2022] Open
Abstract
Background Sugammadex is associated with few postoperative complications. Postoperative pulmonary complications (PPC) are related to prolonged hospitalizations. Present study explored whether the use of sugammadex could reduce PPCs and thereby reduce hospital length of stay (LOS) after lung surgery. Methods We reviewed the medical records of patients who underwent elective open lobectomy for lung cancer from January 2010 to December 2015. Patients were divided into the sugammadex group and pyridostigmine group. The primary outcome was hospital LOS and secondary outcomes were postoperative complications and overall survival at 1 year. The cohort was subdivided into patients with and without prolonged LOS to explore the effects of sugammadex on outcomes in each group. Risk factors for LOS were determined via multivariate analyses. After propensity score matching, 127 patients were assigned to each group. Results Median hospital LOS was shorter (10.0 vs. 12.0 days) and the incidence of postoperative atelectasis was lower (18.1 vs. 29.9%) in the sugammadex group. However, no significant difference in overall survival between the groups was seen over 1 year (hazard ratio, 0.967; 95% confidence interval, 0.363 to 2.577). Sugammadex was a predictor related to LOS (exponential coefficient 0.88; 95% CI 0.82–0.95). Conclusions Our data suggest that sugammadex is a preferable agent for neuromuscular blockade (NMB) reversal than cholinesterase inhibitors in this patient population. Trial registration This study registered in the Clinical Research Information Service of the Korea National Institute of Health (approval number: KCT0004735, Date of registration: 21 January 2020, Retrospectively registered).
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Affiliation(s)
- Seung Won Song
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501-746, South Korea
| | - Kyung Yeon Yoo
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501-746, South Korea
| | - Yong Sung Ro
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501-746, South Korea
| | - Taehee Pyeon
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501-746, South Korea
| | - Hong-Beom Bae
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501-746, South Korea.
| | - Joungmin Kim
- Department of Anesthesiology and Pain Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, 501-746, South Korea.
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Lima Cavalcanti I, Braga ELC, Verçosa N, Schanaider A, Barrucand L, Boer HDD, Vane L. [Effects of rocuronium, sugammadex and rocuronium-sugammadex complex on coagulation in rats]. Rev Bras Anestesiol 2020; 70:635-641. [PMID: 33218691 DOI: 10.1016/j.bjan.2020.08.007] [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: 09/04/2019] [Revised: 08/15/2020] [Accepted: 08/23/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Sugammadex is an alternative pharmacological drug capable of reversing neuromuscular blockades without the limitations that are presented by anticholinesterase drugs. Coagulation disorders that are related to treatment with sugammadex were reported. The exact mechanism of the effects on coagulation are not fully understood. The objective of this research is to evaluate the effects of rocuronium, sugammadex and the rocuronium-sugammadex complex on coagulation in an experimental model in rats. METHODS This is an experimental randomized animal study. Wistar rats were randomly assigned into the following groups: the Control Group; the Ssal Group - 0.5 mL of intravenous saline; the Sugammadex Group - intravenous sugammadex (100 mg.kg-1); and the Rocuronium-Sugammadex Group - intravenous solution with rocuronium (3.75 mg.kg-1) and sugammadex (100 mg.kg-1). Anesthesia was performed by using isoflurane with controlled ventilation. Coagulation factors were measured 10 minutes after the end of the preoperative preparation and 30 minutes after the administration of the drugs in accordance with the chosen groups. RESULTS Platelet counts, prothrombin times and activated partial thromboplastin times were similar between the groups and between the moments within each group. There were reductions in the plasma fibrinogen levels between sample times 1 and 2 in the Rocuronium-Sugammadex group (p=0.035). CONCLUSIONS The rocuronium-sugammadex complex promoted reductions in plasma fibrinogen counts, although the levels were still within normal limits.
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Affiliation(s)
| | | | - Nubia Verçosa
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Louis Barrucand
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Luiz Vane
- Universidade Estadual Paulista (UNESP), São Paulo, SP, Brasil
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Oliveira C, Marques C, Simões V, Spencer L, Poeira R, Casteleira M. [Severe bradycardia and asystole associated with sugammadex: case report]. Rev Bras Anestesiol 2018; 69:218-221. [PMID: 30348442 DOI: 10.1016/j.bjan.2018.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 03/01/2018] [Revised: 09/16/2018] [Accepted: 09/20/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Sugamadex is a modified gamma-cyclodextrin, the first selective agent for reversal of neuromuscular blockade induced by steroidal non-depolarizing muscle relaxants, with greater affinity for rocuronium. In this article we present a case of severe bradycardia and asystole following sugammadex administration. CASE REPORT A 54-year-old male patient, ASA II, with a history of hypertension, dyslipidemia and obesity, who underwent an emergency umbilical herniorrhaphy under balanced general anesthesia. Intraoperative muscle relaxation was maintained with rocuronium. At the end of the surgery, the patient maintained a neuromuscular block with two TOF responses, and sugammadex (200mg) was administered. About thirty seconds after its administration, the patient developed marked bradycardia (HR 30 bpm) followed by asystole. CONCLUSIONS Documented bradycardia and asystole were attributed to the administration of sugammadex. This case shows that, although rare, cardiac arrest is a possible adverse effect of this drug, and that the knowledge of this situation can be determinant for the patient's evolution.
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Affiliation(s)
| | | | - Vânia Simões
- Centro Hospitalar Lisboa Central, EPE, Lisboa, Portugal
| | - Leina Spencer
- Centro Hospitalar Lisboa Central, EPE, Lisboa, Portugal
| | - Rita Poeira
- Centro Hospitalar Lisboa Central, EPE, Lisboa, Portugal
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Schepens T, Cammu G, Maes S, Desmedt B, Vos W, Deseure K. [Functional respiratory imaging after neostigmine- or sugammadex-enhanced recovery from neuromuscular blockade in the anesthetised rat: a randomised controlled pilot study]. Rev Bras Anestesiol 2017; 67:443-449. [PMID: 28526472 DOI: 10.1016/j.bjan.2017.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/24/2015] [Accepted: 11/23/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Reductions in diaphragm activity are associated with the postoperative development of atelectasis. Neostigmine reversal is also associated with increased atelectasis. We assessed the effects of neostigmine, sugammadex, and spontaneous reversal on regional lung ventilation and airway flow. METHODS Six Sprague-Dawley rats were paralysed with rocuronium and mechanically ventilated until recovery of the train-of-four ratio to 0.5. We administered neostigmine (0.06mg.kg-1), sugammadex (15mg.kg-1), or saline (n=2 per group). Computed tomography scans were obtained during the breathing cycle. Three-dimensional models of lung lobes were generated using functional respiratory imaging technology, and lobar volumes were calculated during the breathing cycle. The diaphragmatic surface was segmented for the end-expiratory and end-inspiratory scans. The total change in volume was reported by the lung volume change from the end-expiratory scan to the end-inspiratory scan. Chest wall movement was defined as the lung volume change minus the volume change that resulted from diaphragm excursion. RESULTS The two rats that received neostigmine exhibited a smaller relative contribution of diaphragm movement to the total change in lung volume compared with the two rats that received sugammadex or saline (chest wall contribution (%): 26.69 and 25.55 for neostigmine; -2.77 and 15.98 for sugammadex; 18.82 and 10.30 for saline). CONCLUSION This pilot study in rats demonstrated an increased relative contribution of chest wall expansion after neostigmine compared with sugammadex or saline. This smaller relative contribution of diaphragm movement may be explained by a neostigmine-induced decrease in phrenic nerve activity or by remaining occupied acetylcholine receptors after neostigmine.
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Affiliation(s)
- Tom Schepens
- Antwerp University Hospital, Department of Anesthesiology, Edegem, Bélgica
| | - Guy Cammu
- Onze-Lieve-Vrouw Ziekenhuis, Anesthesiology and Critical Care Medicine, Aalst, Bélgica.
| | - Sabine Maes
- Antwerp University Hospital, Department of Anesthesiology, Edegem, Bélgica
| | | | | | - Kristof Deseure
- University of Antwerp, Deparment of Algology, Wilrijk, Bélgica
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Hancı V, Özbilgin Ş, Özbal S, Kamacı G, Ateş H, Boztaş N, Ergür BU, Arıkanoğlu A, Yılmaz O, Yurtlu BS. Evaluation of the effects of intra-arterial sugammadex and dexmedetomidine: an experimental study. Braz J Anesthesiol 2016; 66:456-64. [PMID: 27591458 DOI: 10.1016/j.bjane.2015.01.003] [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: 12/20/2014] [Accepted: 01/30/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Intra-arterial injection of medications may cause acute and severe ischemia and result in morbidity and mortality. There is no information in the literature evaluating the arterial endothelial effects of sugammadex and dexmedetomidine. The hypothesis of our study is that sugammadex and dexmedetomidine will cause histological changes in arterial endothelial structure when administered intra-arterially. METHODS Rabbits were randomly divided into 4 groups. Group Control (n=7); no intervention performed. Group Catheter (n=7); a cannula inserted in the central artery of the ear, no medication was administered. Group Sugammadex (n=7); rabbits were given 4mg/kg sugammadex into the central artery of the ear, and Group Dexmedetomidine (n=7); rabbits were given 1μg/kg dexmedetomidine into the central artery of the ear. After 72h, the ears were amputated and histologically investigated. RESULTS There was no significant difference found between the control and catheter groups in histological scores. The endothelial damage, elastic membrane and elastic fiber damage, smooth muscle hypertrophy and connective tissue increase scores in the dexmedetomidine and sugammadex groups were significantly higher than both the control and the catheter groups (p<0.05). There was no significant difference found between the dexmedetomidine and sugammadex groups in histological scores. CONCLUSION Administration of sugammadex and dexmedetomidine to rabbits by intra-arterial routes caused histological arterial damage. To understand the histological changes caused by sugammadex and dexmedetomidine more clearly, more experimental research is needed.
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Affiliation(s)
- Volkan Hancı
- Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İnciraltı, İzmir, Turkey.
| | - Şule Özbilgin
- Dokuz Eylül University, School of Medicine, Department of Histology and Embryology, İnciraltı, İzmir, Turkey
| | - Seda Özbal
- Dokuz Eylül University, School of Medicine, Department of Histology and Embryology, İnciraltı, İzmir, Turkey
| | - Gonca Kamacı
- Dokuz Eylül University, School of Medicine, Department of Experienced Laboratory Animal Science, İnciraltı, İzmir, Turkey
| | - Hasan Ateş
- Dokuz Eylül University, School of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, İnciraltı, İzmir, Turkey
| | - Nilay Boztaş
- Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İnciraltı, İzmir, Turkey
| | - Bekir Uğur Ergür
- Dokuz Eylül University, School of Medicine, Department of Histology and Embryology, İnciraltı, İzmir, Turkey
| | - Ahmet Arıkanoğlu
- Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İnciraltı, İzmir, Turkey
| | - Osman Yılmaz
- Dokuz Eylül University, School of Medicine, Department of Experienced Laboratory Animal Science, İnciraltı, İzmir, Turkey
| | - Bülent Serhan Yurtlu
- Dokuz Eylül University, School of Medicine, Department of Anesthesiology and Reanimation, İnciraltı, İzmir, Turkey
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Pişkin Ö, Küçükosman G, Altun DU, Çimencan M, Özen B, Aydın BG, Okyay RD, Ayoğlu H, Turan IÖ. The effect of sugammadex on postoperative cognitive function and recovery. Braz J Anesthesiol 2016; 66:376-82. [PMID: 27343787 DOI: 10.1016/j.bjane.2014.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/29/2014] [Revised: 10/20/2014] [Accepted: 10/28/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. METHODS Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S) or the Neostigmine group (Group N). The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). After baseline assessment 12-24h before the operation. After the operation, when the Modified Aldrete Recovery Score was ≥9 the MMSE and 1h later the MoCA tests were repeated. RESULTS Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p>0.05). The time to reach TOF 0.9 was 2.19min in Group S and 6.47min in Group N (p<0.0001). Recovery time was 8.26min in Group S and 16.93min in Group N (p<0.0001). CONCLUSION We showed that the surgical procedure and/or accompanying anesthetic procedure may cause a temporary or permanent regression in cognitive function in the early postoperative period. However, better cognitive performance could not be proved in the Sugammadex compared to the Neostigmine.
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Affiliation(s)
- Özcan Pişkin
- Department of Anesthesiology and Reanimation, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey.
| | - Gamze Küçükosman
- Department of Anesthesiology and Reanimation, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | | | - Murat Çimencan
- Department of Anesthesiology and Reanimation, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Banu Özen
- Department of Neurology, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Bengü Gülhan Aydın
- Department of Anesthesiology and Reanimation, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Rahşan Dilek Okyay
- Department of Anesthesiology and Reanimation, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Hilal Ayoğlu
- Department of Anesthesiology and Reanimation, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Işıl Özkoçak Turan
- Department of Anesthesiology and Reanimation, Ankara Numune Practice and Research Hospital, Ankara, Turkey
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Pişkin Ö, Küçükosman G, Altun DU, Çimencan M, Özen B, Aydın BG, Okyay RD, Ayoğlu H, Turan IÖ. [The effect of sugammadex on postoperative cognitive function and recovery]. Rev Bras Anestesiol 2016; 66:376-82. [PMID: 27157202 DOI: 10.1016/j.bjan.2016.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 05/29/2014] [Accepted: 10/28/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Sugammadex is the first selective relaxant binding agent. When compared with neostigmine, following sugammadex administration patients wake earlier and have shorter recovery times. In this study, we hypothesized that fast and clear awakening in patients undergoing general anesthesia has positive effects on cognitive functions in the early period after operation. METHODS Approved by the local ethical committee, 128 patients were enrolled in this randomized, prospective, controlled, double-blind study. Patients were allocated to either Sugammadex group (Group S) or the Neostigmine group (Group N). The primary outcome of the study was early postoperative cognitive recovery as measured by the Montreal Cognitive Assessment (MoCA) and Mini Mental State Examination (MMSE). After baseline assessment 12-24h before the operation. After the operation, when the Modified Aldrete Recovery Score was ≥9 the MMSE and 1h later the MoCA tests were repeated. RESULTS Although there was a reduction in MoCA and MMSE scores in both Group S and Group N between preoperative and postoperative scores, there was no statistically significant difference in the slopes (p>0.05). The time to reach TOF 0.9 was 2.19min in Group S and 6.47min in Group N (p<0.0001). Recovery time was 8.26min in Group S and 16.93min in Group N (p<0.0001). CONCLUSION We showed that the surgical procedure and/or accompanying anesthetic procedure may cause a temporary or permanent regression in cognitive function in the early postoperative period. However, better cognitive performance could not be proved in the Sugammadex compared to the Neostigmine.
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Affiliation(s)
- Özcan Pişkin
- Departamento de Anestesiologia e Reanimação, School of Medicine, Bulent Ecevit University, Zonguldak, Turquia.
| | - Gamze Küçükosman
- Departamento de Anestesiologia e Reanimação, School of Medicine, Bulent Ecevit University, Zonguldak, Turquia
| | | | - Murat Çimencan
- Departamento de Anestesiologia e Reanimação, School of Medicine, Bulent Ecevit University, Zonguldak, Turquia
| | - Banu Özen
- Departamento de Neurologia, School of Medicine, Bulent Ecevit University, Zonguldak, Turquia
| | - Bengü Gülhan Aydın
- Departamento de Anestesiologia e Reanimação, School of Medicine, Bulent Ecevit University, Zonguldak, Turquia
| | - Rahşan Dilek Okyay
- Departamento de Anestesiologia e Reanimação, School of Medicine, Bulent Ecevit University, Zonguldak, Turquia
| | - Hilal Ayoğlu
- Departamento de Anestesiologia e Reanimação, School of Medicine, Bulent Ecevit University, Zonguldak, Turquia
| | - Işıl Özkoçak Turan
- Departamento de Anestesiologia e Reanimação, Ankara Numune Practice and Research Hospital, Ankara, Turquia
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Rodríguez Sánchez M E, Martínez Torres C, Herrera Calo P, Jiménez I. [Use of sugammadex in burn patients: descriptive study]. Rev Bras Anestesiol 2015; 65:240-3. [PMID: 26071837 DOI: 10.1016/j.bjan.2014.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 08/13/2014] [Accepted: 10/08/2014] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The burn patient is a challenge for the anesthesiologist, undergoing several surgeries during admission, and requiring general anesthesia and muscle relaxation most of the times. They have respiratory system impairment and a response to muscle relaxants that differs from the healthy patient, thus proper monitoring and reversal is crucial. We analyzed sugammadex effectiveness and safety in this population. MATERIAL AND METHODS Prospectively descriptive study including four patients, all of them considered major burn patients, who underwent escharotomy with general anesthesia and neuromuscular relaxation. The main variable was the time for recovery of a TOF higher than 0.9 after the administration of sugammadex before extubation. RESULTS Mean time of recovery from a TOF ratio higher than 0.9 following the administration of Sugammadex was of 4.95minutes 95% CI (3.25-6.64, p=.53); CONCLUSIONS The reversion of neuromuscular relaxation with sugammadex appears to be effective and safe in the burn patient. More analytical, comparative studies, of larger populations would be necessary to confirm this data.
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Affiliation(s)
| | | | - Pablo Herrera Calo
- Anestesiologia e Reanimação, Hospitais Universitários Virgen del Rocío, Sevilha, Espanha
| | - Ignacio Jiménez
- Anestesiologia e Reanimação, Hospitais Universitários Virgen del Rocío, Sevilha, Espanha
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