Metabolic syndrome predicts worse perioperative outcomes in patients treated with radical prostatectomy for non-metastatic prostate cancer
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01.06.2021 |
Luzzago S.
Palumbo C.
Rosiello G.
Pecoraro A.
Deuker M.
Stolzenbach F.
Mistretta F.A.
Tian Z.
Musi G.
Montanari E.
Shariat S.F.
Saad F.
Briganti A.
de Cobelli O.
Karakiewicz P.I.
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Surgical Oncology |
10.1016/j.suronc.2020.12.013 |
0 |
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© 2021 Elsevier Ltd Objectives: Metabolic syndrome (MetS) and its components (high blood pressure, BMI≥30, altered fasting glucose, low HDL cholesterol and high triglycerides) may undermine early perioperative outcomes after radical prostatectomy (RP). We tested this hypothesis. Materials & methods: Within the National Inpatient Sample database (2008–2015) we identified RP patients. The effect of MetS was tested in four separate univariable analyses, as well as in multivariable regression models predicting: 1) overall complications, 2) length of stay, 3) total hospital charges and 4) non-home based discharge. All models were weighted and adjusted for clustering, as well as all available patient and hospital characteristics. Results: Of 91,618 patients: 1) 50.2% had high blood pressure, 2) 8.0% had BMI≥30, 3) 13.0% had altered fasting glucose, 4) 22.8% had high triglycerides and 5) 0.03% had low HDL cholesterol. Respectively, one vs. two vs. three vs. four MetS components were recorded in 36.2% vs. 19.0% vs. 5.5% vs. 0.8% patients. Of all patients, 6.3% exhibited ≥3 components and qualified for MetS diagnosis. The rates of MetS increased over time (EAPC:+9.8%; p < 0.001). All four tested MetS components (high blood pressure, BMI≥30, altered fasting glucose and high triglycerides) achieved independent predictor status in all four examined endpoints. Moreover, a highly statistically significant dose-response was also confirmed for all four tested endpoints. Conclusion: MetS and its components consistently and strongly predict early adverse outcomes after RP. Moreover, the strength of the effect was directly proportional to the number of MetS components exhibited by each individual patient, even if formal MetS diagnosis of ≥3 components has not been met.
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An updated systematic review on the association between Cd exposure, blood pressure and hypertension
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15.01.2021 |
Martins A.C.
Almeida Lopes A.C.B.
Urbano M.R.
Carvalho M.d.F.H.
Silva A.M.R.
Tinkov A.A.
Aschner M.
Mesas A.E.
Silbergeld E.K.
Paoliello M.M.B.
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Ecotoxicology and Environmental Safety |
10.1016/j.ecoenv.2020.111636 |
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© 2020 The Authors Background: Since the first report by Perry et al. (1955), most studies affirmed the hypertensive effects of cadmium (Cd) in humans. Nonetheless, conclusions between studies remain inconsistent. Objective: The aim of this study was to reevaluate the evidence for a potential relationship between Cd exposure and altered blood pressure and/or hypertension, focusing on studies published between January 2010 and March 2020. Methods: We reviewed all observational studies from database searches (PubMed and SCOPUS) on Cd exposure and blood pressure or hypertension. We extracted information from studies that provided sufficient data on population characteristics, smoking status, exposure, outcomes, and design. Results: Thirty-eight studies met our inclusion criteria; of those, twenty-nine were cross sectional, three case control, five cohort and one interventional study. Blood or urinary Cd levels were the most commonly used biomarkers. Conclusions: A positive association between blood Cd levels and blood pressure and/or hypertension was identified in numerous studies at different settings. Limited number of representative population-based studies of never-smokers was observed, which may have confounded our conclusions. The association between urinary Cd and blood pressure and/or hypertension remains uncertain due to conflicting results, including inverse relationships with lack of strong mechanistic support. We point to the urgent need for additional longitudinal studies to confirm our findings.
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An updated systematic review on the association between Cd exposure, blood pressure and hypertension
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15.01.2021 |
Martins A.C.
Almeida Lopes A.C.B.
Urbano M.R.
Carvalho M.d.F.H.
Silva A.M.R.
Tinkov A.A.
Aschner M.
Mesas A.E.
Silbergeld E.K.
Paoliello M.M.B.
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Ecotoxicology and Environmental Safety |
10.1016/j.ecoenv.2020.111636 |
0 |
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© 2020 The Authors Background: Since the first report by Perry et al. (1955), most studies affirmed the hypertensive effects of cadmium (Cd) in humans. Nonetheless, conclusions between studies remain inconsistent. Objective: The aim of this study was to reevaluate the evidence for a potential relationship between Cd exposure and altered blood pressure and/or hypertension, focusing on studies published between January 2010 and March 2020. Methods: We reviewed all observational studies from database searches (PubMed and SCOPUS) on Cd exposure and blood pressure or hypertension. We extracted information from studies that provided sufficient data on population characteristics, smoking status, exposure, outcomes, and design. Results: Thirty-eight studies met our inclusion criteria; of those, twenty-nine were cross sectional, three case control, five cohort and one interventional study. Blood or urinary Cd levels were the most commonly used biomarkers. Conclusions: A positive association between blood Cd levels and blood pressure and/or hypertension was identified in numerous studies at different settings. Limited number of representative population-based studies of never-smokers was observed, which may have confounded our conclusions. The association between urinary Cd and blood pressure and/or hypertension remains uncertain due to conflicting results, including inverse relationships with lack of strong mechanistic support. We point to the urgent need for additional longitudinal studies to confirm our findings.
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Antihypertensive efficacy of a triple fixed-dose combination of perindopril, indapamide, and amlodipine: Clinical effectiveness in ambulatory practice (results of the PETRA study)
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01.01.2018 |
Lishuta A.
Privalova Elena V.
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Kardiologiya |
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0 |
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© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Most patients with arterial hypertension (AH) for successful long-term blood pressure (BP) control require combination of antihypertensive drugs acting on various target organs. Accumulated experience shows that about 30% of patients require combination therapy with 3 drugs from different pharmacological classes. Efficacy of BP control in real clinical practice with the use of various doses of perindopril, indapamide, and amlodipine as components of taken once-daily triple fixed combination was assessed in the 3-months prospective observational open-label PETRA study. In this study data of office BP measurements and 24-hour ambulatory BP monitoring (ABPM) were obtained from 11209 ambulatory patients (47.6% women) with AH. Initial mean office BP (BPmoff) was 156.58±16.10/91.56±9.33 mm Hg, AH duration - 9.48±7.19 years. After switching to triple fixed dose combination of perindopril, indapamide, and amlodipine BPmoff decreased by 24.81±15.47/11.41±9.90 mm Hg (p<0.0001). Doses of perindopril, indapamide, and amlodipine in combination at the final visit were 5/1.25/5, 10/2.5/5, and 10/2.5/10 mg. 24-hour ambulatory BP monitoring (ABPM) was carried out in 76 patients. Mean 24-hour BP lowed from mean 155.51±17.43/85.28±11.48 down to 134.63±12.51/77.83±8.99 mm Hg (p<0.0001). Clinically relevant improvement of a number of parameters of metabolism occurred after 3 months of the study (in particular, lowering of levels of total and low-density lipoprotein cholesterol [-8.6 and - 11.4%, respectively], triglycerides [-12,1%], fasting blood glucose [-6.6%]). Thus, results of the PETRA study confirmed 24-hour long antihypertensive efficacy of triple fixed dose combination of perindopril, indapamide, and amlodipine. This drug combination can present novel possibility in treatment of patients with AH who have not achieved target BP values on preceding dual combination therapy and fully corresponds with the single pill concept for formation of adherence to therapy.
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Influence of childhood and adulthood obesity on arterial stiffnes and central blood pressure in men
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01.01.2018 |
Isaykina O.
Rozanov V.
Alexandrov A.
Ivanova E.
Pugoeva H.
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Rational Pharmacotherapy in Cardiology |
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© 2018 Stolichnaya Izdatelskaya Kompaniya. Цель. Изучить влияние ожирения в детском и зрелом возрасте на показатели артериальной жесткости, центрального аортального давления в популяционной выборке мужчин 42-43 лет. Материал и методы. Представленное исследование является частью 32-летнего проспективного, когортного наблюдения за лицами мужского пола, начиная с детского возраста (11-12 лет). Через 32 года обследованы 303 (30,1%) представителя исходной популяционной выборки - 1005 человек. В анализ включены 290 человек. Средний возраст мужчин на момент настоящего обследования составил 42,9 лет. Обследование включало опрос по стандартной анкете, измерение антропометрических показателей, артериального давления (АД), подсчет пульса. Измерение жесткости артериальной стенки и центрального давления проводилось методом аппланационной тонометрии. Результаты. Согласно нашим данным из 290 мужчин в возрасте 43 лет только 95 (32,8%) имеют нормальную массу тела (МТ), у 111 (38,3%) выявлена избыточная МТ (ИМТ), а у 84 (28,9%) - ожирение (ОЖ). Мужчины с ОЖ и ИМТ во взрослом возрасте имели статистически значимую ИМТ уже в детском возрасте. Центральное аортальное АД (ЦАД) как суррогатный показатель жесткости сосудов было статистически значимо выше в группах с ОЖ и ИМТ. Корреляционный анализ выявил статистически значимую положительную взаимосвязь между показа- телями, характеризующими ОЖ в детском возрасте (индекс Кетле, толщина кожных складок), и уровнем АД в детском возрасте. Имеется по- ложительная корреляция между толщиной кожных складок в детстве с ЦАД во взрослом возрасте, а также слабая положительная связь между периферическим систолическим АД (пСАД) в детстве и центральным систолическим АД (цСАД) во взрослом возрасте. Из потенци- альных предикторов, оцененных в возрасте 12 лет и включенных в регрессионную модель, только толщина кожной складки под лопаткой (КСЛ) оказывает влияние на значение цСАД в возрасте 43 лет. С увеличением толщины КСЛ в детском возрасте на 1 мм связано повышение цСАД во взрослом состоянии на 0,4 мм.рт.ст. Среди предикторов, оцененных во взрослом возрасте, статистически значимое влияние на уровень цСАД оказывают пСАД, периферическое диастолическое АД (пДАД) и индекс Кетле. На значение центрального диастолического АД (цДАД) в возрасте 43 лет оказывает влияние толщина кожной складки на животе в 12-летнем возрасте. Среди потенциальных предикторов, оцененных во взрослом возрасте, статистически значимое влияние на уровень цДАД оказывают пДАД, показатели ожирения. Заключение. Во взрослом возрасте центральное аортальное давление максимально зависит от повышения периферического АД и показа- телей, характеризующих ожирение. Из детских предикторов (12-летнего возраста) значение имело только ожирение.
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Blood pressure variability in hypertension associated with coronary heart disease: Prognostic value and management approaches
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01.01.2018 |
Ostroumova O.
Kochetkov A.
Guseva T.
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Arterial Hypertension (Russian Federation) |
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2 |
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© 2018 All-Russian Public Organization Antihypertensive League. All rights reserved. The review discusses the role of blood pressure variability as a novel risk factor and its prognostic value in hypertension associated with the coronary artery disease. We discuss the modern approaches to calculation of blood pressure variability, its classification. The choice of antihypertensive drugs based on the blood pressure variability is discussed considering hypertension associated with coronary artery disease. We pay special attention to angiotensin enzyme converting inhibitors and calcium channel blockers, as well as their combinations. We present the evidence of the effects of perindopril and amlodipine and their fixed combination on the blood pressure variability and the decrease in cardiovascular risk in hypertension associated with coronary artery disease.
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Day-by day blood pressure variability: methodological aspects; prognostic value, effects of antihypertensive therapy
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01.01.2018 |
Ostroumova O.
Borisova E.
Guseva T.
Temirbulatov I.
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Kardiologiya |
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0 |
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© 2018 Media Sphera Publishing Group. All rights reserved. In this article we present problems of prognostic value of day-by-day blood pressure (BP) variability, its role in development and progression of damage of target organs in arterial hypertension, and impact on risk of cardiovascular, cerebral-vascular complications, and mortality. We also discuss methodological aspects of assessment of day-by-day BP variability. The article contains literature data on effects of antihypertensive therapy on variability of home BP, and consideration of evidence base of possibilities of the fixed amlo-dipine/perindopril combination for lowering day-by-day BP variability.
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Cognitive functions, emotional status, MRI measurements in treatment-naive middle-aged patients with uncomplicated essential arterial hypertension
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01.01.2018 |
Parfenov V.
Ostroumova T.
Ostroumova O.
Borisova E.
Perepelov V.
Perepelova E.
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Zhurnal Nevrologii i Psihiatrii imeni S.S. Korsakova |
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© 2018, Media Sphera Publishing Group. All rights reserved. Objective. To study cognitive functions, anxiety and depression levels, 24-hour blood pressure (BP) profile, cerebral blood flow (CBF) perfusion in treatment-naive middle-aged patients with uncomplicated essential arterial hypertension (EAH) depending on the white matter hyperintensities (WMH) burden. Material and methods. Forty-one hypertensive patients (mean age 46.2±4.6 years) and 41 healthy volunteers (mean age 50.3±6.7 years) were enrolled to the study. All subjects underwent brain MRI (MAGNETOM Skyra 3.0T, T1, T2 FSE, T2 FLAIR, T1 MPRAGE, ASL), Montreal cognitive assessment (MoCA), 10-word learning task, verbal fluency test, trail making test, Stroop color and word test, anxiety and depression assessment with Hamilton rating scales, 24-hour blood pressure monitoring (ABPM). Results. WMH were found in 22 (53.7%) hypertensive patients and in 3 (7.3%) healthy volunteers (p=0.0002). Hypertensive patients had the significantly lower CBF compared to controls (p<0.001). Conclusion. WMH were identified in treatment-naive middle-aged patients with uncomplicated mild to moderate EAH. There was an association between WMH and lower CBF in the cortical plate of frontal lobes, SBP variability and worse cognition. Cerebral hypoperfusion can cause cognitive impairment even in the earliest stages of EAH, which increases due to emotional disorders.
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Predictive significance of raised blood pressure in children and adolescents (32-year prospective follow-up)
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01.01.2018 |
Aleksandrov
Rozanov V.
Pugoeva K.
Ivanova E.
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Cardiovascular Therapy and Prevention (Russian Federation) |
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0 |
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© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. Although on the first glance, the prevention of arterial hypertension (AH) is effective since childhood and adolescence, further research is needed, as it is not well known how to make it effective. Aim. Based upon the analysis of 32-year long dynamics of various levels of blood pressure (BP), to define the efficacy of screening investigations in children. Material and methods. A 32-year long prospective, cohort study conducted, the observation of males beginning at age 11-12 y.o. In 32 years, among 1005 participants, 303 (30,1%) were investigated, and the cohort consisted finally of 290 persons. The assessment included: surveying, triple BP measurement, pulse count, body mass and height measurement, triceps skin folds thickness measurement, as scapular and abdominal, waist and hip circumference, total cholesterol measurement, as the high density, and level of triglycerides, electrocardiogram. Results. Among the males that at the age 12 were in the upper 20% (5th quintile) by systolic BP, in 32 years almost one quarter remained in the same quintile. The stability of raised BP the parameters influence such as body mass and skin fold thickness. Combination of raised systolic BP in high body mass in 13 y.o. adolescents does increase the risk of AH at 43 y.o. the same grade that does an isolated body mass increase - this witness on the decrease of baseline BP values role in hypertension developemnt with remaining role of body mass. The risk of AH development with the baseline age 15 y.o. was significantly higher in combination of overweight and AH. Conclusion. For AH prevention, even in childhood and adolescence it necessary to monitor closely those with raised systolic BP and overweight, and active prevention should start before the age 20 y.o.
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Effect of indapamide/perindopril fixed-dose combination on 24-hour blood pressure and cognitive functions in treatment-naive middle-aged patients with essential arterial hypertension
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01.01.2018 |
Ostroumova T.
Parfenov V.
Ostroumova O.
Borisova E.
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Nevrologiya, Neiropsikhiatriya, Psikhosomatika |
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1 |
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© Ima-Press Publishing House. All rights reserved. Objective: to investigate the effect of indapamide/perindopril fixed-dose combination (FC) on 24-hour blood pressure (BP) and cognitive functions in antihypertensive treatment-naive middle-aged patients with uncomplicated grade 1-2 essential arterial hypertension (EAH). Patients and methods. The open prospective study enrolled 25 patients (9 men and 16 women) aged 40-59 years with a diastolic BP of 90-109 mm Hg and/or a systolic BP of 140-179 mm Hg, as evidenced by routine measurements. As starting antihypertensive therapy, the patients received indapamide 1.25/perindopril 5 mg FC once daily in the morning; if necessary, after 2 weeks (if the routine blood pressure was ≥140/90 mm Hg) they took indapamide 2.5/perindopril 10 mg once daily in the morning. The follow-up period was 14-16 weeks. Before and at the end of the follow-up, the patients underwent 24-hour ambulatory BP monitoring (ABPM) and evaluation of cognitive functions using the Montreal Cognitive Assessment (MoCA), ten-words test (immediate and delayed word recall), verbal association test (literal and categorical associations), number connecting test (Trail making test (TMT), part A and numbers and letters connecting test (TMT) part B), and Stroop test. Results. At the end of the follow-up period, treatment with indapamide/perindopril fixed-dose combination showed a statistically significant reduction in BPs, as evidenced by routine measurements and ABPM (during 24-hour, and awake and sleep periods); a statistically significant cognitive improvement: an increase in the number of the so-called words in the ten-words test during both immediate (from 5.5±1.6 6.5±1.5 words; p=0.02 vs baseline) and delayed (from 6.2±1.7 to 7.4±1.4 words; p=vs baseline) recalls, a decrease in the performance time of TMT-B (from 112.6±42.5 to 90.4±28.4 sec; p=0.02) and Stroop test Part 3 (from 135.5±50.1 to 112.6±19.6 sec; p=0.02), and a larger number of called words in the categorical associations test (from 6.5±2.4 to 8.1±2.9 words; p=0.02). Conclusion. The results obtained indicate that in treatment-naive middle-aged patients with EAH, indapamide/perindopril fixed-dose combination assures an effective reduction in BPs, as evidenced by routine measurements and ABPM, also improves cognitive functions, particularly attention, information processing speed, semantic memory, cognitive flexibility, and short-term and long-term memory.
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Orthostatic hypotension: Definition, pathophysiology, classification, prognostic aspects, diagnostics and treatment
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01.01.2018 |
Ostroumova O.
Cherniaeva M.
Petrova M.
Golovina O.
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Rational Pharmacotherapy in Cardiology |
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1 |
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© 2018 Stolichnaya Izdatelskaya Kompaniya. All rights reserved. The urgency of the problem of orthostatic hypotension (OH) has increased in recent years. It was due to the high prevalence and its adverse effect on the prognosis and quality of life of patients, especially the elderly and oldest old. The purpose of this review was to summarize the contemporary domestic and foreign literature data about disease. The article presents an updated definition of OH, modern classification, pathophysiology, feature of the course of OH in the elderly, recommendations for diagnosis and treatment. Particular attention is paid to reviewing the results of scientific research on the influence of OH on the risk of developing coronary and cerebrovascular events and overall mortality. OH is one of the forms of orthostatic tolerance and diagnostic criteria were determined by the 2011 Consensus as a sustained fall of systolic blood pressure by at least 20 mm Hg and/or a diastolic blood pressure by 10 mm Hg within 3 min of standing. The prevalence of OH ranges depending on the age of the patients and the presence of a number of concomitant diseases: from 6% in healthy people without arterial hypertension up to 50% or more in people older than 75 years with a comorbid pathology. OH is an independent predictor of overall mortality and adverse cardiovascular events. OH is associated with an increased risk of serious adverse cerebrovascular and coronary events, and may also contribute to cognitive impairment and the development of dementia. For today, we have three clinical options OH: classical, early and delayed OH. In addition, OH is classified based on etiology-primary and secondary; and pathophysiological principle-neurogenic OH and not a neurogenic OH (or functional). The algorithm for identifying patients with a high risk of development of OH and diagnostic methods are also presented. Non-medicamentous and medicamentous methods of OH treatment are considered.
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