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Marschalek J, Egarter C, Vytiska-Binsdorfer E, Obruca A, Campbell J, Harris P, van Santen M, Lesoine B, Ott J, Franz M. Pregnancy rates after slow-release insemination (SRI) and standard bolus intrauterine insemination (IUI) - A multicentre randomised, controlled trial. Sci Rep 2020; 10:7719. [PMID: 32382043 PMCID: PMC7206062 DOI: 10.1038/s41598-020-64164-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 04/07/2020] [Indexed: 11/20/2022] Open
Abstract
This multicentre, randomised, controlled cross-over trial was designed to investigate the effect of intra-uterine slow-release insemination (SRI) on pregnancy rates in women with confirmed infertility or the need for semen donation who were eligible for standard bolus intra-uterine insemination (IUI). Data for a total of 182 women were analysed after randomisation to receive IUI (n = 96) or SRI (n = 86) first. The primary outcome was serological pregnancy defined by a positive beta human chorionic gonadotropin test, two weeks after insemination. Patients who did not conceive after the first cycle switched to the alternative technique for the second cycle: 44 women switched to IUI and 58 switched to SRI. In total, there were 284 treatment cycles (IUI: n = 140; SRI: n = 144). Pregnancy rates following SRI and IUI were 13.2% and 10.0%, respectively, which was not statistically significant (p = 0.202). A statistically significant difference in pregnancy rates for SRI versus IUI was detected in women aged under 35 years. In this subgroup, the pregnancy rate with SRI was 17% compared to 7% with IUI (relative risk 2.33; p = 0.032) across both cycles. These results support the hypothesis that the pregnancy rate might be improved with SRI compared to standard bolus IUI, especially in women aged under 35 years.
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Affiliation(s)
- Julian Marschalek
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Egarter
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Elisabeth Vytiska-Binsdorfer
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Andreas Obruca
- Kinderwunschzentrum Goldenes Kreuz, Lazarettgasse 16, 1090, Vienna, Austria
| | - Jackie Campbell
- Faculty of Health and Society, University of Northampton, Northampton, NN2 7AL, UK
| | - Philip Harris
- Department of Gynaecology, Wrightington Hospital, Wigan, Lancashire, WN6 9EP, UK
| | - Maarten van Santen
- Private Office and Spermbank, Kriegsstrasse 216, 76135, Karlsruhe, Germany
| | - Bernd Lesoine
- A.R.T. Bogenhausen, Prinzregentenstraße 69, 81675, Munich, Germany
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Maximilian Franz
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Siriwardhana C, Kulasekera KB, Datta S. Personalized treatment selection using data from crossover designs with carry-over effects. Stat Med 2019; 38:5391-5412. [PMID: 31637762 DOI: 10.1002/sim.8372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 05/29/2019] [Accepted: 08/24/2019] [Indexed: 11/07/2022]
Abstract
In this work, we propose a semiparametric method for estimating the optimal treatment for a given patient based on individual covariate information for that patient when data from a crossover design are available. Here, we assume there are carry-over effects for patients switching from one treatment to another. For the K treatment (K ≥ 2) scenario, we show that nonparametric estimation of carry-over effects can have the undesirable property that comparison of treatment means can only be done using independent outcome measurements from different groups of patients rather than using available joint measurements for each patient. To overcome this barrier, we compare probabilities of outcome variable of each treatment dominating outcome variables for all other treatments conditional on patient-specific scores constructed from patient covariates. We suggest single-index models as appropriate models connecting outcome variables to covariates and our empirical investigations show that frequencies of correct treatment assignments are highly accurate. The proposed method is also rather robust against departures from a single-index model structure. We also conduct a real data analysis to show the applicability of the proposed procedure.
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Affiliation(s)
- Chathura Siriwardhana
- Department of Quantitative Health Sciences, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii
| | - K B Kulasekera
- Department of Bioinformatics & Biostatistics, University of Louisville, Louisville, Kentucky
| | - Somnath Datta
- Department of Biostatistics, University of Florida, Gainesville, Florida
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Budhram DR, Shi D, McDonald SD, Walter SD. The crossover design for studies of infertility employing in-vitro fertilization: A methodological survey. Contemp Clin Trials Commun 2019; 16:100426. [PMID: 31517133 PMCID: PMC6734149 DOI: 10.1016/j.conctc.2019.100426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/21/2019] [Accepted: 08/04/2019] [Indexed: 01/06/2023] Open
Abstract
Background Infertility has become increasingly common worldwide. There is a need for the infertility literature to evaluate new interventions with IVF. The crossover design presents many methodological advantages for IVF trials. In addition to providing a within-person comparison of outcomes, it offers participants the opportunity to potentially benefit from more than one available treatment. However, infertility studies present a unique challenge in terms of bias: successful participants do not cross over to the second treatment group. Objectives The main objective of our study was to survey the methodological features of crossover trials for infertility with in-vitro fertilization (IVF) based interventions. A secondary focus was reporting key results. Study design & setting We conducted a methodological survey by systematically searching Medline and Embase databases. The capture-recapture technique was used to estimate the number of relevant studies that were not retrieved by our search strategy. We employed the Cochrane risk of bias tool to assess methodological rigour. Crossover-specific methods features were summarized. Treatment effects for pregnancy outcomes across studies are also presented. Results 15 studies met inclusion criteria. Most studies were deemed to have high or unclear risks of bias, usually because of incomplete reporting of outcome data and assessment procedures. 13 studies did not employ crossover-specific methods to analyze outcome data by period, which may bias treatment effect estimates. Four studies reported pregnancy outcome data with sample sizes from both treatment periods. Of these four studies, three reported that the control intervention was favoured. Conclusions The main limitation of our survey was the small sample size of studies. Future reviews should be larger and seek to encompass a broader range of the infertility literature. Despite the issues identified in the included trials, consideration should still be given to using the crossover design in future infertility research. Employing crossover-specific analysis methods, such as accounting for participant non-completion, along with strict adherence to CONSORT reporting guidelines, may significantly reduce the risk of bias in individual studies.
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Affiliation(s)
- Dalton R Budhram
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, ON, L8S 4K1, Canada
| | - Daniel Shi
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, ON, L8S 4K1, Canada
| | - Sarah D McDonald
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, ON, L8S 4K1, Canada.,Department of Obstetrics and Gynecology, McMaster University Faculty of Health Sciences, Hamilton, ON, L8S 4K1, Canada.,Department of Radiology, McMaster University Faculty of Health Sciences, Hamilton, ON, L8S 4K1, Canada
| | - Stephen D Walter
- Department of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, ON, L8S 4K1, Canada
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Tsaousi GG, Marocchi L, Sergi PG, Pourzitaki C, Santoro A, Bilotta F. Early and late clinical outcomes after decompressive craniectomy for traumatic refractory intracranial hypertension: a systematic review and meta-analysis of current evidence. J Neurosurg Sci 2018; 64:97-106. [PMID: 30356035 DOI: 10.23736/s0390-5616.18.04527-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Decompressive craniectomy (DC) to control refractory intracranial hypertension in patients with traumatic brain injury (TBI), has been listed as possible but controversial therapeutic approach in the latest version of TBI management guidelines. This study aimed to perform a systematic review and meta-analysis on efficacy and safety of DC compared to standard care in TBI patients. EVIDENCE ACQUISITION A database search from 2011 to 2017 was conducted to identify studies pertinent to DC compared to standard care after TBI. The primary outcomes were mortality and functional outcome upon hospital discharge and at 6 and 12 months after intervention, whereas secondary outcomes were intracranial pressure (ICP) control, hospitalization data and occurrence of adverse events. EVIDENCE SYNTHESIS Three randomized controlled trials and two observational studies enrolling 3451 patients were selected for qualitative analysis, among which four were included in the meta-analysis. DC-treated patients showed a significant reduction of overall mortality (RR, 0.57; 95% CI: 0.5-0.66; P<0.001; I2=17%) with no profound beneficial effect on functional outcome (RR, 0.89; 95% CI: 0.78-1.02; P=0.09; I2=58%) compared to those receiving standard care. A more efficient ICP reduction and a tendency towards shorter duration of hospitalization were recorded in DC versus standard care group. Adverse events are more common in DC-treated patients. CONCLUSIONS It seems that, in TBI patients with intracranial hypertension, the use of DC is associated with survival benefit when compared to medical therapy alone, but with no clear improvement of functional outcome. Yet no definite conclusion can be drawn due to limited quantity and considerable heterogeneity of available data.
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Affiliation(s)
- Georgia G Tsaousi
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece -
| | - Lorenzo Marocchi
- Department of Anesthesiology and Intensive Care Medicine, Sapienza University, Rome, Italy
| | - Paola G Sergi
- Department of Anesthesiology and Intensive Care Medicine, Sapienza University, Rome, Italy
| | - Chryssa Pourzitaki
- Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonio Santoro
- Department of Neurosurgery, Sapienza University, Rome, Italy
| | - Federico Bilotta
- Department of Anesthesiology and Intensive Care Medicine, Sapienza University, Rome, Italy
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Pendola F, Gadde R, Ripat C, Sharma R, Picado O, Lobo L, Sleeman D, Livingstone AS, Merchant N, Yakoub D. Distal pancreatectomy for benign and low grade malignant tumors: Short-term postoperative outcomes of spleen preservation-A systematic review and update meta-analysis. J Surg Oncol 2017; 115:137-143. [PMID: 28133818 DOI: 10.1002/jso.24507] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 10/21/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND The value of spleen preservation with distal pancreatectomy (DP) for benign and low grade malignant tumors remains unclear. The aim of this study was to evaluate the short-term postoperative clinical outcomes in patients undergoing DP with splenectomy (DPS) or spleen preservation (SPDP). METHODS Online database search was performed (2000 to present); key bibliographies were reviewed. Studies comparing patients undergoing DP with either DPS or SPDP, and assessing postoperative complications were included. RESULTS Meta-analysis of included data showed SPDP patients had significantly less operative blood loss, shorter duration of hospitalization, lower incidence of fluid collection and abscess, lower incidence of postoperative splenic and portal vein thrombosis, and lower incidence of new onset postoperative diabetes. For the whole group, there was no difference in incidence of postoperative pancreatic fistula (POPF) (RR = 0.95; 95%CI 0.65-1.40, P = 0.80), however, subgroup analysis of studies using ISGPF criteria showed that DPS patients had increased rates of Grade B/C POPF (RR = 1.35; 95%CI 1.08-1.70, P = 0.01). CONCLUSIONS SPDP for benign and low grade malignant tumors is associated with shorter hospital stay and decreased morbidity compared to DPS. J. Surg. Oncol. 2017;115:137-143. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Fiorella Pendola
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, Florida
| | - Rahul Gadde
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Caroline Ripat
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Rishika Sharma
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Omar Picado
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Laila Lobo
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Danny Sleeman
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida
| | - Alan S Livingstone
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, Florida
| | - Nipun Merchant
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, Florida
| | - Danny Yakoub
- Division of Surgical Oncology, Department of Surgery, University of Miami - Miller School of Medicine, Miami, Florida.,Sylvester Comprehensive Cancer Center, University of Miami - Miller School of Medicine, Miami, Florida
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Marschalek J, Franz M, Gonen Y, Kruessel JS, Weichselbaum A, Kuessel L, Trofaier ML, Ott J. The effect of slow release insemination on pregnancy rates: report of two randomized controlled pilot studies and meta-analysis. Arch Gynecol Obstet 2017; 295:1025-1032. [PMID: 28197716 PMCID: PMC5350232 DOI: 10.1007/s00404-017-4290-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/04/2017] [Indexed: 12/16/2022]
Abstract
Purpose A modified application technique of intrauterine insemination (IUI) is slow release insemination (SRI), first described by Muharib et al. (Hum Reprod 7(2):227–229, 1992), who postulated higher pregnancy rates with a slow release of spermatozoa for 3 h. Methods To investigate this approach, two randomized controlled, cross-over pilot studies were performed from 2004 to 2006 in Israel and Germany to compare SRI with the standard bolus IUI. We aimed to present the results and perform a meta-analysis on available data for SRI. Univariate comparisons of pregnancy rates were performed using one-tailed z tests for method superiority. For meta-analysis, a fixed-effect Mantel–Haentzel weighted average of relative risk was performed. Results Fifty treatment cycles (IUI: n = 25, SRI: n = 25) were performed in Germany, achieving four pregnancies (IUI: 4%, SRI: 12%, p > 0.05). Thirty-nine treatment cycles (IUI: n = 19, SRI: n = 20) were performed in Israel achieving six pregnancies (IUI: 10.5%, SRI: 20%; p > 0.05). Meta-analysis of all eligible studies for SRI (n = 3) revealed a combined relative risk for pregnancy after SRI of 2.64 (95% CI 1.04–6.74), p = 0.02). Conclusions In conclusion, these results lend support to the hypothesis that the pregnancy rate might be improved by SRI compared to the standard bolus technique.
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Affiliation(s)
- Julian Marschalek
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Maximilian Franz
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Jan-Steffen Kruessel
- Department of Obstetrics and Gynecology, Interdisciplinary Center for Reproductive Medicine (UniKiD), University of Düesseldorf, Düesseldorf, Germany
| | | | - Lorenz Kuessel
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Marie-Louise Trofaier
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Johannes Ott
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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Role of Dexmedetomidine for Sedation in Neurocritical Care Patients: A Qualitative Systematic Review and Meta-analysis of Current Evidence. Clin Neuropharmacol 2017; 39:144-51. [PMID: 27046655 DOI: 10.1097/wnf.0000000000000151] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION This systematic review appraises the clinical evidence on efficacy and safety of dexmedetomidine (DEX), as a sole sedative or as sedative adjunct in adult neurocritical care (NCC) patients. MATERIALS AND METHODS A database search was conducted to identify randomized clinical trials and observational studies reporting the use of DEX alone or as adjunct for sedation in NCC setting. The primary outcome was the occurrence of hemodynamic changes, whereas the secondary outcomes were sedative and analgesic efficacy, quality and time to awakening, and development of adverse events. RESULTS Eight trials including 3 randomized controlled trials and 5 observational studies, enrolling 650 patients, were selected. All the retrieved studies had a high risk of bias and a low to moderate quality. Dexmedetomidine provided a better sedation score and reduced analgesic requirements when compared to propofol or midazolam sedation. No statistically significant difference in the combined hemodynamic effect (hypotension or bradycardia) between DEX and controls (risk ratio, 1.50; 95% confidence interval, 0.65-3.48; P = 0.34; I = 56%) was identified. Adverse events were not consistently reported. CONCLUSIONS Available clinical literature supporting the efficacy and safety of DEX use in adult NCC setting is of limited quantity and quality. However, from the current evidence on the use of DEX in NCC, as sole sedative agent or as an adjunct, seems to be both efficient and safe.
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Pourzitaki C, Tsaousi G, Apostolidou E, Karakoulas K, Kouvelas D, Amaniti E. Efficacy and safety of prophylactic levetiracetam in supratentorial brain tumour surgery: a systematic review and meta-analysis. Br J Clin Pharmacol 2016; 82:315-25. [PMID: 26945547 DOI: 10.1111/bcp.12926] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 02/05/2016] [Accepted: 03/02/2016] [Indexed: 01/01/2023] Open
Abstract
AIMS The aim of this study was to perform an up-to-date systematic review and meta-analysis on the efficacy and safety of prophylactic administration of levetiracetam in brain tumour patients. METHOD A systematic review of studies published until April 2015 was conducted using Scopus/Elsevier, EMBASE and MEDLINE. The search was limited to articles reporting results from adult patients, suffering from brain tumour, undergoing supratentorial craniotomy for tumour resection or biopsy and administered levetiracetam in the perioperative period for seizure prophylaxis. Outcomes included the efficacy and safety of levetiracetam, as well as the tolerability of the specific regimen, defined by the discontinuation of the treatment due to side effects. RESULTS The systematic review included 1148 patients from 12 studies comparing levetiracetam with no treatment, phenytoin and valproate, while only 243 patients from three studies, comparing levetiracetam vs phenytoin efficacy and safety, were included in the meta-analysis. The combined results from the meta-analysis showed that levetiracetam administration was followed by significantly fewer seizures than treatment with phenytoin (OR = 0.12 [0.03-0.42]: χ(2) = 1.76: I(2) = 0%). Analysis also showed significantly fewer side effects in patients receiving levetiracetam, compared to other groups (P < 0.05). The combined results showed fewer side effects in the levetiracetam group compared to the phenytoin group (OR = 0.65 [0.14-2.99]: χ(2) = 8.79: I(2) = 77%). CONCLUSIONS The efficacy of prophylaxis with levetiracetam seems to be superior to that with phenytoin and valproate administration. Moreover, levetiracetam use demonstrates fewer side effects in brain tumour patients. Nevertheless, high risk of bias and moderate methodological quality must be taken into account when considering these results.
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Affiliation(s)
- Chryssa Pourzitaki
- 1st Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Georgia Tsaousi
- Clinic of Anaesthesiology and Intensive Care, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Eirini Apostolidou
- 2nd Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Konstantinos Karakoulas
- Clinic of Anaesthesiology and Intensive Care, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Dimitrios Kouvelas
- 2nd Department of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Ekaterini Amaniti
- Clinic of Anaesthesiology and Intensive Care, School of Medicine, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
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