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Cappelli A, Mosconi C, Cocozza MA, Brandi N, Bartalena L, Modestino F, Galaverni MC, Vara G, Paccapelo A, Pizzoli G, Villa G, Seracchioli R, Renzulli M. Uterine Artery Embolization for the Treatment of Symptomatic Uterine Fibroids of Different Sizes: A Single Center Experience. J Pers Med 2023; 13:906. [PMID: 37373895 DOI: 10.3390/jpm13060906] [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: 04/12/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
The present study aimed to evaluate the clinical and radiological 1-year outcomes of uterine artery embolization (UAE) performed in a selected population of women with symptomatic myomas and who do not wish to conceive. Between January 2004 and January 2018, a total of 62 patients with pre-menopausal status and with no wish to conceive in the future underwent UAE for the treatment of symptomatic fibroids. All the patients underwent magnetic resonance imaging (MRI) and/or transvaginal ultrasonography (TV-US) before and after the procedure at 1-year follow-up. Clinical and radiological parameters were recorded, stratifying the population into 3 groups according to the size of the dominant myoma (group 1: <50 mm; group 2: ≥50 and ≤80 mm; group 3: >80 mm). Mean fibroid diameter was significantly reduced (42.6% ± 21.6%) at 1-year follow-up, with excellent improvements in terms of both symptoms and quality of life. No significant difference was observed regarding baseline dimension and the number of myomas. No major complications were reported (2.5%). The present study confirms the safety and efficacy of UAE in the treatment of symptomatic fibroids in pre-menopausal women with no desire to conceive.
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Affiliation(s)
- Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Maria Adriana Cocozza
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Laura Bartalena
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Francesco Modestino
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Maria Cristina Galaverni
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Giulio Vara
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Alexandro Paccapelo
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Gloria Pizzoli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Gioia Villa
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Renato Seracchioli
- Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40138 Bologna, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
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Çakır Ç, Kılınç F, Deniz MA, Karakaş S. Can pre-procedural MRI signal intensity ratio predict the success of uterine artery embolization in treatment of myomas? Turk J Med Sci 2021; 51:1380-1387. [PMID: 33550765 PMCID: PMC8283489 DOI: 10.3906/sag-2012-136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 02/06/2021] [Indexed: 11/18/2022] Open
Abstract
Background/aim Magnetic resonance (MR) images, signal intensity ratios calculated using region of interests (ROI) in T2W images by proportioning the dominant myoma to iliac muscle can aid patient selection and, thus, in achieving better outcomes with the uterine artery embolization (UAE) procedure. The present study investigates the association between the success of UAE treatment with signal intensity (SI) ratio of the dominant myoma to the iliac muscle in MR imaging performed prior to the procedure. Materials and methods This is a retrospective study and included 30 patients who admitted to our clinic between February 2017 and July 2019 due to symptoms associated with myoma and who underwent MR imaging before and after UAE treatment. All patients, MR images obtained before UAE treatment and at the 12th month after the procedure were evaluated. In MRI, SI values were calculated by proportioning the dominant myoma to the iliac muscle using circular ROI in T1 weighted (W), T2W, and post-contrast T1W images. In the present study, 50% or more volumetric regression of the myoma with infarction of fibroids (loss of enhancement) at the 12-month follow-up MRI after the procedure was considered a successful procedure. Results Myoma volumes calculated in MR images showed significant differences between the MRI performed before UAE procedure and the MRI performed at the 12th month after the procedure (p < 0.0001). SI ratio calculated from pre-procedure T2W MR images was found to be a significant determinant of 50% or more volumetric regression in the myoma after UAE procedure (p = 0.017), T1W, post-contrast T1W images were not statistically significant (p = 0.211). Conclusion Our results indicate that SI ratio of the dominant myoma to the iliac muscle calculated using ROI in T2W images of MR studies performed before UAE procedure can predict the success of the procedure.
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Affiliation(s)
- Çağlayan Çakır
- Department of Radiology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey
| | - Fatih Kılınç
- Department of Radiology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey
| | - Muhammed Akif Deniz
- Department of Internal Medical Sciences, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Sema Karakaş
- Department of Obstetrics and Gynecology, University of Health Sciences, Bakırkoy Dr. Sadi Konuk Education and Research Hospital, İstanbul, Turkey
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de Bruijn AM, Huisman J, Hehenkamp WJK, Lohle PNM, Reekers JA, Timmermans A, Twijnstra ARH. Implementation of uterine artery embolization for symptomatic fibroids in the Netherlands: an inventory and preference study. CVIR Endovasc 2019; 2:18. [PMID: 32026034 PMCID: PMC6966393 DOI: 10.1186/s42155-019-0061-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/22/2019] [Indexed: 12/04/2022] Open
Abstract
Background and purpose The Dutch national guideline on heavy menstrual bleeding was updated and published in 2013. It recommended (for the first time) that uterine artery embolization (UAE) should be part of counseling of women with symptomatic fibroids. We aimed to evaluate the implementation of UAE for symptomatic uterine fibroids in the Netherlands and to investigate gynecologists preference and other influential factors. Methods The primary outcome was to examine the UAE/hysterectomy ratio before and after introduction of the 2013 guideline by the use of annual hospital reports. The secondary outcome assessed factors that could influence implementation by means of a questionnaire to gynecologists. Results A total of 29/30 (97%) UAE+ hospitals and 36/52 (69%) UAE- hospitals sent their annual reports. The UAE/hysterectomy percentages in 2012, 2013 and 2014 were 7,0%, 7.0% and 6.9%, respectively. Regarding the questionnaire, the response rates were 88% and 91%, respectively. In both groups we observed a high self-perceived tendency for UAE counseling (90% versus 70%, p = .001). Approximately 50% of gynecologists from UAE- hospitals indicate they have insufficient information about UAE for appropriate counseling and 40% doubts the effectiveness of UAE. Furthermore, in the majority of gynecologists some ‘urban myths’ about the effectiveness and side-effects of UAE seem to persevere. Conclusion Adding UAE as a treatment option to the national guideline did not change the number of performed UAEs for symptomatic fibroids. It might be useful to develop an option grid in order to offer appropriate, independent counseling and encourage shared decision making. Electronic supplementary material The online version of this article (10.1186/s42155-019-0061-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annefleur M de Bruijn
- Department of Gynecology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1007 MB, Amsterdam, The Netherlands.
| | - Jolijn Huisman
- Faculty of Medicine, VU University, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
| | - Wouter J K Hehenkamp
- Department of Gynecology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1007 MB, Amsterdam, The Netherlands
| | - Paul N M Lohle
- Department of Radiology, Elisabeth Tweesteden Ziekenhuis, Tilburg, The Netherlands
| | - Jim A Reekers
- Department of Radiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Anne Timmermans
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - Andries R H Twijnstra
- Leiden University Medical Center, Albinusdreef 2, 2300-2333 ZA, Leiden, the Netherlands
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Impact of grayscale and Doppler ultrasound characteristics on reducing the size of tumors in the treatment of uterine fibroids by uterine artery embolization. Contemp Oncol (Pozn) 2019; 23:32-36. [PMID: 31061634 PMCID: PMC6500395 DOI: 10.5114/wo.2019.84111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 03/03/2019] [Indexed: 11/21/2022] Open
Abstract
Aim of the study Uterine fibroids are one of the most prevalent benign tumors. This study aimed to evaluate the effect of uterine artery embolization on treating and reducing the size of symptomatic uterine fibroids. Material and methods Eighty patients with uterine fibroids were selected for this study. Then ultrasound and Doppler were performed by a radiologist to evaluate the size, number, echogenicity, vascularity, and location of fibroids in the uterine wall. Before performing uterine artery embolization, prothrombin time, partial thromboplastin time, international normalized ratio, blood urea nitrogen, and creatinine tests were performed for all the patients to identify background problems. Finally, SPSS 22 was used for data analysis. Results The dominant fibroid volume before the embolization was 244.57 cm3, which decreased to 219.96 cm3, 190.58 cm3, 114.18 cm3, 140.51 cm3, and 78.86 cm3 in the first week, first month, third month, sixth month and first year after embolization, which was statistically significant (p < 0.001 in all cases). Uterine volume in multiple tumor before the embolization was 486.27 cm3, which decreased to 408.36 cm3, 387.60 cm3, 299.67 cm3, 190.00 cm3 and 172.33 cm3 after the first week, first month, third month, sixth month and first year after embolization, which in the first week and third month was statistically significant and not significant in other cases (p = 0.003, p = 0.500, p = 0.028, p = 0.068, p = 0.109). The relationships of the number of fibroid tumors, echogenicity and vascularity with volume reduction were not statistically significant (p = 0.924, p = 0.208, p = 0.455). Conclusions Uterine artery embolization is an effective treatment for fibroid tumors. In this study, the number of tumors, echogenicity, and vascularity of tumors had no effect on tumor volume reduction.
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Gingold JA, Gueye NA, Falcone T. Minimally Invasive Approaches to Myoma Management. J Minim Invasive Gynecol 2018; 25:237-250. [DOI: 10.1016/j.jmig.2017.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 10/19/2022]
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Krug R, Do L, Rieke V, Wilson MW, Saeed M. Evaluation of MRI protocols for the assessment of lumbar facet joints after MR-guided focused ultrasound treatment. J Ther Ultrasound 2016; 4:14. [PMID: 27054038 PMCID: PMC4822243 DOI: 10.1186/s40349-016-0057-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 03/23/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND MR-guided focused ultrasound (MRgFUS) might be a very safe and effective minimally invasive technique to treat facet joint pain caused by arthritis and other degenerative changes. However, there are still safety concerns for this treatment and challenges regarding MR imaging and temperature mapping due to susceptibility effects between the bone and soft tissue near the joint, which has resulted in poor MR image quality. The goal of this research was to evaluate multiple magnetic resonance imaging (MRI) pulse sequences for characterizing ablated lumbar facet joint lesions created by high-intensity focused ultrasound (FUS) and compare the findings to histological tissue assessment. In particular, we investigated the use of T2-weighted MRI to assess treatment effects without contrast administration. METHODS An IACUC approved study (n = 6 pigs) was performed using a 3T widebore MRI system equipped with an MRgFUS system. Facet joints of the lumbar vertebra were ablated using 1-MHz frequency and multiple sonication energies (300-800 J). In addition to T2-weighted MRI for treatment planning, T1-, T2-, and T2*-weighted and perfusion MRI sequences were applied. Signal intensity ratios of the lesions were determined. Histopathology was used to characterize cellular changes. RESULTS Ablation of the facet joint, using MRgFUS, was successful in all animals. T2-weighted images showed high signal intensity in the edematous facet joint and adjacent muscle, while delayed contrast-enhanced T1-weighted images showed an enhanced ring surrounding the target volume. T2*-weighted GRE images revealed inconsistent lesion visualization. Histopathology confirmed the presence of cellular coagulation (shrinkage), extracellular expansion (edema), and hemorrhage in the bone marrow. CONCLUSIONS MRgFUS provided sufficient precision and image quality for visualization and characterization of ablated facet joints directly after ablation. MRI may help in monitoring the efficacy of FUS ablation without contrast after treating patients with back pain.
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Affiliation(s)
- Roland Krug
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry Street, Suite 350, Campus Box 0946, San Francisco, CA 94107-5705 USA
| | - Loi Do
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry Street, Suite 350, Campus Box 0946, San Francisco, CA 94107-5705 USA
| | - Viola Rieke
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry Street, Suite 350, Campus Box 0946, San Francisco, CA 94107-5705 USA
| | - Mark W Wilson
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry Street, Suite 350, Campus Box 0946, San Francisco, CA 94107-5705 USA
| | - Maythem Saeed
- Department of Radiology and Biomedical Imaging, School of Medicine, University of California San Francisco, 185 Berry Street, Suite 350, Campus Box 0946, San Francisco, CA 94107-5705 USA
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Noorda YH, Bartels LW, Viergever MA, Pluim JPW. Subject-specific four-dimensional liver motion modeling based on registration of dynamic MRI. J Med Imaging (Bellingham) 2016; 3:015002. [PMID: 27493981 DOI: 10.1117/1.jmi.3.1.015002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/25/2016] [Indexed: 11/14/2022] Open
Abstract
Magnetic resonance-guided high intensity focused ultrasound treatment of the liver is a promising noninvasive technique for ablation of liver lesions. For the technique to be used in clinical practice, however, the issue of liver motion needs to be addressed. A subject-specific four-dimensional liver motion model is presented that is created based on registration of dynamically acquired magnetic resonance data. This model can be used for predicting the tumor motion trajectory for treatment planning and to indicate the tumor position for treatment guidance. The performance of the model was evaluated on a dynamic scan series that was not used to build the model. The method achieved an average Dice coefficient of 0.93 between the predicted and actual liver profiles and an average vessel misalignment of 3.0 mm. The model performed robustly, with a small variation in the results per subject. The results demonstrate the potential of the model to be used for MRI-guided treatment of liver lesions. Furthermore, the model can possibly be applied in other image-guided therapies, for instance radiotherapy of the liver.
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Affiliation(s)
- Yolanda H Noorda
- University Medical Center Utrecht , Image Sciences Institute, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Lambertus W Bartels
- University Medical Center Utrecht , Image Sciences Institute, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Max A Viergever
- University Medical Center Utrecht , Image Sciences Institute, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Josien P W Pluim
- University Medical Center Utrecht , Image Sciences Institute, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Noorda YH, Bartels LW, Huisman M, Nijenhuis RJ, van den Bosch MAAJ, Pluim JPW. Registration of CT to pre-treatment MRI for planning of MR-HIFU ablation treatment of painful bone metastases. Phys Med Biol 2014; 59:4167-79. [DOI: 10.1088/0031-9155/59/15/4167] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Rasuli P, Sabri A, Hammond I, French GJ, Gamache N, Jolly EE. Outpatient Uterine Artery Embolization for Symptomatic Fibroids: Short- and Long-Term Single Institution-Based Outcomes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:156-163. [DOI: 10.1016/s1701-2163(15)31021-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Horhoianu IA, Horhoianu VV, Joita D, Carstoiu M, Dorobat B. Uterine artery embolization for leioyomas, ultrasonography and angiography aspects. J Med Life 2012; 5:491-5. [PMID: 23346257 PMCID: PMC3539832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 12/10/2012] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE AND RATIONALE The purpose of this study is to evaluate the degree of fibroid shrinkage which well correlates with symptom regression, and thus to assess the effectiveness of the procedure. METHOD 31 patients were included in the trial after selection. All the patients were thoroughly evaluated before embolization, the following day and at a month after but also at 3 months for 10 of them. A certain protocol was followed passing through well established steps. The purpose was to discover and rule out any associated possible disease and to assess and grade the symptoms, ultrasound and angiographic aspects. RESULTS Regarding the uterus, its volume evolution registered a descending trend, the mean decrease at 30 days being of 25% (-81,6 cm³) and at 90 days of 52%(-173,15 cm³). The fibroids also decreased statistically, the mean global variation at 30 days registering a decrease of -17,66 cm³(27%) and 61% at day 90. The mean global reduction at 30 days was of 44% (-33,18 cm³) and of 62% (-60,85 cm³) at 90 days. Absence of uterine anastomoses lead to proper fibroid decrease whereas their presence diminished the chances. CONCLUSIONS The uterine and fibroid volumes registered a statistical volume decrease at 30 and 90 days in comparison with the volumes before embolization. Absence of uterine anastomoses led to proper fibroid decrease. Longer evaluation time is needed for an accurate evaluation of volume reduction degree.
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Affiliation(s)
- IA Horhoianu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest,Gynecology Department University Emergency Hospital, Bucharest
| | - VV Horhoianu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest,Gynecology Department University Emergency Hospital, Bucharest
| | - D Joita
- "Titu Mairescu" University, Informatics Department
| | - M Carstoiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest,Gynecology Department University Emergency Hospital, Bucharest
| | - B Dorobat
- Gynecology Department University Emergency Hospital, Bucharest
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Tavare AN, Alsafi A, Hamady MS. Analysis of the Quality of Information Obtained About Uterine Artery Embolization From the Internet. Cardiovasc Intervent Radiol 2012; 35:1355-62. [DOI: 10.1007/s00270-012-0345-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Accepted: 12/15/2011] [Indexed: 11/24/2022]
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