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Hsu CPD, Hutcheson JD, Ramaswamy S. Oscillatory fluid-induced mechanobiology in heart valves with parallels to the vasculature. VASCULAR BIOLOGY 2020; 2:R59-R71. [PMID: 32923975 PMCID: PMC7439923 DOI: 10.1530/vb-19-0031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/17/2020] [Indexed: 12/31/2022]
Abstract
Forces generated by blood flow are known to contribute to cardiovascular development and remodeling. These hemodynamic forces induce molecular signals that are communicated from the endothelium to various cell types. The cardiovascular system consists of the heart and the vasculature, and together they deliver nutrients throughout the body. While heart valves and blood vessels experience different environmental forces and differ in morphology as well as cell types, they both can undergo pathological remodeling and become susceptible to calcification. In addition, while the plaque morphology is similar in valvular and vascular diseases, therapeutic targets available for the latter condition are not effective in the management of heart valve calcification. Therefore, research in valvular and vascular pathologies and treatments have largely remained independent. Nonetheless, understanding the similarities and differences in development, calcific/fibrous pathologies and healthy remodeling events between the valvular and vascular systems can help us better identify future treatments for both types of tissues, particularly for heart valve pathologies which have been understudied in comparison to arterial diseases.
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Affiliation(s)
- Chia-Pei Denise Hsu
- Engineering Center, Department of Biomedical Engineering, Florida International University, Miami, Florida, USA
| | - Joshua D Hutcheson
- Engineering Center, Department of Biomedical Engineering, Florida International University, Miami, Florida, USA
| | - Sharan Ramaswamy
- Engineering Center, Department of Biomedical Engineering, Florida International University, Miami, Florida, USA
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2
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Ayoub S, Ferrari G, Gorman RC, Gorman JH, Schoen FJ, Sacks MS. Heart Valve Biomechanics and Underlying Mechanobiology. Compr Physiol 2016; 6:1743-1780. [PMID: 27783858 PMCID: PMC5537387 DOI: 10.1002/cphy.c150048] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Heart valves control unidirectional blood flow within the heart during the cardiac cycle. They have a remarkable ability to withstand the demanding mechanical environment of the heart, achieving lifetime durability by processes involving the ongoing remodeling of the extracellular matrix. The focus of this review is on heart valve functional physiology, with insights into the link between disease-induced alterations in valve geometry, tissue stress, and the subsequent cell mechanobiological responses and tissue remodeling. We begin with an overview of the fundamentals of heart valve physiology and the characteristics and functions of valve interstitial cells (VICs). We then provide an overview of current experimental and computational approaches that connect VIC mechanobiological response to organ- and tissue-level deformations and improve our understanding of the underlying functional physiology of heart valves. We conclude with a summary of future trends and offer an outlook for the future of heart valve mechanobiology, specifically, multiscale modeling approaches, and the potential directions and possible challenges of research development. © 2016 American Physiological Society. Compr Physiol 6:1743-1780, 2016.
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Affiliation(s)
- Salma Ayoub
- Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, USA
| | - Giovanni Ferrari
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, USA
| | - Robert C. Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, USA
| | - Joseph H. Gorman
- Gorman Cardiovascular Research Group, University of Pennsylvania, Philadelphia, USA
| | - Frederick J. Schoen
- Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Michael S. Sacks
- Center for Cardiovascular Simulation, Institute for Computational Engineering and Sciences, Department of Biomedical Engineering, The University of Texas at Austin, Austin, USA
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3
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Das A, Wansapura JP, Gottliebson WM, Banerjee RK. Methodology for implementing patient-specific spatial boundary condition during a cardiac cycle from phase-contrast MRI for hemodynamic assessment. Med Image Anal 2014; 19:121-36. [PMID: 25461332 DOI: 10.1016/j.media.2014.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 08/27/2014] [Accepted: 09/01/2014] [Indexed: 11/27/2022]
Abstract
Pulmonary insufficiency (PI) can render the right ventricle dysfunctional due to volume overloading and hypertrophy. The treatment requires a pulmonary valve replacement surgery. However, determining the right time for the valve replacement surgery has been difficult with currently employed clinical techniques such as, echocardiography and cardiac MRI. Therefore, there is a clinical need to improve the diagnosis of PI by using patient-specific (PS) hemodynamic endpoints. While there are many reported studies on the use of PS geometry with time varying boundary conditions (BC) for hemodynamic computation, few use spatially varying PS velocity measurement at each time point of the cardiac cycle. In other words, the gap is that, there are limited number of studies which implement both spatially- and time-varying physiologic BC directly with patient specific geometry. The uniqueness of this research is in the incorporation of spatially varying PS velocity data obtained from phase-contrast MRI (PC-MRI) at each time point of the cardiac cycle with PS geometry obtained from angiographic MRI. This methodology was applied to model the complex developing flow in human pulmonary artery (PA) distal to pulmonary valve, in a normal and a subject with PI. To validate the methodology, the flow rates from the proposed method were compared with those obtained using QFlow software, which is a standard of care clinical technique. For the normal subject, the computed time average flow rates from this study differed from those obtained using the standard of care technique (QFlow) by 0.8 ml/s (0.9%) at the main PA, by 2 ml/s (3.4%) at the left PA and by 1.4 ml/s (3.8%) at the right PA. For the subject with PI, the difference was 7 ml/s (12.4%) at the main PA, 5.5 ml/s (22.6%) at the left PA and 4.9 ml/s (18.0%) at the right PA. The higher percentage differences for the subject with PI, was the result of overall lower values of the forward mean flow rate caused by excessive flow regurgitation. This methodology is expected to provide improved computational results when PS geometry from angiographic MRI is used in conjunction with PS PC-MRI data for solving the flow field.
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Affiliation(s)
- Ashish Das
- Department of Mechanical and Materials Engineering, University of Cincinnati, Cincinnati, OH, United States
| | - Janaka P Wansapura
- Heart Institute, Division of Paediatric Cardiology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, United States
| | - William M Gottliebson
- Heart Institute, Division of Paediatric Cardiology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, United States
| | - Rupak K Banerjee
- Department of Mechanical and Materials Engineering, University of Cincinnati, Cincinnati, OH, United States.
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4
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Balachandran K, Sucosky P, Yoganathan AP. Hemodynamics and mechanobiology of aortic valve inflammation and calcification. Int J Inflam 2011; 2011:263870. [PMID: 21760982 PMCID: PMC3133012 DOI: 10.4061/2011/263870] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 04/29/2011] [Indexed: 01/22/2023] Open
Abstract
Cardiac valves function in a mechanically
complex environment, opening and closing close to
a billion times during the average human lifetime,
experiencing transvalvular pressures and pulsatile
and oscillatory shear stresses, as well as bending
and axial stress. Although valves were originally thought to be
passive pieces of tissue, recent evidence points
to an intimate interplay between the hemodynamic
environment and biological response of the valve.
Several decades of study have been devoted to
understanding these varied mechanical stimuli and
how they might induce valve pathology. Here, we
review efforts taken in understanding the valvular
response to its mechanical milieu and key
insights gained from in vitro and
ex vivo whole-tissue studies in
the mechanobiology of aortic valve remodeling,
inflammation, and calcification.
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Affiliation(s)
- Kartik Balachandran
- Wyss Institute for Biologically Inspired Engineering, School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138, USA
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5
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Migliavacca F, Dubini G, Pietrabissa R, de Leval MR. Computational transient simulations with varying degree and shape of pulmonic stenosis in models of the bidirectional cavopulmonary anastomosis. Med Eng Phys 1997; 19:394-403. [PMID: 9302681 DOI: 10.1016/s1350-4533(96)00070-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The bidirectional cavopulmonary anastomosis is a surgical technique utilized to treat severe congenital malformations of the right part of the heart. It is obtained by anastomosing the superior vena cava to the superior aspect of the undivided right pulmonary artery. Transient simulations with a three-dimensional model of the bidirectional cavopulmonary anastomosis were carried out to evaluate the haemodynamics of different types of pulmonic stenosis (shape and severity of the obstruction). Models with a tunnel-like (supravalvar) or discrete (valvar) pulmonic stenosis with different values of reduction of cross-sectional area (60 and 75%) were investigated and compared to a model without stenosis. Calculations were based on a finite element method analysis. The results showed that a tighter stenosis can lead to a blood volume flow to the left lung reaching 70% of the total pulmonary flow. Moreover, the flow fields are highly influenced by the presence and shape of the pulmonic stenosis; the most intense jets in the left pulmonary artery occur for a discrete pulmonic stenosis of 75%. The flow in the right pulmonary artery is nearly steady because it is damped down by the steady caval flow.
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Affiliation(s)
- F Migliavacca
- Dipartimento di Bioingegneria, Politecnico di Milano, Italy
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6
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Migliavacca F, de Leval MR, Dubini G, Pietrabissa R. A computational pulsatile model of the bidirectional cavopulmonary anastomosis: the influence of pulmonary forward flow. J Biomech Eng 1996; 118:520-8. [PMID: 8950656 DOI: 10.1115/1.2796039] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The bidirectional cavopulmonary anastomosis (BCPA or bidirectional Glenn) is an operation to treat congenital heart diseases of the right heart by diverting the systemic venous return from the superior vena cava to both lungs. The main goal is to provide the correct perfusion to both lungs avoiding an excessive increase in systemic venous pressure. One of the factors which can affect the clinical outcome of the surgically reconstructed circulation is the amount of pulsatile blood flow coming from the main pulmonary artery. The purpose of this work is to analyse the influence of this factor on the BCPA hemodynamics. A 3-D finite element model of the BCPA has been developed to reproduce the flow of the surgically reconstructed district. Geometry and hemodynamic data have been taken from angiocardiogram and catheterization reports, respectively. On the basis of the developed 3-D model, four simulations have been performed with increasing pulsatile blood flow rate from the main pulmonary artery. The results show that hemodynamics in the pulmonary arteries are greatly influenced by the amount of flow through the native main pulmonary artery and that the flow from the superior vena cava allows to have a similar distribution of the blood to both lungs, with a little predilection for the left side, in agreement with clinical postoperative data.
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Affiliation(s)
- F Migliavacca
- Cardiothoracic Unit, Great Ormond Street Hospital for Children NHS Trust, London, U.K
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7
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van Dijk A, Hopman J, Klaessens J, van der Werf T, Daniëls O. The intra- and inter-operator variability of Echo-Doppler measurements for noninvasive pulmonary arterial pressure determination in congenital heart disease. ACTA ACUST UNITED AC 1996. [DOI: 10.1016/0929-8266(95)00179-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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8
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Shortland AP, Black RA, Jarvis JC, Salmons S. A novel video technique for visualizing flow structures in cardiovascular models. J Biomech 1996; 29:239-44. [PMID: 8849818 DOI: 10.1016/0021-9290(95)00047-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We describe a video system that produces good quality images of particle trajectories in seeded fluid flows. The operation of a liquid crystal optical shutter and a modified charge-coupled device (CCD) camera were synchronized to generate images of particle trajectories which were stored in a framegrabber before being transferred to S-VHS tape. The camera system is particularly appropriate for visualizing transient or unsteady flows in models of the cardiovascular system as the integration time may be varied to produce particle trajectories of variable length.
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Affiliation(s)
- A P Shortland
- Department of Clinical Engineering, University of Liverpool, UK
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9
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Katayama H, Henry GW, Lucas C, Ha B, Ferreiro JI, Frantz EG. Blood flow velocity profiles in pulmonary branch arteries in lambs. J Biomech Eng 1995; 117:237-41. [PMID: 7666661 DOI: 10.1115/1.2796006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We studied the detailed profiles of blood flow in the right and left pulmonary arteries using 20 MHz pulsed Doppler ultrasound equipment in a lamb model. Fourteen lambs aged four to six weeks were selected. In six lambs, monocrotaline pyrrole was injected parenterally to create pulmonary hypertension (PH group). Eight other lambs served as unaltered controls (control group). The blood flow velocities were sampled in 1mm increments along the anterior-posterior axis of the branch arteries. The maximum velocity of the forward flow in the left pulmonary artery was higher than that in the right pulmonary artery in the control group (71.7 +/- 15.9 cm/s vs 60.2 +/- 13.5; p < 0.05). The fastest backward flow was located at the posterior position of the vessel in the right pulmonary artery in the control group (71.7 +/- 15.9 cm/s vs 60.2 +/- 13.5; p < 0.05). The fastest backward flow was located at the posterior position of the vessel in the right pulmonary artery in the control group. No significant bias in location was shown in the left pulmonary artery. Using indices of P90, acceleration time, P90*AcT, the velocity waveforms in the PH group were compared with those in the control group. In the left pulmonary artery, every index in the control group showed a significantly greater value that in the PH group. On the other hand, no significant differences were found between either group in the right pulmonary artery.
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Affiliation(s)
- H Katayama
- Department of Pediatrics and Biomedical Engineering, School of Medicine, University of North Carolina, Chapel Hill 27599-7220, USA
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10
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Sloth E, Houlind KC, Oyre S, Kim WY, Pedersen EM, Jørgensen HS, Hasenkam JM. Three-dimensional visualization of velocity profiles in the human main pulmonary artery with magnetic resonance phase-velocity mapping. Am Heart J 1994; 128:1130-8. [PMID: 7985593 DOI: 10.1016/0002-8703(94)90743-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Detailed data on blood velocity fields in the normal human main pulmonary artery are an essential platform for discriminating physiologic from pathologic pulmonary flow patterns. Over the years, many studies have revealed quite inconsistent data mainly because of lack of suitable measuring techniques. By using combined cardiac- and respiratory-triggered magnetic resonance phase velocity mapping, very consistent data were obtained in 12 volunteers. In all subjects the location of the highest axial velocities was shifted from the inferior-right toward the superior-left part of the vessel area during the right ventricular contraction, with rapidly decreasing velocities to the inferior right evolving into retrograde flow in the deceleration phase. The mean temporal velocity profile was consistently skewed with a low flow region also toward the inferior-right vessel wall. The magnetic resonance phase shift method used in this study provided remarkably consistent high-quality data about human pulmonary artery velocity fields. This is most likely because of the use of combined cardiac and respiratory triggering.
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Affiliation(s)
- E Sloth
- Department of Anaesthesia, Aarhus Kommune Hospital, Denmark
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11
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Sloth E, Pedersen EM, Nygaard H, Hasenkam JM, Juhl B. Multiplane transesophageal Doppler echocardiographic measurements of the velocity profile in the human pulmonary artery. J Am Soc Echocardiogr 1994; 7:132-40. [PMID: 8185957 DOI: 10.1016/s0894-7317(14)80118-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Eight healthy, unsedated volunteers were studied to introduce a new non-invasive method for detailed blood velocity measurements and to evaluate flow patterns in the human pulmonary artery during end-expiratory apnea. With a multiplane transesophageal ultrasonic probe, spectral Doppler velocity registration was performed in nine different spatial locations across the vessel area. The pulmonary trunk could be visualized in all patients. The mean temporal velocity profile was virtually flat despite an instantaneous skewness that rotated counterclockwise up to 180 degrees. Furthermore, our data indicate that a good estimate of the temporal and spatial mean velocity can be obtained from velocity recordings based on centrally placed sample volumes. This makes the future application of Doppler-based measurement of cardiac output in the pulmonary artery hopeful. The ability of multiplane transesophageal echocardiography to estimate the area of the elastic human pulmonary artery, however, has to be evaluated more extensively before the clinical importance of this tool for measurement of cardiac output can be established.
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Affiliation(s)
- E Sloth
- Department of Anaesthesia, Skejby Sygehus, Arhus University Hospital, Denmark
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12
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Sømod L, Pedersen EM, Kim WY, Hasenkam JM, Nygaard H, Paulsen PK. Axial development of velocity fields in the porcine main pulmonary artery system. Heart Vessels 1994. [DOI: 10.1007/bf01751940] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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13
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Sung HW, Philpot EF, Nanda NC, Yoganathan AP. Axial flow velocity patterns in a pulmonary artery model with varying degrees of valvular pulmonic stenosis: pulsatile in vitro studies. J Biomech 1990; 23:563-78. [PMID: 2187876 DOI: 10.1016/0021-9290(90)90049-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
With the advent of noninvasive clinical techniques which can measure blood flow velocities (Doppler ultrasound), it is suggested that a fundamental knowledge of the axial flow velocity patterns in the pulmonary artery, and the changes caused by stenosis, may be used to support accurate diagnosis of valvular pulmonic stenosis. The present study was designed to characterize the axial flow velocity patterns in an in vitro model of a human adult pulmonary artery with varying degrees of valvular pulmonic stenosis. A two-dimensional laser Doppler anemometer (LDA) system was used to map the flow fields in the main (MPA), left (LPA), and right (RPA) branches of the pulmonary artery model. The study was conducted in the Georgia Tech. right heart pulse duplicator system. It was observed that the axial flow velocity patterns in the MPA and the LPA change dramatically with increasing degree of valvular stenosis. This indicates that the axial flow velocity patterns in these two branches are strongly influenced by the degree of valvular stenosis. The axial flow velocity patterns in the RPA, however, do not change much with varying degrees of valvular stenosis, indicating that the axial flow fields in the RPA are mainly influenced by the geometry of the bifurcation. It may be concluded therefore, that the changes in the axial flow velocity patterns in the MPA and LPA (rather than in the RPA) could be sensitive and reliable indicators of the severity of the defect.
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Affiliation(s)
- H W Sung
- Cardiovascular Fluid Mechanics Laboratory, School of Chemical Engineering, Georgia Institute of Technology, Atlanta 30332-0100
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