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Malikides O, Simantirakis E, Zacharis E, Fragkiadakis K, Kochiadakis G, Marketou M. Cardiac Remodeling and Ventricular Pacing: From Genes to Mechanics. Genes (Basel) 2024; 15:671. [PMID: 38927607 PMCID: PMC11203142 DOI: 10.3390/genes15060671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/28/2024] Open
Abstract
Cardiac remodeling and ventricular pacing represent intertwined phenomena with profound implications for cardiovascular health and therapeutic interventions. This review explores the intricate relationship between cardiac remodeling and ventricular pacing, spanning from the molecular underpinnings to biomechanical alterations. Beginning with an examination of genetic predispositions and cellular signaling pathways, we delve into the mechanisms driving myocardial structural changes and electrical remodeling in response to pacing stimuli. Insights into the dynamic interplay between pacing strategies and adaptive or maladaptive remodeling processes are synthesized, shedding light on the clinical implications for patients with various cardiovascular pathologies. By bridging the gap between basic science discoveries and clinical translation, this review aims to provide a comprehensive understanding of cardiac remodeling in the context of ventricular pacing, paving the way for future advancements in cardiovascular care.
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Affiliation(s)
- Onoufrios Malikides
- Department of Cardiology, University General Hospital of Heraklion, 71003 Heraklion, Greece; (E.S.); (E.Z.); (K.F.); (G.K.); (M.M.)
| | - Emmanouel Simantirakis
- Department of Cardiology, University General Hospital of Heraklion, 71003 Heraklion, Greece; (E.S.); (E.Z.); (K.F.); (G.K.); (M.M.)
- Medical School, University of Crete, 71003 Heraklion, Greece
| | - Evangelos Zacharis
- Department of Cardiology, University General Hospital of Heraklion, 71003 Heraklion, Greece; (E.S.); (E.Z.); (K.F.); (G.K.); (M.M.)
- Medical School, University of Crete, 71003 Heraklion, Greece
| | - Konstantinos Fragkiadakis
- Department of Cardiology, University General Hospital of Heraklion, 71003 Heraklion, Greece; (E.S.); (E.Z.); (K.F.); (G.K.); (M.M.)
- Medical School, University of Crete, 71003 Heraklion, Greece
| | - George Kochiadakis
- Department of Cardiology, University General Hospital of Heraklion, 71003 Heraklion, Greece; (E.S.); (E.Z.); (K.F.); (G.K.); (M.M.)
- Medical School, University of Crete, 71003 Heraklion, Greece
| | - Maria Marketou
- Department of Cardiology, University General Hospital of Heraklion, 71003 Heraklion, Greece; (E.S.); (E.Z.); (K.F.); (G.K.); (M.M.)
- Medical School, University of Crete, 71003 Heraklion, Greece
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Zeng G, Zhong W, Mazzon G, Choong S, Pearle M, Agrawal M, Scoffone CM, Fiori C, Gökce MI, Lam W, Petkova K, Sabuncu K, Gadzhiev N, Pietropaolo A, Emiliani E, Sarica K. International Alliance of Urolithiasis (IAU) Guideline on percutaneous nephrolithotomy. Minerva Urol Nephrol 2022; 74:653-668. [PMID: 35099162 DOI: 10.23736/s2724-6051.22.04752-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The International Alliance of Urolithiasis (IAU) would like to release the latest guideline on percutaneous nephrolithotomy (PCNL) and to provide a clinical framework for surgeons performing PCNLs. These recommendations were collected and appraised from a systematic review and assessment of the literature covering all aspects of PCNLs from the PubMed database between January 1, 1976, and July 31, 2021. Each generated recommendation was graded using a modified GRADE methodology. The quality of the evidence was graded using a classification system modified from the Oxford Center for Evidence-Based Medicine Levels of Evidence. Forty-seven recommendations were summarized and graded, which covered the following issues, indications and contraindications, stone complexity evaluation, preoperative imaging, antibiotic strategy, management of antithrombotic therapy, anesthesia, position, puncture, tracts, dilation, lithotripsy, intraoperative evaluation of residual stones, exit strategy, postoperative imaging and stone-free status evaluation, complications. The present guideline on PCNL was the first in the IAU series of urolithiasis management guidelines. The recommendations, tips and tricks across the PCNL procedures would provide adequate guidance for urologists performing PCNLs to ensure safety and efficiency in PCNLs.
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Affiliation(s)
- Guohua Zeng
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wen Zhong
- Department of Urology, Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Giorgio Mazzon
- Department of Urology, San Bassiano Hospital, Vicenza, Italy
| | - Simon Choong
- University College Hospital of London, Institute of Urology, London, UK
| | - Margaret Pearle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Madhu Agrawal
- Department of Urology, Center for Minimally Invasive Endourology, Global Rainbow Healthcare, Agra, India
| | | | - Cristian Fiori
- Department of Urology, San Luigi Hospital, University of Turin, Turin, Italy
| | - Mehmet I Gökce
- Department of Urology, Faculty of Medicine, University of Ankara, Ankara, Turkey
| | - Wayne Lam
- Division of Urology, Queen Mary Hospital, Hong Kong, China
| | - Kremena Petkova
- Military Medical Academy, Department of Urology and Nephrology, Sofia, Bulgaria
| | - Kubilay Sabuncu
- Department of Urology, Karacabey State Hospital, Karacabey-Bursa, Turkey
| | - Nariman Gadzhiev
- Department of Urology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Amelia Pietropaolo
- Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
| | - Esteban Emiliani
- Department of Urology, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Kemal Sarica
- Medical School, Department of Urology, Biruni University, Istanbul, Turkey -
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Rai P, Srivastava A, Singh S, Dhayal IR. Comparison of bipolar plasmakinetic transurethral enucleation and resection of prostate gland in patients receiving anticoagulants and/or platelet aggregation inhibitors. MINERVA UROL NEFROL 2019; 71:286-293. [PMID: 30700082 DOI: 10.23736/s0393-2249.19.03282-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the safety and efficacy of bipolar plasmakinetic enucleation of the prostate (BPEP) and bipolar plasmakinetic transurethral resection of prostate (B-TURP) for patients on oral anticoagulants (OA) and/or platelet aggregation inhibitors (PAI) with benign prostatic obstruction (BPO) and having a gland size of >60 g. METHODS Patient database of our hospital for the period of May 2012 to September 2017 was retrospectively reviewed for BPH patients with a gland size of >60 g who either underwent BPEP or B-TURP and were on OA and/or PAI. Patient demographic, perioperative, and follow-up data were analyzed. RESULTS There were no significant differences between the two surgical groups preoperatively. The mean operative time was lower in the BPEP group however, no statistical difference was found between them (P=0.77). There was significant difference in the mean resected tissue weight (52.11±17.92 vs. 77.19±17.78 g, P value ≤0.001), irrigation time and total hospital stay in favor of BPEP group. The blood loss observed in the B-TURP group and BPEP group was 2.57±0.36 and 1.45±0.44 g/dL, respectively, which was statistically significant (P<0.033). Eight and three patients of B-TURP and BPEP groups needed blood transfusion respectively. All patients were followed up for 12 months postoperatively. Both groups resulted in a significant improvement from baseline in terms of IPSS, QoL, Q-max, and PVRU volume values. No significant difference was found between them, however. CONCLUSIONS Both procedures are safe and effective options in patients who are on OA and/or PAI but BPEP is better in terms of low clot retention rate, less irrigation time and decreased hospital stay.
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Affiliation(s)
- Priyanka Rai
- Department of Surgery, Dr. Ram Manohar Lohia Institute of Medical Sciences (Dr.RMLIMS), Lucknow, India
| | - Alok Srivastava
- Department of Urology and Renal Transplant, Dr. Ram Manohar Lohia Institute of Medical Sciences (Dr.RMLIMS), Lucknow, India -
| | - Sanjeet Singh
- Department of Urology and Renal Transplant, Dr. Ram Manohar Lohia Institute of Medical Sciences (Dr.RMLIMS), Lucknow, India
| | - Ishwar R Dhayal
- Department of Urology and Renal Transplant, Dr. Ram Manohar Lohia Institute of Medical Sciences (Dr.RMLIMS), Lucknow, India
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Carneiro A, Cha JD, Baccaglini W, Husain FZ, Wroclawski ML, Nunes-Silva I, Sanchez-Salas R, Ingels A, Kayano PP, Claros OR, Saviano Moran NK, Sotelo R, Lemos GC. Should aspirin be suspended prior to robot-assisted radical prostatectomy? A systematic review and meta-analysis. Ther Adv Urol 2019; 11:1756287218816595. [PMID: 30671139 PMCID: PMC6329037 DOI: 10.1177/1756287218816595] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/06/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Low-dose aspirin use has been correlated with an increased risk of bleeding and overall complications in surgical and invasive diagnostic procedures. In this review, our aim was to analyze the current literature on whether robot-assisted radical prostatectomy (RARP) is feasible and safe in patients taking low-dose aspirin perioperatively. Methods: A systematic review was performed identifying a total of 767 studies, published between January 2000 and September 2017, with five of these studies meeting the inclusion criteria for the meta-analysis, totalizing 1481 patients underwent RARP. Patients were divided into two groups: taking aspirin (group A) and those not taking aspirin (group B) perioperatively. Results: There were no significant differences between groups in the overall [group A 10.7% versus group B 15.7%, risk ratio (RR) 0.83; p = 0.45; I2 = 0%] or major complication rates (group A 1% versus group B 3%, RR 0.98; p = 0.98; I² = 0%), rate of cardiovascular events (group A 1.4% and group B 0.5%, RR 2.06; p = 0.24; I2 = 9%), blood loss (group A 278 ml versus group B 307 ml, SMD −0.12; p = 0.91; I2 = 96%), or hospital length of stay [group A 4 days (3–5) and group B 4 days (3–4), SMD −0.09; p = 0.52; I² = 0%]. There was a slightly higher blood-transfusion rate in group A (2.6%) versus group B (1.6%) (RR, 5.05; p = 0.04; I2 = 0%). Conclusion: Continued aspirin use in the perioperative period does not correlate with an increase in surgical morbidity, blood loss, or hospital length of stay. There was a slightly higher blood-transfusion rate in patients taking low-dose aspirin (group A) perioperatively.
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Affiliation(s)
- Arie Carneiro
- Israelita Albert Einstein Hospital, São Paulo, Brazil Discipline of Urology, ABC Medical School, São Paulo, Brazil
| | - Jonathan Doyun Cha
- Israelita Albert Einstein Hospital, São Paulo, Brazil Discipline of Urology, ABC Medical School, São Paulo, Brazil
| | - Willy Baccaglini
- Discipline of Urology - ABC Medical School, Av. Lauro Gomes, 2000 - Anexo II, Vila Sacadura Cabral - Santo André/SP, CEP: 09060-870, Brazil
| | - Fatima Z Husain
- Institute of Urology, University of Southern California, Los Angeles, California, USA
| | - Marcelo Langer Wroclawski
- Israelita Albert Einstein Hospital, São Paulo, Brazil Discipline of Urology, ABC Medical School, São Paulo, Brazil
| | - Igor Nunes-Silva
- Arnaldo Vieira de Carvalho Cancer Institute - IAVC, São Paulo, Brazil
| | | | - Alexandre Ingels
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | | | | | - René Sotelo
- Institute of Urology, University of Southern California, Los Angeles, California, USA
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Konishi T, Washino S, Nakamura Y, Ohshima M, Saito K, Arai Y, Miyagawa T. Risks and complications of transurethral resection of bladder tumors in patients receiving antiplatelet and/or anticoagulant therapy: a retrospective cohort study. BMC Urol 2017; 17:118. [PMID: 29233118 PMCID: PMC5727922 DOI: 10.1186/s12894-017-0309-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 12/05/2017] [Indexed: 01/24/2023] Open
Abstract
Background Information on the safety of transurethral resection of bladder tumors (TURBT) in patients receiving anti-thromboembolic drugs is currently lacking. This study aimed to evaluate the clinical safety of TURBT in patients receiving anti-thromboembolic agents compared with patients not taking these agents and patients who interrupted their use perioperatively. Methods We retrospectively analyzed data for patients who underwent TURBT at Jichi Medical University Saitama Medical Center from September 2013 to August 2016.Patients who underwent surgery while receiving antiplatelet and/or anticoagulant drugs were allocated to the continuation group, those who interrupted these drugs comprised the interruption group, and those who did not use these agents were designated as the control group. We compared the patient characteristics, hemoglobin levels, and complications among the three groups. Results A total of 174 patients were analyzed including 19, 18, and 137 in the continuation, interruption, and control groups, respectively. There were no significant differences in patient and tumor characteristics, apart from age, among the three groups. Decreases in hemoglobin levels were similar in the continuation, interruption, and control groups (−0.50 g/dl, −0.40 g/dl, and −0.50 g/dl, respectively).Significantly more patients in the continuation group experienced clot retention compared with the control group (21% vs 5%, p = 0.03). Large tumor size tended to be a risk factor for clot retention in the continuation group (p = 0.07). No patient in the continuation or interruption group required blood transfusion, compared with two patients (1%) in the control group. No patients in any of the groups experienced cardiovascular events during their hospital stay or required rehospitalization for hematuria after discharge. Conclusions TURBT can be performed safely in patients who continue to take antiplatelet and/or anticoagulant agents, without increasing the risks of severe hemorrhage and blood transfusion. However, the risk of postoperative clot retention may be increased in these patients.
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Affiliation(s)
- Tsuzumi Konishi
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
| | - Satoshi Washino
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Yuhki Nakamura
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Masashi Ohshima
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Kimitoshi Saito
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Yoshiaki Arai
- Department of Urology, Nishi-Omiya Hospital, 1-1173 Mihashi, Omiya-ku, Saitama, 330-0856, Japan
| | - Tomoaki Miyagawa
- Department of Urology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
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Tzimas P, Tsoumani M, Giannakis D, Kalantzi K, Petrou A, Chantzichristos V, Sofikitis N, Papadopoulos G, Milionis H, Tselepis A. Clopidogrel Therapy in Patients with Cardiovascular Disease Undergoing Transurethral Resection of the Prostate: A Step Towards Individualization. Drugs Aging 2017; 34:917-923. [PMID: 29177885 DOI: 10.1007/s40266-017-0504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study was to test platelet function pre- and peri-operatively in clopidogrel-treated patients undergoing transurethral resection of the prostate. METHODS This was a pilot study involving 20 male patients treated with clopidogrel (75 mg/day) for the secondary prevention of cardiovascular disease and scheduled for elective transurethral resection of the prostate. Platelet function testing with light transmittance aggregometry in platelet-rich plasma of four samples (T0, T1, T2, and T3 drawn on the same day, 3 and 7 days of clopidogrel cessation and 24-h post-operatively, respectively) was performed and evaluated in each patient. P-selectin membrane expression was evaluated using monoclonal antibodies. RESULTS The platelet response to adenosine diphosphate 5 µΜ and 20 µΜ at T0 were 42 ± 15 and 60 ± 14%, respectively. After discontinuation of clopidogrel, corresponding maximum aggregation values at T1 were 60 ± 16 and 74 ± 14%, and increased to 69 ± 16 and 79 ± 18% at T2. No significant difference in platelet aggregation values were noted between T1 and T2, while similar aggregation values were recorded at T3. CONCLUSIONS Our findings indicate that in patients undergoing transurethral resection of the prostate, platelet activation is similar 3 and 7 days from clopidogrel cessation. These results may be of relevance in subjects at increased thrombotic risk prior to a surgical procedure carrying a high-bleeding risk.
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Affiliation(s)
- Petros Tzimas
- Department of Anesthesiology and Postoperative Intensive Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 45110, Ioannina, Greece.
| | - Maria Tsoumani
- Department of Chemistry, Laboratory of Biochemistry, Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Dimitrios Giannakis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Kallirroi Kalantzi
- Department of Chemistry, Laboratory of Biochemistry, Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Anastasios Petrou
- Department of Anesthesiology and Postoperative Intensive Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 45110, Ioannina, Greece
| | - Vasileios Chantzichristos
- Department of Chemistry, Laboratory of Biochemistry, Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Nikolaos Sofikitis
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Georgios Papadopoulos
- Department of Anesthesiology and Postoperative Intensive Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, University Campus, 45110, Ioannina, Greece
| | - Haralampos Milionis
- Department of Chemistry, Laboratory of Biochemistry, Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
| | - Alexandros Tselepis
- Department of Chemistry, Laboratory of Biochemistry, Atherothrombosis Research Centre, University of Ioannina, Ioannina, Greece
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Packiam VT, Nottingham CU, Cohen AJ, Pearce SM, Shalhav AL, Eggener SE. The Impact of Perioperative Aspirin on Bleeding Complications Following Robotic Partial Nephrectomy. J Endourol 2016; 30:997-1003. [DOI: 10.1089/end.2016.0290] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
| | | | - Andrew J. Cohen
- Section of Urology, University of Chicago, Chicago, Illinois
| | - Shane M. Pearce
- Section of Urology, University of Chicago, Chicago, Illinois
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Leavitt DA, Keheila M, Siev M, Shah PH, Moreira DM, George AK, Salami SS, Schwartz MJ, Richstone L, Vira MA, Kavoussi LR. Outcomes of Laparoscopic Partial Nephrectomy in Patients Continuing Aspirin Therapy. J Urol 2016; 195:859-64. [DOI: 10.1016/j.juro.2015.10.132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 01/20/2023]
Affiliation(s)
- David A. Leavitt
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Mohamed Keheila
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Michael Siev
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Paras H. Shah
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Daniel M. Moreira
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Arvin K. George
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Simpa S. Salami
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Michael J. Schwartz
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Lee Richstone
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Manish A. Vira
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
| | - Louis R. Kavoussi
- Department of Urology, Smith Institute for Urology, Hofstra North Shore LIJ School of Medicine, New Hyde Park, New York
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