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Wang C, Yang W, Shi Z, Fang Y. Renal function improvement correlates with 3D echocardiographic findings: Effect of surgical mitral valve repair. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024; 52:385-393. [PMID: 38344863 DOI: 10.1002/jcu.23646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND The association between surgical treatment of mitral regurgitation (MR) and renal function is not sufficiently well-known. We tried to evaluate renal function before and after the procedure of surgical mitral valve repair (SMVR) in degenerative severe MR. METHODS Patients with primary severe (4+) MR and normal left ventricular ejection fraction (LVEF) that underwent SMVR, examined by a cutting-edge 3-dimensional (3D) echocardiographic probe were enrolled in this study. We took three CKD-EPI equations to measure estimated glomerular filtration rate (eGFR) before SMVR and shortly before patients discharge. A total of 40 patients with baseline lower mean eGFR were evaluated. RESULTS Measurements substantiated statistically significant improvements in eGFR (p < 0.001), multivariable linear regression modeling indicating prominent associations between increase in eGFR and decrease of MR (p = 0.003), decline of pulmonary arterial systolic pressure (p = 0.018), as well as increment of forward stroke volume (p = 0.02), in spite of LVEF reduction, left ventricular global longitudinal strain worsening and left atrial ejection fraction impairment. CONCLUSIONS Renal function improves after SMVR in patients with degenerative significant MR and preserved LVEF, regardless of cardiac functional worsening.
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Affiliation(s)
- Chenchen Wang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenbo Yang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhongwei Shi
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuehua Fang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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2
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Duncan CF, Bowcock E, Pathan F, Orde SR. Mitral regurgitation in the critically ill: the devil is in the detail. Ann Intensive Care 2023; 13:67. [PMID: 37530859 PMCID: PMC10397171 DOI: 10.1186/s13613-023-01163-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 07/03/2023] [Indexed: 08/03/2023] Open
Abstract
Mitral regurgitation (MR) is common in the critically unwell and encompasses a heterogenous group of conditions with diverging therapeutic strategies. MR may present acutely with haemodynamic instability or more insidiously with failure to wean from mechanical ventilation. Critical illness is associated with marked physiological stress and haemodynamic changes that dynamically influence the severity and implication of MR. The expanding role of critical care echocardiography uniquely positions the intensivist to apply advanced bedside valvular assessment to recognise haemodynanically significant MR, manipulate and optimise cardiopulmonary physiology and identify patients requiring urgent cardiology and surgical referral. This review will consider common clinical scenarios, therapeutic strategies and the pearls and pitfalls of echocardiographic assessment and quantification in the critically unwell.
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Affiliation(s)
- Chris F Duncan
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, Sydney, NSW, 2747, Australia.
| | - Emma Bowcock
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, Sydney, NSW, 2747, Australia
| | - Faraz Pathan
- Department of Cardiology, Nepean Hospital, Kingswood, Sydney, NSW, 2747, Australia
- Nepean Clinical School of Medicine, Charles Perkin Centre Nepean, University of Sydney, Kingswood, Sydney, NSW, 2747, Australia
| | - Sam R Orde
- Department of Intensive Care Medicine, Nepean Hospital, Kingswood, Sydney, NSW, 2747, Australia
- University of Sydney, Camperdown, Sydney, NSW, 2006, Australia
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3
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Roslan AB, Naser JA, Nkomo VT, Padang R, Lin G, Pislaru C, Greason KL, Pellikka PA, Eleid MF, Thaden JJ, Miller FA, Pislaru SV. Performance of Echocardiographic Algorithms for Assessment of High Aortic Bioprosthetic Valve Gradients. J Am Soc Echocardiogr 2022; 35:682-691.e2. [DOI: 10.1016/j.echo.2022.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 11/26/2022]
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4
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Grønset CN, Thygesen LC, Berg SK, Zangger G, Kristensen MS, Sibilitz KL, Pedersen SS, Oldridge NB, Zwisler AD. Measuring HRQoL following heart valve surgery: the HeartQoL questionnaire is a valid and reliable core heart disease instrument. Qual Life Res 2019; 28:1245-1253. [PMID: 30610503 DOI: 10.1007/s11136-018-02098-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Patient-reported health-related quality of life is a complementary healthcare outcome and important when assessing treatment efficacy. Using COSMIN methodological recommendations, this study evaluates the validity and reliability of a core heart disease-specific health-related quality of life questionnaire, the HeartQoL questionnaire (Danish version) in a sample of patients following heart valve surgery. DESIGN This project involved a cross-sectional validity study and a test-retest reliability study. METHODS Eligible patients completed the HeartQoL, the SF-36 health survey questionnaire, and the Hospital Anxiety and Depression Scale following heart valve surgery. Construct validity was tested using a priori hypotheses. Internal consistency reliability was assessed with Cronbach's alpha. An independent sample of patients participated in the test-retest study and reproducibility was determined with relative [intra-class correlation coefficient (ICC)] and absolute reliability [standard error of measurement (SEM) and smallest detectable change (SDC)]. RESULTS Internal consistency was high with Cronbach's alpha ≥ 0.87. ICC was 0.86-0.92. SEM ranged from 0.17 to 0.26 points and SDC ranged from 0.5 to 0.7 points. Construct validity was confirmed with 87% of all a priori hypotheses for predicted variables. CONCLUSIONS The HeartQoL questionnaire demonstrates acceptable construct validity, internal consistency, and test-retest reproducibility in patients following heart valve surgery. Future studies should focus on assessing the responsiveness of the HeartQoL questionnaire over time and following heart valve surgery.
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Affiliation(s)
- Charlotte N Grønset
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Graziella Zangger
- The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
| | - Marie S Kristensen
- National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Kirstine L Sibilitz
- Department of Internal Medicine, Section of Cardiology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Neil B Oldridge
- College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Ann-Dorthe Zwisler
- The Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital, Odense, Denmark.,University of Southern Denmark, Odense, Denmark
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5
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Hurtado-Aguilar LG, Mulderrig S, Moreira R, Hatam N, Spillner J, Schmitz-Rode T, Jockenhoevel S, Mela P. Ultrasound for In Vitro, Noninvasive Real-Time Monitoring and Evaluation of Tissue-Engineered Heart Valves. Tissue Eng Part C Methods 2017; 22:974-981. [PMID: 27673356 DOI: 10.1089/ten.tec.2016.0300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Tissue-engineered heart valves are developed in bioreactors where biochemical and mechanical stimuli are provided for extracellular matrix formation. During this phase, the monitoring possibilities are limited by the need to maintain the sterility and integrity of the valve. Therefore, noninvasive and nondestructive techniques are required. As such, optical imaging is commonly used to verify valve's functionality in vitro. It provides important information (i.e., leaflet symmetry, geometric orifice area, and closing and opening times), which is, however, usually limited to a singular view along the central axis from the outflow side. In this study, we propose ultrasound as a monitoring method that, in contrast to established optical imaging, can assess the valve from different planes, scanning the whole three-dimensional geometry. We show the potential benefits associated with the application of ultrasound to bioreactors, in advancing heart valve tissue engineering from design to fabrication and in vitro maturation. Specifically, we demonstrate that additional information, otherwise unavailable, can be gained to evaluate the valve's functionality (e.g., coaptation length, and effective cusp height and shape). Furthermore, we show that Doppler techniques provide qualitative visualization and quantitative evaluation of the flow through the valve, in real time and throughout the whole in vitro fabrication phase.
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Affiliation(s)
- Luis G Hurtado-Aguilar
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany
| | - Shane Mulderrig
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany
| | - Ricardo Moreira
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany
| | - Nima Hatam
- 2 Department for Cardiothoracic and Vascular Surgery, University Hospital RWTH Aachen , Aachen, Germany
| | - Jan Spillner
- 2 Department for Cardiothoracic and Vascular Surgery, University Hospital RWTH Aachen , Aachen, Germany
| | - Thomas Schmitz-Rode
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany
| | - Stefan Jockenhoevel
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany .,3 Institute for Textile Engineering, RWTH Aachen University , Aachen, Germany
| | - Petra Mela
- 1 Department of Tissue Engineering and Textile Implants, AME-Helmholtz Institute for Biomedical Engineering, University Hospital RWTH Aachen , Aachen, Germany
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Subramaniam K, Nazarnia S. Prosthesis-patient mismatch - what cardiac anesthesiologists need to know? Ann Card Anaesth 2017; 20:234-242. [PMID: 28393786 PMCID: PMC5408531 DOI: 10.4103/aca.aca_9_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Prosthesis-patient Mismatch (PPM) is not uncommon with an incidence reported up to 70% after aortic valve (AV) replacement. Severe forms of PPM are less common (up to 20%); PPM can lead to increased short- and long-term morbidity and mortality. It is important to discriminate PPM from other forms of prosthetic valve dysfunction. Sometimes, prosthetic valve degenerative disease may coexist with PPM. Echocardiography plays an important role in the prevention and diagnosis of PPM. Preemptive strategies to prevent PPM include insertion of newer generation prosthetic valves with better hemodynamic characteristics, stentless prosthesis, aortic root enlargement to insert a larger prosthesis, aortic homograft, and transcutaneous AV implantation. We present an illustrative case and review the literature on PPM pertinent to anesthesiologists.
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Abstract
The prevalence of pregnant women with cardiovascular heart disease is increasing. Transthoracic echocardiography is safe during pregnancy, and it is an important diagnostic tool in pregnant women with established heart disease in order to monitor ventricular and valvular anatomy and function. In addition, it can be used to delineate cardiac anatomy in complex congenital heart disease and help stratify maternal risk during pregnancy. This review will focus on the use of echocardiography in the diagnosis and management of pregnant women with common congenital lesions and with prosthetic valves.
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Affiliation(s)
- Meena Narayanan
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Uri Elkayam
- Division of Cardiology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Tasneem Z Naqvi
- Division of Cardiology, Department of Medicine, College of Medicine, Mayo Clinic, CK27, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA.
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8
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Smeltz AM, Caranasos TG, Teeter EG. BioGlue-Associated Loss of Aortic Valve Leaflet Motility Sonographically Masked by Both Newly Replaced Mechanical Aortic and Mitral Valves. Semin Cardiothorac Vasc Anesth 2017; 22:91-94. [PMID: 28818015 DOI: 10.1177/1089253217725889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BioGlue is a surgical adhesive widely used to help reinforce complex cardiac and vascular repairs. Since its introduction, several case reports have emerged revealing complications that all providers should be mindful of whenever the product is used. This report considers a unique situation where BioGlue was used after double cardiac valve repair that resulted in adhesion of the new mechanical aortic valve leaflets and was difficult to visualize with transesophageal echocardiography.
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Affiliation(s)
| | | | - Emily G Teeter
- 1 University of North Carolina Hospitals, Chapel Hill, NC, USA
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Repossini A, Fischlein T, Santarpino G, Schäfer C, Claus B, Passaretti B, Di Bacco L, Giroletti L, Bisleri G, Muneretto C, Grubitzsch H. Pericardial Stentless Valve for Aortic Valve Replacement: Long-Term Results. Ann Thorac Surg 2016; 102:1956-1965. [DOI: 10.1016/j.athoracsur.2016.05.080] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/11/2016] [Accepted: 05/20/2016] [Indexed: 11/26/2022]
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10
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Hayashi T, Inuzuka R, Ono H, Kato H. Echocardiographic assessment of prosthetic mitral valves in children. Echocardiography 2016; 34:94-101. [PMID: 27804157 DOI: 10.1111/echo.13406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 08/09/2016] [Accepted: 09/20/2016] [Indexed: 11/28/2022] Open
Abstract
AIMS We studied how Doppler-derived hemodynamic parameters in children change as the relative prosthetic mitral valve (PMV) size decreases with somatic growth and evaluated the diagnostic utility of the parameters for detecting PMV obstruction in children. METHODS AND RESULTS We reviewed 26 echocardiographic examination results of 15 mechanical bileaflet PMVs in 12 children. The median age at echocardiographic examination was 6.6 (0.6-18.1) years. The PMV functioned normally in 24 examinations but was obstructed due to thrombosis in two cases. PMV sizes ranged between 16 and 25 mm, which were standardized to body surface area (BSA) at the examination with z-score calculations. We assessed the peak E velocity, mean pressure gradient (PG), and pressure half time (PHT) of the transprosthetic flow, the velocity-time integral (VTI) ratio of the PMV inflow to the left ventricular outflow, and the BSA-indexed effective orifice area (iEOA) of the PMV calculated with the continuity equation. Linear regression analysis revealed statistically significant correlations between all parameters of normally functioning PMVs and the PMV size z-scores (Pearson correlation coefficients: peak E velocity, -0.68; mean PG, -0.71; PHT, -0.82; VTI ratio, -0.76; iEOA, 0.79). Compared with the predictive values derived from the regression equations, the VTI ratio and iEOA exceeded ± 2 standard errors in both patients with obstructive PMVs. CONCLUSION To assess PMV function in children, Doppler-derived hemodynamic parameters should be compared with their predictive values based on relative PMV sizes. The deviation of the VTI ratio and iEOA from their predictive values may indicate prosthetic obstruction.
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Affiliation(s)
- Taiyu Hayashi
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
| | - Ryo Inuzuka
- Department of Pediatrics, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroshi Ono
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
| | - Hitoshi Kato
- Division of Cardiology, National Center for Child Health and Development, Tokyo, Japan
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12
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Konoske R, Whitener G, Nicoara A. Intraoperative Evaluation of Paravalvular Regurgitation by Transesophageal Echocardiography. Anesth Analg 2015. [DOI: 10.1213/ane.0000000000000787] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Bogunovic N, Horstkotte D, Faber L, Bogunovic L, van Buuren F. Echocardiographically derived effective valve opening area in mitral prostheses: a comparative analysis of various calculations using continuity equation and pressure half time method. Heart Vessels 2015; 31:932-8. [PMID: 26049365 DOI: 10.1007/s00380-015-0690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 05/01/2015] [Indexed: 10/23/2022]
Abstract
Detection of dysfunctional mitral valve prostheses (MP) remains complex even though being optimized by considering echocardiographically derived prosthetic effective orifice area (VA). The purpose was to compare VA in MP, calculated by the continuity equation (CE) using peak velocities (CEVpeak), mean velocities (CEVmean), velocity-time integrals (CEVTI) and the pressure half time method using 220 ms as constant first (PHT220) as well as optimized constants. In 267 consecutive patients with normally functioning MP, we investigated VA within the first postoperative month. With increasing prosthetic sizes, mean VA values also increase in all calculations. The statistical curves demonstrate no significant difference in graphical steepness but show different levels. Comparison of mean VA showed the known systematic higher values of PHT220 and significantly decreased results when using CEVTI. This systematic difference between mean VA applying PHT220 versus CEVTI is approximately 1.0 cm(2) for all prosthetic sizes. Calculations via CEVpeak were close to the results of CEVTI. CEVmean produced values, which graphically correspond to the PHT220 curve. Only PHT220 detected the constructional equal prosthetic inner ring width between 29 and 31 mm. To compensate the systematic difference between CEVTI and PHT220, an optimized constant of 140 ms was calculated to be applied in PHT (PHT140). VA is a robust and, therefore, preferable parameter for investigating MP. If needed, both CE and PHT are applicable with a systematical difference between CEVTI and PHT220. An optimized constant of 140 ms (PHT140) should be applied when calculating VA of mitral valve prostheses via PHT.
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Affiliation(s)
- Nikola Bogunovic
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany.
| | - Dieter Horstkotte
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Lothar Faber
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
| | - Lukas Bogunovic
- Department of Physics, University of Bielefeld, Bielefeld, Germany
| | - Frank van Buuren
- Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany
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