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Liu H, Miao JK, Cai M, Gan L, Zhao HQ, Lei XF, Yu J. Anesthetic drug concentrations and placental transfer rate in fetus between term and preterm infants, twins, and singletons. Front Pharmacol 2023; 14:1213734. [PMID: 37719861 PMCID: PMC10502316 DOI: 10.3389/fphar.2023.1213734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Objective: This study aims to determine the drug concentration of etomidate, remifentanil, and rocuronium bromide for general anesthesia in fetus as well as the placental transport rate between term and preterm delivery, twins, and singleton. Study design: Sixty parturients with 72 fetuses undergoing cesarean section under general anesthesia were included. According to whether the fetus was a twin or premature, parturients were divided into Group I (term singleton), Group II (premature singleton), Group III (term twins), and Group IV (premature twins). The preoperative demographic characteristics and laboratory examination of parturients, hemodynamic indicators, the Apgar score of neonates at 1, 5, and 10 min after delivery and at specific assigned values, umbilical artery blood gas analysis results, neonatal weight, and resuscitative measures were recorded. Anesthetic drug concentrations in maternal arterial (MA), umbilical arterial (UA), and umbilical venous (UV) blood were detected by Ultra Performance Liquid Chromatography Tandem Mass Spectrometry (UPLC-MS/MS). Result: No significant differences were observed in the concentrations of etomidate, remifentanil, and rocuronium bromide in MA, UV, and UA blood, or in the UV/MA and UA/UV ratios between term and preterm infants, twins, and singletons. Moreover, there was no variation in the anesthetic drug concentration among each pair of twins. Additionally, no correlation was found between the neonatal weight and the plasma concentrations of anesthetic drugs in UV and UA blood, except for remifentanil in UA blood. Conclusion: Preterm or twin deliveries do not affect the neonatal concentration of etomidate, remifentanil, and rocuronium bromide used in general anesthesia for cesarean sections. Clinical Trial Registration: www.chictr.org.cn, identifier ChiCTR2100046547.
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Affiliation(s)
- Hao Liu
- Department of Pediatrics, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Jing-Kun Miao
- Department of Pediatrics, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Meng Cai
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Gan
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Hui-Qing Zhao
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Feng Lei
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Jin Yu
- Department of Anesthesiology, Chongqing Health Center for Women and Children, Women and Children’s Hospital of Chongqing Medical University, Chongqing, China
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Morikawa M, Ieko M, Nakagawa-Akabane K, Umazume T, Chiba K, Kawaguchi S, Mayama M, Saito Y, Watari H. Prevention of venous thromboembolism in pregnant women with congenital antithrombin deficiency: a retrospective study of a candidate protocol. Int J Hematol 2022; 116:60-70. [PMID: 35316497 DOI: 10.1007/s12185-022-03327-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The best thromboprophylaxis for pregnant women with congenital antithrombin deficiency (CAD) is controversial. OBJECTIVE To clarify the effectiveness of a protocol for venous thromboembolism (VTE) prevention in pregnant women with CAD. METHODS Women at high risk of VTE were administered antithrombin concentrate and heparin after conception, whereas those at low risk of VTE were administered heparin alone until delivery. All women received antithrombin concentrate at delivery except for one who was diagnosed with CAD. RESULTS Ten women had CAD, including one in the high-risk group and nine in the low-risk group. No women had VTE at delivery as per the protocol for VTE prevention. Almost all women had increased antithrombin activity before delivery followed by maintenance at ≥ 70% due to antithrombin concentrate administration. VTE prophylaxis during and after delivery was successful in all women with CAD. However, one woman in the low-risk group did not receive heparin and developed VTE induced by severe hyperemesis at 9 gestational weeks, before the diagnosis of CAD. Women in the high-risk group received antithrombin concentrate after delivery but had increased D-dimer levels at postpartum. CONCLUSIONS Our protocol to prevent VTE in pregnant women with CAD is safe and effective.
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Affiliation(s)
- Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. .,Department of Obstetrics and Gynecology, Kansai Medical University, Shinmachi 2-5-1, Hirakata City, Osaka, 573-1010, Japan.
| | - Masahiro Ieko
- Department of Clinical Laboratory, Iwate Prefectural Chubu Hospital, Kitakami, Japan
| | - Kinuko Nakagawa-Akabane
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takeshi Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kentaro Chiba
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Kawaguchi
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Michinori Mayama
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoshihiro Saito
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Jiang L, Bi H, Jia X, Sun L, Chang H. Clinical value of predictive nursing intervention in preventing deep venous thrombosis of lower extremities after cesarean section. Panminerva Med 2021; 64:303-305. [PMID: 34240837 DOI: 10.23736/s0031-0808.21.04424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ling Jiang
- Physical Examination Center, Yantai Yuhuangding Hospital, Yantai, China
| | - Haiying Bi
- Department of Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Xizhen Jia
- Central Ward Operating Room, Yantai Yuhuangding Hospital, Yantai, China
| | - Liping Sun
- Department of Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Huili Chang
- Department of Surgery, Yantai Yuhuangding Hospital, Yantai, China -
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Morikawa M, Umazume T, Nakagawa K, Chiba K, Kawaguchi S, Watari H. Low antithrombin activity before delivery predicts subsequent hypertensive disorders in pregnancy. Int J Gynaecol Obstet 2019; 147:375-381. [PMID: 31552678 DOI: 10.1002/ijgo.12980] [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: 03/04/2019] [Revised: 07/12/2019] [Accepted: 09/23/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine whether laboratory parameters can predict the onset of recurrent hypertensive disorders of pregnancy (HDP). METHODS A retrospective study of 257 women with consecutive deliveries at a hospital in Sapporo, Japan, between 2009 and 2017. Women were divided into four groups according to whether or not they had HDP in the first and second peripartum periods (HDP-HPD, HDP-Non, Non-HDP, Non-Non). HDP was defined as gestational hypertension and/or proteinuria. Laboratory parameters measured on the day of or 1 day before delivery were compared between peripartum-1 and peripartum-2. RESULTS Frequency of HDP in peripartum-2 was higher among the 24 (9.3%) women with HPD in peripartum-1 (6/24, 25.0%) than among the 233 (90.7%) women without (3/233, 1.3%) (P<0.001). In peripartum-1, women with HDP had lower median antithrombin activity than those without (74% vs 89%, P=0.021). Antithrombin activity in peripartum-1 was also lower in the HDP-HDP (67%) than in the HDP-Non (79%) group (P=0.021). Antithrombin activities of 77% or less at the first delivery predicted HDP in peripartum-1 (P<0.001) and 70% or less predicted HDP in peripartum-2 (P=0.018). CONCLUSION Women with HDP in peripartum-1 had a higher incidence of HDP recurrence. Low antithrombin before a first delivery might predict recurrent HDP in a second pregnancy.
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Affiliation(s)
- Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takeshi Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kinuko Nakagawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kentaro Chiba
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Kawaguchi
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Abstract
PURPOSE OF REVIEW This review outlines the challenges in looking after pregnant women with thromboembolism and sepsis who either become or are at risk of becoming critically ill during pregnancy. RECENT FINDINGS The Pregnancy Mortality Surveillance systems in both the USA and UK record the most common causes of maternal death as thromboembolism and sepsis. Both of these conditions have improved outcomes with timely maternal critical care provided by a multidisciplinary team. SUMMARY In this review, we discuss the pathophysiology, diagnosis, and management of thromboembolism and sepsis, two very important conditions with high mortality requiring admission to intensive care.
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Imaging in the post-partum period: clinical challenges, normal findings, and common imaging pitfalls. Abdom Radiol (NY) 2017; 42:1543-1555. [PMID: 28260169 DOI: 10.1007/s00261-017-1090-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Complex physiological and biochemical changes occur in women during the post-partum period, many of which are incompletely understood. There are limited descriptions within the medical literature about expected imaging findings during this period and this review aims to illustrate 'normal' appearances following vaginal delivery and Cesarean section. We will also discuss some of the pertinent clinical challenges and imaging pitfalls encountered in assessing the post-partum female.
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Gong JM, Shen Y, He YX. Reference Intervals of Routine Coagulation Assays During the Pregnancy and Puerperium Period. J Clin Lab Anal 2016; 30:912-917. [PMID: 27061783 DOI: 10.1002/jcla.21956] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 01/30/2016] [Accepted: 02/04/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Significant changes occur in the coagulation and fibrinolytic systems during pregnancy and puerperium in the plasma levels. However, reference ranges based on healthy people are not optimal for informing clinical decisions during the pregnancy and puerperium. Therefore, it is essential to explore coagulation assays' reference ranges during the pregnancy and puerperium. METHODS Prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fib.), and D-dimer were all measured according to the manufacturer's specifications and laboratory standard operating procedure of the STA-R evolution coagulation analyzer. A total of 11,601 women were enrolled in this study. RESULTS The reference ranges for PT, APTT, TT, Fib., and D-dimer in nonpregnancy period were 10.87-13.76 s, 29.22-44.61 s, 15.39-20.15 s, 1.59-3.97 g/l, and 0-0.56 mg/l, respectively. In early-pregnancy period, the ranges were 11.14-14.07 s, 29.97-44.69 s, 14.92-19.03 s, 1.98-4.13 g/l, and 0-1.67 mg/l, respectively. In midpregnancy period, the ranges were 9.98-12.84 s, 28.53-40.70 s, 13.51-19.82 s, 2.63-5.19 g/l, and 0-2.81 mg/l, respectively. In late-pregnancy period, the ranges were 9.48-12.58 s, 28.61-40.80 s, 14.10-19.61 s, 2.80-5.56 g/l, and 0-27.08 mg/l, respectively. In puerperium period, the ranges were 10.85-13.72 s, 30.51-43.02 s, 15.31-19.64 s, 1.14-5.07 g/l, and 1.27-4.85 mg/l, respectively. CONCLUSION We presented reference intervals for coagulation assays from the nonpregnancy to puerperium period that can be adopted in other laboratories after further validation.
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Affiliation(s)
- Jiao-Mei Gong
- Department of Clinical Laboratory, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Shen
- Department of Clinical Laboratory, Affiliated Tumor Hospital of Zhengzhou University, Henan Tumor Hospital, Zhengzhou, China
| | - Yan-Xia He
- Department of Clinical Laboratory, the Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Matsumura Y, Yamamoto Y, Kikuchi I, Takahashi N, Matsuda Y, Saito T, Yorifuji T, Makino S, Itakura A, Takeda S. Early detection of thrombosis after cesarean section using changes in D-dimer levels. HYPERTENSION RESEARCH IN PREGNANCY 2014. [DOI: 10.14390/jsshp.2.1_26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yuko Matsumura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
| | - Yuka Yamamoto
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
| | - Iwaho Kikuchi
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
| | - Nanase Takahashi
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
| | - Yuko Matsuda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
| | - Tomomi Saito
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
| | - Takashi Yorifuji
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
| | - Shintaro Makino
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
| | - Atsuo Itakura
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
| | - Satoru Takeda
- Department of Obstetrics and Gynecology, Juntendo University Faculty of Medicine
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Opening Remarks. HYPERTENSION RESEARCH IN PREGNANCY 2014. [DOI: 10.14390/jsshp.2.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Kawaguchi S, Yamada T, Takeda M, Nishida R, Yamada T, Morikawa M, Minakami H. Changes in d-dimer levels in pregnant women according to gestational week. Pregnancy Hypertens 2013; 3:172-7. [PMID: 26106030 DOI: 10.1016/j.preghy.2013.03.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 01/09/2013] [Accepted: 03/07/2013] [Indexed: 10/27/2022]
Abstract
We performed a retrospective review of medical charts regarding blood d-dimer levels determined cross-sectionally by the latex agglutination assay in 1952 samples from 1185 women to determine changes in d-dimer levels according to the stage of pregnancy. Three of 17 women in whom further investigations were performed were found to have clinical venous thromboembolism (VTE). The median and 95th percentile values of d-dimer (μg/mL) in the 1182 women without clinical VTE, 0.54 and 2.41 at gestational week (GW) 4-13, increased gradually to 1.22 and 5.03 at GW 14-27, 1.81 and 6.18 at GW 28-35, and 2.13 and 5.85 at GW 36-42, respectively. A total of nine women (0.76%), including three women with clinical VTE, exhibited a d-dimer level >14.0μg/mL, which was well above the 99th percentile for any stage of pregnancy. Thus, 3 (33%) of the nine with a d-dimer level >14μg/mL developed clinical VTE, while none of the remaining 1176 women with a d-dimer level ⩽14μg/mL developed clinical VTE. Although further prospective studies are required, our results suggested that there is a certain cut-off d-dimer value that would allow us to differentiate between pregnant women with and without clinical VTE.
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Affiliation(s)
- Satoshi Kawaguchi
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takashi Yamada
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Masamitsu Takeda
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryutaro Nishida
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takahiro Yamada
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mamoru Morikawa
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hisanori Minakami
- Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Serum levels of N-terminal fragment of precursor protein brain-type natriuretic peptide (NT-proBNP) in twin pregnancy. Clin Chim Acta 2013; 415:41-4. [DOI: 10.1016/j.cca.2012.08.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 08/17/2012] [Accepted: 08/17/2012] [Indexed: 11/22/2022]
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Kikuchi M, Itakura A, Miki A, Nishibayashi M, Ikebuchi K, Ishihara O. Fibrinogen concentrate substitution therapy for obstetric hemorrhage complicated by coagulopathy. J Obstet Gynaecol Res 2012; 39:770-6. [PMID: 23278972 DOI: 10.1111/j.1447-0756.2012.02058.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 09/17/2012] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to assess the efficacy and safety of fibrinogen concentrate therapy for women with obstetric hemorrhage complicated by dilutional or consumptive coagulopathy by retrospectively reviewing the medical records of relevant patients from a single tertiary center. MATERIAL AND METHODS Eighteen cases of coagulopathy (8 dilutional, 10 consumptive) administered fibrinogen concentrate at our center over the past 5 years for treating hypofibrinogenemia were identified. Hemoglobin levels, platelet counts, fibrinogen levels, prothrombin time, activated partial thromboplastin time, and D-dimer levels were examined before and after fibrinogen substitution. Units of red blood cells, fresh frozen plasma, and pooled platelet concentrates transfused; blood loss volume; patient outcomes; and adverse events were obtained from medical and laboratory records. RESULTS The overall response to fibrinogen concentrate was considered good in 12 cases, moderate in four, and poor in two. The response rate was good or moderate in 88% (7/8) of dilutional coagulopathy cases and 89% (9/10) of consumptive coagulopathy cases. Fibrinogen levels significantly increased after fibrinogen substitution therapy (approximately 40 mg/L per g fibrinogen concentrate) in both groups. Although prothrombin time and activated partial thromboplastin time improved after substitution, hemoglobin levels, platelet counts, and D-dimer levels remained unchanged. No serious adverse event was causally associated with fibrinogen substitution therapy. CONCLUSION Fibrinogen concentrate substitution therapy for obstetric hemorrhage increases fibrinogen levels and appears to be effective in managing dilutional or consumptive coagulopathy.
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Affiliation(s)
- Mariko Kikuchi
- Department of Obstetrics and Gynecology, Saitama Medical University, Saitama, Japan
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Koyama T, Yamada T, Furuta I, Morikawa M, Yamada T, Minakami H. Plasma Aldosterone Concentration and Plasma Renin Activity Decrease during the Third Trimester in Women with Twin Pregnancies. Hypertens Pregnancy 2012; 31:419-26. [DOI: 10.3109/10641955.2012.690057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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