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Cheval M, Hingray C, Kanemoto K, de Toffol B, Tarrada A. Insights into Postictal Psychosis, from functional imaging and EEG: A systematic review. Seizure 2024; 121:45-55. [PMID: 39074414 DOI: 10.1016/j.seizure.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/27/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
Multiple hypotheses exist about the pathophysiology of Postictal Psychosis (PIP). As the clinical manifestations of PIP are roughly stereotyped, we assumed the existence of a common neurological pathway. This study aimed to determine if a specific brain network sustained the psychotic episode, regardless of the localization of the epileptogenic zone. We conducted a systematic review following the PRISMA guidelines. We included a total of 24 studies providing electrophysiological results(n=22) and metabolic imaging performed during the PIP(n=5). Temporal and frontal lobes seemed frequently involved, without clear evidence for lateralization. The EEG patterns were heterogenous, varying from unchanged to diffuse slowing. Metabolic pattern showed an increased perfusion within temporal and frontal lobes during PIP. These results correspond to the patterns described during postictal state, but they persisted throughout PIP, within regions larger than the epileptogenic zone and resolved with the recovery. PIP symptoms are associated with an excessive persistence of postictal changes within extended frontotemporal networks. A hypothesis could be that PIP results from an abnormally prolonged and diffuse post-ictal dysregulation.
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Affiliation(s)
- Margaux Cheval
- EEG-monitoring Unit, Neurology Department, Hôpital Central, CHU de Nancy, 54000 Nancy, France; Epileptology Unit, Reference Center for Rare Epilepsies, Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.; Rehabilitation Unit, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Coraline Hingray
- EEG-monitoring Unit, Neurology Department, Hôpital Central, CHU de Nancy, 54000 Nancy, France; Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, 54000 Laxou, France
| | - Kousuke Kanemoto
- Department of Neuropsychiatry, Aichi Medical University, Nagoya, Japan
| | - Bertrand de Toffol
- UMR 1253, iBrain, Université de Tours, Inserm, France; Neurology and Neurophysiology Unit, Centre Hospitalier de Cayenne, France & CIC INSERM 1424
| | - Alexis Tarrada
- EEG-monitoring Unit, Neurology Department, Hôpital Central, CHU de Nancy, 54000 Nancy, France; Pôle Universitaire du Grand Nancy, Centre Psychothérapique de Nancy, 54000 Laxou, France..
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Scullen T, Teja N, Song SH, Couldwell M, Carr C, Mathkour M, Lee DJ, Tubbs RS, Dallapiazza RF. Use of stereoelectroencephalography beyond epilepsy: a systematic review. World Neurosurg 2021; 155:96-108. [PMID: 34217862 DOI: 10.1016/j.wneu.2021.06.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Tyler Scullen
- Tulane University School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Nikhil Teja
- Department of Psychiatry, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire, USA
| | - Seo Ho Song
- Geisel School of Medicine, Dartmouth University, Hanover, New Hampshire, USA
| | - Mitchell Couldwell
- Tulane University School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Chris Carr
- Tulane University School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Mansour Mathkour
- Tulane University School of Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Darrin J Lee
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - R Shane Tubbs
- Tulane University School of Medicine, Tulane University, New Orleans, Louisiana, USA; Department of Structural & Cellular Biology, Tulane University, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, Grenada
| | - Robert F Dallapiazza
- Tulane University School of Medicine, Tulane University, New Orleans, Louisiana, USA.
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Barany L, Meszaros C, Ganslandt O, Buchfelder M, Kurucz P. Neural and vascular architecture of the septum pellucidum: an anatomical study and considerations for safe endoscopic septum pellucidotomy. J Neurosurg 2020; 133:902-911. [PMID: 31374555 DOI: 10.3171/2019.5.jns19754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 05/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The septum pellucidum is a bilateral thin membranous structure representing the border between the frontal horns of the lateral ventricles. Its most examined components are the septal veins due to their surgical importance during endoscopic septum pellucidotomy (ESP), which is a well-accepted method for surgical treatment of unilateral hydrocephalus. It is widely accepted that the septum pellucidum contains nerve fibers as well, but interestingly, no anatomical study has been addressed to its neural components before. The aim of the present study was to identify these elements as well as their relations to the septal veins and to define major landmarks within the ventricular system for neurosurgical use. METHODS Nine formalin-fixed human cadaveric brains (18 septa pellucida) were involved in this study. A central block containing both septa pellucida was removed and frozen at -30°C for 2 weeks in 7 cases. The fibers of the septum pellucidum and the adjacent areas including the venous elements were dissected under magnification by using homemade wooden spatulas and microsurgical instruments. In 2 cases a histological technique was used to validate the findings of the dissections. The blocks were sliced, embedded in paraffin, cut in 7-µm-thick slices, and then stained as follows: 1) with H & E, 2) with Luxol fast blue combined with cresyl violet, and 3) with Luxol fast blue combined with Sirius red. RESULTS The septum pellucidum and the subjacent septum verum form the medial wall of the frontal horn of the lateral ventricle. Both structures contain nerve fibers that were organized in 3 groups: 1) the precommissural fibers of the fornix; 2) the inferior fascicle; and 3) the superior fascicle of the septum pellucidum. The area directly rostral to the postcommissural column of the fornix consisted of macroscopically identifiable gray matter corresponding to the septal nuclei. The histological examinations validated the findings of the authors' fiber dissections. CONCLUSIONS The nerve elements of the septum pellucidum as well as the subjacent septum verum were identified with fiber dissection and verified with histology for the first time. The septal nuclei located just anterior to the fornix and the precommissural fibers of the fornix should be preserved during ESP. Considering the venous anatomy as well as the neural architecture of the septum pellucidum, the fenestration should ideally be placed above the superior edge of the fornix and preferably dorsal to the interventricular foramen.
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Affiliation(s)
- Laszlo Barany
- 1Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology, and Embryology, Semmelweis University, Budapest, Hungary
| | - Cintia Meszaros
- 1Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology, and Embryology, Semmelweis University, Budapest, Hungary
| | - Oliver Ganslandt
- 2Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Germany; and
| | - Michael Buchfelder
- 3Department of Neurosurgery, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Peter Kurucz
- 2Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Germany; and
- 3Department of Neurosurgery, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Eloge JC, Ross DA, Cooper JJ. Afflicted by the Gods: The Shared History and Neurobiology of Psychosis and Epilepsy. Biol Psychiatry 2020; 87:e35-e36. [PMID: 32498791 PMCID: PMC7815043 DOI: 10.1016/j.biopsych.2020.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Joshua C Eloge
- Department of Psychiatry, Rush University Medical Center, Chicago, Illinois.
| | - David A Ross
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Joseph J Cooper
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
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Kim SY, Park MH, Jung KI. Chronic schizophrenia with the absence of the septum pellucidum: A case report. Schizophr Res 2019; 204:430-431. [PMID: 30150022 DOI: 10.1016/j.schres.2018.08.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/17/2018] [Accepted: 08/18/2018] [Indexed: 01/27/2023]
Abstract
The absence of the septum pellucidum is a rare brain abnormality, especially when it co-occurs with schizophrenia. This report describes an unusual case of a middle-aged adult with chronic schizophrenia found to be missing the septum pellucidum. The relationship of the septum pellucidum to the other structures in the limbic system suggests that disturbance of the septum pellucidum may have a role in the neurological etiology of schizophrenia.
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Affiliation(s)
- Shin-Young Kim
- Department of Psychiatry, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, 180, Wangsan-ro, Dongdaemun-gu, Seoul 02559, Republic of Korea
| | - Min-Hyeon Park
- Department of Psychiatry, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, 180, Wangsan-ro, Dongdaemun-gu, Seoul 02559, Republic of Korea
| | - Kyu-In Jung
- Department of Psychiatry, St. Paul's Hospital, College of Medicine, The Catholic University of Korea, 180, Wangsan-ro, Dongdaemun-gu, Seoul 02559, Republic of Korea.
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Butler T, Zaborszky L, Pirraglia E, Li J, Wang XH, Li Y, Tsui W, Talos D, Devinsky O, Kuchna I, Nowicki K, French J, Kuzniecky R, Wegiel J, Glodzik L, Rusinek H, deLeon MJ, Thesen T. Comparison of human septal nuclei MRI measurements using automated segmentation and a new manual protocol based on histology. Neuroimage 2014; 97:245-51. [PMID: 24736183 PMCID: PMC4180657 DOI: 10.1016/j.neuroimage.2014.04.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/08/2014] [Accepted: 04/06/2014] [Indexed: 11/18/2022] Open
Abstract
Septal nuclei, located in basal forebrain, are strongly connected with hippocampi and important in learning and memory, but have received limited research attention in human MRI studies. While probabilistic maps for estimating septal volume on MRI are now available, they have not been independently validated against manual tracing of MRI, typically considered the gold standard for delineating brain structures. We developed a protocol for manual tracing of the human septal region on MRI based on examination of neuroanatomical specimens. We applied this tracing protocol to T1 MRI scans (n=86) from subjects with temporal epilepsy and healthy controls to measure septal volume. To assess the inter-rater reliability of the protocol, a second tracer used the same protocol on 20 scans that were randomly selected from the 72 healthy controls. In addition to measuring septal volume, maximum septal thickness between the ventricles was measured and recorded. The same scans (n=86) were also analyzed using septal probabilistic maps and DARTEL toolbox in SPM. Results show that our manual tracing algorithm is reliable, and that septal volume measurements obtained via manual and automated methods correlate significantly with each other (p<.001). Both manual and automated methods detected significantly enlarged septal nuclei in patients with temporal lobe epilepsy in accord with a proposed compensatory neuroplastic process related to the strong connections between septal nuclei and hippocampi. Septal thickness, which was simple to measure with excellent inter-rater reliability, correlated well with both manual and automated septal volume, suggesting it could serve as an easy-to-measure surrogate for septal volume in future studies. Our results call attention to the important though understudied human septal region, confirm its enlargement in temporal lobe epilepsy, and provide a reliable new manual delineation protocol that will facilitate continued study of this critical region.
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Affiliation(s)
- Tracy Butler
- Center for Brain Health, Department of Psychiatry, New York University School of Medicine, 145 East 32nd Street, New York, NY 10016, USA; Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, 223 East 34th Street, New York, NY 10016, USA.
| | - Laszlo Zaborszky
- Center for Molecular and Behavioral Neuroscience, Rutgers, The State University of New Jersey, 197 University Avenue, Newark, NJ 07102, USA
| | - Elizabeth Pirraglia
- Center for Brain Health, Department of Psychiatry, New York University School of Medicine, 145 East 32nd Street, New York, NY 10016, USA
| | - Jinyu Li
- Center for Brain Health, Department of Psychiatry, New York University School of Medicine, 145 East 32nd Street, New York, NY 10016, USA
| | - Xiuyuan Hugh Wang
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, 223 East 34th Street, New York, NY 10016, USA
| | - Yi Li
- Center for Brain Health, Department of Psychiatry, New York University School of Medicine, 145 East 32nd Street, New York, NY 10016, USA
| | - Wai Tsui
- Center for Brain Health, Department of Psychiatry, New York University School of Medicine, 145 East 32nd Street, New York, NY 10016, USA
| | - Delia Talos
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, 223 East 34th Street, New York, NY 10016, USA
| | - Orrin Devinsky
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, 223 East 34th Street, New York, NY 10016, USA
| | - Izabela Kuchna
- Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, NY 10314, USA
| | - Krzysztof Nowicki
- Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, NY 10314, USA
| | - Jacqueline French
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, 223 East 34th Street, New York, NY 10016, USA
| | - Rubin Kuzniecky
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, 223 East 34th Street, New York, NY 10016, USA
| | - Jerzy Wegiel
- Institute for Basic Research in Developmental Disabilities, 1050 Forest Hill Road, Staten Island, NY 10314, USA
| | - Lidia Glodzik
- Center for Brain Health, Department of Psychiatry, New York University School of Medicine, 145 East 32nd Street, New York, NY 10016, USA
| | - Henry Rusinek
- Center for Brain Health, Department of Psychiatry, New York University School of Medicine, 145 East 32nd Street, New York, NY 10016, USA
| | - Mony J deLeon
- Center for Brain Health, Department of Psychiatry, New York University School of Medicine, 145 East 32nd Street, New York, NY 10016, USA
| | - Thomas Thesen
- Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, 223 East 34th Street, New York, NY 10016, USA
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Butler T, Weisholtz D, Isenberg N, Harding E, Epstein J, Stern E, Silbersweig D. Neuroimaging of frontal-limbic dysfunction in schizophrenia and epilepsy-related psychosis: toward a convergent neurobiology. Epilepsy Behav 2012; 23:113-22. [PMID: 22209327 PMCID: PMC3339259 DOI: 10.1016/j.yebeh.2011.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 09/28/2011] [Accepted: 11/06/2011] [Indexed: 12/27/2022]
Abstract
Psychosis is a devastating, prevalent condition considered to involve dysfunction of frontal and medial temporal limbic brain regions as key nodes in distributed brain networks involved in emotional regulation. The psychoses of epilepsy represent an important, though understudied, model relevant to understanding the pathophysiology of psychosis in general. In this review, we (1) discuss the classification of epilepsy-related psychoses and relevant neuroimaging and other studies; (2) review structural and functional neuroimaging studies of schizophrenia focusing on evidence of frontal-limbic dysfunction; (3) report our laboratory's PET, fMRI, and electrophysiological findings; (4) describe a theoretical framework in which frontal hypoactivity and intermittent medial temporal hyperactivity play a critical role in the etiopathology of psychosis both associated and unassociated with epilepsy; and (5) suggest avenues for future research.
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Affiliation(s)
- Tracy Butler
- NYU Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York, NY, USA.
| | - Daniel Weisholtz
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nancy Isenberg
- Division of Behavioral Neurology, New Jersey Neuroscience Institute, Edison, NJ
| | - Elizabeth Harding
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jane Epstein
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Emily Stern
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David Silbersweig
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Butler T, Blackmon K, Zaborszky L, Wang X, DuBois J, Carlson C, Barr WB, French J, Devinsky O, Kuzniecky R, Halgren E, Thesen T. Volume of the human septal forebrain region is a predictor of source memory accuracy. J Int Neuropsychol Soc 2012; 18:157-61. [PMID: 22152217 PMCID: PMC3339258 DOI: 10.1017/s1355617711001421] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Septal nuclei, components of basal forebrain, are strongly and reciprocally connected with hippocampus, and have been shown in animals to play a critical role in memory. In humans, the septal forebrain has received little attention. To examine the role of human septal forebrain in memory, we acquired high-resolution magnetic resonance imaging scans from 25 healthy subjects and calculated septal forebrain volume using recently developed probabilistic cytoarchitectonic maps. We indexed memory with the California Verbal Learning Test-II. Linear regression showed that bilateral septal forebrain volume was a significant positive predictor of recognition memory accuracy. More specifically, larger septal forebrain volume was associated with the ability to recall item source/context accuracy. Results indicate specific involvement of septal forebrain in human source memory, and recall the need for additional research into the role of septal nuclei in memory and other impairments associated with human diseases.
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Affiliation(s)
- Tracy Butler
- Comprehensive Epilepsy Center, Department of Neurology, New York University Medical Center, 223 East 34th Street, New York, NY 10016, USA.
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Carhart-Harris RL, Friston KJ. The default-mode, ego-functions and free-energy: a neurobiological account of Freudian ideas. Brain 2010; 133:1265-83. [PMID: 20194141 PMCID: PMC2850580 DOI: 10.1093/brain/awq010] [Citation(s) in RCA: 221] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2009] [Revised: 12/23/2009] [Accepted: 12/23/2009] [Indexed: 01/01/2023] Open
Abstract
This article explores the notion that Freudian constructs may have neurobiological substrates. Specifically, we propose that Freud's descriptions of the primary and secondary processes are consistent with self-organized activity in hierarchical cortical systems and that his descriptions of the ego are consistent with the functions of the default-mode and its reciprocal exchanges with subordinate brain systems. This neurobiological account rests on a view of the brain as a hierarchical inference or Helmholtz machine. In this view, large-scale intrinsic networks occupy supraordinate levels of hierarchical brain systems that try to optimize their representation of the sensorium. This optimization has been formulated as minimizing a free-energy; a process that is formally similar to the treatment of energy in Freudian formulations. We substantiate this synthesis by showing that Freud's descriptions of the primary process are consistent with the phenomenology and neurophysiology of rapid eye movement sleep, the early and acute psychotic state, the aura of temporal lobe epilepsy and hallucinogenic drug states.
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Affiliation(s)
- R L Carhart-Harris
- Neuropsychopharmacology Unit, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 ONN, UK.
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Abstract
Schizophrenia (SZ) is a complex, heterogeneous, and disabling psychiatric disorder that impairs multiple aspects of human cognitive, perceptual, emotional, and behavioral functioning. SZ is relatively frequent (prevalence around 1%), with onset usually during adolescence or early adulthood, and has a deteriorating course. The rapidly growing area of neuroimaging research has has found clear evidence of many cortical and subcortical abnormalities in individuals with SZ. In this article the most recent findings from multiple studies on neurological disorders in SZ are reviewed, and the authors make a strong argument for a neurological basis of the schizophrenic process.
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Affiliation(s)
- Arman Danielyan
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH 45244, USA
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