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Matsumoto R, Shibuya T, Saijo F, Watanabe K, Sawa Y. Successful Repair of Superior Mesenteric Artery Aneurysm with Reconstruction of Branches. Ann Vasc Dis 2020; 13:450-453. [PMID: 33391570 PMCID: PMC7758580 DOI: 10.3400/avd.cr.20-00108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Superior mesenteric artery aneurysms (SMAAs) are rare and potentially life-threatening. Whether surgical or endovascular repair is performed, mesenteric ischemic complication is the greatest concern. A 56-year-old gentleman with SMAA underwent surgical resection with reconstruction of the superior mesenteric artery (SMA) and its branches using the great saphenous vein with several techniques, including island reconstruction of the branches, staged segmental cross-clamping, and an external shunt, to reduce the mesenteric ischemia time. The postoperative course was uneventful with no signs of mesenteric ischemia. A computed tomography scan showed that all grafts to the SMA and its branches were patent.
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Affiliation(s)
- Ryota Matsumoto
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Shibuya
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Fumiyoshi Saijo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kenichi Watanabe
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Kiuchi R, Tomita S, Yamaguchi S, Nishida Y, Ohtake H, Nakamura H, Watanabe G. A novel coronary active perfusion system using a conventional intra-aortic balloon pump for off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2014; 148:304-10. [PMID: 24472314 DOI: 10.1016/j.jtcvs.2013.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/15/2013] [Accepted: 11/22/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE It is important for coronary active perfusion systems to avoid myocardial ischemia during off-pump coronary artery bypass grafting. We have developed a new concept for a perfusion system to pump blood based on changes in helium gas volume. This system uses a conventional intra-aortic balloon pump to activate the perfusion pump. Our study used basic and animal experiments to investigate the most suitable system for coronary perfusion using this new concept. METHODS A conventional intra-aortic balloon pump was used to supply power. A device for perfusion was developed with a balloon placed inside a stiff syringe barrel. The device was connected to the helium gas line of the intra-aortic balloon pump. Changes in flow with changes in augmentation level were noted when volumes outside and within the balloon were changed. Six pigs with occlusion of the left anterior descending artery were used for system validation, with monitoring to identify changes in hemodynamics and cardiac enzyme levels. RESULTS In the basic experiment, an 80-mL outside volume and 3.0-mL inner volume resulted in the greatest percentage change in flow rate with respect to changes in augmentation. In the animal experiment, the new coronary active perfusion system prevented myocardial ischemia during coronary occlusion. CONCLUSIONS We clarified the most suitable method for our new coronary active perfusion system. Using this system, safe anastomosis was consistently performed in animal experiments. Clinically, off-pump coronary artery bypass may potentially be performed more safely and easily using this new system.
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Affiliation(s)
- Ryuta Kiuchi
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan.
| | - Shigeyuki Tomita
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Shojiro Yamaguchi
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Yuji Nishida
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Hiroshi Ohtake
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
| | - Hiroyuki Nakamura
- Department of Environmental and Preventive Medicine, Kanazawa University, Kanazawa, Japan
| | - Go Watanabe
- Department of General and Cardiothoracic Surgery, Kanazawa University, Kanazawa, Japan
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Takami Y, Tajima K, Kato W, Fujii K, Hibino M, Munakata H, Sakai Y. Clinical validation of coronary artery flow through an intracoronary shunt during off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2012; 147:259-63. [PMID: 23141031 DOI: 10.1016/j.jtcvs.2012.10.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 09/19/2012] [Accepted: 10/16/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Intracoronary shunts have been developed for a bloodless field and preserved forward flow preventing ischemia during off-pump coronary artery bypass (OPCAB) surgery. However, reports directly measuring the forward flow through the shunt in clinical settings are lacking. METHODS Using a 7.5-MHz Doppler probe, we investigated the coronary flow through a 1.5-mm shunt inserted into the left anterior descending artery (LAD) for anastomosis with the internal thoracic artery during OPCAB in 30 consecutive patients. The following Doppler flow parameters were obtained before and after shunting: peak velocity, mean velocity, time-velocity integral, and flow. RESULTS No patients developed significant electrocardiographic changes and the peak value of postoperative myocardial band of creatine kinase was 17 ± 16 IU/L. All Doppler flow parameters of the LAD decreased significantly after shunting; peal velocity: 71.3 ± 34.6 cm/second to 54.5 ± 25.3 cm/second (-24% ± 27%), mean velocity: 33.3 ± 18.3 cm/second to 26.3 ± 14.0 cm/second (-21% ± 23%), and time-velocity integral: 28.7 ± 12.1 cm to 19.0 ± 7.1 cm (-28% ± 14%), and flow: 38.7 ± 16.8 mL/minute to 25.0 ± 9.5 mL/minute (-31% ± 13%) (P < .01). CONCLUSIONS The LAD flow is preserved at least 50% through a 1.5-mm intracoronary shunt, although the flow pattern was attenuated, during OPCAB anastomosis. The Doppler evaluation of the coronary artery flow before and after shunting is useful to justify the protective use of the shunt on myocardial perfusion during OPCAB.
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Affiliation(s)
- Yoshiyuki Takami
- Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
| | - Kazuyoshi Tajima
- Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Wataru Kato
- Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Kei Fujii
- Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Makoto Hibino
- Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Hisaaki Munakata
- Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Yoshimasa Sakai
- Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
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Doi T, Kamiya H, Watanabe G, Misaki T. A coronary active perfusion system for off-pump coronary artery bypass grafting in an experimental porcine model: the relationship between flow rate and myocardial function. Artif Organs 2008; 32:525-30. [PMID: 18638306 DOI: 10.1111/j.1525-1594.2008.00579.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We developed a coronary active perfusion system (synchronized arterial flow ensuring system [SAFE-System]) to prevent myocardial ischemia during distal anastomosis in off-pump coronary artery bypass grafting (CABG). The purpose of this study was to identify the relationship between the flow rate of the SAFE-System and myocardial function. Studies were performed on pigs, which were divided into five groups: external shunt perfusion group (group A, n = 6); 0.1 mL/beat flow rate for the SAFE-System group (group B, n = 6); 0.2 mL/beat flow rate group (group C, n = 6); 0.3 mL/beat flow rate group (group D, n = 6); and 0.4 mL/beat flow rate group (group E, n = 6). Regional myocardial blood flow and left ventricular function were monitored for 30 min. The regional myocardial blood flow in group A was severely decreased (P < 0.001), and was significantly lower than in the other groups (P < 0.001). The slope of the end-systolic pressure-volume relationship, and the slope of the preload recruitable stroke work relationship in groups A, D, and E were lower than in groups B and C. As compared with the use of a passive external shunt, a coronary active perfusion system provides adequate myocardial blood flow and hemodynamics. It was possible to maintain left ventricular function when using 0.1 or 0.2 mL/beat flow rate. The use of a coronary active perfusion system appears to make the off-pump CABG procedure safer and may increase the application of off-pump bypass grafting.
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Affiliation(s)
- Toshio Doi
- First Department of Surgery, University of Toyama, Toyama, Japan.
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Collison SP, Agarwal A, Trehan N. Controversies in the Use of Intraluminal Shunts During Off-Pump Coronary Artery Bypass Grafting Surgery. Ann Thorac Surg 2006; 82:1559-66. [PMID: 16996987 DOI: 10.1016/j.athoracsur.2006.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2006] [Revised: 05/03/2006] [Accepted: 05/04/2006] [Indexed: 10/24/2022]
Abstract
Technical advances have made the performance of multivessel off-pump coronary artery bypass feasible. Snaring and intraluminal shunts are the techniques used for vascular control. Snaring provides a bloodless surgical field, is usually well tolerated by the patient, and is supported by years of clinical experience. Intraluminal shunts aim to achieve hemostasis at the arteriotomy site and to allow antegrade flow to provide myocardial protection. There are unresolved issues regarding whether shunts have a clinical benefit, do provide adequate flow to provide myocardial protection, and whether they cause significant endothelial damage. In this article, we have reviewed the literature to lend perspective to these issues.
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Koshida Y, Watanabe G, Yasuda T, Tomita S, Kadoya S, Kanamori T. Portable coronary active perfusion system for off-pump coronary artery bypass grafting. Ann Thorac Surg 2006; 81:706-10. [PMID: 16427878 DOI: 10.1016/j.athoracsur.2005.06.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Revised: 06/16/2005] [Accepted: 06/22/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE The present study was performed to develop a new perfusion system for off-pump coronary artery bypass grafting and to examine whether even a simple coronary perfusion system can maintain adequate blood flow delivery during anastomosis. DESCRIPTION The experiment was performed in two stages. In procedure 1, 3 pigs with left anterior descending artery occlusion were used to evaluate optimal perfusion flow rate and coronary artery internal pressure, and to evaluate the safety area of perfusion. In procedure 2, 6 pigs were used to validate the new portable coronary perfusion system. EVALUATION The optimal blood flow in the portable coronary active perfusion system was less than approximately 40 mL/min. The small, easy to use pump system (ie, the portable coronary active perfusion system) may prevent hemodynamic deterioration and ventricular arrhythmia during coronary occlusion, resulting in better maintenance of left ventricular function. CONCLUSIONS Even a simple pump system can achieve effective perfusion for safe anastomosis. Further studies are required to allow the clinical use of this system.
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Affiliation(s)
- Yoshinao Koshida
- Department of General and Cardiothoracic Surgery, Kanazawa University School of Medicine, Kanazawa, Ishikawa, Japan.
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Manabe S, Arai H, Tanaka H, Tabuchi N, Sunamori M. Physiological comparison of off-pump and on-pump coronary artery bypass grafting in patients on chronic hemodialysis. ACTA ACUST UNITED AC 2006; 54:3-10. [PMID: 16482929 DOI: 10.1007/bf02743776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Despite the long-term benefit, the operative results of conventional coronary artery bypass grafting for chronic hemodialysis patients remain unsatisfactory. The efficacy of off-pump coronary artery bypass grafting for hemodialysis patients is yet to be determined. The purpose of this study was to investigate the postoperative physiology of off-pump coronary artery bypass grafting for hemodialysis patients. METHODS Twenty-five hemodialysis cases who underwent isolated coronary artery bypass grafting were reviewed. Fifteen of these patients underwent off-pump coronary artery bypass grafting (off-group) and 10 underwent on-pump coronary artery bypass grafting (on-group). Comparisons were made in cardiac function (cardiac index and stroke volume index), respiratory function (AaDO2), hemodialysis management (blood urea nitrogen, creatinine, right atrial pressure, pulmonary wedge pressure), and bleeding tendency (postoperative blood loss and blood transfusion). RESULTS There was no operative mortality, but 3 major postoperative complications occurred (2 sternal wound infections in the off-group and 1 pneumonia in the on-group). There was no difference in cardiac index or stroke volume index. AaDO2 was significantly lower in the off-group. Plasma concentrations of blood urea nitrogen and creatinine were similar between groups. Right atrial pressure was lower and pulmonary wedge pressure tended to be lower in the off-group. Postoperative bleeding and blood transfusion were similar between groups. CONCLUSION Our study confirmed that off-pump coronary artery bypass grafting is feasible for hemodialysis patients. Physiologic data showed that off-pump coronary artery bypass grafting might be effective in preserving postoperative lung oxygenation.
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Affiliation(s)
- Susumu Manabe
- Department of Cardiothoracic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Japan
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Arai H, Kozakai A, Manabe S, Kawaguchi S, Shimizu M, Egi K, Tabuchi N, Tanaka H, Sunamori M. Perfusion Flow Assessment of Coronary Shunt during Off-Pump Coronary Artery Bypass Grafting. Heart Surg Forum 2005; 7:E136-40. [PMID: 15138091 DOI: 10.1532/hsf98.200371320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Coronary shunts are widely used to prevent myocardial ischemia during off-pump coronary artery bypass graft (OPCAB) procedures. Although clinical effectiveness has been reported, actual perfusion flow has not been well assessed. The purpose of this study was to evaluate actual shunt flow and its pattern during passive coronary perfusion in clinical OPCAB. METHODS In 15 OPCAB cases, the coronary perfusion flow of the external shunt (1.7 or 2.0 mm) during anastomosis and the free flow of the shunt were measured with an in-line electromagnetic or ultrasonic flow probe. The perfused coronary blood vessel was either the left anterior descending coronary artery or the right coronary artery. The inflow vessel of the external shunt was either the femoral artery (FA) or the ascending aorta (AA). RESULTS Free flow values of a 1.7-mm FA shunt, 1.7-mm AA shunt, and 2.0-mm FA shunt were 34+/- 7, 39 +/- 3, and 44 +/- 7 mL/min. Perfusion flows were 13 +/- 4, 14 +/- 3, and 22 +/- 4 mL/min, respectively. Perfusion flow was significantly lower than free flow and correlated well with coronary resistance. Although inflow site did not influence net perfusion flow, diastolic/systolic flow fraction ratio was significantly greater when the shunt was perfused from the FA. CONCLUSIONS External shunt from FA would provide limited but effective perfusion flow with a physiological pattern, which is passively regulated by coronary resistance.
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Affiliation(s)
- Hirokuni Arai
- Department of Cardiothoracic Surgery, Tokyo Medical and Dental University Graduate School of Medicine, Japan.
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Verma S, Fedak PWM, Weisel RD, Szmitko PE, Badiwala MV, Bonneau D, Latter D, Errett L, LeClerc Y. Off-pump coronary artery bypass surgery: fundamentals for the clinical cardiologist. Circulation 2004; 109:1206-11. [PMID: 15023895 DOI: 10.1161/01.cir.0000120292.65143.f5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Subodh Verma
- Division of Cardiac Surgery, Toronto General Hospital, Toronto, Ontario, Canada.
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Muraki S, Tsukamoto M, Komatsu K, Sakata J, Ohori S, Hasegawa T, Abe T. Minimally ischemic off-pump coronary artery bypass grafting: active perfusion-assist with nitroglycerin-supplemented blood. Ann Thorac Surg 2003; 76:298-300. [PMID: 12842571 DOI: 10.1016/s0003-4975(02)04895-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
During off-pump coronary artery bypass surgery, concern remains about possible myocardial injury associated with the transient occlusion and stabilization of the target vessels. To try to minimize myocardial ischemia and achieve hemodynamic stability, we used a coronary perfusion catheter combined with the perfusion-assisted direct coronary artery bypass system, which enables active and modified coronary perfusion of the target vessel throughout the duration of multiple grafting.
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Affiliation(s)
- Satoshi Muraki
- Second Department of Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan.
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Kawano S, Isoyama T, Kobayashi S, Arai H, Takiura K, Saito I, Chinzei T, Abe Y, Yambe T, Nitta S, Imachi K, Hashimoto H. Miniature vibrating flow blood pump using a cross-slider mechanism for external shunt catheter. Artif Organs 2003; 27:73-7. [PMID: 12534716 DOI: 10.1046/j.1525-1594.2003.07186.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The prototype of the miniature vibrating flow pump (VFP) is developed for the external shunt catheter. The cross-slider mechanism is applied to vibrate the tube, which causes the pumping effect. This mechanism results in successful development of the miniature and lightweight VFP. By the use of the prototype VFP, the experiment of the basic pump performance is made in detail based on the authorized procedure in the research field of fluids engineering. The typical H-Q curve of VFP, which is the relationship between the pump head and the flow rate, can be obtained. This result suggests that the miniature VFP developed here can be expected to be used as the booster pump for the external shunt catheter in clinical applications.
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Affiliation(s)
- S Kawano
- Department of Aeronautics and Space Engineering, Tohoku University, Sendai, Japan.
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Kamiya H, Watanabe G, Doi T, Saito T, Takahashi M, Tomita S, Tukioka T, Kanamori T. A coronary active perfusion system for off-pump coronary artery bypass: advantage over passive perfusion regarding the physiology of the coronary artery. ASAIO J 2002; 48:658-64. [PMID: 12455779 DOI: 10.1097/00002480-200211000-00015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To avoid myocardial ischemia during off-pump coronary artery bypass, we developed a coronary active perfusion system (CAPS) that perfuses arterial blood to the coronary artery at the diastolic phase of the cardiac cycle by a syringe pump system. We report herein the details and compare CAPS with a passive shunt circuit from the femoral artery (FA shunt), regarding the physiology of the coronary artery. Six pigs were used for this study. After CAPS or FA shunt perfusion was established, coronary flow and coronary pressure were measured. The coronary flows in the native coronary artery, FA shunt perfusion, and CAPS perfusion with syringe pump stroke volume settings ranging from 0.1 to 0.4 ml were 27.2+/-3.0, 4.1+/-1.5, 12.7+/-1.2, 24.8+/-1.9, 33.3+/-1.6, and 42.2+/-1.9 ml/min, respectively. Mean coronary pressures under FA shunt perfusion and CAPS perfusion with stroke settings from 0.1 to 0.4 ml were 23.7+/-4.6, 48.8+/-5.0, 61.3+/-7.5, 70.8+/-5.4, and 82.3+/-5.2 mm Hg, respectively. CAPS had an advantage over the FA shunt regarding coronary flow with safe coronary pressure. Using CAPS, an off-pump coronary artery bypass can be performed safely without myocardial ischemia.
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Affiliation(s)
- Hiroyuki Kamiya
- Department of General and Cardiothoracic Surgery, Kanazawa University Graduate School of Medicine, Japan
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