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Samadi M, Najafi A, Naziriyan A, Toosi R, Faramarzi A, Balighi K, Noormohammadpour P, Mahmoudi H, Daneshpazhooh M. Indirect immunofluorescence on rat bladder epithelium in patients with pemphigus vulgaris with an extended follow-up. SKIN HEALTH AND DISEASE 2022; 2:e142. [PMID: 36092265 PMCID: PMC9435460 DOI: 10.1002/ski2.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/02/2022] [Accepted: 06/11/2022] [Indexed: 11/14/2022]
Abstract
Background Indirect immunofluorescence (IIF) on rat bladder epithelium (RBE) has been widely used to detect anti-plakin antibodies present in paraneoplastic pemphigus (PNP). However, anti-plakin antibodies have also been found in a group of patients with pemphigus vulgaris (PV). Objectives To assess the reactivity rate of PV sera in IIF using RBE as substrate and the diagnostic usefulness of the aforementioned test. Methods Patients diagnosed with PV presenting to Razi Hospital, Tehran, Iran, were recruited. The patients' demographics, disease severity, and response to the initial treatment were recorded. Sera were collected and tested by IIF on RBE and by desmoglein 3/1 (Dsg 3/1) enzyme-linked immunosorbent assay. Patients were followed up closely for a mean of 53.9 months for any evidence of malignancy. Results Forty-six patients were enroled (mean age of 42.9 years old, 31 females). Nine sera (19.6%) showed reactivity in IIF on RBE. Mean serum anti-Dsg levels did not differ significantly among the two groups with positive and negative IIF results. Negative anti-Dsg3 was related to a higher positive rate in IIF on RBE. There was no significant correlation between the reactivity of IIF on RBE and patients' demographic, clinical, or serological characteristics. Conclusions IIF on RBE is a sensitive test for detecting antibodies against plakins. However, it has a relatively high false-positive rate in PV, probably due to the epitope spreading phenomenon. This test should be suggested when there is a clinical or immunohistopathological suspicion of PNP and should be interpreted with caution.
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Affiliation(s)
- Mahsa Samadi
- School of MedicineTehran University of Medical SciencesTehranIran
- Department of DermatologyAutoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Anahita Najafi
- School of MedicineTehran University of Medical SciencesTehranIran
- Department of DermatologyAutoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Amir Naziriyan
- School of MedicineTehran University of Medical SciencesTehranIran
- Department of DermatologyAutoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Roja Toosi
- Department of DermatologyAutoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Atefeh Faramarzi
- Department of DermatologyAutoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Kamran Balighi
- Department of DermatologyAutoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Pedram Noormohammadpour
- Department of DermatologyAutoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Hamidreza Mahmoudi
- Department of DermatologyAutoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
| | - Maryam Daneshpazhooh
- Department of DermatologyAutoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
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Lepekhova AA, Teplyuk NP, Bolotova IM. Modern diagnostic methods of paraneoplastic pemphigus. VESTNIK DERMATOLOGII I VENEROLOGII 2019. [DOI: 10.25208/0042-4609-2019-95-5-7-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Paraneoplastic pemphigus (PNP) is one of the least investigated and rare forms of bullous dermatoses, which comes from underlying neoplasm. The article presents a literature review of dermatologist`s longstanding international experience about etiology, pathogenesis, diagnostics and treatment of this disease. According to the research results of native and foreign authors systematization of modern diagnostic methods of PNP and detectable antigens was performed.Conflict of interest: the authors state that there is no potential conflict of interest requiring disclosure in this article.
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Affiliation(s)
- A. A. Lepekhova
- I. M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation
| | - N. P. Teplyuk
- I. M. Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation
| | - I. M. Bolotova
- Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation
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Adaszewska A, Kalińska‐Bienias A, Jagielski P, Woźniak K, Kowalewski C. The use of BIOCHIP mosaics in diagnostics of bullous pemphigoid: Evaluation and comparison to conventional multistep procedures. J Cutan Pathol 2019; 47:121-127. [DOI: 10.1111/cup.13591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Alicja Adaszewska
- Department of Dermatology and ImmunodermatologyMedical University of Warsaw Warsaw Poland
| | | | - Paweł Jagielski
- Human Nutrition Department, Faculty of Health ScienceJagiellonian University Medical College Krakow Poland
| | - Katarzyna Woźniak
- Department of Dermatology and ImmunodermatologyMedical University of Warsaw Warsaw Poland
| | - Cezary Kowalewski
- Department of Dermatology and ImmunodermatologyMedical University of Warsaw Warsaw Poland
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4
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Adaszewska A, Kalinska-Bienias A, Jagielski P, Wozniak K, Kowalewski C. The use of BIOCHIP technique in diagnosis of different types of pemphigus: Vulgaris and foliaceus. J Immunol Methods 2019; 468:35-39. [DOI: 10.1016/j.jim.2019.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
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Xuan RR, Yang A, Murrell DF. New biochip immunofluorescence test for the serological diagnosis of pemphigus vulgaris and foliaceus: A review of the literature. Int J Womens Dermatol 2018; 4:102-108. [PMID: 29872685 PMCID: PMC5986232 DOI: 10.1016/j.ijwd.2017.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 09/30/2017] [Accepted: 10/01/2017] [Indexed: 12/19/2022] Open
Abstract
The immunoassays that are available for the serological diagnosis of the more common subtypes of autoimmune blistering diseases such as pemphigus vulgaris (PV) and pemphigus foliaceus (PF) include enzyme-linked immunosorbent assay (ELISA) testing to specific antigens desmoglein (Dsg)1 and Dsg3, direct immunofluorescence (DIF), indirect immunofluorescence (IIF), and immunoblotting. A review of the literature on the biochip assay was conducted. Six studies investigated the validity of a new biochip, mosaic-based, IIF test in patients with pemphigus and demonstrated its relatively high sensitivity and specificity (Dsg3: 97.62-100%, 99.6-100%; Dsg1: 90%, 100%) in comparison with ELISA (Dsg3: 81-100%, 94-100%; Dsg1: 69-100%, 61.1-100%), and/or IIF (PV: 75-100%, 91.8-100%; PF: 67-100%) using suitable substrates. So far, validation studies of the biochip have been conducted in four countries (Germany, Italy, Turkey, and Poland) but none in the southern hemisphere. Caucasian patients were recruited as normal controls for these studies; thus, the diagnostic value of the biochip remains uncertain in population groups of other ethnicities. A range of disease control patients were recruited including patients with linear immunoglobulin A dermatosis, psoriasis, discoid lupus erythematosus, lichen planus, and noninflammatory skin diseases (e.g., squamous cell carcinoma, basal cell carcinoma, and vascular leg ulcers). Prospective studies with control patients from a diverse range of ethnicities are needed to better validate the biochip.
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Affiliation(s)
- Rachel R Xuan
- Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Anes Yang
- Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Dedee F Murrell
- Department of Dermatology, St George Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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Wang Y, Luo Z, Liu K, Wang J, Duan Y. In situ targeting TEM8 via immune response and polypeptide recognition by wavelength-modulated surface plasmon resonance biosensor. Sci Rep 2016; 6:20006. [PMID: 26822761 PMCID: PMC4731803 DOI: 10.1038/srep20006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 12/22/2015] [Indexed: 12/12/2022] Open
Abstract
There is an increasing interest in real-time and in situ monitoring of living cell activities in life science and medicine. This paper reports a whole cell sensing protocol over the interface of Au film coupled in a wavelength-modulated surface plasmon resonance (WMSPR) biosensor. With dual parabolic mirrors integrated in the sensor, the compact and miniaturized instrument shows satisfactory refractive index sensitivity (2220 nm/RIU) and a high resolution of resonance wavelength shift of 0.3 nm to liquid samples. The affinity interactions between the biomarker of human tumor endothelial marker 8 (TEM8) and antibody (Ab) or specific polypeptide (PEP) were firstly introduced to WMSPR biosensor analysis. Both the interaction events of Ab-cell and PEP-cell over the Au film interface can be recognized by the sensor and the balance time of interactions is about 20 min. The concentration range of Ab for quantitative monitoring of the TEM8 expression on human colon carcinoma SW620 cells was investigated. The present low-cost and time-saving method provides a time resolution of binding specificity between Ab/PEP and TEM8 for real-time analysis of antigen on living tumor cell surface.
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Affiliation(s)
- Yimin Wang
- Research Center of Analytical Instrumentation, Key Laboratory of Bio-resource and Eco-environment, Ministry of Education, College of Life Science, Sichuan University, Chengdu 610065, PR China
| | - Zewei Luo
- Research Center of Analytical Instrumentation, Key Laboratory of Bio-resource and Eco-environment, Ministry of Education, College of Life Science, Sichuan University, Chengdu 610065, PR China
| | - Kunping Liu
- Research Center of Analytical Instrumentation, Key Laboratory of Bio-resource and Eco-environment, Ministry of Education, College of Life Science, Sichuan University, Chengdu 610065, PR China.,Faculty of biotechnology industry, Chengdu University, Chengdu, 610106, PR China
| | - Jie Wang
- School of Manufacturing Science and Engineering, Sichuan University, Chengdu, 610065, PR China
| | - Yixiang Duan
- Research Center of Analytical Instrumentation, Key Laboratory of Bio-resource and Eco-environment, Ministry of Education, College of Life Science, Sichuan University, Chengdu 610065, PR China
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Poot AM, Diercks GFH, Kramer D, Schepens I, Klunder G, Hashimoto T, Borradori L, Jonkman MF, Pas HH. Laboratory diagnosis of paraneoplastic pemphigus. Br J Dermatol 2014; 169:1016-24. [PMID: 23796242 DOI: 10.1111/bjd.12479] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Paraneoplastic pemphigus (PNP) is a multiorgan disease characterized by antibodies against plakins, desmogleins and the α2-macroglobulin-like-1 (A2ML1) protein, in association with an underlying neoplasm. Accurate diagnosis relies on the demonstration of these autoantibodies in serum. OBJECTIVES To evaluate the value of different laboratory techniques in the serological diagnosis of PNP. METHODS We performed immunoblotting, envoplakin (EP) enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescence (IIF) on rat bladder, radioactive immunoprecipitation and a nonradioactive combined immunoprecipitation-immunoblot assay. Additional assays included BP180 ELISA and BP230 ELISA. We included the sera of 19 patients with PNP and 40 control subjects. RESULTS The sensitivities were 63% for anti-EP ELISA, 74% for rat bladder IIF, 89% for immunoblotting, 95% for radioactive immunoprecipitation and 100% for nonradioactive immunoprecipitation. Specificities ranged from 86% to 100%. The BP180 and BP230 ELISAs had low sensitivity and specificity for PNP. The combination of rat bladder IIF and immunoblot showed 100% sensitivity and specificity. The analysis of sequential PNP sera showed that antibody titres may decrease over time, possibly resulting in negative outcomes for EP ELISA and rat bladder IIF studies. CONCLUSIONS The detection of autoantibodies against EP and periplakin, or A2ML1 by immunoprecipitation is most sensitive for PNP. The combination of rat bladder IIF and immunoblotting is equally sensitive and highly specific, and represents an alternative valuable and relatively easy approach for the serological diagnosis of PNP.
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Affiliation(s)
- A M Poot
- Department of Dermatology, Center for Blistering Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Jukić IL, Marinović B. Significance of immunofluorescence in the diagnosis of autoimmune bullous dermatoses. Clin Dermatol 2011; 29:389-97. [DOI: 10.1016/j.clindermatol.2011.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Kalajian AH, Callen JP. Atypical herpes simplex infection masquerading as recalcitrant pemphigus vulgaris. Australas J Dermatol 2008; 48:242-7. [PMID: 17956485 DOI: 10.1111/j.1440-0960.2007.00406.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 57-year-old woman presented with refractory genital erosive disease. One year earlier she experienced gingival fragility; direct immunofluorescence resulted in the diagnosis of cicatricial pemphigoid, and prednisone therapy led to initial improvement. Initial skin biopsy of her genital erosions demonstrated full-thickness ulceration with viral cytopathic change and a re-epithelializing subepidermal separation. Indirect immunofluorescence revealed intercellular IgG staining on monkey oesophagus at a titre of 1:320 consistent with pemphigus, leading to the diagnoses of pemphigus vulgaris with herpetic superinfection. Immunosuppressive treatment initially led to improvement; however, disease subsequently recurred as extensive genital erosions. We diagnosed atypical herpes simplex virus infection and oral candidiasis, discontinued all immunosuppressive medications, and initiated antiviral and antifungal therapy. Dramatic resolution was observed and the patient has remained free of disease for 13 months while taking only prophylactic famciclovir.
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Affiliation(s)
- Andrew H Kalajian
- Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky, USA.
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12
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Campos Domínguez M, Suárez Fernández R, Lázaro Ochaita P. Métodos diagnósticos en las enfermedades ampollosas subepidérmicas autoinmunes. ACTAS DERMO-SIFILIOGRAFICAS 2006; 97:485-502. [PMID: 17067526 DOI: 10.1016/s0001-7310(06)73450-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
There is considerable clinical and histological overlap among the subepidermal autoimmune bullous diseases. The knowledge at the molecular level of the dermo-epidermal junction is essential to understand this group of diseases. The immune-based techniques have contributed to increase the knowledge of these entities and have been progressively incorporated into clinical practice. In this review of the diagnostic methods of subepidermal autoimmune bullous diseases we summarize the most recent advances on the molecular biology of the dermo-epidermal junction, focusing on the immune-based diagnostic techniques. We distinguish two main groups of diagnostic methods: those that detect autoimmune deposits in the skin (direct immunofluorescence and its variants including confocal microscopy) and those that detect antibodies in serum or in other fluids (indirect immunofluorescence and its variants, ELISA, immunoblot and immunoprecipitation). We explain the methodology and diagnostic keys of the techniques most widely applied in our milieu.
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Affiliation(s)
- Minia Campos Domínguez
- Unidad de Enfermedades Ampollosas, Hospital General Universitario Gregorio Marañón, Madrid, España.
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13
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Mouquet H, Gilbert D, Musette P, Tron F, Joly P. Avancées moléculaires dans la physiopathologie des maladies bulleuses autoimmunes. Ann Dermatol Venereol 2005; 132:231-42. [PMID: 15924045 DOI: 10.1016/s0151-9638(05)79252-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Autoimmune blistering skin diseases are characterized by the production of autoantibodies directed against adhesive structures of the skin. These organ specific autoimmune diseases included pemphigus in which autoantibodies target proteins of the desmosomal complex, and subepidermal autoimmune diseases characterized by autoantibodies directed against structural proteins of the dermoepidermal junction. Binding of autoantibodies to their targets induces a loss of adhesion between keratinocytes in pemphigus and alterations of the dermoepidermal junction in subepidermal autoimmune diseases. Progresses during the last twenty years had allowed the identification of target autoantigens and the characterization of their adhesive functions, a better understanding of the pathogenesis of these diseases and the development of new diagnostic tools.
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Affiliation(s)
- H Mouquet
- INSERM U519, Institut Fédératif de Recherche Multidisciplinaire sur les Peptides (IFRMP23), Faculté de Médecine et de Pharmacie, Rouen.
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Vodegel RM, Jonkman MF, Pas HH, de Jong MCJM. U-serrated immunodeposition pattern differentiates type VII collagen targeting bullous diseases from other subepidermal bullous autoimmune diseases. Br J Dermatol 2004; 151:112-8. [PMID: 15270879 DOI: 10.1111/j.1365-2133.2004.06006.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidermolysis bullosa acquisita (EBA) can be differentiated from other subepidermal bullous diseases by sophisticated techniques such as immunoelectron microscopy, salt-split skin antigen mapping, fluorescence overlay antigen mapping, immunoblot and enzyme-linked immunosorbent assay. OBJECTIVES To determine whether the diagnosis can also be made by routine direct immunofluorescence microscopy. METHODS We studied frozen skin biopsies from 157 patients with various subepidermal immunobullous diseases. RESULTS We found three distinct 'linear' fluorescence patterns at the basement membrane zone: true linear, n-serrated and u-serrated. The true linear pattern, often seen in conjunction with either the n- or the u-serrated pattern, was found in any subepidermal immunobullous disease with nongranular depositions. In bullous pemphigoid, mucous membrane pemphigoid, antiepiligrin cicatricial pemphigoid, p200 pemphigoid and linear IgA disease the n-serrated pattern was found, corresponding with depositions located in hemidesmosomes, lamina lucida or lamina densa. However, in EBA and bullous systemic lupus erythematosus the u-serrated staining pattern was seen, corresponding with the ultralocalization of type VII collagen in the sublamina densa zone. The diagnosis of EBA with IgG or IgA autoantibodies directed against type VII collagen was confirmed by immunoelectron microscopy, salt-split skin antigen mapping, fluorescence overlay antigen mapping or immunoblotting. CONCLUSIONS Using this pattern recognition by direct immunofluorescence microscopy we discovered several cases of EBA which would otherwise have been erroneously diagnosed as a form of pemphigoid or linear IgA disease.
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Affiliation(s)
- R M Vodegel
- Center for Blistering Diseases, Department of Dermatology, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
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Abstract
Certain dermatologic lesions may initially present or be more commonly ascribed to the elderly. These disorders encompass a diverse array of etiologically unrelated degenerative, autoimmune, idiopathic, and neoplastic conditions that may dramatically impact the quality of life and produce significant morbidity and mortality. As the population ages, a more complete understanding of the clinical and histopathologic features unique to the geriatric dermatologic patient is essential.
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Affiliation(s)
- Connie A Keehn
- Department of Pathology, University of South Florida College of Medicine, 12901 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
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