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Eisa M, Sandhu A, Prakash R, Ganocy SJ, Fass R. The Risk of Acute Myocardial Infarction in Patients With Gastroesophageal Reflux Disease. J Neurogastroenterol Motil 2020; 26:471-476. [PMID: 32989184 PMCID: PMC7547190 DOI: 10.5056/jnm19192] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 06/01/2020] [Accepted: 06/09/2020] [Indexed: 12/13/2022] Open
Abstract
Background/Aims A number of inflammatory mediators have been documented to be elevated in gastroesophageal reflux disease (GERD). Similar inflammatory mediators are involved in coronary artery disease. Thus, the aim of the study is to determine if GERD is a risk factor for developing acute myocardial infarction (AMI). Methods We used Explorys, a private cloud-based data store to which a number of health care systems feed information. We identified a cohort of GERD patients who have undergone an esophagogastroduodenoscopy compared to those without GERD. Incidence of AMI was studied after statistically controlling for known AMI risk factors. Results Total of 200 400 patients were included in the GERD group and 386 800 patients in non-GERD group. The primary event of AMI occurred in 17 200 patients in the GERD group (8.6%) vs 24 300 in non-GERD group (6.3%). Using logistic regression analysis and controlling for 6 major risk factors which included male gender (OR, 1.09; 95% CI, 1.07-1.11; P < 0.001), hypertension (OR, 6.53; 95% CI, 6.21-6.88; P < 0.001), hyperlipidemia (OR, 3.08; 95% CI, 2.96-3.20; P < 0.001), diabetes mellitus (OR, 1.72; 95% CI, 1.69-1.76; P < 0.001), obesity (OR, 1.02; 95% CI, 1.00-1.04; P = 0.044), and smoking (OR, 1.38; 95% CI, 1.35-1.41; P < 0.001). The odds of developing AMI in the GERD population was 1.11 (95% CI, 1.08-1.13; P < 0.001). GERD had higher odds of developing AMI than male gender or obesity in our study. Conclusions This study demonstrated that GERD is a risk factor for AMI, higher than male gender and obesity. However, the increased risk may be clinically insignificant.
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Affiliation(s)
- Mohamed Eisa
- Department of Internal Medicine, The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Annumeet Sandhu
- Department of Internal Medicine, The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Ravi Prakash
- Department of Internal Medicine, The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Stephen J Ganocy
- Center for Health Care Research and Policy, Case Western Reserve University, Cleveland, OH, USA
| | - Ronnie Fass
- Department of Internal Medicine, The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Alhilali L, Seo SH, Branstetter BF, Fakhran S. Yield of neck CT and barium esophagram in patients with globus sensation. AJNR Am J Neuroradiol 2013; 35:386-9. [PMID: 23928133 DOI: 10.3174/ajnr.a3683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Globus sensation is common and difficult to treat. The purpose of our study was to compare the diagnostic and therapeutic efficacy of barium esophagram and neck CT in patients with isolated globus sensation, to determine which of these modalities should be preferred in the evaluation of this condition. MATERIALS AND METHODS We retrospectively identified patients presenting with isolated globus sensation from January 1, 2005, to December 31, 2012, who underwent neck CT or barium esophagram. We calculated the proportion of patients with abnormal findings, tabulated the nature of the abnormality, and reviewed the medical records to determine whether imaging changed management. RESULTS One hundred forty-eight neck CTs and 104 barium esophagrams were included. Five (3.4%) patients with neck CTs and 4 (3.9%) with barium esophagrams demonstrated significant findings related to the history of globus sensation. Of these, 1 (0.7%) neck CT and 1 (1.0%) barium esophagram resulted in a change in clinical management. CONCLUSIONS Imaging evaluation of the patient with uncomplicated globus sensation is unlikely to identify clinically significant imaging findings and is very unlikely to result in a change in clinical management, with a combined therapeutic efficacy of 0.8%. Thus, the routine use of imaging in the evaluation of patients with globus sensation cannot be recommended.
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Affiliation(s)
- L Alhilali
- From the Departments of Radiology (L.A., S.-h.S., B.F.B., S.F.)
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Yildirim D, Ekçi B, Gürses B, Oruç F. Evaluation of the gastro-oesophageal junction: defining the incompetent cardio-oeosophageal angle non-invasively with ultrasound and computerized tomography. J Int Med Res 2012; 39:1193-200. [PMID: 21986121 DOI: 10.1177/147323001103900407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
This study aimed to demonstrate the presence of gastro-oesophageal reflux disease (GORD) non-invasively using ultrasound (US) and computerized tomography (CT). Intra-abdominal oesophageal length (IAOL) and cardio-oesophageal angle (COA) were measured by US in 25 patients with known reflux and in 25 healthy subjects (control group). CT images of 42 patients with reflux disease and 44 controls were reviewed retrospectively, and IAOL and COA were measured on curved multiplanar format images. Using a cut-off value for IAOL of 20.5 mm, the sensitivity to detect GORD with US was 96% and the specificity was 80% and, with CT, the sensitivity was 95% and the specificity was 78%. A cut-off value of 138.5° for COA yielded sensitivity and specificity values for GORD detection of 76% and 72% with US and 83% and 80% with CT, respectively. In conclusion, with equivocal diagnostic findings, IAOL and COA are useful parameters that can be determined non-invasively by US or CT and may aid diagnosis and treatment choices for patients with suspected GORD.
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Affiliation(s)
- D Yildirim
- Department of Radiology, Kasimpasa Military Hospital, Istanbul, Turkey.
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Wang Y, Yuan Y, Meng L, Fan H, Xu J, Zhang H, Wang M, Yuan H, Ou N, Zhang H, Chao Y, Shi R. Study of the pharmacokinetics and intragastric pH of rabeprazole given as successive intravenous infusion to healthy Chinese volunteers. Eur J Clin Pharmacol 2010; 67:25-31. [PMID: 21110014 DOI: 10.1007/s00228-010-0949-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 10/29/2010] [Indexed: 01/14/2023]
Abstract
OBJECTIVES To investigate the pharmacokinetics and pharmacodynamics of rabeprazole (RPZ) given as successive intravenous infusion to healthy Chinese volunteers. METHODS A total of 63 subjects (33 males and 30 females) were recruited at four research centers and given a 5-day therapeutic course of RPZ (10, 20, or 40 mg) administered as single daily doses during a 30-min period. Plasma concentrations were monitored by sampling at very short intervals for the first 330, 360, or 420 min post-RPZ administration. Intragastric pH was recorded 24 h post-RPZ administration on day 1 and day 5. RESULTS After receiving a single and repeated doses of RPZ, the area under the plasma concentration-time curve (AUC(0-τ)) was 51.9 ± 22.1, 96.7 ± 27.6, and 188.4 ± 65.8 mg·min/L on day 1 and 59.3 ± 23.9, 106.7 ± 27.8, and 200.3 ± 79.0 mg·min/L on day 5 for the low-, middle-, and high-dose groups, respectively. The corresponding peak concentrations (C(max)) were 0.64 ± 0.11, 1.30 ± 0.26, and 2.6 ± 0.54 μg/mL on day 1 and 0.76 ± 0.15, 1.39 ± 0.25, and 2.91 ± 0.53 μg/mL on day 5, respectively. Although the mean AUC and C(max) values increased from a single dose to repeated doses in the three groups, the difference was not significant. The mean AUC((0, τ)) and C(max) ratios of repeated dose to single dose were 1.14, 1.10, and 1.06 on day 1 and 1.19, 1.07, and 1.12 on day 5 for the low-, middle-, and high-dose groups, respectively. After administration of a single dose, the 24-h pH value was significantly higher in the high-dose group than in the low-dose group. After repeated doses, significant increases in pH were observed in the low-, middle-, and high-dose groups; however, the between-group differences were not statistically significant. CONCLUSIONS There is a relationship between the pharmacokinetics and pharmacodynamics of RPZ, with the latter depending in part on the duration of administration, as evidenced by a higher AUC or C(max) and intragastric pH from repeated dosing.
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Indrio F, Riezzo G, Raimondi F, Cavallo L, Francavilla R. Regurgitation in healthy and non healthy infants. Ital J Pediatr 2009; 35:39. [PMID: 20003194 PMCID: PMC2796655 DOI: 10.1186/1824-7288-35-39] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2009] [Accepted: 12/09/2009] [Indexed: 12/15/2022] Open
Abstract
Uncomplicate regurgitation in otherwise healthy infants is not a disease. It consists of milk flow from mouth during or after feeding. Common causes include overfeeding, air swallowed during feeding, crying or coughing; physical exam is normal and weight gain is adequate. History and physical exam are diagnostic, and conservative therapy is recommended. Pathologic gastroesophageal reflux or gastroesophageal reflux disease refers to infants with regurgitation and vomiting associated with poor weight gain, respiratory symptoms, esophagitis. Reflux episodes occur most often during transient relaxations of the lower esophageal sphincter unaccompanied by swallowing, which permit gastric content to flow into the esophagus. A minor proportion of reflux episodes occurs when the lower esophageal sphincter fails to increase pressure during a sudden increase in intraabdominal pressure or when lower esophageal sphincter resting pressure is chronically reduced. Alterations in several protective mechanisms allow physiologic reflux to become gastroesophageal reflux disease; diagnostic approach is both clinical and instrumental: radiological series are useful to exclude anatomic abnormalities; pH-testing evaluates the quantity, frequency and duration of the acid reflux episodes; endoscopy and biopsy are performed in the case of esophagitis. Therapy with H2 receptor antagonists and proton pump inhibitors are suggested.
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Affiliation(s)
- Flavia Indrio
- Department of Pediatrics, University of Bari Policlinico Piazza G.Cesare, 70124 Bari, Italy
| | - Giuseppe Riezzo
- Laboratory of Experimental Pathophysiology, National Institute for Digestive Diseases, I.R.C.C.S. "Saverio de Bellis" Via Turi, 14, 70013 Castellana Grotte (Bari), Italy
| | - Francesco Raimondi
- Department of Pediatrics, University Federico II Policlinico Via S Pansini, 12, 80100 Naples, Italy
| | - Luciano Cavallo
- Department of Pediatrics, University of Bari Policlinico Piazza G.Cesare, 70124 Bari, Italy
| | - Ruggiero Francavilla
- Department of Pediatrics, University of Bari Policlinico Piazza G.Cesare, 70124 Bari, Italy
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Glover EJ, Leland MM, Dick EJ, Hubbard GB. Gastroesophageal reflux disease in baboons (Papio sp.): a new animal model. J Med Primatol 2008; 37:18-25. [PMID: 18199068 DOI: 10.1111/j.1600-0684.2007.00217.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Gastroesophageal reflux disease (GERD) is increasingly prevalent in the human population. Current animal models require surgical or other manipulation to produce symptoms. An animal model that exhibits spontaneous GERD would provide the opportunity for much-needed research examining the susceptibility, diagnosis, and treatment of GERD. METHODS Eight baboons (Papio hamadryas sp.) were diagnosed with GERD histopathologically using biopsies or postmortem tissues. RESULTS The disease was characterized by a spectrum of symptoms comparable with that found in the human population. Some subjects had no gross signs of clinical disease, but were diagnosed by histopathological examination. Almost all subjects presented with at least one clinical sign of the disease. Regurgitation was the most common. CONCLUSIONS The baboon may be a superior animal model for GERD research because it is a naturally occurring model and is anatomically and physiologically similar to humans.
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Affiliation(s)
- E J Glover
- Southwest National Primate Research Center, Southwest Foundation for Biomedical Research, San Antonio, TX 78245-0549, USA
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Ehsani MJ, Maleki I, Mohammadzadeh F, Mashayekh A. Epidemiology of gastroesophageal reflux disease in Tehran, Iran. J Gastroenterol Hepatol 2007; 22:1419-22. [PMID: 17716346 DOI: 10.1111/j.1440-1746.2006.04616.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIM Epidemiological studies have indicated an increase in the prevalence of gastroesophageal reflux disease in Western countries; however, there is a lack of information about its prevalence in Iran. The aim of this study was to measure gastroesophageal reflux disease prevalence in a representative sample of the Tehran population in 1999. METHODS In a cross-sectional study, 700 people, with a male : female ratio of 1:1, were selected by stratified randomization based on the probability of 20% prevalence of gastroesophageal reflux disease and 3% error. They were divided equally into seven age groups. Heartburn and acid regurgitation were considered as the most common symptoms of gastroesophageal reflux disease. The severity and frequency of heartburn and the role of personal habits in the appearance of this symptom were determined. The prevalence of gastroesophageal reflux disease in samples was measured, and its actual prevalence in society was estimated. RESULTS Of 700 people, 350 were male and 350 were female. The major symptoms of gastroesophageal reflux disease were observed in 278 (39.7%) people. The prevalence of gastroesophageal reflux disease of smokers was twice that of non-smokers. CONCLUSIONS Gastroesophageal reflux disease is a serious and unresolved problem in Western countries, and its increasing prevalence correlates with an increasing prevalence of adenocarcinoma of distal esophagus. The prevalence of gastroesophageal reflux disease appears to be increasing in Iran also; therefore, it is recommended that major attention be paid to this disease.
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Affiliation(s)
- Mohammad J Ehsani
- Department of Gastroenterology and Hepatology, Taleghani Hospital, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
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Biertho L, Sanjeev D, Sebajang H, Antony M, Anvari M. The influence of psychological factors on the outcomes of laparoscopic Nissen fundoplication. ANNALS OF SURGICAL INNOVATION AND RESEARCH 2007; 1:2. [PMID: 17411450 PMCID: PMC1839765 DOI: 10.1186/1750-1164-1-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2006] [Accepted: 02/20/2007] [Indexed: 11/19/2022]
Abstract
Background Psychological factors play a role in a variety of gastrointestinal illness, including gastroesophageal reflux disease (GERD). Their impact on the surgical outcomes of antireflux surgery is unknown. Methods This is a single institution prospective controlled trial, comparing patients undergoing a laparoscopic Nissen fundoplication for GERD (LNF Group, n = 17) to patients undergoing an elective laparoscopic cholecystectomy for biliary colic (Control Group, n = 10). All patients had a psychological assessment before surgery, at 3 months and 6 months after surgery (i.e. Symptom CheckList-90-R somatization subset (SCL-90-R), Depression Anxiety Stress Scales, Anxiety sensitivity index, Illness attitude scale and Beck Depression Inventory II). GERD symptoms were recorded in the LNF Group using a standardized questionnaire (score 0–60). Patients with post-operative GERD symptoms score above 12 at 6 months were evaluated specifically. Statistical analysis was performed using a Student T test, and statistical significance was set at 0.05. Results There was no significant difference in preoperative and postoperative psychological assessment between the two groups. In the LNF Group, 7 patients had persisting GERD symptoms at 6 months (GERD score greater than 12). The preoperative SCL-90-R score was also significantly higher in this subgroup, when compared to the rest of the LNF Group (18.2 versus 8.3, p < 0.05) and to the Control Group (18.2 versus 7.9, p < 0.05). There was no significant difference for the other psychological tests. Conclusion The SCL-90-R Somatization Subset, reflecting the level of somatization in a patient, may be useful to predict poor outcomes after antireflux surgery. Cognisance of psychological disorders could improve the selection of an optimal treatment for GERD and help reduce the rate of ongoing symptoms after LNF.
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Affiliation(s)
- Laurent Biertho
- Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Dutta Sanjeev
- Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Herawati Sebajang
- Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Marty Antony
- Department of Psychology, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Mehran Anvari
- Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
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Canon CL, Morgan DE, Einstein DM, Herts BR, Hawn MT, Johnson LF. Surgical approach to gastroesophageal reflux disease: what the radiologist needs to know. Radiographics 2006; 25:1485-99. [PMID: 16284130 DOI: 10.1148/rg.256055016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Gastroesophageal reflux disease (GERD) is defined as gastroesophageal reflux resulting in symptoms or in injury to the esophageal epithelium. Although the medical management of GERD has improved, an increasing number of laparoscopic antireflux surgical procedures are being performed. Barium studies, endoscopy, manometry, and pH monitoring are all integral components of preoperative evaluation. Barium swallow examination must allow critical evaluation of esophageal peristalsis, the presence and extent of gastroesophageal reflux, and complications including esophagitis, stricture, and Barrett esophagus. It is crucial to identify and characterize hiatal hernia and longitudinal stricture, which can result in a shortened esophagus. In such cases, it becomes necessary for the surgeon to incorporate an esophageal lengthening procedure prior to fundoplication; otherwise, poor surgical outcome is likely. Normal postfundoplication radiographic findings as well as postoperative complications (eg, tight wrap, perforation, abscess, complete or partial dehiscence, recurrent stricture, recurrent hernia, intrathoracic migration of the wrap) must also be recognized and clearly understood by the radiologist. Given the chronic nature and prevalence of symptomatic GERD and the increasing number of patients undergoing surgical intervention, it is imperative that the radiologist understand the pre- and postsurgical evaluation of affected patients.
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Affiliation(s)
- Cheri L Canon
- Division of Gastroenterology, Department of Radiology, University of Alabama, Birmingham, AL 35249-6830, USA.
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Fass R, Quan SF, O'Connor GT, Ervin A, Iber C. Predictors of Heartburn During Sleep in a Large Prospective Cohort Study. Chest 2005; 127:1658-66. [DOI: 10.1378/chest.127.5.1658] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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Kim HN, Vorona RD, Winn MP, Doviak M, Johnson DA, Ware JC. Symptoms of gastro-oesophageal reflux disease and the severity of obstructive sleep apnoea syndrome are not related in sleep disorders center patients. Aliment Pharmacol Ther 2005; 21:1127-33. [PMID: 15854175 DOI: 10.1111/j.1365-2036.2005.02447.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Studies suggest obstructive sleep apnea syndrome (OSAS) frequently manifests in patients with gastroesophageal reflux disease (GERD) and that there may be a causal relationship. AIM To determine the relationship between OSAS and symptoms of GERD. METHODS Consecutive patients referred to the Sleep Disorders Center (SDC) 18 years and older with polysomnographically defined OSAS were evaluated prospectively for GERD using a validated symptoms questionnaire. The GERD and OSAS relationship was assessed by 1) determining frequency of GERD in patients with and without OSAS; 2) ascertaining the relationship between OSAS severity categories and presence of GERD; 3) examining GERD score in relation to those factors that might affect both GERD and OSAS, e.g. obesity. RESULTS One thousand and twenty-three SDC patients met entry criteria. Amongst participants, GERD was common (29% of women and 17% of males) and OSAS extremely common (58% of women and 80% of males). GERD score did not correlate with OSAS variables. The severity of OSAS did not influence the prevalence of GERD. CONCLUSION In a large group of patients referred to a sleep disorders center, there was no relationship between OSAS and GERD symptoms. Also, there was no relationship between the severity of OSAS and the likelihood of GERD symptoms.
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Affiliation(s)
- H-N Kim
- Department of Internal Medicine, University of Virginia, Charlottesville, VA, USA
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