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Patel S, Govindarajan V, Chakravarty S, Dubey N. From blood to brain: Exploring the role of fibrinogen in the pathophysiology of depression and other neurological disorders. Int Immunopharmacol 2024; 143:113326. [PMID: 39388892 DOI: 10.1016/j.intimp.2024.113326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 10/02/2024] [Accepted: 10/02/2024] [Indexed: 10/12/2024]
Abstract
Recent findings indicate that fibrinogen, a protein involved in blood clotting, plays a significant role in neuroinflammation and mood disorders. Elevated fibrinogen levels are consistently observed in individuals with depression, potentially contributing to microglial activation. This could impair fibrinolysis and contribute to a pro-inflammatory environment in the brain. This neuroinflammatory response can impair neuroplasticity, a key process for learning, memory, and mood regulation. Fibrinogen may also indirectly influence neurotransmitters like serotonin, which play a vital role in mood regulation. Furthermore, fibrinogen's interaction with astrocytes may trigger a cascade of events leading to demyelination, a process where the protective sheath around nerve fibers deteriorates. This can disrupt communication within the nervous system and contribute to depression symptoms. Intriguingly, targeting fibrinogen or related pathways holds promise for therapeutic interventions. For instance, modulating PAI-1 (Plasminogen activator inhibitor-1) activity or inhibiting fibrinogen's interaction with brain cells could be potential strategies. This review explores the multifaceted relationship between fibrinogen and neurological disorders with a focus on depression highlighting its potential as a therapeutic target. Further research is necessary to fully elucidate the mechanisms underlying this association and develop effective therapeutic strategies targeting the fibrinolytic system for mood disorders.
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Affiliation(s)
- Shashikant Patel
- Applied Biology, CSIR-Indian Institute of Chemical Technology, Tarnaka, Hyderabad 500007, Telangana, India; Academy of Scientific and Innovation Research (AcSIR), Ghaziabad, India
| | - Venkatesh Govindarajan
- Dr. Reddy's Institute of Life Sciences, University of Hyderabad Campus, Gachibowli, Hyderabad 500046, Telangana, India
| | - Sumana Chakravarty
- Applied Biology, CSIR-Indian Institute of Chemical Technology, Tarnaka, Hyderabad 500007, Telangana, India; Academy of Scientific and Innovation Research (AcSIR), Ghaziabad, India.
| | - Neelima Dubey
- Dr. Reddy's Institute of Life Sciences, University of Hyderabad Campus, Gachibowli, Hyderabad 500046, Telangana, India.
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Abulfateh MK, Alghanem S. Acute Superior Mesenteric Thrombosis in a Young Adult With No Traditional Risk Factors: A Case Study. Cureus 2024; 16:e69364. [PMID: 39398737 PMCID: PMC11471293 DOI: 10.7759/cureus.69364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2024] [Indexed: 10/15/2024] Open
Abstract
This is a case report of acute superior mesenteric vein (SMV) thrombosis in a 24-year-old male with history of underlying psychiatric symptoms who had no traditional risk factors. The patient presented with abdominal pain, fever, and constipation. The patient's worsening symptoms led to an eventual diagnosis via computed tomography (CT) imaging. Management included anticoagulation therapy and multidisciplinary care. This case highlights the importance of considering SMV thrombosis in young adults and suggests a potential link between psychiatric conditions and thrombotic events, as evidenced by this patient's psychiatric history.
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Affiliation(s)
- Maryam K Abulfateh
- Department of Emergency Medicine, Bahrain Defence Force, Royal Medical Services, Military Hospital, Riffa, BHR
| | - Salah Alghanem
- Department of Emergency Medicine, Bahrain Defence Force, Royal Medical Services, Military Hospital, Riffa, BHR
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von Känel R. Stress-Induced Hypercoagulability: Insights from Epidemiological and Mechanistic Studies, and Clinical Integration. Semin Thromb Hemost 2024. [PMID: 38914118 DOI: 10.1055/s-0044-1787660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
By integrating findings from comprehensive reviews, meta-analyses, and cutting-edge genetic studies, this article illuminates the significance of stress-induced hypercoagulability in clinical medicine. In particular, the findings from numerous prospective cohort studies indicate that stress and hemostatic factors of a hypercoagulable state are associated with increased incident risk and poor prognosis for atherosclerotic cardiovascular disease and venous thromboembolism. Mendelian randomization studies suggest that these associations are partially causal. The review synthesizes extensive research on the link between acute and chronic stress and hypercoagulability, outlining a potential pathway from stress to thrombosis risk. Consistent with the allostatic load concept, acute stress-induced hypercoagulability, initially adaptive, can turn maladaptive under chronic stress or excessive acute stress, leading to arterial or venous thrombotic events. Individuals with predisposing factors, including atherosclerosis, thrombophilia, or immobilization, may exhibit an increased risk of thrombotic disease during stress. Contextual sociodemographic characteristics, the stress experience, and coping resources additionally modulate the extent of stress-induced hypercoagulability. Research into the neuroendocrine, cellular, and molecular bases reveals how stress influences platelet activation coagulation and fibrinolysis. The activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, along with vagal withdrawal, and the effects of catecholamines, cortisol, and vasopressin, are the central mechanisms involved. Hemoconcentration, inflammation, endothelial dysfunction, and thrombopoiesis additionally contribute to stress-induced hypercoagulability. Further research is needed to prove a causal link between chronic stress and hypercoagulability. This includes exploring its implications for the prevention and management of thrombotic diseases in stressed individuals, with a focus on developing effective psychosocial and pharmacological interventions.
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Affiliation(s)
- Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Wang Q, Xu C, He Z, Zou P, Yang J, Huang Y. An exploration of proactive health oriented symptom patterns in patients undergoing percutaneous coronary intervention with stent implantation: A mixed-methods study protocol. PLoS One 2023; 18:e0292285. [PMID: 37796788 PMCID: PMC10553226 DOI: 10.1371/journal.pone.0292285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/17/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Coronary Heart Disease (CHD) is one of the most prevalent chronic diseases worldwide. Currently, percutaneous coronary intervention (PCI) with stent implantation is the main clinical treatment for CHD, and patients can achieve better outcomes after stenting. However, adverse cardiovascular events continue to recur, ultimately failing to yield good results. Several symptoms exist after stenting and are associated with health outcomes. Little is known about the symptom patterns of patients during the different postoperative periods. Therefore, this study aims to explore the dynamics of symptoms and clarify the experiences of post-stenting in patients during different periods, which may help the delivery of more specific patient management and improve survival outcomes in the future. METHODS A mixed method (quantitative/qualitative) design will be adopted. Longitudinal research, including surveys regarding three different periods, will be sued to describe the symptom patterns of patients undergoing PCI with stent implantation, clarifying their focused symptom problems during different time periods or in populations with different features. Qualitative individual interviews aim to understand the feelings, experiences, opinions, and health conditions of patients post-stenting, which can explain and supplement quantitative data. Quantitative data will be analyzed using descriptive statistics, latent class analysis (LCA), and latent translation analysis (LTA). Qualitative data will be analyzed using content analysis. DISCUSSION This study is the first study to explore the symptom patterns and experiences of patients in various domains after stent implantation using a novel design including quantitative and qualitative methods, which will help the delivery of more specific patient management, reduce the recurrence of adverse cardiovascular events, and improve survival outcomes in the future. It is also meaningful to use PROMIS profile-57 to help patients to proactively focus on their health problems, promote health literacy, and incorporate active patient participation into health management, which is a successful transition from passive medical treatment to active management.
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Affiliation(s)
- Qi Wang
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Chaoyue Xu
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Zhiqing He
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
| | - Ping Zou
- Nipissing University, Toronto, Ontario, Canada
| | - Jing Yang
- The Second Affiliated Hospital of University of South China, Hengyang, China
| | - Yanjin Huang
- School of Nursing, Hengyang Medical School, University of South China, Hengyang, China
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Wang Z, Yang Y, He X, Jiang X, Gao X, Liu P, He Z, Zhang L, Zhang M, Niu X, Liu B, Zhang L, Li Z. Incidence and Clinical Features of Venous Thromboembolism in Inpatients with Mental Illness. Clin Appl Thromb Hemost 2023; 29:10760296231160753. [PMID: 36855268 PMCID: PMC9986904 DOI: 10.1177/10760296231160753] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
AIMS We investigated the incidence and clinical features of venous thromboembolism (VTE) in inpatients with mental illnesses. METHODS We retrospectively analyzed records of inpatients with mental illnesses and confirmed VTE at The First Hospital of Hebei Medical University between August 2018 and July 2022. We recorded demographic characteristics, psychosis-related conditions, and thrombus distribution. RESULTS Among 12939 patients diagnosed with mental illness, 156 (1.21%) presented with VTE at the first visit or during the disease course. Crude VTE incidence varied significantly across mental illnesses, being highest in patients with organic mental disorders (5.20%), followed by emotional disorders (1.10%), and others (P < 0.001). Distal and proximal deep venous thromboses (DVT) occurred in 79.17% and 20.84% of patients, respectively. The Hamilton Depression Scale (HAMD) score was higher in patients with proximal DVT than in those with distal DVT (P < 0.001). On multivariate analysis, the HAMD score (odds ratio [OR] 1.173, confidence interval [CI] 1.100-1.251, P<0.001) was a risk factor and the Hamilton Anxiety Scale (HAMA) (OR 0.862, CI 0.796-0.934, P<0.001), a protective factor against DVT progression. CONCLUSION VTE is not rare in patients with mental illnesses and is most commonly associated with organic mental disorders. Psychosis-related DVT typically shows a significantly high incidence of distal DVT. Prevention and early treatment in patients with severe depression and distal DVT can prevent DVT aggravation.
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Affiliation(s)
- Zibin Wang
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yan Yang
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xinqi He
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xia Jiang
- Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Departments of Gastrointestinal Surgery and General Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xian Gao
- Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Departments of Gastrointestinal Surgery and General Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Peng Liu
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhaopeng He
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Like Zhang
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Miao Zhang
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xupeng Niu
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Boyu Liu
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lei Zhang
- Department of Vascular Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zhongxin Li
- Hebei Key Laboratory of Colorectal Cancer Precision Diagnosis and Treatment, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China.,Departments of Gastrointestinal Surgery and General Surgery, 220742The First Hospital of Hebei Medical University, Shijiazhuang, China
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Li G, Tian Y, Zhang Q, Jin Z, Song Y. The Predictive Effect of Negative Psychological Emotions of Anxiety and Depression on the Poor Prognosis of CHD Patients with Stent Implantation and the Improvement of Clinical Intervention Measures. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2534277. [PMID: 35136415 PMCID: PMC8818400 DOI: 10.1155/2022/2534277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/05/2022] [Accepted: 01/08/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To explore the predictive effect of negative emotions such as anxiety and depression on the poor prognosis of coronary heart disease (CHD) patients with stent implantation and to seek the improvement of clinical intervention measures. METHODS A total of 303 patients with CHD and PCI were recruited from February 2019 to April 2021. The risk factors of CHD such as anxiety and depression, age, sex, smoking and drinking, BMI, hypertension, diabetes, dyslipidemia, and family history of CHD were collected. Meanwhile, clinical data such as laboratory examination, angiography, diseased vessels, and stent types were collected. The patients were followed up for 1 year, and the medical records, hospitalization records, or death records were checked by telephone interview once a month. Major adverse cardiovascular events (MACE) such as emergency and causes, readmission times and causes, new nonfatal myocardial infarction, stent restenosis, heart failure, arrhythmia, and death were recorded. The incidence of anxiety and depression in patients after PCI was counted, and Cox regression was applied to analyze the influence and prediction of anxiety and depression on MACE in patients with CHD stent implantation and improve clinical intervention measures. RESULTS Compared with those without MACE, anxiety (56.25% vs 30.63%), depression (62.5% vs 22.88%, P < 0.01), anxiety combined with depression (46.88% vs 15.50%, P < 0.01), and hypertension history (71.8% vs 39.11%, P < 0.01) were more common in patients with MACE. Uncorrected Cox proportional hazard regression found that people with anxiety had a higher risk of developing MACE than those without anxiety (HR 3.181, P < 0.01). Multiple Cox proportional hazard regression analysis of anxiety showed that anxiety was an independent predictor of cumulative MACE (P < 0.01). The risk of developing MACE in patients with anxiety was 3.742 times higher than that in patients without anxiety (P < 0.01). Uncorrected Cox hazard regression analysis showed that people with depression had a higher risk of developing MACE than those without depression (HR 5.434, P < 0.01). Furthermore, the results also uncovered that depression was an independent predictor of cumulative MACE (P < 0.01). The risk of MACE in patients with depression was 3.087 times higher than that in patients without depression (P < 0.01). Cox hazard regression showed that the risk of MACE in patients with anxiety and depression was significantly higher than that in patients without anxiety and depression (HR 4.642, P < 0.01). After screening, it was found that anxiety with depression could predict the occurrence of MACE (P < 0.01). The risk of MACE in patients with anxiety and depression was 3.702 times higher than that in patients without anxiety and depression (P < 0.01). Cox regression analysis showed that the risk of MACE with only anxiety and depression was 2.793 times higher than that without anxiety and depression (95% CI 0.914 8.526), with no statistical significance (P > 0.05), and the risk of MACE with depression without anxiety was significantly higher than that without anxiety and depression (P < 0.01). The risk of MACE in patients with anxiety and depression was 7.303 times higher than that in patients without anxiety and depression (P < 0.01). CONCLUSION Negative emotions such as anxiety and depression can increase the risk of poor prognosis of patients with CHD. Therefore, in clinical work, in addition to routine treatment and nursing during hospitalization, it is recommended to screen patients with depression in CHD patients. Medical staff should use simple and effective assessment tools in time and take active measures to improve the depression of patients. This trial is registered with ChiCTR2200055645.
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Affiliation(s)
- Guoxing Li
- Weifang Medical University, Weifang, Shandong 261053, China
| | - Yuhuan Tian
- Weifang Medical University, Weifang, Shandong 261053, China
| | - Qiumin Zhang
- Weifang Medical University, Weifang, Shandong 261053, China
| | - Zhaofeng Jin
- Weifang Medical University, Weifang, Shandong 261053, China
| | - Yuping Song
- Weifang Medical University, Weifang, Shandong 261053, China
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Song R, Shi Y, Li X, Zhu J, Zhang H, Li K, Wang B, Zhang H, Yang Y, Gao L, Zhao Y, Zhang Z. Potential of Antithrombin III as a Biomarker of Antidepressive Effect in Major Depressive Disorder. Front Psychiatry 2021; 12:678384. [PMID: 34777034 PMCID: PMC8580946 DOI: 10.3389/fpsyt.2021.678384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/20/2021] [Indexed: 12/20/2022] Open
Abstract
Background: The evaluation of treatment response to antidepressant therapy commonly depends on neuropsychologic assessments, as there are currently no suitable biomarkers. Previous research has identified a panel of increased proteins in patients with major depressive disorder (MDD), including antithrombin III (ATIII), as potential biomarkers of depression. Methods: A total of 90 MDD patients were recruited. Of these, 74 patients received occipital repetitive transcranial magnetic stimulation (rTMS) as individualized, standard, or sham treatment for 5 days, and underwent the complete procedure, including clinical assessments, blood collection, and protein measurement. Results: After treatment, ATIII was significantly decreased in both the individualized and standard groups (both p < 0.001) relative to the sham group. In the individualized group, reduction in ATIII was associated with improvements in several neuropsychological assessments. Furthermore, ATIII at baseline in the standard group and after individualized rTMS showed good performance for evaluating or predicting the response to five-day treatment (AUC = 0.771, 95% CI, 0.571-0.971; AUC = 0.875, 95% CI, 0.714-1.000, respectively) and remission at follow-up (AUC = 0.736, 95% CI, 0.529-0.943; AUC = 0.828, 95% CI, 0.656-1.000, respectively). Lastly, both baseline ATIII and change in ATIII showed good predictive value for the 24-item Hamilton Depression Rating Scale at follow-up (p = 0.024 and 0.023, respectively). Conclusion: Our study revealed a reduction in ATIII after occipital rTMS in MDD patients and a relationship between change in ATIII and therapeutic response. Taken together, these findings provide evidence for the potential of ATIII as a biomarker for the evaluation and prediction of antidepressive effects.
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Affiliation(s)
- Ruize Song
- Department of Neurology, School of Medicine, Affiliated ZhongDa Hospital, Southeast University, Nanjing, China
| | - Yachen Shi
- Department of Neurology, School of Medicine, Affiliated ZhongDa Hospital, Southeast University, Nanjing, China
| | - Xianrui Li
- Department of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Jianli Zhu
- Department of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Hongxing Zhang
- Department of Psychology, Xinxiang Medical University, Xinxiang, China.,Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Kun Li
- Department of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Bi Wang
- Department of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Haisan Zhang
- Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Yongfeng Yang
- Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China
| | - Lijuan Gao
- Department of Neurology, School of Medicine, Affiliated ZhongDa Hospital, Southeast University, Nanjing, China
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zhijun Zhang
- Department of Neurology, School of Medicine, Affiliated ZhongDa Hospital, Southeast University, Nanjing, China.,Department of Psychology, Xinxiang Medical University, Xinxiang, China
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