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Zhao S, Xu C, Xiong J, Xu Y, Zhang Y. Association of incident cardiovascular events with unilateral low ankle-brachial index and bilateral low ankle-brachial index. Eur J Intern Med 2024; 120:142-144. [PMID: 37989690 DOI: 10.1016/j.ejim.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/31/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Song Zhao
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 20072, China
| | - Chong Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 20072, China
| | - Jing Xiong
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 20072, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 20072, China
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Shanghai 20072, China.
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Manolis AA, Manolis TA, Manolis AS. Patients with Polyvascular Disease: A Very High-risk Group. Curr Vasc Pharmacol 2022; 20:475-490. [PMID: 36098413 DOI: 10.2174/1570161120666220912103321] [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: 05/16/2022] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 01/25/2023]
Abstract
Polyvascular disease (PolyvascDis) with atherosclerosis occurring in >2 vascular beds (coronary, carotid, aortic, visceral and/or peripheral arteries) is encountered in 15-30% of patients who experience greater rates of major adverse cardiovascular (CV) events. Every patient with multiple CV risk factors or presenting with CV disease in one arterial bed should be assessed for PolyvascDis clinically and noninvasively prior to invasive angiography. Peripheral arterial disease (PAD) can be readily diagnosed in routine practice by measuring the ankle-brachial index. Carotid disease can be diagnosed by duplex ultrasound showing % stenosis and/or presence of plaques. Coronary artery disease (CAD) can be screened by determining coronary artery calcium score using coronary computed tomography angiography; further, non-invasive testing includes exercise stress and/or myocardial perfusion imaging or dobutamine stress test, prior to coronary angiography. Abdominal ultrasound can reveal an abdominal aortic aneurysm. Computed tomography angiography will be needed in patients with suspected mesenteric ischemia to assess the mesenteric arteries. Patients with the acute coronary syndrome and concomitant other arterial diseases have more extensive CAD and poorer CV outcomes. Similarly, PolyvascDis in patients with carotid disease and/or other PAD is independently associated with an increased risk for all-cause and CV mortality during long-term follow-up. Treatment of patients with PolyvascDis should include aggressive management of all modifiable risk factors by lifestyle changes and drug therapy, with particular attention to patients who are commonly undertreated, such as those with PAD. Revascularization should be reserved for symptomatic vascular beds, using the least aggressive strategy in a multidisciplinary vascular team approach.
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Jagt VL, Hazenberg CEVB, Kapelle J, Cramer MJ, Visseren FLJ, Westerink J. Screen-detected abnormal ankle brachial index: A risk indicator for future cardiovascular morbidity and mortality in patients with manifest cardiovascular disease. PLoS One 2022; 17:e0265050. [PMID: 35271641 PMCID: PMC8912207 DOI: 10.1371/journal.pone.0265050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 02/22/2022] [Indexed: 01/04/2023] Open
Abstract
Objectives
The ankle brachial index (ABI) can be used to diagnose peripheral arterial disease (PAD). The clinical relevance of the ABI, especially in patients with known clinically manifest cardiovascular disease (CVD), is unknown. The authors set out to investigate the relationship between a screen-detected ABI and the risk for future cardiovascular morbidity and mortality in patients with clinically manifest CVD.
Design, materials and methods
Patients with clinically manifest CVD were selected from the UCC-SMART cohort (n = 8360) and divided into four groups: normal ABI (0.91–1.39), screen-detected low ABI ≤ 0.9, screen-detected high ABI ≥ 1.4, and patients with known PAD irrespective of their ABI. Adjusted Cox Proportional Hazard Ratios (HRs) for Major Adverse Cardiovascular Events (MACE), Major Adverse Limb Events (MALE), and all-cause mortality were calculated. In addition, stratified analyses for women and men and for the presence of diabetes were performed.
Results
During a median follow-up of 8.3 years (IQR 7.7) 1646 MACE, 601 MALE and 1958 all-cause mortalities were observed. Compared with normal ABI patients, patients with a screen-detected low ABI and patients with manifest PAD had a higher risk of MACE, MALE, and all-cause mortality with HRs of 1.9 (95% CI 1.6–2.2) for MACE, 7.6 (95% CI 5.7–10.1) for MALE, 1.7 (95% CI 1.5–2.0) for mortality and 1.3 (95% CI 1.2–1.5) for MACE, 13.8 (95% CI 11.1–17.1) for MALE, 1.7 (95% CI 1.5–1.9) for mortality, respectively. Screen-detected high ABI did not increase the risk of either MACE or MALE, however, was associated with lower risk of all-cause mortality with a HR of 0.6 (95% CI 0.5–0.9). Stratified analyses for women & men and for diabetes status were comparable for all three outcomes.
Conclusions
In patients with manifest CVD but without PAD, a screen-detected low ABI is a powerful risk indicator for cardiovascular events, limb events, and all-cause mortality.
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Affiliation(s)
- Vivianne L. Jagt
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Jaap Kapelle
- Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten J. Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank L. J. Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- * E-mail:
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Shi Y, Hu L, Li M, Ding C, Zhou W, Wang T, Zhu L, Bao H, Cheng X. The ankle-brachial index and risk of incident stroke in Chinese hypertensive population without atrial fibrillation: A cross-sectional study. J Clin Hypertens (Greenwich) 2020; 23:114-121. [PMID: 33200878 PMCID: PMC8029689 DOI: 10.1111/jch.14102] [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] [Received: 08/04/2020] [Revised: 09/23/2020] [Accepted: 10/20/2020] [Indexed: 12/03/2022]
Abstract
We aimed to evaluate the relation of the ankle–brachial index (ABI) with the prevalence of stroke and to examine any possible effect modifiers among hypertensive patients without atrial fibrillation. A total of 10 750 subjects with hypertension aged 27‐96 years were included in the current study. The outcome was a stroke. Odds ratios of stroke concerning ABI were calculated using multivariate logistic regression models. Among 10 750 hypertensive participants, 690 (6.42%) had a stroke. Multivariate logistic analyses showed that ABI was negatively correlated with the prevalence of stroke (per SD increment; adjusted OR, 0.88; 95% CI, 0.82‐0.94). Compared with participants in Q 1, the odds ratios (95% CI) for those in the Q2 (1.05 to 1.10), Q3 (1.10 to 1.15), and Q4 (≥1.15) were 0.71 (0.56, 0.90), 0.87 (0.70, 1.08), and 0.81 (0.65, 1.01), respectively. However, compared with higher ABI value, lower ABI value (<1.05) would significantly increase the odds of stroke (OR: 1.26, 95% CI [1.05‐1.50]), especially in the elderly over 65 years old. A generalized additive model and a smooth curve fitting showed that there existed an L‐shaped association between ABI and the prevalence of stroke. Our results suggest that an L‐shaped association between ABI and the prevalence of stroke was found in general hypertensive patients, with a turning point at about 1.05. Compared with higher ABI value, lower ABI value (<1.05) would significantly increase the prevalence of stroke (OR: 1.26, 95% CI [1.05‐1.50]), especially in the elderly over 65 years old.
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Affiliation(s)
- Yumeng Shi
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lihua Hu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Minghui Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Congcong Ding
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Zhou
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Wang
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lingjuan Zhu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huihui Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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Yang Y, Liu L, Sun H, Nie F, Hu X. Relation between high Ankle-Brachial Index and cardiovascular outcomes in the general population and cardiovascular disease: a meta-analysis. INT ANGIOL 2019; 39:131-138. [PMID: 31814377 DOI: 10.23736/s0392-9590.19.04276-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Conflicting findings have been reported on the association between high Ankle-Brachial Index (ABI) and cardiovascular outcomes. This meta-analysis aimed to assess the association of abnormally high ABI and cardiovascular outcomes in the general population and suspected or established cardiovascular disease (CVD) patients. EVIDENCE ACQUISITION A comprehensive literature search was conducted in PubMed and Embase databases through November 10th, 2018. All observational studies evaluating the association of high ABI with cardiovascular events including stroke, coronary heart disease (CHD), congestive heart failure, and composite of CVD/all-cause mortality in the general population and suspected or established CVD patients were included. We pooled risk ratios (RR) with 95% confidence intervals (CI) for the abnormally high ABI (> 1.3 or >1.4) versus the reference normal ABI category. EVIDENCE SYNTHESIS We identified 10 cohort studies enrolling 39,421 participants. A random effect model meta-analysis indicated that the pooled RR of composite of CVD/all-cause mortality was 1.07 (95% CI 0.83-1.38) in the general population and 1.26 (95% CI 1.03-1.55) in suspected or established CVD patients. Moreover, participants with abnormally high ABI did not increase the risk of stroke (RR 1.60; 95% CI 0.83-3.06) and CHD (RR 1.40; 95% CI 0.87-2.24) in the general population. CONCLUSIONS Abnormally high ABI appears to be associated with an increased risk of a composite of CVD/all-cause mortality in suspected or established CVD patients but not in the general population. However, additional well-designed studies are required to support the current findings.
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Affiliation(s)
- Yu Yang
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Longguang Liu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Hongxiao Sun
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Fengze Nie
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xinhua Hu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China -
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Gu X, Man C, Zhang H, Fan Y. High ankle-brachial index and risk of cardiovascular or all-cause mortality: A meta-analysis. Atherosclerosis 2019; 282:29-36. [DOI: 10.1016/j.atherosclerosis.2018.12.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/12/2018] [Accepted: 12/20/2018] [Indexed: 11/16/2022]
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Manzano L. El índice tobillo-brazo como técnica de cribado: ¿promesa o realidad? Rev Clin Esp 2014; 214:24-5. [DOI: 10.1016/j.rce.2013.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 10/07/2013] [Indexed: 11/16/2022]
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Cardiovascular morbidity–mortality associated to ankle-brachial index in the general population. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2013.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lahoz C, Barrionuevo M, García-Fernández T, Vicente I, García-Iglesias MF, Mostaza JM. Cardiovascular morbidity-mortality associated to ankle-brachial index in the general population. Rev Clin Esp 2013; 214:1-7. [PMID: 24119392 DOI: 10.1016/j.rce.2013.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/05/2013] [Accepted: 08/17/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Abnormal ankle-brachial index (ABI) is associated with a high risk of cardiovascular disease. This study has aimed to investigate the association between low ABI and risk of cardiovascular death in a general population attended in a primary care center. PATIENTS AND METHODS A total of 1,361 volunteers aged between 60 and 79 years without any evidence of peripheral artery disease who attended a primary care center participated in the study. They underwent a complete physical examination, together with standard blood tests and ABI was determined. The participants were contacted by telephone 4 years later and asked about any cardiovascular problems for that period. Causes of death and hospitalization were confirmed in the medical records in the primary care center and/or hospital. RESULTS Information was obtained about the clinical evolution of 1,300 participants (mean age 69.9 years, 38.2% men). Mean follow-up was 49.8 months. There were 13 cardiovascular death and 49 major cardiovascular events. Low ABI (<0.9) was associated with a significant higher risk of cardiovascular death (adjusted relative risk 6.83; 95% confidence interval 1.36-34.30, P=.020), and with a higher risk of major cardiovascular events (adjusted relative risk 2.42; 95% confidence interval 0.99-5.91, P=.051). High or uncompressible ABI was not associated with higher cardiovascular risk. CONCLUSIONS A low ABI was associated with higher risk of cardiovascular death in the general population followed-up in a primary care center.
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Affiliation(s)
- C Lahoz
- Unidad de Lípidos y Riesgo Cardiovascular, Hospital Carlos III, Madrid, España.
| | | | | | - I Vicente
- Centro de Salud Monóvar, Madrid, España
| | - M F García-Iglesias
- Unidad de Lípidos y Riesgo Cardiovascular, Hospital Carlos III, Madrid, España
| | - J M Mostaza
- Unidad de Lípidos y Riesgo Cardiovascular, Hospital Carlos III, Madrid, España
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Fan H, Hu X, Yu W, Cao H, Wang J, Li J, Liu B, Yang J, Zhang Q. Low ankle-brachial index and risk of stroke. Atherosclerosis 2013; 229:317-23. [DOI: 10.1016/j.atherosclerosis.2013.05.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 04/15/2013] [Accepted: 05/01/2013] [Indexed: 10/26/2022]
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Suarez Fernandez C. ¿Debemos buscar enfermedad subclínica en pacientes de alto riesgo vascular? Med Clin (Barc) 2013; 140:356-7. [DOI: 10.1016/j.medcli.2012.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 11/22/2012] [Accepted: 11/22/2012] [Indexed: 10/27/2022]
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Clinically evident polyvascular disease and regression of coronary atherosclerosis after intensive statin therapy in patients with acute coronary syndrome: Serial intravascular ultrasound from the Japanese assessment of pitavastatin and atorvastatin in acute coronary syndrome (JAPAN-ACS) trial. Atherosclerosis 2011; 219:743-9. [DOI: 10.1016/j.atherosclerosis.2011.08.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 08/10/2011] [Accepted: 08/13/2011] [Indexed: 11/23/2022]
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Bronas UG, Treat-Jacobson D. Peripheral Artery Disease in the Elderly: Prevalence, Clinical Implications, and Therapy. CURRENT CARDIOVASCULAR RISK REPORTS 2011. [DOI: 10.1007/s12170-011-0185-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Escobar C, Blanes I, Ruiz A, Vinuesa D, Montero M, Rodríguez M, Barbera G, Manzano L. Prevalence and clinical profile and management of peripheral arterial disease in elderly patients with diabetes. Eur J Intern Med 2011; 22:275-81. [PMID: 21570647 DOI: 10.1016/j.ejim.2011.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 01/27/2011] [Accepted: 02/03/2011] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Peripheral arterial disease (PAD) increases with age and diabetes. The aim of this study was to assess the prevalence of PAD in an elderly population with diabetes. METHODS This multicenter and cross-sectional study included patients >70 years, with an established diagnosis of diabetes. PAD was defined as those patients with a history of revascularization or amputation due to ischemia, or a pathological ankle-brachial index (ABI). Adequate blood pressure (BP), LDL cholesterol and HbA1c control were considered as <130/80 mm Hg, <100 mg⁄dL and <7.0%, respectively. RESULTS A total of 1462 patients were included. The most frequent cardiovascular risk factor and cardiovascular disease were hypertension (80.37%) and PAD (60.60% overall; 83.2% of those assisted by vascular surgeons vs 31.9% of those attended by other medical specialists; p<0.001), respectively. However, when ABI was measured, 70.99% of the study population had PAD (80.2% of those assisted by vascular surgeons vs 59.6% of those attended by other medical specialists; p<0.001). The predictors for a pathological ABI included male gender, smoking, dyslipidemia, family history of premature cardiovascular disease, sedentary lifestyle, diabetic-related complications, heart and cerebrovascular diseases. Although risk factors control was very poor, it was even lower in patients with PAD. CONCLUSIONS The prevalence of PAD is high in diabetic elderly patients. The concomitance with other risk factors and cardiovascular diseases was very high. The ABI allowed increasing the diagnosis of PAD.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, Hospital Infanta Sofía, Madrid, Spain
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Maufus M, Guitton JB, Vanzetto G, Belle L, Imbert B, Pernod G. Prognostic value of the ankle-brachial index in patients with stable chronic cardiovascular disease. J Thromb Haemost 2011; 9:610-2. [PMID: 21232004 DOI: 10.1111/j.1538-7836.2011.04184.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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