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Prasad SK, Mehta SK, Poddar A. A Rare Case of Caroli's Syndrome. Int J Appl Basic Med Res 2021; 11:195-197. [PMID: 34458125 PMCID: PMC8360226 DOI: 10.4103/ijabmr.ijabmr_160_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 12/02/2020] [Accepted: 06/02/2021] [Indexed: 11/13/2022] Open
Abstract
Caroli's syndrome is a rare autosomal recessive congenital disorder of the biliary tree characterized by intrahepatic bile duct dilation and hepatic fibrosis. Very few cases have been encountered in routine day-to-day practice. The patients usually present with features of cholangitis such as pain abdomen and jaundice. They may also present with features of chronic liver disease and portal hypertension. Very rarely, they may develop cholangiocarcinoma and present with jaundice, weight loss, and abdominal mass or ascites. Here, we report one such case of a young female who presented to us with features of cholangitis with sepsis and encephalopathy, which was finally diagnosed as Caroli's syndrome. The aim of presenting this case is to learn that even patients with common symptoms of pain abdomen and jaundice may be harboring some rare congenital disease like Caroli's syndrome, as in our case.
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Affiliation(s)
| | | | - Ankit Poddar
- Department Of Medicine, Tata Main Hospital, Jamshedpur, Karnataka Medical Council, Bengaluru, Karnataka, India
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Choledochal Malformations: Surgical Implications of Radiologic Findings. AJR Am J Roentgenol 2018; 210:748-760. [DOI: 10.2214/ajr.17.18402] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Chen CB, Hu WD, Zhao WW, Gu YY, Hou HW, Pan Z. Laparoscopic hepatectomy for the treatment of Caroli's disease: a case report. Ann Surg Treat Res 2018. [PMID: 29520352 PMCID: PMC5842090 DOI: 10.4174/astr.2018.94.3.162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Caroli disease is a rare congenital disorder characterized by nonobstructive dilatation of intrahepatic ducts. In cases with symptomatic intrahepatic manifestations, treatment should correspond to the type with hepatic resection for localized disease and transplantation for diffuse forms. If possible, complete resection of the cysts can cure the symptoms and avoid the risk of malignancy. A 66-year-old woman presented to Wuxi Xishan People's Hospital with recurrent intermittent upper quadrant abdominal pain. Further examinations suggested the diagnosis of Caroli disease limited to the left hepatic lobe. She underwent laparoscopic hepatectomy. Pathological examination confirmed the diagnosis of Caroli disease, and no malignancy was found. There were no immediate complications and no long-term complications after one and one-half years of follow-up. Laparoscopic hepatectomy could be a feasible, safe treatment option for localized Caroli disease.
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Affiliation(s)
- Chao-Bo Chen
- Department of General Surgery, Wuxi Xishan People's Hospital, Wuxi, China
| | - Wei-Dong Hu
- Department of General Surgery, Wuxi Xishan People's Hospital, Wuxi, China
| | - Wan-Wen Zhao
- Department of General Surgery, Wuxi Xishan People's Hospital, Wuxi, China
| | - Yan-Yan Gu
- Department of General Surgery, Wuxi Xishan People's Hospital, Wuxi, China
| | - Hong-Wei Hou
- Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - Zheng Pan
- Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China
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Pitchaimuthu M, Duxbury M. Cystic lesions of the liver-A review. Curr Probl Surg 2017; 54:514-542. [PMID: 29173653 DOI: 10.1067/j.cpsurg.2017.09.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/08/2017] [Indexed: 01/10/2023]
Affiliation(s)
- Maheswaran Pitchaimuthu
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom; Department of HPB and Transplant Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
| | - Mark Duxbury
- Department of General Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Affiliation(s)
- Min Hye Jang
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoon Jin Lee
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Gu DH, Park MS, Jung CH, Yoo YJ, Cho JY, Lee YH, Seo YS, Yim HJ, Um SH, Ryu HS. Caroli's disease misdiagnosed as intraductal papillary neoplasm of the bile duct. Clin Mol Hepatol 2015; 21:175-9. [PMID: 26157755 PMCID: PMC4493361 DOI: 10.3350/cmh.2015.21.2.175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/09/2013] [Accepted: 10/15/2013] [Indexed: 12/25/2022] Open
Abstract
Caroli's disease is a rare autosomal-recessive disorder caused by malformation of the ductal plate during embryonic development. Although it is present at birth, Caroli's disease is typically not diagnosed until between the second and fourth decades of life, as it was in the present patient. Here we report a rare case of Caroli's disease limited to one liver segment, which was initially misdiagnosed as an intraductal papillary neoplasm of the bile duct. The asymptomatic patient was treated with liver segmentectomy.
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Affiliation(s)
- Dae Hoe Gu
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Min Seon Park
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Chang Ho Jung
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yang Jae Yoo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jae Young Cho
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yun Ho Lee
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Yeon Seok Seo
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hyung Joon Yim
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Soon Ho Um
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Ho Sang Ryu
- Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Wang ZX, Li YG, Wang RL, Li YW, Li ZY, Wang LF, Yang HY, Zhu Y, Wang Y, Bai YF, He TT, Zhang XF, Xiao XH. Clinical classification of Caroli's disease: an analysis of 30 patients. HPB (Oxford) 2015; 17:278-83. [PMID: 25327281 PMCID: PMC4333791 DOI: 10.1111/hpb.12330] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/17/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND Caroli's disease (CD) is a rare congenital disorder. The early diagnosis of the disease and differentiation of types I and II are of extreme importance to patient survival. This study was designed to review and discuss observations in 30 patients with CD and to clarify the clinical characteristics of the disease. METHODS The demographic and clinical features, laboratory indicators, imaging findings and pathology results for 30 patients with CD were reviewed retrospectively. RESULTS Caroli's disease can occur at any age. The average age of onset in the study cohort was 24 years. Patients who presented with symptoms before the age of 40 years were more likely to develop type II CD. Approximately one-third of patients presented without positive signs at original diagnosis and most of these patients were found to have type I CD on pathology. Anaemia, leucopoenia and thrombocytopoenia were more frequent in patients with type II than type I CD. Magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) examinations were most useful in diagnosing CD. CONCLUSIONS No typical symptoms, signs or laboratory indicators are able to distinguish CD from other conditions. Both MRCP and CT were most valuable in diagnosis. The two types of CD may be differentiated by age of onset and routine blood tests.
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Affiliation(s)
- Zhong-Xia Wang
- Department of Graduate School, 301 HospitalBeijing, China
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Yong-Gang Li
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Rui-Lin Wang
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Yong-Wu Li
- Imaging Centre, 302 HospitalBeijing, China
| | - Zhi-Yan Li
- Imaging Centre, 302 HospitalBeijing, China
| | - Li-Fu Wang
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Hui-Ying Yang
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Yun Zhu
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Yao Wang
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Yun-Feng Bai
- Integrative Medical Centre, 302 HospitalBeijing, China
| | - Ting-Ting He
- Integrative Medical Centre, 302 HospitalBeijing, China
| | | | - Xiao-He Xiao
- Department of Graduate School, 301 HospitalBeijing, China
- Integrative Medical Centre, 302 HospitalBeijing, China
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Monolobar Caroli’s disease with renal cysts: Case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2013.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ren XS, Sato Y, Harada K, Sasaki M, Furubo S, Song JY, Nakanuma Y. Activation of the PI3K/mTOR pathway is involved in cystic proliferation of cholangiocytes of the PCK rat. PLoS One 2014; 9:e87660. [PMID: 24498161 PMCID: PMC3907540 DOI: 10.1371/journal.pone.0087660] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/28/2013] [Indexed: 12/13/2022] Open
Abstract
The polycystic kidney (PCK) rat is an animal model of Caroli’s disease as well as autosomal recessive polycystic kidney disease (ARPKD). The signaling pathways involving the mammalian target of rapamycin (mTOR) are aberrantly activated in ARPKD. This study investigated the effects of inhibitors for the cell signaling pathways including mTOR on cholangiocyte proliferation of the PCK rat. Cultured PCK cholangiocytes were treated with rapamycin and everolimus [inhibitors of mTOR complex 1 (mTOC1)], LY294002 [an inhibitor of phosphatidylinositol 3-kinase (PI3K)] and NVP-BEZ235 (an inhibitor of PI3K and mTORC1/2), and the cell proliferative activity was determined in relation to autophagy and apoptosis. The expression of phosphorylated (p)-mTOR, p-Akt, and PI3K was increased in PCK cholangiocytes compared to normal cholangiocytes. All inhibitors significantly inhibited the cell proliferative activity of PCK cholangiocytes, where NVP-BEZ235 had the most prominent effect. NVP-BEZ235, but not rapamycin and everolimus, further inhibited biliary cyst formation in the three-dimensional cell culture system. Rapamycin and everolimus induced apoptosis in PCK cholangiocytes, whereas NVP-BEZ235 inhibited cholangiocyte apoptosis. Notably, the autophagic response was significantly induced following the treatment with NVP-BEZ235, but not rapamycin and everolimus. Inhibition of autophagy using siRNA against protein-light chain3 and 3-methyladenine significantly increased the cell proliferative activity of PCK cholangiocytes treated with NVP-BEZ235. In vivo, treatment of the PCK rat with NVP-BEZ235 attenuated cystic dilatation of the intrahepatic bile ducts, whereas renal cyst development was unaffected. These results suggest that the aberrant activation of the PI3K/mTOR pathway is involved in cystic proliferation of cholangiocytes of the PCK rat, and inhibition of the pathway can reduce cholangiocyte proliferation via the mechanism involving apoptosis and/or autophagy.
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Affiliation(s)
- Xiang Shan Ren
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
- Department of Pathology, Yanbian University College of Medicine, Yanji-city, China
| | - Yasunori Sato
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kenichi Harada
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Motoko Sasaki
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Shinichi Furubo
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Jing Yu Song
- Department of Pathology, Yanbian University College of Medicine, Yanji-city, China
| | - Yasuni Nakanuma
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
- Department of Pathology, Shizuoka Cancer Center, Shizuoka, Japan
- * E-mail:
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Ruh H, Salonikios T, Fuchser J, Schwartz M, Sticht C, Hochheim C, Wirnitzer B, Gretz N, Hopf C. MALDI imaging MS reveals candidate lipid markers of polycystic kidney disease. J Lipid Res 2013; 54:2785-94. [PMID: 23852700 DOI: 10.1194/jlr.m040014] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Autosomal recessive polycystic kidney disease (ARPKD) is a severe, monogenetically inherited kidney and liver disease. PCK rats carrying the orthologous mutant gene serve as a model of human disease, and alterations in lipid profiles in PCK rats suggest that defined subsets of lipids may be useful as molecular disease markers. Whereas MALDI protein imaging mass spectrometry (IMS) has become a promising tool for disease classification, widely applicable workflows that link MALDI lipid imaging and identification as well as structural characterization of candidate disease-classifying marker lipids are lacking. Here, we combine selective MALDI imaging of sulfated kidney lipids and Fisher discriminant analysis (FDA) of imaging data sets for identification of candidate markers of progressive disease in PCK rats. Our study highlights strong increases in lower mass lipids as main classifiers of cystic disease. Structure determination by high-resolution mass spectrometry identifies these altered lipids as taurine-conjugated bile acids. These sulfated lipids are selectively elevated in the PCK rat model but not in models of related hepatorenal fibrocystic diseases, suggesting that they be molecular markers of the disease and that a combination of MALDI imaging with high-resolution MS methods and Fisher discriminant data analysis may be applicable for lipid marker discovery.
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Affiliation(s)
- Hermelindis Ruh
- Institute of Instrumental Analytics and Bioanalytics, Mannheim University of Applied Sciences, 68163 Mannheim, Germany
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Furubo S, Sato Y, Harada K, Nakanuma Y. Roles of myofibroblasts and notch and hedgehog signaling pathways in the formation of intrahepatic bile duct lesions in polycystic kidney rats. Pediatr Dev Pathol 2013; 16:177-90. [PMID: 23331119 DOI: 10.2350/12-11-1267-oa.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Polycystic kidney (PCK) rats, an animal model of Caroli's disease, show a dilatation of intrahepatic bile ducts (IHBD) called "ductal plate malformation." Mesenchymal cells and the Notch and Hedgehog signaling pathways in portal tracts are reportedly involved in the normal development of IHBD, although there have been no studies on the roles of these signaling pathways in PCK rats. We immunohistochemically examined the expression of the molecules related to these signaling pathways in portal tracts. All molecules related to these signaling pathways expressed in portal tracts in Sprague Dawley (SD) rats (control) were also expressed in PCK rats. Mesenchymal cells (myofibroblasts) were frequently found in the connective tissue of portal tracts of 20 embryonic-day-old (E20D), 1-day-old (1D), and 1-week-old (1W) SD and PCK rats and were abundant in PCK rats. Interestingly, myofibroblasts almost disappeared at in both strains of 3W rats. Jagged1 was expressed in mesenchymal cells in portal tracts and was abundant in PCK rats. Double immunostaining showed that Jagged1-positive cells were myofibroblasts. Notch2 and HES1 were expressed in cholangiocytes of the bile ducts of both rats. Sonic Hedgehog was similarly expressed in the bile ducts of both rats. A well-balanced and time-sequential expression of the Notch and Hedgehog family in portal tracts might be essential for the normal development of IHBD in E20D to 1W SD rats, and an imbalanced interaction of these molecules, particularly increased Jagged1 expression in periductal and periportal myofibroblasts and Notch2 expressed in cholangiocytes, may be involved in the formation of bile duct lesions in PCK rats.
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Affiliation(s)
- Shinichi Furubo
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
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Simo KA, Mckillop IH, Ahrens WA, Martinie JB, Iannitti DA, Sindram D. Invasive biliary mucinous cystic neoplasm: a review. HPB (Oxford) 2012; 14:725-40. [PMID: 23043661 PMCID: PMC3482668 DOI: 10.1111/j.1477-2574.2012.00532.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Biliary mucinous cystic neoplasms (BMCNs) are recently redefined rare liver tumours in which insufficient recognition frequently leads to an incorrect initial or delayed diagnosis. A concise review of the subtle, sometimes non-specific, clinical, serologic and radiographic features will allow for a heightened awareness and more comprehensive understanding of these entities. METHODS Literature relating to the presentation, diagnosis, treatment, pathology and outcomes of BMCNs and published prior to March 2012 was reviewed. RESULTS Biliary mucinous cystic neoplasms most commonly occur in females (≥60%) in the fifth decade of life. Clinical symptoms, serologic markers and imaging modalities are unreliable for diagnosis of BMCNs, which leads to misdiagnosis in 55-100% of patients. Perioperative cyst aspiration is not recommended as invasive BMCNs can only be differentiated from non-invasive BMCNs by microscopic evaluation for the presence of ovarian-type stroma. Intraoperative biopsy and frozen section(s) are essential to differentiate BMCNs from other cystic liver lesions. The treatment of choice is complete excision and can result in excellent survival with initial correct diagnosis. CONCLUSIONS A low threshold for considering BMCN in the differential diagnosis of cystic liver lesions and increased attentiveness to its subtle diagnostic characteristics are imperative. The complete surgical resection of BMCNs and the use of appropriate nomenclature are necessary to improve outcomes and accurately define prognosis.
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Affiliation(s)
- Kerri A Simo
- Section of Hepatobiliary and Pancreas Surgery, Department of SurgeryCharlotte, NC, USA
| | - Iain H Mckillop
- Section of Hepatobiliary and Pancreas Surgery, Department of SurgeryCharlotte, NC, USA
| | - William A Ahrens
- Department of Pathology, Carolinas Medical CenterCharlotte, NC, USA
| | - John B Martinie
- Section of Hepatobiliary and Pancreas Surgery, Department of SurgeryCharlotte, NC, USA
| | - David A Iannitti
- Section of Hepatobiliary and Pancreas Surgery, Department of SurgeryCharlotte, NC, USA
| | - David Sindram
- Section of Hepatobiliary and Pancreas Surgery, Department of SurgeryCharlotte, NC, USA
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Cordiner DS, Evans CA, Brundler MA, McPhillips M, Murio E, Darling M, Taheri S. A complex case of congenital cystic renal disease. BMJ Case Rep 2012; 2012:bcr.12.2011.5463. [PMID: 22605879 DOI: 10.1136/bcr.12.2011.5463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case outlines the potential complexity of autosomal recessive polycystic kidney disease (ARPKD). It highlights the challenges involved in managing this condition, some of the complications faced and areas of uncertainty in the decision making process. With a paucity of published paediatric cases on this subject, this should add to the pool of information currently available.
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Affiliation(s)
- David S Cordiner
- Department of Paediatrics, Royal Hospital for Sick Children, Edinburgh, UK.
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