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Kipele M, Buchfelder M, Taudte RV, Stadlbauer A, Kinfe T, Bozhkov Y. Immunometabolic Profiling of Chronic Subdural Hematoma through Untargeted Mass Spectrometry Analysis: Preliminary Findings of a Novel Approach. Diagnostics (Basel) 2023; 13:3345. [PMID: 37958242 PMCID: PMC10650661 DOI: 10.3390/diagnostics13213345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/07/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Objective: Metabolomics has growing importance in the research of inflammatory processes. Chronic subdural hematoma (cSDH) is considered to be, at least in part, of inflammatory nature, but no metabolic analyses yet exist. Therefore, a mass spectrometry untargeted metabolic analysis was performed on hematoma samples from patients with cSDH. Methods: A prospective analytical cross-sectional study on the efficacy of subperiosteal drains in cSDH was performed. Newly diagnosed patients had the option of granting permission for the collection of a hematoma sample upon its removal. The samples were analyzed using liquid chromatography-mass spectrometry to obtain different types of metabolites from diverse biochemical classes. The statistical analysis included data cleaning, imputation, and log transformation, followed by PCA, PLS-DA, HCA, and ANOVA. The postoperative course of the disease was followed for 3 months. The metabolite concentrations in the hematoma fluid were compared based on whether a recurrence of the disease was recorded within this time frame. Results: Fifty-nine samples from patients who were operated on because of a cSDH were gathered. Among those, 8 samples were eliminated because of missing metabolites, and only 51 samples were analyzed further. Additionally, 39 samples were from patients who showed no recurrence over the course of a 3-month follow-up, and 12 samples were from a group with later recurrence. We recorded a noticeable drop (35%) in the concentration of acylcarnitines in the "recurrence group", where 10 of the 22 tested metabolites showed a significant reduction (p < 0.05). Furthermore, a noticeable reduction in different Acyl-CoA-dehydrogenases was detected (VLCAD-deficiency p < 0.05, MCAD-deficiency p = 0.07). No further changes were detected between both populations. Conclusions: The current study presents a new approach to the research of cSDH. The measurements presented us with new data, which, to date, are without any reference values. Therefore, it is difficult to interpret the information, and our conclusions should be considered to be only speculative. The results do, however, point in the direction of impaired fatty acid oxidation for cases with later recurrence. As fatty acid oxidation plays an important role in inflammatory energy metabolism, the results suggest that inflammatory processes could be aggravated in cases with recurrence. Because our findings are neither proven through further analyses nor offer an obvious therapy option, their implications would not change everyday practice in the management of cSDH. They do, however, present a further possibility of research that might, in the future, be relevant to the therapy.
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Affiliation(s)
- Maria Kipele
- Department of Neurosurgery, Erlangen University, 91054 Erlangen, Germany; (M.K.); (M.B.); (A.S.)
| | - Michael Buchfelder
- Department of Neurosurgery, Erlangen University, 91054 Erlangen, Germany; (M.K.); (M.B.); (A.S.)
| | - R. Verena Taudte
- Core Facility for Metabolomics, Department of Medicine, Philipps University Marburg, 35037 Marburg, Germany;
| | - Andreas Stadlbauer
- Department of Neurosurgery, Erlangen University, 91054 Erlangen, Germany; (M.K.); (M.B.); (A.S.)
| | - Thomas Kinfe
- Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, Erlangen University, 91054 Erlangen, Germany;
| | - Yavor Bozhkov
- Department of Neurosurgery, Erlangen University, 91054 Erlangen, Germany; (M.K.); (M.B.); (A.S.)
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Musmar B, Spellicy S, Salim H, Abdelgadir J, Zomorodi A, Cutler A, Jabbour P, Hasan D. Comparative outcomes of middle meningeal artery embolization with statins versus embolization alone in the treatment of chronic subdural hematoma: a systematic review and meta-analysis. Neurosurg Rev 2023; 46:262. [PMID: 37783962 DOI: 10.1007/s10143-023-02165-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/04/2023]
Abstract
Chronic subdural hematoma (cSDH) is common among the elderly, with surgical evacuation as a prevalent treatment, facing recurrence rates up to 30%. Recently, middle meningeal artery embolization (MMAE) has emerged as a promising approach, offering reduced treatment failures and recurrence rates. Additionally, statins, known for their anti-inflammatory properties, have been considered as a potential adjunctive or sole treatment for cSDH. However, the combination of MMAE with statins remains understudied. This systematic review and meta-analysis aims to evaluate the comparative outcomes of MMAE with statins versus MMAE alone in the treatment of cSDH. A comprehensive systematic search of the PubMed, Web of Science, and SCOPUS databases was conducted. Inclusion criteria were: studies published in English between the dates of inception of each database and August 2023, studies comparing the treatment of cSDH with either MMAE + statin or MMAE alone were included. Main outcome measures were complete resolution of the hematoma at follow-up and the recurrence rates. Two studies comprising 715 patients were included; 408 patients underwent MMAE + statin; and 307 underwent MMAE alone. MMAE + statin was not significantly superior to MMAE alone in achieving complete resolution of the hematoma at follow-up (RR: 0.99; CI: 0.91 to 1.07, P = 0.84), nor was it a significant difference in rates of recurrence (RR: 1.35; CI: 0.83 to 2.17, P = 0.21) between the two groups. MMAE + statin did not demonstrate significant superiority over MMAE alone for achieving complete resolution and decreasing the recurrence rates in cSDH patients. Further research with larger, randomized studies may be required to fully elucidate the potential synergistic effects of MMAE and statins in this patient population.
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Affiliation(s)
- Basel Musmar
- Department of Neurosurgery, Duke University Hospital, Durham, NC, USA
- School of Medicine, An-Najah National University, Nablus, Palestine
| | - Samantha Spellicy
- Department of Neurosurgery, Duke University Hospital, Durham, NC, USA
| | - Hamza Salim
- School of Medicine, An-Najah National University, Nablus, Palestine
| | - Jihad Abdelgadir
- Department of Neurosurgery, Duke University Hospital, Durham, NC, USA
| | - Ali Zomorodi
- Department of Neurosurgery, Duke University Hospital, Durham, NC, USA
| | - Andrew Cutler
- Department of Neurosurgery, Duke University Hospital, Durham, NC, USA
| | - Pascal Jabbour
- Department of Neurosurgery, Thomas Jefferson Hospital, Philadelphia, PA, USA
| | - David Hasan
- Department of Neurosurgery, Duke University Hospital, Durham, NC, USA.
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Bumpetch D, Sitthinamsuwan B, Nunta-aree S. A Prospective Study of the Effect and Safety of Atorvastatin on the Recurrence of Chronic Subdural Hematoma after Burr Hole Surgery. Asian J Neurosurg 2023; 18:567-572. [PMID: 38152511 PMCID: PMC10749861 DOI: 10.1055/s-0043-1771372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Introduction Chronic subdural hematoma (CSDH) is a common neurosurgical condition. Recent studies showed efficacy of atorvastatin in reducing the requirement of surgical treatment. This study aimed to evaluate the efficacy and safety of atorvastatin in reducing the recurrence of CSDH after burr hole surgery. Methods This prospective study included patients with CSDH who underwent burr hole surgery. Atorvastatin at 20 mg per day was administered to all patients for 4 weeks postoperatively. The major outcome was the recurrence rate of CSDH at 8 weeks following the operation. Results Seventy-three patients who completed the 4-week course of atorvastatin were included. The mean age was 73.9 years. The most common cause of CSDH was falling. The mean hematoma volume was 106.3 mL. There was no adverse effect of atorvastatin in all of 73 patients. During the 8-week postoperative period, recurrent CSDH was found in 2 of 73 (2.7%) patients. In a comparison of the recurrence rate of CSDH between patients with use of atorvastatin from the present and previous studies (2.6-4.8%), and patients without use of atorvastatin from previous studies (9.8-19%), a marked reduction in recurrent CSDH after burr hole surgery was found in patients with use of atorvastatin. Conclusion An administration of atorvastatin of 20 mg daily for 4 weeks following burr hole surgery is safe and may be helpful in reducing the recurrence rate of CSDH after burr hole surgery.
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Affiliation(s)
- Duangkamol Bumpetch
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Surgery, Nan Hospital, Nan, Thailand
| | - Bunpot Sitthinamsuwan
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sarun Nunta-aree
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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The Effect of Statins on the Recurrence of Chronic Subdural Hematomas: A Systematic Review and Meta-Analysis. World Neurosurg 2022; 166:244-250.e1. [PMID: 35917921 DOI: 10.1016/j.wneu.2022.07.079] [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: 04/22/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Statins have been proposed to improve the resolution of chronic subdural hematoma (cSDH), with conflicting results likely due to underpowered analysis or confounding factors, such as the use of antithrombotic medication. We performed a systematic literature review and meta-analysis to better elucidate the effect of statin therapy on cSDH recurrence. METHODS We performed a comprehensive search of PubMed, MEDLINE, and Embase databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were included if the number of recurrences requiring surgical evacuation or leading to neurological deterioration was reported and could be extracted separately for patients who did or did not receive statin therapy. RESULTS Seven studies were included, comprising 1359 cSDH patients (statin therapy, 449 vs. non-statin therapy, 910). Age was not different between groups (P = 0.548). The proportion of men was significantly different (statin, 80.1% vs. non-statin, 74.7%; P = 0.02). Use of antithrombotic medication was significantly higher (P = 0.005) in the statin group (11.7%) than in the non-statin group (7.3%). The statin group had a non-significant lower odds of recurrence (odds ratio 0.80, 95% confidence interval 0.35-1.81). In an exploratory data analysis of 4 studies without a difference between groups in antithrombotic medication use, the statin group had significantly lower odds of recurrence (odds ratio 0.29, 95% confidence interval 0.17-0.50). CONCLUSIONS Overall, we found that statin use did not result in lower odds of cSDH recurrence, likely due to a dilution caused by the higher rate of patients on antithrombotic medications in the statin group.
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Statins versus Nonstatin Use in Patients with Chronic Subdural Hematomas Treated with Middle Meningeal Artery Embolization Alone – A Single-Center Experience. World Neurosurg 2022; 168:e376-e380. [DOI: 10.1016/j.wneu.2022.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/07/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
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Abdulla E, Rahman R, Rahman S, Rahman MM. Letter to the Editor Regarding “Surgery After Primary Dexamethasone Treatment for Patients with Chronic Subdural Hematoma—A Retrospective Study”. World Neurosurg 2022; 164:456. [DOI: 10.1016/j.wneu.2022.03.092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 11/25/2022]
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Klein J, Mauck L, Schackert G, Pinzer T. Do statins reduce the rate of revision surgery after chronic subdural hematoma drain? Acta Neurochir (Wien) 2021; 163:1843-1848. [PMID: 34036461 PMCID: PMC8195925 DOI: 10.1007/s00701-021-04871-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/30/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND With chronic subdural hematoma (CSDH), surgery is the therapeutic mainstay for large or symptomatic cases. Statins are reported to be effective as the primary therapy of CSDH to obviate the need for surgery. However, the effect of statins on the postoperative course of CSDH is largely unclear. We therefore sought to determine whether statins reduce the rate of repeat surgery after CSDH drain. METHODS We performed an analysis of all patients who underwent surgery for CSDH at our institution between 2012 and 2018. The patients were separated into those who received statins as part of their previous medication (statin group) and those who did not (control group). The medical records were reviewed for repeat surgeries and complications. Additionally, patients or their relatives were contacted via phone to obtain missing data and inquire about possible repeat surgeries at other institutions. RESULTS We identified 407 patients who received CSDH evacuation via burr hole craniotomy. In total, 123 patients were treated with statins as part of their daily medication. Repeat surgery was performed in 26 patients in the statin group (21.1%) and 57 patients in the non-statin group (20.1%, p = 0.81). Upon multivariate logistic regression analysis, neither of the variables statins, age, antithrombotic medication, Charlson comorbidity index, or Markwalder grading score yielded a statistically significant effect upon the revision rate. CONCLUSIONS We found no evidence for the protective effect of statins in patients who underwent surgery for CSDH. We thus conclude that statin therapy is not warranted for CSDH perioperatively.
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Affiliation(s)
- Johann Klein
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Lisa Mauck
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Gabriele Schackert
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Thomas Pinzer
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Wang D, Wang H, Xu M, Chen P, Yu B, Wen J, Zhang H, Zeng W, He S, Wang C. The effect of atorvastatin on recurrence of chronic subdural hematoma after novel YL-1 puncture needle surgery. Clin Neurol Neurosurg 2021; 202:106548. [PMID: 33609954 DOI: 10.1016/j.clineuro.2021.106548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Chronic subdural hematoma (CSDH) is a common neurological disorder with a high recurrence rate. This study investigates the effect that atorvastatin has when used as a postoperative adjuvant therapy on the prevention of CSDH recurrence after YL-1 puncture needle surgery. PATIENTS AND METHODS A retrospective analysis of 516 CSDH patients who underwent YL-1 puncture needle surgery was undertaken. Baseline characteristics including sex, age, history of injury, past medical histories (anticoagulation, liver dysfunction, heart diseases, malignant tumors, diabetes, hemodialysis, and chronic alcoholism), and computed tomography (CT) or magnetic resonance imaging (MRI) diagnostic indicators (bilateral, mixed density or signal, maximum hematoma width, and brain atrophy) were recorded. Differences in recurrence rates were compared between two groups: one with atorvastatin after surgery and one without. RESULTS 516 patients (429 men and 87 women), aged 14-98 years (mean age, 67.09 ± 11.74 years) were included in the study. YL-1 puncture needle surgery was performed 610 times. 94 patients had bilateral surgery, totaling 184 procedures. 301 patients with 360 procedures were treated with atorvastatin after surgery, of which 25 had recurrent CSDH; recurrence rate: 7.0 % (25/360). 215 patients with 250 procedures had surgery without subsequent atorvastatin, of which 14 had recurrent CSDH; recurrence rate: 5.6 % (14/250). Univariate analysis indicated no statistically significant difference in recurrence rates between groups (P > 0.05). Baseline characteristics of the two groups (age, sex, history of injury, past medical histories, CT or MRI diagnostic indicators) also showed no statistical difference (all P > 0.05). CONCLUSIONS YL-1 puncture needle surgery with irrigation and closed-system drainage is an effective surgical treatment for CSDH. Atorvastatin has no statistically significant effect on the prevention of CSDH recurrence after surgery.
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Affiliation(s)
- Dongdong Wang
- School of Clinical Medicine, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province, 116000, China; Department of Neurosurgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Hui Wang
- School of Clinical Medicine, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province, 116000, China; Department of Neurosurgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Min Xu
- Department of Neurosurgery, Traditional Chinese Medicine Hospital of Kunshan, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, 189 Chaoyang Road, Kunshan, Jiangsu Province, 215300, China
| | - Pin Chen
- Department of Neurosurgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Bo Yu
- Department of Neurosurgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Jinkun Wen
- Department of Neurosurgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Hengzhu Zhang
- Department of Neurosurgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Wei Zeng
- Department of Neurosurgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Shiwei He
- School of Clinical Medicine, Dalian Medical University, 9 West Section, Lvshun South Road, Dalian, Liaoning Province, 116000, China; Department of Neurosurgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China
| | - Cunzu Wang
- Department of Neurosurgery, Northern Jiangsu People's Hospital, Clinical Medical College, Yangzhou University, 98 Nantong West Road, Yangzhou, Jiangsu Province, 225001, China.
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Tang R, Shi J, Li X, Zou Y, Wang L, Chen Y, Yan R, Gao B, Feng H. Effects of Atorvastatin on Surgical Treatments of Chronic Subdural Hematoma. World Neurosurg 2018; 117:e425-e429. [PMID: 29920396 DOI: 10.1016/j.wneu.2018.06.047] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the effects of atorvastatin on the surgical treatment of patients with chronic subdural hematoma (CSDH). METHODS Our retrospective study included 245 consecutive adult patients undergoing burr-hole craniotomy for CSDH. Data included baseline characteristics and recurrence, postoperative complications, and mortality. Univariate and multivariate regression models analyzed the association between administration of atorvastatin perioperatively and recurrence rates. RESULTS Multivariate analysis showed perioperative atorvastatin administration (odds ratio [OR] 0.336; P = 0.039), diabetes mellitus (OR 3.949, P = 0.010), and GCS of 15 preoperatively (OR 0.197; P = 0.020) to be significantly related to recurrence risk. Postoperative complications and mortality did not significantly differ between patients with and those without atorvastatin therapy. CONCLUSIONS Our findings demonstrate that the administration of atorvastatin perioperatively is associated with a lower risk of CSDH recurrence rate. The use of atorvastatin perioperatively was not associated with higher rates of morbidity or mortality.
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Affiliation(s)
- Rongrui Tang
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Jiantao Shi
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Xuegang Li
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yongjie Zou
- Department of Neurosurgery, No. 184 of PLA Hospital, Yingtan, China
| | - Long Wang
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Yujie Chen
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Rubin Yan
- Department of Rehabilitation, Southwest Hospital, Army Medical University, Chongqing, China
| | - Boyuan Gao
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Army Medical University, Chongqing, China.
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