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Signorino C, Fusco E, Galli L, Chiappini E. Effectiveness of Antimicrobial Lock Therapy for the Treatment of Catheter-Related and Central-Line-Associated Bloodstream Infections in Children: A Single Center Retrospective Study. Antibiotics (Basel) 2023; 12:antibiotics12050800. [PMID: 37237703 DOI: 10.3390/antibiotics12050800] [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] [Received: 03/22/2023] [Revised: 04/15/2023] [Accepted: 04/19/2023] [Indexed: 05/28/2023] Open
Abstract
Antimicrobial lock solutions (ALT) in combination with systemic antibiotics can represent a valid option to attempt central venous catheter (CVC) salvage in the case of catheter-related and central-line-associated bloodstream infections (CRBSI and CLABSI). However, data concerning the effectiveness and safety of ALT in children are limited. We aimed to share our center's experience in order to contribute to investigations into the causes of ALT failure in the pediatric population. All children consecutively admitted to Meyer Children's Hospital, University of Florence, Italy, from 1 April 2016 to 30 April 2022, who received salvage ALT to treat an episode of CRBSI/CLABSI, were reviewed. According to ALT failure or success, children were compared with the aim of identifying the risk factors for unsuccessful ALT outcome. Data from 28 children, 37 CLABSI/CRBSI episodes, were included. ALT was associated with clinical and microbiologic success in 67.6% (25/37) of children. No statistically significant differences were observed between the two groups, successes and failures, considering age, gender, reason for use, duration, insertion, type and presence of insertion site infection of the CVC, laboratory data and number of CRBSI episodes. Nevertheless, a trend towards a higher success rate was observed for a dwell time of 24 h for the entire duration of ALT (88%; 22/25 vs. 66.7%; 8/12; p = 0.1827), while the use of taurolidine and the infections sustained by MDR bacteria were associated with a tendency toward greater failure (25%; 3/12 vs. 4%; 1/25; p = 0.1394; 60%; 6/10 vs. 33.3%; 8/24; p = 0.2522). No adverse events, except one CVC occlusion, were observed. ALT combined with systemic antibiotics appears to be an effective and safe strategy for treating children with CLABSI/CRBSI episodes.
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Affiliation(s)
- Claudia Signorino
- Department of Health Sciences, Meyer Children's University Hospital IRCCS, University of Florence, Florence 50139, Italy
| | - Eleonora Fusco
- Department of Health Sciences, Meyer Children's University Hospital IRCCS, University of Florence, Florence 50139, Italy
| | - Luisa Galli
- Division of Pediatric Infectious Disease, Department of Health Sciences, Meyer Children's University Hospital IRCCS, University of Florence, 50139 Florence, Italy
| | - Elena Chiappini
- Division of Pediatric Infectious Disease, Department of Health Sciences, Meyer Children's University Hospital IRCCS, University of Florence, 50139 Florence, Italy
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Vassallo M, Denis E, Manni S, Lotte L, Fauque P, Sindt A. Treatment of long-term catheter-related bloodstream infections with short-course Daptomycin lock and systemic therapy associated with Taurolidine-lock: A multicenter experience. J Vasc Access 2023:11297298231152500. [PMID: 36726226 DOI: 10.1177/11297298231152500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Few studies describe the efficacy of antibiotic lock therapy (ALT) in long-term catheter-related bloodstream (CRBSI) infections. We applied local protocols combining Daptomycin (DPT) and Taurolidine ALT, associated with systemic antibiotic treatment (SAT), for conservative management of coagulase-negative Staphylococci (CoNS) CRBSI. METHODS Patients admitted for CoNS-associated CRBSI and treated with DPT and Taurolidine as ALT were retrospectively analyzed. Success was defined as catheter retention 30 days after ending treatment. Catheter removal within 30 days was considered as failure. RESULTS From April 2018 to September 2021, 22 subjects with CoNS-associated-CRBSI were included (95% with cancer, mean age 64 years, 59% male). Staphylococcus epidermidis was isolated in 82% of cases. Mean duration of DPT was 3.9 and 3 days as ALT and SAT, respectively. SAT also included Rifampin for 3 days. Taurolidine ALT was started on day 4 and was combined with oral SAT, that is, either Linezolid or Tedizolid. Mean duration of Taurolidine was 10.5 days, while total antibiotic treatment lasted 13.5 days. Clinical success and failure rates were 95% and 5%, respectively. DISCUSSION Short course DPT as ALT, combined with SAT and Taurolidine ALT, allowed high rates of conservative management of catheters in case of CoNS-associated-CRBSI.
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Affiliation(s)
- Matteo Vassallo
- Department of Internal Medicine/Infectious Diseases, Cannes General Hospital, Cannes, France
| | - Eric Denis
- Department of Internal Medicine, Antibes General Hospital, Antibes, France
| | - Sabrina Manni
- Department of Internal Medicine/Infectious Diseases, Cannes General Hospital, Cannes, France
| | - Laurene Lotte
- Multipurpose Laboratory, Bacteriology and Virology Unit, Cannes General Hospital, Cannes, France
| | | | - Audrey Sindt
- Multipurpose Laboratory, Bacteriology and Virology Unit, Cannes General Hospital, Cannes, France
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Lock terapia na prevenção e tratamento da infecção da corrente sanguínea associada ao cateter vascular: revisão integrativa. ACTA PAUL ENFERM 2023. [DOI: 10.37689/acta-ape/2023ar01221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Gompelman M, Paus C, Bond A, Akkermans RP, Bleeker-Rovers CP, Lal S, Wanten GJA. Comparing success rates in central venous catheter salvage for catheter-related bloodstream infections in adult patients on home parenteral nutrition: a systematic review and meta-analysis. Am J Clin Nutr 2021; 114:1173-1188. [PMID: 34038951 PMCID: PMC8408872 DOI: 10.1093/ajcn/nqab164] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Catheter-related bloodstream infection (CRBSI) is a life-threatening complication of parenteral nutrition. Therefore, optimal management, ideally with catheter salvage, is required to maintain long-term venous access. OBJECTIVES We aimed to evaluate successful catheter salvage rates in patients on home parenteral nutrition (HPN). METHODS Studies were retrieved from medical databases, conference proceedings, and article reference lists. Data were collected relating to clinical outcomes of 3 treatments: systemic antibiotics, antimicrobial lock therapy (ALT), and catheter exchange. ORs and 95% CIs were calculated from a mixed logistic effects model. RESULTS From 10,036 identified publications, 28 met the inclusion criteria (22 cohort studies, 5 case-control studies, and 1 randomized clinical trial), resulting in a total of 4911 CRBSIs. To achieve successful catheter salvage, the addition of an antimicrobial lock solution was superior to systemic antibiotics alone (OR: 1.75; 95% CI: 1.21, 2.53; P = 0.003). Recurrence of infection was less common in studies that used ALT than in those that used systemic antibiotics alone (OR: 0.26; 95% CI: 0.11, 0.61; P = 0.002). The catheter exchange group was excluded from multilevel regression analysis because only 1 included study applied this treatment. Successful salvage rates were highest for coagulase-negative staphylococci, followed by Gram-negative rods and Staphylococcus aureus . CONCLUSIONS The addition of an antimicrobial lock solution seems beneficial for successful catheter salvage in HPN-dependent patients with a CRBSI. Future prospective randomized studies should identify the most effective and pathogen-specific strategy.This review was registered at www.crd.york.ac.uk/PROSPERO as CRD42018102959.
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Affiliation(s)
- Michelle Gompelman
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Carmen Paus
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Ashley Bond
- Intestinal Failure Unit, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
| | - Reinier P Akkermans
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Chantal P Bleeker-Rovers
- Division of Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal National Health Service Foundation Trust, Salford, United Kingdom
- Manchester Academic Health Sciences Centre, University of Manchester, Manchester, United Kingdom
| | - Geert J A Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, Netherlands
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Fahrner R, Möller A, Press AT, Kortgen A, Kiehntopf M, Rauchfuss F, Settmacher U, Mosig AS. Short-term treatment with taurolidine is associated with liver injury. BMC Pharmacol Toxicol 2017; 18:61. [PMID: 28800748 PMCID: PMC5553585 DOI: 10.1186/s40360-017-0168-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/04/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Taurolidine has been used for peritonitis, oncological and catheter-lock treatment because of its anti-inflammatory properties. It has been suggested that taurolidine has no severe side-effects, but after long-term use morphological and functional changes of the liver were reported. The aim of this study was to investigate the effect of short-term use of taurolidine on the liver. METHODS In HepaRG cell cultures and on a novel liver biochip dose-dependent effects of taurolidine treatment on hepatocyte adherence and cell viability was investigated. Furthermore, liver enzymes and interleukin- (IL-) 6 were measured in supernatants. Male rats were treated with low- or high-dose taurolidine, respectively, and compared to controls with physiological saline solution administration regarding blood serum parameters and histology. RESULTS In HepaRG cell cultures, hepatocyte adherence was significantly decreased, cell death and cleaved caspase-3 were significantly increased after administration of taurolidine in a dose-dependent manner. High-dose application of taurolidine led to elevated liver enzymes and IL-6 secretion in hepatic organoid. After 24 h a significant increase of serum GLDH and ASAT was observed in rats treated with high-dose taurolidine treatment. CONCLUSIONS Our results suggest that taurolidine caused liver injury after short-term use in in vitro and in vivo models probably due to direct toxic effects on hepatocytes. Therefore, the taurolidine dose should be titrated in further investigations regarding liver injury and inflammation.
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Affiliation(s)
- René Fahrner
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, 07747, Jena, Germany. .,Center for Sepsis Control and Care (CSCC), University Hospital Jena, 07747, Jena, Germany.
| | - Anika Möller
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, 07747, Jena, Germany
| | - Adrian T Press
- Center for Sepsis Control and Care (CSCC), University Hospital Jena, 07747, Jena, Germany.,Department of Anesthesiology and Intensive Care Therapy, University Hospital Jena, 07747, Jena, Germany
| | - Andreas Kortgen
- Center for Sepsis Control and Care (CSCC), University Hospital Jena, 07747, Jena, Germany.,Department of Anesthesiology and Intensive Care Therapy, University Hospital Jena, 07747, Jena, Germany
| | - Michael Kiehntopf
- Center for Sepsis Control and Care (CSCC), University Hospital Jena, 07747, Jena, Germany.,Department of Clinical Chemistry and Laboratory Diagnostics, University Hospital Jena, 07747, Jena, Germany
| | - Falk Rauchfuss
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, 07747, Jena, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, 07747, Jena, Germany
| | - Alexander S Mosig
- Center for Sepsis Control and Care (CSCC), University Hospital Jena, 07747, Jena, Germany
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Implantable venous ports in pediatric oncology: experience of single institution in Russia. J Vasc Access 2016; 17:345-7. [PMID: 27151568 DOI: 10.5301/jva.5000556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To review our experience with implantable venous port-systems (IVPs) in pediatric cancer patients. MATERIALS AND METHODS From 2010 to 2015 we were monitoring the treatment of 163 children (aged 3 months to 17 years) with oncologic diseases. These patients underwent venous port implantations. RESULTS During insertion of 163 IVPs the following complications and technical difficulties were present: unintended puncture of the common carotid artery (CCA) during the puncture of the internal jugular vein (IJV) - 7 cases (4.3%); retrograde positioning of the distal end of the guidewire in the IJV - 17 cases (14.4%); placement of the distal end of the guidewire into the punctured subclavian vein (SV) - 12 cases (7.6%); difficulties driving the guidewire into the IJV after successful puncture - 15 cases (9.3%). The use of 163 IVPs was complicated by the following: venous port contamination - 4 cases (2.5%); occlusion of the IVPs by a clot - 8 cases (5%); withdrawal of the Huber needle bevel from the port chamber - 22 cases (13.6%); subcutaneous fat layer thinning above the port chamber - 3 cases (1.7%). CONCLUSIONS There are many complications, but they can be reduced by proper choice of materials and methodology.
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The prevention, diagnosis and management of central venous line infections in children. J Infect 2015; 71 Suppl 1:S59-75. [PMID: 25934326 DOI: 10.1016/j.jinf.2015.04.029] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2015] [Indexed: 11/21/2022]
Abstract
With advancing paediatric healthcare, the use of central venous lines has become a fundamental part of management of neonates and children. Uses include haemodynamic monitoring and the delivery of lifesaving treatments such as intravenous fluids, blood products, antibiotics, chemotherapy, haemodialysis and total parenteral nutrition (TPN). Despite preventative measures, central venous catheter-related infections are common, with rates of 0.5-2.8/1000 catheter days in children and 0.6-2.5/1000 catheter days in neonates. Central line infections in children are associated with increased mortality, increased length of hospital and intensive care unit stay, treatment interruptions, and increased complications. Prevention is paramount, using a variety of measures including tunnelling of long-term devices, chlorhexidine antisepsis, maximum sterile barriers, aseptic non-touch technique, minimal line accessing, and evidence-based care bundles. Diagnosis of central line infections in children is challenging. Available samples are often limited to a single central line blood culture, as clinicians are reluctant to perform painful venepuncture on children with a central, pain-free, access device. With the advancing evidence basis for antibiotic lock therapy for treatment, paediatricians are pushing the boundaries of line retention if safe to do so, due to among other reasons, often limited venous access sites. This review evaluates the available paediatric studies on management of central venous line infections and refers to consensus guidelines such as those of the Infectious Diseases Society of America (IDSA).
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Luther MK, Mermel LA, LaPlante KL. Comparison of ML8-X10 (a prototype oil-in-water micro-emulsion based on a novel free fatty acid), taurolidine/citrate/heparin and vancomycin/heparin antimicrobial lock solutions in the eradication of biofilm-producing staphylococci from central venous catheters. J Antimicrob Chemother 2014; 69:3263-7. [PMID: 25096074 DOI: 10.1093/jac/dku281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Antimicrobial lock solutions are used for prevention and management of catheter-related bloodstream infections. ML8-X10 (a prototype oil-in-water micro-emulsion based on a novel free fatty acid), vancomycin/heparin and taurolidine/citrate/heparin (Taurolock™-Hep500) lock solutions were tested against biofilm-forming Staphylococcus epidermidis and methicillin-susceptible Staphylococcus aureus. METHODS MICs were tested in neutral broth (pH ~7) and acidified broth (pH 5). In an established in vitro central venous catheter (CVC) lock model, solutions were introduced after 24 h of bacterial growth in a CVC incubated at 37°C. After an additional 8, 24 or 72 h of incubation, saline flush and cut catheter segments were processed for bacterial quantification. The cfu/mL at 0 h was subtracted from cfu/mL at the different timepoints. RESULTS The activities of ML8-X10 and taurolidine solutions were enhanced at lower pH (P < 0.05). Against S. epidermidis, ML8-X10 solution demonstrated less activity than taurolidine at 8 h (P < 0.001), but was not significantly different from vancomycin. At 24 h, ML8-X10 solution demonstrated significantly less activity than taurolidine (P < 0.001), but was significantly more active than vancomycin (P < 0.001). Against S. aureus, ML8-X10 solution was less active than taurolidine at 8 and 24 h (P < 0.001 for both), but was similar to vancomycin. At 72 h, all lock solutions reduced colony counts to levels that approached or reached the limit of detection against both strains. CONCLUSIONS In our in vitro catheter lock model, the novel free fatty acid emulsion demonstrated activity against biofilm-forming staphylococci similar to or greater than that of vancomycin lock solution. Taurolidine was the most active lock solution at 8 and 24 h, with all lock solutions tested demonstrating high activity at 72 h.
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Affiliation(s)
- Megan K Luther
- University of Rhode Island, College of Pharmacy, Kingston, RI, USA Rhode Island Infectious Diseases Research Program, Veterans Affairs Medical Center, Providence, RI, USA
| | - Leonard A Mermel
- University of Rhode Island, College of Pharmacy, Kingston, RI, USA Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA Division of Infectious Diseases, Rhode Island Hospital, Providence, RI, USA
| | - Kerry L LaPlante
- University of Rhode Island, College of Pharmacy, Kingston, RI, USA Rhode Island Infectious Diseases Research Program, Veterans Affairs Medical Center, Providence, RI, USA Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Castagnola E, Ginocchio F. Rescue therapy of difficult-to-treat indwelling central venous catheter-related bacteremias in cancer patients: a review for practical purposes. Expert Rev Anti Infect Ther 2014; 11:179-86. [DOI: 10.1586/eri.12.160] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Liu Y, Zhang AQ, Cao L, Xia HT, Ma JJ. Taurolidine lock solutions for the prevention of catheter-related bloodstream infections: a systematic review and meta-analysis of randomized controlled trials. PLoS One 2013; 8:e79417. [PMID: 24278133 PMCID: PMC3836857 DOI: 10.1371/journal.pone.0079417] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 09/22/2013] [Indexed: 11/19/2022] Open
Abstract
Background Catheter-related bloodstream infections (CRBSIs) are a significant cause of morbidity and mortality in critically ill patients, contributing to prolonged hospital stays and increased costs. Whether taurolidine lock solutions (TLS) are beneficial for the prevention of CRBSIs remains controversial. In this meta-analysis, we aim to assess the efficacy of TLS for preventing CRBSIs. Methods We conducted a systematic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Eligible studies included randomized controlled trials that reported on the effects of TLS for preventing CRBSIs. The primary outcome in these studies was catheter-related bloodstream infections, with microbial distribution of CRBSI and catheter-associated thrombosis as secondary outcomes. Data were combined using random-effects models owing to significant clinical heterogeneity. Results Six randomized controlled trials (RCTs) conducted from 2004 through 2013 involving 431 patients and 86,078 catheter-days were included in the review. TLS were significantly associated with a lower incidence of CRBSIs when compared to heparin lock solutions (Risk Ratio [RR], 0.34; 95% Confidence Interval [CI], 0.21–0.55). Use of TLS significantly decreased the incidence of CRBSIs from gram-negative (G−) bacteria (P = 0.004; RR, 0.27; CI, 0.11–0.65), and was associated with a non-significant decrease in gram-positive (G+) bacterial infections (P = 0.07; RR, 0.41; CI, 0.15–1.09). No significant association was observed with TLS and catheter-associated thrombosis (RR, 1.99; CI, 0.75–5.28). Conclusions The use of TLS reduced the incidence of CRBSIs without obvious adverse effects or bacterial resistance. However, the susceptibility of G+ and G- bacteria to taurolidine and the risk for catheter-associated thrombosis of TLS are indeterminate due to limited data. The results should be treated with caution due to the limited sample sizes and methodological deficiencies of included studies. Therefore, additional well-designed and adequately powered RCTs are needed to confirm these findings.
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Affiliation(s)
- Yong Liu
- Intensive care unit, Suining Central Hospital, Chuanshan District, Suining, Sichuan, China
- * E-mail:
| | - An-Qiang Zhang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Yuzhong District, Chongqing, China
| | - Lin Cao
- Intensive care unit, Suining Central Hospital, Chuanshan District, Suining, Sichuan, China
| | - Hong-Tao Xia
- Intensive care unit, Suining Central Hospital, Chuanshan District, Suining, Sichuan, China
| | - Jun-Jie Ma
- Intensive care unit, Suining Central Hospital, Chuanshan District, Suining, Sichuan, China
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