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Uranga A, Urrechaga E, Aguirre U, Intxausti M, Ruiz-Martinez C, Goicoechea MJLD, Ponga C, Quintana JM, Sancho C, Sanz P, España PP, Uranga A, Artaraz A, Ballaz A, Dorado S, Pascual S, Aguirre U, Quintana JM, Villanueva A, Mar C, Ponga C, Arriaga I, Intxausti M, Fernandez D, Benito I, Ruiz-Martinez C, Ugeda J, Sanz P, Bernardo I, España PP. Utility of Differential White Cell Count and Cell Population Data for Ruling Out COVID-19 Infection in Patients With Community-Acquired Pneumonia. Arch Bronconeumol 2022; 58:802-808. [PMID: 36243636 PMCID: PMC9489980 DOI: 10.1016/j.arbres.2022.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The main aim of this study was to assess the utility of differential white cell count and cell population data (CPD) for the detection of COVID-19 in patients admitted for community-acquired pneumonia (CAP) of different etiologies. METHODS This was a multicenter, observational, prospective study of adults aged ≥18 years admitted to three teaching hospitals in Spain from November 2019 to November 2021 with a diagnosis of CAP. At baseline, a Sysmex XN-20 analyzer was used to obtain detailed information related to the activation status and functional activity of white cells. RESULTS The sample was split into derivation and validation cohorts of 1065 and 717 patients, respectively. In the derivation cohort, COVID-19 was confirmed in 791 patients and ruled out in 274 patients, with mean ages of 62.13 (14.37) and 65.42 (16.62) years, respectively (p<0.001). There were significant differences in all CPD parameters except MO-Y. The multivariate prediction model showed that lower NE-X, NE-WY, LY-Z, LY-WY, MO-WX, MO-WY, and MO-Z values and neutrophil-to-lymphocyte ratio were related to COVID-19 etiology with an AUC of 0.819 (0.790, 0.846). No significant differences were found comparing this model to another including biomarkers (p=0.18). CONCLUSIONS Abnormalities in white blood cell morphology based on a few cell population data values as well as NLR were able to accurately identify COVID-19 etiology. Moreover, systemic inflammation biomarkers currently used were unable to improve the predictive ability. We conclude that new peripheral blood biomarkers can help determine the etiology of CAP fast and inexpensively.
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Uranga A, Artaraz A, Bilbao A, Quintana JM, Arriaga I, Intxausti M, Lobo JL, García JA, Camino J, España PP. Correction to: Impact of reducing the duration of antibiotic treatment on the long-term prognosis of community acquired pneumonia. BMC Pulm Med 2021; 21:21. [PMID: 33430824 PMCID: PMC7802248 DOI: 10.1186/s12890-020-01378-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An amendment to this paper has been published and can be accessed via the original article.
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Affiliation(s)
- Ane Uranga
- Department of Pneumology, Osakidetza, Universitary Hospital of Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Bizkaia, Spain.
| | - Amaia Artaraz
- Department of Pneumology, Osakidetza, Universitary Hospital of Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Bizkaia, Spain
| | - Amaia Bilbao
- Research Unit, Osakidetza, Universitary Hospital of Basurto, Bilbao, Bizkaia, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain.,Institute of Research in Health Services Kronikgune, Barakaldo, Bizkaia, Spain
| | - Jose María Quintana
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain.,Institute of Research in Health Services Kronikgune, Barakaldo, Bizkaia, Spain.,Research Unit, Osakidetza, Universitary Hospital of Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Ignacio Arriaga
- Department of Pneumology, Osakidetza, Universitary Hospital of Basurto, Bilbao, Bizkaia, Spain
| | - Maider Intxausti
- Department of Pneumology, Osakidetza, Universitary Hospital of Basurto, Bilbao, Bizkaia, Spain
| | - Jose Luis Lobo
- Department of Pneumology, Osakidetza, Universitary Hospital of Alava, Vitoria, Alava, Spain
| | - Julia Amaranta García
- Department of Pneumology, Osakidetza, Universitary Hospital of Alava, Vitoria, Alava, Spain
| | - Jesus Camino
- Department of Pneumology, Osakidetza, Hospital of San Eloy, Barakaldo, Bizkaia, Spain
| | - Pedro Pablo España
- Department of Pneumology, Osakidetza, Universitary Hospital of Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Bizkaia, Spain
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Uranga A, Artaraz A, Bilbao A, Quintana JM, Arriaga I, Intxausti M, Lobo JL, García JA, Camino J, España PP. Impact of reducing the duration of antibiotic treatment on the long-term prognosis of community acquired pneumonia. BMC Pulm Med 2020; 20:261. [PMID: 33028293 PMCID: PMC7538840 DOI: 10.1186/s12890-020-01293-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022] Open
Abstract
Background The optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) is not well established. The aim of this study was to assess the impact of reducing the duration of antibiotic treatment on long-term prognosis in patients hospitalized with CAP. Methods This was a multicenter study assessing complications developed during 1 year of patients previously hospitalized with CAP who had been included in a randomized clinical trial concerning the duration of antibiotic treatment. Mortality at 90 days, at 180 days and at 1 year was analyzed, as well as new admissions and cardiovascular complications. A subanalysis was carried out in one of the hospitals by measuring C-reactive protein (CRP), procalcitonin (PCT) and proadrenomedullin (proADM) at admission, at day 5 and at day 30. Results A total of 312 patients were included, 150 in the control group and 162 in the intervention group. Ninety day, 180 day and 1-year mortality in the per-protocol analysis were 8 (2.57%), 10 (3.22%) and 14 (4.50%), respectively. There were no significant differences between both groups in terms of 1-year mortality (p = 0.94), new admissions (p = 0.84) or cardiovascular events (p = 0.33). No differences were observed between biomarker level differences from day 5 to day 30 (CRP p = 0.29; PCT p = 0.44; proADM p = 0.52). Conclusions Reducing antibiotic treatment in hospitalized patients with CAP based on clinical stability criteria is safe, without leading to a greater number of long-term complications.
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Affiliation(s)
- Ane Uranga
- Department of Pneumology, Osakidetza, Universitary Hospital of Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Bizkaia, Spain.
| | - Amaia Artaraz
- Department of Pneumology, Osakidetza, Universitary Hospital of Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Bizkaia, Spain
| | - Amaia Bilbao
- Research Unit, Osakidetza, Universitary Hospital of Basurto, Bilbao, Bizkaia, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain.,Institute of Reasearch in Health Services Kronikgune, Barakaldo, Bizkaia, Spain
| | - Jose María Quintana
- Health Services Research on Chronic Patients Network (REDISSEC), Galdakao, Bizkaia, Spain.,Institute of Reasearch in Health Services Kronikgune, Barakaldo, Bizkaia, Spain.,Research Unit, Osakidetza, Universitary Hospital of Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | - Ignacio Arriaga
- Department of Pneumology, Osakidetza, Universitary Hospital of Basurto, Bilbao, Bizkaia, Spain
| | - Maider Intxausti
- Department of Pneumology, Osakidetza, Universitary Hospital of Basurto, Bilbao, Bizkaia, Spain
| | - Jose Luis Lobo
- Department of Pneumology, Osakidetza, Universitary Hospital of Alava, Vitoria, Alava, Spain
| | - Julia Amaranta García
- Department of Pneumology, Osakidetza, Universitary Hospital of Alava, Vitoria, Alava, Spain
| | - Jesus Camino
- Department of Pneumology, Osakidetza, Hospital of San Eloy, Barakaldo, Bizkaia, Spain
| | - Pedro Pablo España
- Department of Pneumology, Osakidetza, Universitary Hospital of Galdakao-Usansolo, Barrio Labeaga s/n, 48960, Galdakao, Bizkaia, Spain
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Cowell AN, Istvan ES, Lukens AK, Gomez-Lorenzo MG, Vanaerschot M, Sakata-Kato T, Flannery EL, Magistrado P, Owen E, Abraham M, LaMonte G, Painter HJ, Williams RM, Franco V, Linares M, Arriaga I, Bopp S, Corey VC, Gnädig NF, Coburn-Flynn O, Reimer C, Gupta P, Murithi JM, Moura PA, Fuchs O, Sasaki E, Kim SW, Teng CH, Wang LT, Akidil A, Adjalley S, Willis PA, Siegel D, Tanaseichuk O, Zhong Y, Zhou Y, Llinás M, Ottilie S, Gamo FJ, Lee MCS, Goldberg DE, Fidock DA, Wirth DF, Winzeler EA. Mapping the malaria parasite druggable genome by using in vitro evolution and chemogenomics. Science 2018; 359:191-199. [PMID: 29326268 PMCID: PMC5925756 DOI: 10.1126/science.aan4472] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/02/2017] [Indexed: 12/21/2022]
Abstract
Chemogenetic characterization through in vitro evolution combined with whole-genome analysis can identify antimalarial drug targets and drug-resistance genes.We performed a genome analysis of 262 Plasmodium falciparum parasites resistant to 37 diverse compounds.We found 159 gene amplifications and 148 nonsynonymous changes in 83 genes associated with drug-resistance acquisition, where gene amplifications contributed to one-third of resistance acquisition events. Beyond confirming previously identified multidrug-resistance mechanisms, we discovered hitherto unrecognized drug target–inhibitor pairs, including thymidylate synthase and a benzoquinazolinone, farnesyltransferase and a pyrimidinedione, and a dipeptidylpeptidase and an arylurea.This exploration of the P. falciparum resistome and druggable genome will likely guide drug discovery and structural biology efforts, while also advancing our understanding of resistance mechanisms available to the malaria parasite.
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Affiliation(s)
- Annie N Cowell
- School of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Eva S Istvan
- Departments of Medicine and Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Amanda K Lukens
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.,Infectious Disease Program, The Broad Institute, 415 Main Street, Cambridge, MA 02142, USA
| | - Maria G Gomez-Lorenzo
- Tres Cantos Medicines Development Campus, Malaria Discovery Performance Unit, GlaxoSmithKline, Severo Ochoa 2, Tres Cantos 28760, Madrid, Spain
| | - Manu Vanaerschot
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Tomoyo Sakata-Kato
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - Erika L Flannery
- School of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Pamela Magistrado
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - Edward Owen
- Department of Biochemistry and Molecular Biology, Pennsylvania State University, University Park, PA 16802, USA
| | - Matthew Abraham
- School of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Gregory LaMonte
- School of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Heather J Painter
- Department of Biochemistry and Molecular Biology, Pennsylvania State University, University Park, PA 16802, USA
| | - Roy M Williams
- School of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Virginia Franco
- Tres Cantos Medicines Development Campus, Malaria Discovery Performance Unit, GlaxoSmithKline, Severo Ochoa 2, Tres Cantos 28760, Madrid, Spain
| | - Maria Linares
- Tres Cantos Medicines Development Campus, Malaria Discovery Performance Unit, GlaxoSmithKline, Severo Ochoa 2, Tres Cantos 28760, Madrid, Spain
| | - Ignacio Arriaga
- Tres Cantos Medicines Development Campus, Malaria Discovery Performance Unit, GlaxoSmithKline, Severo Ochoa 2, Tres Cantos 28760, Madrid, Spain
| | - Selina Bopp
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - Victoria C Corey
- School of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Nina F Gnädig
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Olivia Coburn-Flynn
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Christin Reimer
- School of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Purva Gupta
- School of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - James M Murithi
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Pedro A Moura
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Olivia Fuchs
- School of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Erika Sasaki
- School of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Sang W Kim
- School of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Christine H Teng
- School of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Lawrence T Wang
- School of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Aslı Akidil
- Malaria Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SA, UK
| | - Sophie Adjalley
- Malaria Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SA, UK
| | - Paul A Willis
- Medicines for Malaria Venture, Post Office Box 1826, 20 Route de Pre-Bois, 1215 Geneva 15, Switzerland
| | - Dionicio Siegel
- Skaggs School of Pharmacy and Pharmaceutical Sciences, UCSD, 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Olga Tanaseichuk
- Genomics Institute of the Novartis Research Foundation, 10675 John J Hopkins Drive, San Diego, CA 92121, USA
| | - Yang Zhong
- Genomics Institute of the Novartis Research Foundation, 10675 John J Hopkins Drive, San Diego, CA 92121, USA
| | - Yingyao Zhou
- Genomics Institute of the Novartis Research Foundation, 10675 John J Hopkins Drive, San Diego, CA 92121, USA
| | - Manuel Llinás
- Department of Biochemistry and Molecular Biology, Pennsylvania State University, University Park, PA 16802, USA
| | - Sabine Ottilie
- School of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093, USA
| | - Francisco-Javier Gamo
- Tres Cantos Medicines Development Campus, Malaria Discovery Performance Unit, GlaxoSmithKline, Severo Ochoa 2, Tres Cantos 28760, Madrid, Spain
| | - Marcus C S Lee
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.,Malaria Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SA, UK
| | - Daniel E Goldberg
- Departments of Medicine and Molecular Microbiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - David A Fidock
- Department of Microbiology and Immunology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.,Division of Infectious Diseases, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
| | - Dyann F Wirth
- Department of Immunology and Infectious Disease, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA.,Infectious Disease Program, The Broad Institute, 415 Main Street, Cambridge, MA 02142, USA
| | - Elizabeth A Winzeler
- School of Medicine, University of California San Diego (UCSD), 9500 Gilman Drive, La Jolla, CA 92093, USA. .,Skaggs School of Pharmacy and Pharmaceutical Sciences, UCSD, 9500 Gilman Drive, La Jolla, CA 92093, USA
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Uranga A, España PP, Bilbao A, Quintana JM, Arriaga I, Intxausti M, Lobo JL, Tomás L, Camino J, Nuñez J, Capelastegui A. Duration of Antibiotic Treatment in Community-Acquired Pneumonia: A Multicenter Randomized Clinical Trial. JAMA Intern Med 2016; 176:1257-65. [PMID: 27455166 DOI: 10.1001/jamainternmed.2016.3633] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The optimal duration of antibiotic treatment for community-acquired pneumonia (CAP) has not been well established. OBJECTIVE To validate Infectious Diseases Society of America/American Thoracic Society guidelines for duration of antibiotic treatment in hospitalized patients with CAP. DESIGN, SETTING, AND PARTICIPANTS This study was a multicenter, noninferiority randomized clinical trial performed at 4 teaching hospitals in Spain from January 1, 2012, through August 31, 2013. A total of 312 hospitalized patients diagnosed as having CAP were studied. Data analysis was performed from January 1, 2014, through February 28, 2015. INTERVENTIONS Patients were randomized at day 5 to an intervention or control group. Those in the intervention group were treated with antibiotics for a minimum of 5 days, and the antibiotic treatment was stopped at this point if their body temperature was 37.8°C or less for 48 hours and they had no more than 1 CAP-associated sign of clinical instability. Duration of antibiotic treatment in the control group was determined by physicians. MAIN OUTCOMES AND MEASURES Clinical success rate at days 10 and 30 since admission and CAP-related symptoms at days 5 and 10 measured with the 18-item CAP symptom questionnaire score range, 0-90; higher scores indicate more severe symptoms. RESULTS Of the 312 patients included, 150 and 162 were randomized to the control and intervention groups, respectively. The mean (SD) age of the patients was 66.2 (17.9) years and 64.7 (18.7) years in the control and intervention groups, respectively. There were 95 men (63.3%) and 55 women (36.7%) in the control group and 101 men (62.3%) and 61 women (37.7%) in the intervention group. In the intent-to-treat analysis, clinical success was 48.6% (71 of 150) in the control group and 56.3% (90 of 162) in the intervention group at day 10 (P = .18) and 88.6% (132 of 150) in the control group and 91.9% (147 of 162) in the intervention group at day 30 (P = .33). The mean (SD) CAP symptom questionnaire scores were 24.7 (11.4) vs 27.2 (12.5) at day 5 (P = .10) and 18.6 (9.0) vs 17.9 (7.6) at day 10 (P = .69). In the per-protocol analysis, clinical success was 50.4% (67 of 137) in the control group and 59.7% (86 of 146) in the intervention group at day 10 (P = .12) and 92.7% (126 of 137) in the control group and 94.4% (136 of 146) in the intervention group at day 30 (P = .54). The mean (SD) CAP symptom questionnaire scores were 24.3 (11.4) vs 26.6 (12.1) at day 5 (P = .16) and 18.1 (8.5) vs 17.6 (7.4) at day 10 (P = .81). CONCLUSIONS AND RELEVANCE The Infectious Diseases Society of America/American Thoracic Society recommendations for duration of antibiotic treatment based on clinical stability criteria can be safely implemented in hospitalized patients with CAP. TRIAL REGISTRATION clinicaltrialsregister.eu Identifier: 2011-001067-51.
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Affiliation(s)
- Ane Uranga
- Department of Pneumology, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain
| | - Pedro P España
- Department of Pneumology, Galdakao-Usansolo Hospital, Galdakao, Bizkaia, Spain
| | - Amaia Bilbao
- Research Unit, Basurto University Hospital, Bilbao, Bizkaia, Spain
| | | | - Ignacio Arriaga
- Department of Pneumology, Basurto University Hospital, Bilbao, Bizkaia, Spain
| | - Maider Intxausti
- Department of Pneumology, Basurto University Hospital, Bilbao, Bizkaia, Spain
| | - Jose Luis Lobo
- Department of Pneumology, Alava University Hospital, Vitoria, Alava, Spain
| | - Laura Tomás
- Department of Pneumology, Alava University Hospital, Vitoria, Alava, Spain
| | - Jesus Camino
- Department of Pneumology, San Eloy Hospital, Barakaldo, Bizkaia, Spain
| | - Juan Nuñez
- Department of Pneumology, San Eloy Hospital, Barakaldo, Bizkaia, Spain
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