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Staber J, Croteau SE, Davis J, Grabowski EF, Kouides P, Sidonio RF. The spectrum of bleeding in women and girls with haemophilia B. Haemophilia 2017; 24:180-185. [PMID: 29178325 DOI: 10.1111/hae.13376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 01/03/2023]
Abstract
Although hemophilia B affects 1 in 25,000 males there may be 3 female hemophilia B carriers per affected male. This clinical review highlights the unique challenges faced by hemophilia B carriers including the under-recognition of bleeding symptoms associated with and without FIX deficiency, discrepancies in correlation between genotype and bleeding phenotype and therapeutic considerations utilizing clinical vignettes of common scenarios.
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Affiliation(s)
- J Staber
- University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA
| | - S E Croteau
- Dana-Farber Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - J Davis
- University of Miami Health System, Miami, FL, USA
| | | | - P Kouides
- University of Rochester Medical Center, Rochester, NY, USA
| | - R F Sidonio
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
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Walsh CE, Workowski K, Terrault NA, Sax PE, Cohen A, Bowlus CL, Kim AY, Hyland RH, Han B, Wang J, Stamm LM, Brainard DM, McHutchison JG, von Drygalski A, Rhame F, Fried MW, Kouides P, Balba G, Reddy KR. Ledipasvir-sofosbuvir and sofosbuvir plus ribavirin in patients with chronic hepatitis C and bleeding disorders. Haemophilia 2017; 23:198-206. [PMID: 28124511 DOI: 10.1111/hae.13178] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Chronic hepatitis C virus (HCV) infection is prevalent among patients with inherited bleeding disorders and is a leading cause of mortality in those with haemophilia. AIM We evaluated the efficacy and safety of ledipasvir-sofosbuvir and sofosbuvir plus ribavirin in patients with chronic HCV genotype 1-4 infection and an inherited bleeding disorder. METHODS Ledipasvir-sofosbuvir was administered for 12 weeks to patients with genotype 1 or 4 infection and for 12 or 24 weeks to treatment-experienced cirrhotic patients with genotype 1 infection. Patients with genotype 2 and 3 infection received sofosbuvir plus ribavirin for 12 and 24 weeks respectively. RESULTS The majority of the 120 treated patients had a severe bleeding disorder (55%); overall, 65% of patients had haemophilia A and 26% of patients had haemophilia B; 22% were HIV coinfected. Sustained virologic response at 12 weeks posttreatment was 99% (98/99) in patients with genotype 1 or 4 infection; 100% (5/5) in treatment-experienced cirrhotic patients with genotype 1 infection; 100% (10/10) in patients with genotype 2 infection; and 83% (5/6) in patients with genotype 3 infection. There were no treatment discontinuations due to adverse events (AEs). The most frequent non-bleeding AEs were fatigue, headache, diarrhoea, nausea and insomnia. Bleeding AEs occurred in 22 patients, of which all but one were considered unrelated to treatment. CONCLUSION Treatment with ledipasvir-sofosbuvir for patients with HCV genotype 1 or 4 infection or sofosbuvir plus ribavirin for patients with genotype 2 or 3 infection was highly effective and well tolerated among those with inherited bleeding disorders.
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Affiliation(s)
- C E Walsh
- Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
| | | | - N A Terrault
- University of California at San Francisco, San Francisco, CA, USA
| | - P E Sax
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - A Cohen
- Newark Beth Israel Medical Center, Barnabas Health, Newark, NJ, USA
| | - C L Bowlus
- University of California at Davis, Davis, CA, USA
| | - A Y Kim
- Massachusetts General Hospital, Boston, MA, USA
| | - R H Hyland
- Gilead Sciences Inc., Foster City, CA, USA
| | - B Han
- Gilead Sciences Inc., Foster City, CA, USA
| | - J Wang
- Gilead Sciences Inc., Foster City, CA, USA
| | - L M Stamm
- Gilead Sciences Inc., Foster City, CA, USA
| | | | | | | | - F Rhame
- Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - M W Fried
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - P Kouides
- The Mary M. Gooley Hemophilia Center, Rochester, NY, USA
| | - G Balba
- MedStar Georgetown University Hospital, Washington, DC, USA
| | - K R Reddy
- University of Pennsylvania, Philadelphia, PA, USA
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Poudyal BS, Shrestha GS, Tuladhar S, Gyawali B, Sedain G, Battajo R, Maskey P, Paudyal S, Regmi S, RC DR, Kouides P. Use of donated clotting factors for surgeries on haemophilic patients in a resource-constrained country: a kind donor, good outcome, change of practice and future directions. Haemophilia 2016; 22:e453-5. [DOI: 10.1111/hae.13017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
- B. S. Poudyal
- Haematology and bone marrow transplant unit; Civil service hospital and Alka hospital; Kathmandu Nepal
| | - G. S. Shrestha
- Department of Anaesthesiology; Tribhuvan University Teaching Hospital; Kathmandu Nepal
| | - S. Tuladhar
- Department of Pathology; Civil service hospital; Kathmandu Nepal
| | - B. Gyawali
- Department of Haematology and Oncology; Nobel Hospital; Kathmandu Nepal
| | - G. Sedain
- Department of Neurosurgery; Tribhuvan University Teaching Hospital; Kathmandu Nepal
| | - R. Battajo
- Department of Urosurgery; Alka Hospital; Kathmandu Nepal
| | - P. Maskey
- Department of Urosurgery; Alka Hospital; Kathmandu Nepal
| | - S. Paudyal
- Department of General surgery; Alka Hospital; Kathmandu Nepal
| | - S. Regmi
- Urosurgery Unit; Civil service Hospital; Kathmandu Nepal
| | - D. R. RC
- Department of Orthopedics; Civil service Hospital; Kathmandu Nepal
| | - P. Kouides
- Mary M Gooley hemophilia center; Rochester NY USA
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Zia A, Lau M, Journeycake J, Sarode R, Marshall J, De Simone N, Wilson E, Winborn A, Kouides P. Developing a multidisciplinary Young Women's Blood Disorders Program: a single-centre approach with guidance for other centres. Haemophilia 2016; 22:199-207. [DOI: 10.1111/hae.12836] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 11/29/2022]
Affiliation(s)
- A. Zia
- Department of Pediatrics; The University of Texas Southwestern Medical Center; Dallas TX USA
- Division of Hematology/Oncology; The University of Texas Southwestern Medical Center; Dallas TX USA
- Children's Medical Center; Dallas TX USA
| | - M. Lau
- Department of Pediatrics; The University of Texas Southwestern Medical Center; Dallas TX USA
- Children's Medical Center; Dallas TX USA
| | - J. Journeycake
- Department of Pediatrics; The University of Texas Southwestern Medical Center; Dallas TX USA
- Division of Hematology/Oncology; The University of Texas Southwestern Medical Center; Dallas TX USA
- Children's Medical Center; Dallas TX USA
| | - R. Sarode
- Department of Pathology; The University of Texas Southwestern Medical Center; Dallas TX USA
| | | | - N. De Simone
- Department of Pathology; The University of Texas Southwestern Medical Center; Dallas TX USA
| | - E. Wilson
- Department of Obstetrics and Gynecology; The University of Texas Southwestern Medical Center; Dallas TX USA
| | - A. Winborn
- Children's Medical Center; Dallas TX USA
| | - P. Kouides
- Mary M. Gooley Hemophilia Center; University of Rochester School of Medicine; Rochester NY USA
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Abshire T, Cox-Gill J, Kempton CL, Leebeek FWG, Carcao M, Kouides P, Donfield S, Berntorp E. Prophylaxis escalation in severe von Willebrand disease: a prospective study from the von Willebrand Disease Prophylaxis Network. J Thromb Haemost 2015; 13:1585-9. [PMID: 25930155 DOI: 10.1111/jth.12995] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Treatment of mucosal bleeding (epistaxis, gastrointestinal bleeding, and menorrhagia) and joint bleeding remains problematic in clinically severe von Willebrand disease (VWD). Patients are often unresponsive to treatment (e.g. desmopressin or antifibrinolytic therapy) and may require von Willebrand factor (VWF) replacement therapy. There are little data on the use of prophylaxis in VWD, and none have been applied in a prospective, treatment escalation design. OBJECTIVE Evaluate the effect of escalating dose prophylaxis in severe VWD. METHODS Patients eligible for enrollment in this prospective study included those with type 1 VWD with VW factor activity-ristocetin cofactor ratio ≤ 20% and unresponsive to desmopressin, patients with type 2 VWD not responsive to desmopressin and all subjects with type 2B and type 3 VWD. Entry criteria were strictly defined, as were therapy escalation parameters and clinical data collection. RESULTS Eleven subjects completed the study. Six had type 2A, and five had type 3 VWD. Six patients presented with epistaxis, three with GI bleeding, and two with joint bleeding. Seven had dose escalation above the first level. Among the 10 subjects with evaluable bleeding log data, use of prophylaxis decreased the median annualized bleeding rate from 25 to 6.1 (95% confidence interval of the rate difference: -51.6 to -1.7), and the median annualized bleeding rate was even lower (4.0; 95% confidence interval: -57.5 to -5.3) when the subjects reached their final dosing level. CONCLUSION This is the first prospective study to demonstrate that prophylaxis with VW factor concentrates is highly effective in reducing mucosal and joint bleeding rates in clinically severe VWD.
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Affiliation(s)
- T Abshire
- Blood Research Institute and Departments of Pediatrics and Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - J Cox-Gill
- Pediatric Hematology, Medical College of Wisconsin, Comprehensive Center for Bleeding Disorders, BloodCenter of Wisconsin, Milwaukee, WI, USA
| | - C L Kempton
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Emory University, Atlanta, GA, USA
- Department of Hematology and Medical Oncology, Emory University, Atlanta, GA, USA
| | - F W G Leebeek
- Department of Hematology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - M Carcao
- Department of Paediatrics, Division of Haematology/Oncology, Hospital for Sick Children, Toronto, ON, Canada
| | - P Kouides
- Department of Medicine, Rochester General Hospital, Rochester, NY, USA
| | - S Donfield
- Department of Biostatistics, Rho, Inc., Chapel Hill, NC, USA
| | - E Berntorp
- Malmö Centre for Thrombosis and Haemostasis, Skåne University Hospital, Lund University, Malmö, Sweden
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James AH, Konkle BA, Kouides P, Ragni MV, Thames B, Gupta S, Sood S, Fletcher SK, Philipp CS. Postpartum von Willebrand factor levels in women with and without von Willebrand disease and implications for prophylaxis. Haemophilia 2014; 21:81-7. [DOI: 10.1111/hae.12568] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | - B. A. Konkle
- Puget Sound Blood Center Seattle WA USA
- University of Washington Seattle WA USA
| | - P. Kouides
- Rochester General Hospital Rochester NY USA
| | - M. V. Ragni
- University of Pittsburgh Pittsburgh PA USA
- Hemophilia Center of Western Pennsylvania Pittsburgh PA USA
| | | | - S. Gupta
- Indiana Hemophilia & Thrombosis Center Indianapolis IN USA
| | - S. Sood
- University of Michigan Ann Arbor MI USA
| | | | - C. S. Philipp
- Rutgers Robert Wood Johnson Medical School New Brunswick NJ USA
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Kurth M, Puetz J, Kouides P, Sanders J, Sexauer C, Bernstein J, Gruppo R, Manco-Johnson M, Neufeld EJ, Rodriguez N, Wicklund B, Quon D, Aledort L. The use of a single von Willebrand factor-containing, plasma-derived FVIII product in hemophilia A immune tolerance induction: the US experience. J Thromb Haemost 2011; 9:2229-34. [PMID: 21883884 DOI: 10.1111/j.1538-7836.2011.04493.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Inhibitors are a serious complication for patients with severe hemophilia A. Immune tolerance induction (ITI) is the primary method for eradicating these inhibitors. The role of type of concentrate and in particular the use of von Willebrand factor-containing, plasma-derived factor VIII (VWF/pd-FVIII) concentrate in primary or rescue ITI remains unclear. OBJECTIVES To report retrospective collection of data on the use of a single VWF/pd-FVIII concentrate in primary and rescue ITI. METHODS Retrospective chart review of hemophilia A inhibitor patients at 11 US institutions who received VWF/pd-FVIII concentrate in primary or rescue ITI. RESULTS Primary ITI was carried out in eight inhibitor patients with a 75% complete and partial success. Secondary ITI was carried out in 25 inhibitor patients, with 52% attaining complete or partial success. CONCLUSIONS This report represents the largest group of primarily pediatric, high-titer inhibitor patients treated with a single VWF/pd-FVIII concentrate. It adds retrospective data to the use of VWF-containing plasma-derived factor VIII concentrate in primary and rescue ITI, particularly in those patients with characteristics of poor response to ITI.
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Affiliation(s)
- M Kurth
- Department of Pediatrics, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
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Abstract
Menorrhagia at the time of menarche is relatively common and historically attributed primarily to immaturity of the pituitary-ovarian-uterine axis. Intuitively, a proportion of these patients should have an underlying disorder of haemostasis, given the 5-20% prevalence of von Willebrand's disease and the > or =20% prevalence of platelet dysfunction in light of recent epidemiological studies in menorrhagia, although the average age of the patients in those studies has been approximately 35 years. However, there are a few comprehensive studies in the adolescent population determining whether widespread haemostasis evaluation should be carried out in adolescents presenting with menorrhagia. A retrospective chart review study of disorders of haemostasis was carried out in 61 consecutive adolescent patients, ages 11-19 at the time of evaluation referred to the Hemophilia Treatment Center (HTC)/Hematology unit. The mean and median ages were 15 +/- 2.2 and 14 years (11, 19), respectively. Standard evaluation included complete blood count, prothrombin time, partial thromboplastin time, von Willebrand factor (VWF) levels and platelet aggregation. The proportion of patients with VWF deficiency was 22/61 (36%) [95% confidence interval (CI), 24-49%]; the proportion of patients with platelet aggregation abnormalities was 4/61 (7%) (95% CI, 2-16%). There was no difference in the frequency of additional muco-cutaneous bleeding symptoms. A relatively high proportion of adolescents are identified with an underlying disorder of haemostasis when referred to an HTC for evaluation of menorrhagia. This involves in part a selective referral bias, but underscores the role of the HTC in evaluating adolescents referred with menorrhagia for an underlying bleeding disorder, given the relatively high yield of haemostatic disorders detected in this setting.
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Affiliation(s)
- S Mikhail
- Department of Medicine, Rochester General Hospital, 1415 Portland Avenue, Rochester, NY 14621, USA
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Abstract
BACKGROUND The Clot Signature Analyzer (CSA) was designed to assess global hemostasis as a screening assay using non-anticoagulated whole blood. Three different measurements are produced by the instrument: platelet hemostasis time (PHT), clot time (CT), and collagen-induced thrombus formation (CITF). OBJECTIVES The purpose of the present study was to determine normal ranges for these measurements and assess the performance of the CSA in patients with well-characterized hemostatic disorders and in normal subjects. PATIENTS AND METHODS Four institutions participated in the study. Each established their own normal reference ranges. Patients with well-characterized hemostatic disorders and concurrent normal controls were subsequently examined. RESULTS Normal ranges between institutions were similar although statistically different. One hundred and eight patients were examined: 46 individuals with von Willebrand disease (VWD) (type 1, 26; type 2A, 11; type 2B, six; type 3, three); 38 patients with a coagulation factor deficiency; 13 individuals with platelet function defects; 10 patients taking warfarin; and one individual on low-molecular-weight heparin. Of these patients, 89% had at least one abnormality by CSA: 42/46 VWD patients, 35/38 coagulation protein defect patients, 9/13 patients with platelet function defects, 9/10 patients on warfarin and 1/1 patient on low-molecular-weight heparin. Of 116 normal subjects, 103 (89%) fell within the centers' normal range. These data suggest that the CSA has a good sensitivity for bleeding disorders.
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Affiliation(s)
- W Fricke
- Department of Internal Medicine, Georgetown University, Washington, DC, USA.
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10
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Kouides P. Decreased platelet dense granule number and volume associated with menorrhagia. Obstet Gynecol 2000. [DOI: 10.1016/s0029-7844(00)00623-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Phatak PD, Janas JS, Kouides P, Leisveld J, Shafer J, Marder VJ. Infections affecting blood cell morphology. Am J Hematol 1998; 59:238-41. [PMID: 9798663 DOI: 10.1002/(sici)1096-8652(199811)59:3<238::aid-ajh10>3.0.co;2-o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- P D Phatak
- Department of Medicine, University of Rochester School of Medicine and Dentistry, New York, USA
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Reykdal S, Sham R, Kouides P. Cytarabine-induced pericarditis: a case report and review of the literature of the cardio-pulmonary complications of cytarabine therapy. Leuk Res 1995; 19:141-4. [PMID: 7869742 DOI: 10.1016/0145-2126(94)00123-r] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Pericarditis is a rare complication of chemotherapy. This report describes a patient who developed symptoms, signs, and electrocardiographic evidence of pericarditis following treatment with high dose cytarabine. The patient had no clinical or echocardiographic evidence of infection or leukemic involvement of the pericardium. Isolated pericarditis associated with high dose cytarabine has been rarely reported. This therapy is frequently used and, therefore, it seems prudent to alert physicians to this potential complication of cytarabine. The cardiopulmonary complications of cytarabine are also reviewed.
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Affiliation(s)
- S Reykdal
- Department of Medicine, Rochester General Hospital, NY 14621
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Rowe J, Ryan D, Dipersio J, Gaspari A, Nilsson B, Larsson L, Liesveld J, Kouides P, Simonsson B. Autografting in chronic myelogenous leukemia followed by immunotherapy. Stem Cells 1993; 11 Suppl 3:34-42. [PMID: 8298476 DOI: 10.1002/stem.5530110911] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Patients with chronic myelogenous leukemia (CML) can be cured with allogeneic bone marrow transplantation. Over the past decade, it has become clear that immunological mechanisms, in the form of graft-versus-leukemia, constitute an integral part of this therapy. Because of limitations imposed by a lack of suitable donors, age, and toxicity, only a minority of patients can be offered allogeneic bone marrow transplantation (BMT). Recently, attempts have been made to employ autologous bone marrow transplantation (ABMT) for the therapy of CML using a variety of pre- and post-transplantation manipulations. This report describes the rationale for an ongoing clinical trial using the immunomodulator roquinimex (Linomide), following autologous bone marrow transplantation, in an attempt to stimulate the immunological responses thought to be critical for successful therapy in CML.
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Affiliation(s)
- J Rowe
- Hematology Unit, University of Rochester, Medical Center, NY 14642
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