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Colombo PC, Castagna F, Onat D, Wong KY, Harxhi A, Hayashi Y, Friedman RA, Pinsino A, Ladanyi A, Mebazaa A, Jelic S, Arrigo M, Lejemtel TH, Papapanou P, Sabbah HN, Schmidt AM, Yuzefpolskaya M, Demmer RT. Experimentally Induced Peripheral Venous Congestion Exacerbates Inflammation, Oxidative Stress, and Neurohormonal and Endothelial Cell Activation in Patients With Systolic Heart Failure. J Card Fail 2024; 30:580-591. [PMID: 37625581 PMCID: PMC10884348 DOI: 10.1016/j.cardfail.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Venous congestion (VC) is a hallmark of symptomatic heart failure (HF) requiring hospitalization; however, its role in the pathogenesis of HF progression remains unclear. We investigated whether peripheral VC exacerbates inflammation, oxidative stress and neurohormonal and endothelial cell (EC) activation in patients with HF with reduced ejection fraction (HFrEF). METHODS AND RESULTS Two matched groups of patients with HFrEF and with no peripheral VC vs without recent HF hospitalization were studied. We modeled peripheral VC by inflating a cuff around the dominant arm, targeting ∼ 30 mmHg increase in venous pressure (venous stress test [VST]). Blood and ECs were sampled before and after 90 minutes of VST. We studied 44 patients (age 53 ± 12 years, 32% female). Circulating endothelin-1, tumor necrosis factor-α, interleukin-6, isoprostane, angiotensin II (ang-2), angiopoietin-2, vascular cell adhesion molecule-1, and CD146 significantly increased after the VST. Enhanced endothelin-1 and angiopoietin-2 responses to the VST were present in patients with vs without recent hospitalization and were prospectively associated with incident HF-related events; 6698 messenger ribonucleic acid (mRNA probe sets were differentially expressed in ECs after VST. CONCLUSIONS Experimental VC exacerbates inflammation, oxidative stress, neurohormonal and EC activation and promotes unfavorable transcriptome remodeling in ECs of patients with HFrEF. A distinct biological sensitivity to VC appears to be associated with high risk for HF progression.
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Affiliation(s)
- Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA.
| | - Francesco Castagna
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, New York, New York, USA
| | - Duygu Onat
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Ka Yuk Wong
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Ante Harxhi
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Yacki Hayashi
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Richard A Friedman
- Herbert Irving Comprehensive Cancer Center Columbia University, New York, New York, USA
| | - Alberto Pinsino
- Department of Anesthesia, Division of Critical Care, Montefiore Medical Center, New York, New York, USA
| | - Annamaria Ladanyi
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Alexander Mebazaa
- Department of Anesthesiology and Critical Care Medicine, AP-HP Saint Louis and Lariboisière University Hospitals, Paris, France
| | - Sanja Jelic
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Thierry H Lejemtel
- Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Panos Papapanou
- Department of Periodontology Columbia University Irving Medical Center, New York, New York, USA
| | - Hani N Sabbah
- Department of Medicine, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ann Marie Schmidt
- Department of Medicine, Division of Endocrinology, New York University, New York, New York, USA
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA; and Department of Epidemiology, Mailman School of Public Health Columbia University, New York, New York, USA
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Jeger RV, Urban P, Harkness SM, Tseng CH, Stauffer JC, Lejemtel TH, Sleeper LA, Pfisterer ME, Hochman JS. Early revascularization is beneficial across all ages and a wide spectrum of cardiogenic shock severity: A pooled analysis of trials. ACTA ACUST UNITED AC 2011; 13:14-20. [PMID: 21244231 DOI: 10.3109/17482941.2010.538696] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A pooled analysis in cardiogenic shock due to acute coronary syndromes is desirable to assess the effect of early revascularization (ERV) across all ages and a wide spectrum of disease severity. METHODS Only two randomized controlled trials (RCT), i.e. SMASH and SHOCK, met the inclusion criteria and were combined for a pooled analysis using individual patient data (n = 348). RESULTS SMASH patients (n = 54, 16%) had more severe disease than SHOCK patients (n = 294, 84%). After adjustment for age, anoxic brain damage, non-inferior myocardial infarction, prior coronary artery bypass graft surgery, renal failure, systolic blood pressure, and selection for coronary angiography, one-year mortality was similar (relative risk SHOCK versus SMASH 0.87, 95% CI: 0.61-1.25). Relative risk of one-year death for ERV versus initial medical stabilization was 0.82 (95% CI: 0.70-0.96). There was no significant difference in the treatment effect by age (≤75 years relative risk at one year 0.79, 95% CI: 0.63-0.99; > 75 years relative risk at one year 0.93, 95% CI: 0.56-1.53; interaction P = 0.10). CONCLUSIONS Only two RCT have been published emphasizing the difficulty of enrolling critically ill patients. Despite large differences in shock severity, ERV benefit is similar across all ages and not significantly different for the elderly.
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Affiliation(s)
- Raban V Jeger
- Cardiovascular Clinical Research Center, New York University School of Medicine, New York, NY, USA.
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Ennezat PV, Lefetz Y, Maréchaux S, Six-Carpentier M, Deklunder G, Montaigne D, Bauchart JJ, Mounier-Véhier C, Jude B, Nevière R, Bauters C, Asseman P, de Groote P, Lejemtel TH. Left ventricular abnormal response during dynamic exercise in patients with heart failure and preserved left ventricular ejection fraction at rest. J Card Fail 2008; 14:475-80. [PMID: 18672195 DOI: 10.1016/j.cardfail.2008.02.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2007] [Revised: 02/01/2008] [Accepted: 02/25/2008] [Indexed: 11/15/2022]
Abstract
BACKGROUND The mechanisms that contribute to limit functional capacity are incompletely understood in patients with preserved resting ejection fraction (HFpREF). We assessed left ventricular (LV) systolic response to dynamic exercise in patients with HFpREF and in patients with similar comorbidities to HFpREF patients but without history or evidence of heart failure. METHODS AND RESULTS Twenty-five HFpREF patients in steady-state clinical condition without significant coronary artery disease and 25 hypertensive controls underwent exercise echocardiography. At rest, systolic pulmonary artery pressure, left atrial area, E/A and E/e' ratios were greater in patients with HFpREF than in control patients, whereas peak systolic mitral annular velocity was lower in HFpREF patients. The exercise-induced changes in LVEF, forward stroke volume, and cardiac output were significantly lower in HFpREF compared with control patients (-4 +/- 8 vs. +6 +/- 6 %, P = .001; -4 +/- 9 vs. +10 +/- 10 mL, P < .0001, and 1.6 +/- 1.2 vs. 3.5 +/- 1.8 L/min, P < .0001, respectively). Exercise-induced changes in effective arterial elastance significantly differed in HFpREF and control patients (0.5 +/- 0.6 vs. -0.2 +/- 0.5 mm Hg/mL, P < .0001). In addition, 7 of the 25 HFpREF patients developed functional mitral regurgitation during exercise and none in controls. CONCLUSIONS When compared with patients with similar comorbidities but without history or evidence of heart failure, patients with HFpREF experience greater arterial stiffening and thereby a deterioration of global LV systolic performance during dynamic exercise.
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Affiliation(s)
- Pierre V Ennezat
- Division of Cardiology, Centre Hospitalier Régional et Universitaire de Lille, and EA 2693, Université de Lille II, Faculté de Médecine, Lille, France
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Abstract
BACKGROUND Vascular nitric oxide (NO)-mediated vasodilation is reduced in the limb vasculature of patients with chronic heart failure. Depressed gene expression of vascular endothelial NO synthase has been reported in experimental models of heart failure. We sought to investigate endothelial NO synthase (eNOS) mRNA expression in the skeletal muscle vasculature of patients with chronic heart failure (CHF) and in controls. METHODS AND RESULTS Transcript levels for eNOS were measured and normalized to von Willebrand factor gene expression level, in samples of skeletal muscle from patients with CHF (n = 20) and healthy subjects (n = 7). CHF was not associated with a decrease in eNOS expression. There was a trend towards an increased expression in NYHA class IV patients. Similar results were found when normalized to GAPDH mRNA levels. CONCLUSION Vascular endothelial dysfunction that is observed in patients with severe heart failure does not appear to be related to a specific decrease in the expression of the gene encoding for endothelial NOS.
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Affiliation(s)
- Pierre V Ennezat
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, New York, USA.
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Ennezat PV, Marechaux S, Asseman P, Lejemtel TH, Van Belle E, Bauters C, De Groote P. Functional mitral regurgitation and chronic heart failure. Minerva Cardioangiol 2006; 54:725-33. [PMID: 17167384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Functional mitral regurgitation (MR) frequently develops during the progression of chronic heart failure and predicts poor outcome. Impaired left ventricular (LV) function, LV remodeling associated with papillary muscle apical displacement and annular enlargement result in decreased mitral closing forces and tenting of the mitral valve at closure. Reduced closing forces and tenting both promote MR. Active myocardial ischemia, myocardial asynchronism and excessive loading conditions worsen MR at rest and during exercise. The therapeutic target in functional MR is the left ventricle and not the valve.
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Sleeper LA, Ramanathan K, Picard MH, Lejemtel TH, White HD, Dzavik V, Tormey D, Avis NE, Hochman JS. Functional Status and Quality of Life After Emergency Revascularization for Cardiogenic Shock Complicating Acute Myocardial Infarction. J Am Coll Cardiol 2005; 46:266-73. [PMID: 16022953 DOI: 10.1016/j.jacc.2005.01.061] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2004] [Revised: 01/07/2005] [Accepted: 01/11/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Our goal was to describe the functional status of cardiogenic shock survivors, identify the correlates of cardiogenic shock, and compare global quality of life and functional status of patients randomly assigned to treatment with emergency revascularization (ERV) versus initial medical stabilization (IMS). BACKGROUND Historically, the hospital survival rate of patients with cardiogenic shock complicating acute myocardial infarction (MI) has been very low. Shock survivors are salvaged from a critically ill state, and their later functional status is not well documented. The SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK (SHOCK) trial showed significantly improved one-year survival after ERV compared with IMS. METHODS The SHOCK trial survivors completed interviews at 2 weeks after discharge and at 6 and 12 months after MI. Functional status assessment included the Multidimensional Index of Life Quality and New York Heart Association (NYHA) congestive heart failure functional class. RESULTS Eighty-seven percent of one-year survivors of the SHOCK trial were in NYHA functional class I or II. Between two weeks after discharge and one year after MI, improvement was similar in the two treatment groups (18% overall), but fewer patients remained stable (44% vs. 71%), and more patients worsened or died (34% vs. 15%) in the IMS group compared with those assigned to ERV. Assignment to ERV was the only independent predictor of outcome at one year. CONCLUSIONS Although one-year mortality after ERV is still high (54%), most survivors have good functional status. The ERV patients have a lower rate of deterioration than IMS patients. The level of recovery for shock patients undergoing ERV is similar to that of historical controls not in cardiogenic shock undergoing elective revascularization.
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Affiliation(s)
- Lynn A Sleeper
- New England Research Institutes, Watertown, Massachusetts 02472, USA.
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Abstract
We report the case of a 51-year-old woman who underwent mitral valve replacement for prolapse with severe regurgitation, depressed ejection fraction, and atrial fibrillation. Two weeks post-operatively, a transesophageal echocardiogram was performed for bacteremia. The patient was found incidentally to have a large free-floating ball thrombus in the left atrium. The patient was managed with anticoagulation because of the high-risk nature of repeat surgery. One month following diagnosis, the patient still had persistent thrombus in the left atrium seen on transthoracic echocardiography despite therapeutic anticoagulation. Free-floating ball thrombus is a rare and dramatic finding seen on echocardiography in patients with mitral valve disease.
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Affiliation(s)
- Timothy Chen
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA
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Bourge RC, Abraham WT, Wagoner LE, Horton DP, Lejemtel TH. Nesiritide improves hemodynamics in patients with acutely decompensated heart failure: Hemodynamic subgroup analysis. J Card Fail 1998. [DOI: 10.1016/s1071-9164(98)90132-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Testa M, Biasucci LM, Cacciola M, Lombardo A, Pennestrí F, Lejemtel TH, Loperfido F. Variable response of the peripheral circulation to acetylcholine in patients with coronary artery disease. Am J Cardiol 1996; 77:149-53. [PMID: 8546082 DOI: 10.1016/s0002-9149(96)90586-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The purpose of this study was to assess endothelium-mediated vasodilation in the peripheral circulation of patients with coronary artery disease who are free from hypertension, hypercholesterolemia, diabetes mellitus, and congestive heart failure. The vascular response of the superficial femoral artery to an endothelium-dependent (i.e., acetylcholine 10-7, 10-6, and 10-5 mol/L) and to an endothelium-independent (i.e., nitroglycerin 10-8 and 10-6 mol/L) dilator was compared in 13 patients with angiographically documented coronary artery disease and in 7 patients with normal coronary angiograms. Vascular response was assessed by Doppler ultrasonography. Whereas the vascular responses to nitroglycerin in patients with abnormal and normal findings on coronary angiograms were similar, the responses to acetylcholine were clearly different. The ratio of mean blood flow velocity (+/-SD) measured during administration of acetylcholine 10-6 mol/L and mannitol was significantly lower in patients with abnormal versus normal results of coronary angiography (1.15 +/- 0.35 vs 2.20 +/- 1.06; p < 0.05). The vascular response to acetylcholine 10-5 mol/L in patients with an abnormal finding on their coronary angiogram was highly variable when compared with that in patients with normal results. Thus, in patients with angiographically proven coronary artery disease, the response of the peripheral circulation to acetylcholine is characterized by a great variability and a reduced sensitivity, when compared with that in patients with normal findings on coronary angiography.
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Affiliation(s)
- M Testa
- Institute of Cardiology, Catholic University, Rome, Italy
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Testa M, Sonnenblick EH, Lejemtel TH. Practical issues for the use of ACE inhibitors in acute myocardial infarction. J Cardiovasc Risk 1995; 2:429-33. [PMID: 8749270 DOI: 10.1177/174182679500200507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Numerous large, double-blind, randomized trials have demonstrated that, overall, angiotensin converting enzyme (ACE) inhibition improves survival of patients after acute myocardial infarction (AMI). However, several practical issues concerning ACE inhibition in the presence of AMI have not yet been answered. These include whether ACE inhibition should be initiated in all patients with AMI, how soon ACE inhibition should be attempted in relation to onset of pain and possibly thrombolysis, and, lastly, how long ACE inhibition should be maintained after the acute event. Each of these issues is addressed, and recommendations are made on the basis of the results from recent randomized trials in AMI and congestive heart failure.
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Affiliation(s)
- M Testa
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Keren G, Laniado S, Sonnenblick EH, Lejemtel TH. Dynamics of functional mitral regurgitation during dobutamine therapy in patients with severe congestive heart failure: a Doppler echocardiographic study. Am Heart J 1989; 118:748-54. [PMID: 2801481 DOI: 10.1016/0002-8703(89)90588-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Functional mitral regurgitation plays a major role in determining the therapeutic response to vasodilators in patients with severe congestive heart failure. Its role in the response to inotropic therapy has not been studied in these patients. Ten patients with stage 3 or 4 congestive heart failure (New York Heart Association class) and secondary mitral regurgitation were studied before and during intravenous administration of dobutamine (mean dose, 7.4 microgram/kg/min). Hemodynamic measurements were obtained invasively. Echo and Doppler cardiography were used to determine cardiac volumes. Mitral regurgitation was calculated as the difference between total stroke volume by echo and forward stroke volume by Doppler. Mitral regurgitation area was calculated from a modified hemodynamic formula. Dobutamine caused a marked rise in mean forward stroke volume (43 to 61 ml), with a decrease in mitral regurgitation volume from 20 to 10 ml/beat and a drop in pulmonary capillary wedge pressure from 21 to 13 mm Hg. Since the pressure gradient between the left ventricle and atrium increased significantly during dobutamine therapy, only a marked decrease in the orifice of regurgitation could explain the changes in regurgitant volume. Indeed, the end-diastolic volume decreased from 254 to 234 ml and the orifice of mitral regurgitation was reduced from 0.25 to 0.12 cm2.
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Affiliation(s)
- G Keren
- Department of Cardiology, Tel Aviv Medical Center and University
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Abstract
In 11 dogs ischemic left ventricular failure characterized by a 30 percent reduction in cardiac output and a left ventricular end-diastolic pressure of 18 mm Hg or more was produced by proximal occlusion of the left anterior descending coronary artery followed by serial occlusions of the distal left circumflex coronary artery. Administration of amrinone in an intravenous bolus injection followed by a constant infusion produced improvements in cardiac output (from 1.62 +/- 0.50 to 2.19 +/- 0.52 liters/min [mean +/- standard deviation], p less than 0.05), left ventricular end-diastolic pressure (from 21.6 +/- 3.5 to 11.0 +/- 5.4 mm Hg, p less than 0.05) and peak positive rate of rise of left ventricular pressure [dP/dt] (from 1,264 +/- 241 to 1,800 +/- 458 mm Hg.s-1, p less than 0.05). These improvements were maintained throughout the 20 minute period of therapy. No significant alteration in heart rate or arterial pressure was noted. In parallel with the hemodynamic improvement myocardial oxygen consumption improved to 0.094 +/- 0.05 and 0.092 +/- 0.04 vol.min-1.g-1 after 2 and 20 minutes, respectively, of amrinone compared with 0.124 +/- 0.05 during left ventricular failure (both p less than 0.05). The effects of amrinone on left ventricular failure are due to augmented contractility and mild systemic vasodilatation. The reduction in myocardial oxygen consumption during amrinone-treated left ventricular failure presumably results from a reduction in ventricular wall tension that more than offsets the effect of an increase in contractility.
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Elkayam U, Lejemtel TH, Mathur M, Ribner HS, Frishman WH, Strom J, Sonnenblick EH. Marked early attenuation of hemodynamic effects of oral prazosin therapy in chronic congestive heart failure. Am J Cardiol 1979; 44:540-5. [PMID: 474434 DOI: 10.1016/0002-9149(79)90409-0] [Citation(s) in RCA: 89] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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