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Villanueva-Castro E, Meraz-Soto JM, Hernández-Dehesa IA, Tena-Suck ML, Hernández-Reséndiz R, Mateo-Nouel EDJ, Ponce-Gómez JA, Arriada-Mendicoa JN. Spinal Ependymomas: An Updated WHO Classification and a Narrative Review. Cureus 2023; 15:e49086. [PMID: 38125233 PMCID: PMC10731541 DOI: 10.7759/cureus.49086] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Ependymomas are neuroepithelial tumors that develop from ependymal cells found in the brain parenchyma and can spread to any part of the spinal cord. Three to six percent of all malignancies affecting the central nervous system (CNS) are ependymomas. Even the most talented surgeons are challenged by spinal cord ependymomas; as a result, research into this clinical phenomenon should continue. Since 1979, the World Health Organization (WHO) has published a classification and grading system for CNS malignancies to ensure consistent diagnostic standards worldwide. The WHO prepared an update on these tumors, paying particular attention to molecular techniques to categorize the therapeutic management of each patient with greater accuracy and clarity. We thoroughly reviewed the literature on the epidemiology, etiology, diagnosis, and treatment of spinal ependymomas since there has not been a recent review of these tumors. This included modifications to the 2021 WHO Classification of Tumors of the Central Nervous System.
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Affiliation(s)
- Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Juan Marcos Meraz-Soto
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Martha Lilia Tena-Suck
- Department of Neuropathology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Edgardo de Jesus Mateo-Nouel
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Juan Antonio Ponce-Gómez
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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Costa MDSD, Torres Soares C, Dastoli PA, Mendonça Nicácio J, de Seixas Alves MT, Chen MJ, Cappellano AM, Saba da Silva N, Cavalheiro S. Survival analysis and prognostic factors in posterior fossa ependymomas in children and adolescents. J Neurosurg Pediatr 2023; 32:404-412. [PMID: 37410603 DOI: 10.3171/2023.5.peds22350] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 05/19/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE In this study, the authors aimed to analyze the overall survival (OS) and progression-free survival (PFS) of patients younger than 18 years of age who were diagnosed with posterior fossa ependymomas, and to identify prognostic factors such as the degree of resection, tumor topography, and involvement of the lesion in the hindbrain. METHODS The authors performed a retrospective cohort study of patients younger than 18 years of age, treated beginning in 2000, with a diagnosis of posterior fossa ependymoma. Ependymomas were separated into three groups: tumors restricted to the fourth ventricle, tumors inside the fourth ventricle and exiting from the foramen of Luschka, and tumors inside the fourth ventricle and completely surrounding the hindbrain. Furthermore, the tumors were classified by molecular group using the staining method for H3K27me3. Statistical analysis was performed using Kaplan-Meier survival curves, with p < 0.05 considered statistically significant. RESULTS Of 1693 patients who underwent surgical treatment between January 2000 and May 2021, 55 patients who met the inclusion criteria were included. The median age at diagnosis was 2.98 years. The median OS was 44 months, and the survival rates at 1, 5, and 10 years were 92.5%, 49.1%, and 38.3%, respectively. The cases were assigned to two posterior fossa ependymoma molecular groups: 35 (63.6%) cases to group A and 8 (14.5%) to group B. The median ages in groups A and B were 2.94 and 2.85 years and the median OS values were 44 and 38 months, respectively (p = 0.9245). Statistical analysis was performed on multiple variables, including age, sex, histological grade, Ki-67 expression, tumor volume, extent of resection, and adjuvant therapies. The median PFS of patients with dorsal-only involvement was 28 months; for dorsolateral involvement, it was 15 months; and for total involvement, it was 9.5 months (p = 0.0464). No statistically significant difference was found for OS. There was a statistically significant difference between the proportion of patients in whom gross-total resection was achieved in the dorsal-only involvement group (73.1%, 19/26) and those in the total involvement group (0%, 0/6) (p = 0.0019). CONCLUSIONS This study confirmed that the extent of resection has an impact on OS and PFS. The authors found that adjuvant radiotherapy resulted in a higher OS but did not prevent progression, that the pattern of involvement of the brainstem in the tumor at diagnosis could elicit important information regarding the patient's prognosis regarding PFS, and that the total involvement of the rhombencephalon impaired the gross-total resection of these tumors.
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Affiliation(s)
| | | | | | | | | | - Michael Jenwei Chen
- 3Division of Radiotherapy, Institute of Pediatric Oncology (IOP/GRAACC), São Paulo; and
| | - Andrea Maria Cappellano
- 4Division of Neuro-Oncology, Institute of Pediatric Oncology (IOP/GRAACC), São Paulo, Brazil
| | - Nasjla Saba da Silva
- 4Division of Neuro-Oncology, Institute of Pediatric Oncology (IOP/GRAACC), São Paulo, Brazil
| | - Sergio Cavalheiro
- Departments of1Neurosurgery and
- 2Pathology, Federal University of São Paulo
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Abi A, Ghaedi K, Khosravi A, Hayat SMG. Circular RNAs and Glioma: Small Molecule with Big Actions. Curr Mol Med 2021; 21:25-44. [PMID: 32520689 DOI: 10.2174/1566524020666200610171139] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 11/22/2022]
Abstract
Glioma is known as one of very important tumors that is associated with high rate of mortality worldwide. The mean rate of survival of these patients has not changed (approximately 14 months) even with improvements in comprehensive therapeutic approaches, such as chemotherapy, radiation, and surgery. Therefore, it seems that new therapeutic or developed platforms are needed. In this regard, more understanding about genetic and epigenetic modifications in the glioma, could contribute to finding and developing these platforms. Among epigenetic mechanisms, circular RNAs have crucial roles in the glioma pathogenesis. Reported by several studies, some of the abilities of circRNAs include the exhibition of tissue specificity in humans and regulation of genes. Research has also confirmed the participation of circRNAs in different pathological or biological procedures, including migration, invasion, and apoptosis of glioma. Herein, we summarized circular RNAs involved in glioma.
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Affiliation(s)
- Abbas Abi
- Department of Biotechnology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kamran Ghaedi
- Department of Biology, Faculty of Science, University of Isfahan, Isfahan 81746-73441, Iran
| | - Alireza Khosravi
- Clinical Immunology Research Center, Department of Neurology, school of medicine, Zahedan University of medical science, Zahedan, Iran
| | - Seyed Mohammad Gheibi Hayat
- Department of Medical Genetics, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Abstract
BACKGROUND Paediatric brain tumour resection rates have been shown to correlate with outcome and, it is argued, are linked to operator volume and caseload. The British paediatric neurosurgery community has previously debated centralisation of paediatric neuro-oncology. At the 2018 British Paediatric Neurosurgery Group (BPNG) meeting, a commitment was made to prospectively collect tumour resection data at each Neurosurgical Unit (NSU). Here we review our prospectively-collected 10-year database of the three commonest paediatric posterior fossa tumours - astrocytomas, medulloblastomas and ependymomas. MATERIALS AND METHODS Our primary outcome was extent of resection (EOR) on post-operative MRI scans reviewed by neuro-radiologists. Secondary outcomes comprised neurosurgical morbidity including infection, need for cerebrospinal fluid (CSF) diversion and the occurrence of posterior fossa syndrome (PFS). RESULTS 55 children had 62 operations, where our complete resection rates for pilocytic astrocytomas, medulloblastomas and ependymomas were 77%, 79% and 63%, respectively. Both our primary and secondary outcomes were in keeping with the published literature and we discuss here some of the factors which may contribute towards favourable outcomes in a small volume centre. CONCLUSION Our results suggest that small volume centres can expect equivalent results to larger volume NSUs with regards to paediatric brain tumour surgery. Continuing efforts nationally for data collection on resection rates and operative outcomes is a key step towards optimising management in these children.
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Affiliation(s)
- Harsh Bhatt
- Department of Paediatric Neurosurgery, University Hospital of Wales, Cardiff, UK
| | | | - Chirag Patel
- Department of Paediatric Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Paul Leach
- Department of Paediatric Neurosurgery, University Hospital of Wales, Cardiff, UK
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Xianwang L, Lei H, Hong L, Juan D, Shenglin L, Caiqiang X, Yan H, Junlin Z. Apparent Diffusion Coefficient to Evaluate Adult Intracranial Ependymomas: Relationship to Ki-67 Proliferation Index. J Neuroimaging 2020; 31:132-136. [PMID: 32961009 DOI: 10.1111/jon.12789] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE There are important differences in the treatment and prognosis of adult intracranial low-grade ependymomas (grade II) versus anaplastic ependymomas (grade III). We evaluated the value of the apparent diffusion coefficient (ADC) for differentiating these two tumors and further investigated the relationship between ADC values and the Ki-67 proliferation index. METHODS Clinical and preoperative magnetic resonance imaging data of 35 cases of adult intracranial ependymomas were retrospectively analyzed, including 20 low-grade ependymomas and 15 anaplastic ependymomas. The minimum ADC (ADCmin), average ADC (ADCmean), and normalized ADC (nADC) were compared between the two groups. Receiver operating characteristic curves were drawn to evaluate the differentiating accuracy of ADC values. The Ki-67 proliferation index of the solid tumor components was also measured to explore its relationship with ADC values. RESULTS The ADCmin (.89 ± .17 vs. .66 ± .09 × 10-3 mm2 /second), ADCmean (.98 ± .21 vs. .72 ± .11 × 10-3 mm2 /second), and nADC (1.38 ± .31 vs. 1.02 ± .18 × 10-3 mm2 /second) were significantly higher in adult intracranial low-grade ependymomas than anaplastic ependymomas cases (all P < .05). ADCmean best distinguished the two groups, with an area under the curve value of .900. Using .716 × 10-3 mm2 /second as the optimal threshold, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the two groups were 66.7%, 100%, 85.7%, 100%, and 80%, respectively. ADCmin (r = -.490), ADCmean (r = -.449), and nADC (r = -.425) showed significant negative correlations with the Ki-67 proliferation index (all P < .05). CONCLUSIONS ADC values can differentiate adult intracranial low-grade ependymomas and anaplastic ependymomas, which could improve the preoperative diagnostic accuracy of these two tumors and guide their treatment.
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Affiliation(s)
- Liu Xianwang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging, Lanzhou, China
| | - Han Lei
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging, Lanzhou, China
| | - Liu Hong
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging, Lanzhou, China
| | - Deng Juan
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging, Lanzhou, China
| | - Li Shenglin
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging, Lanzhou, China
| | - Xue Caiqiang
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging, Lanzhou, China
| | - Hao Yan
- Department of Pathology, Lanzhou University Second Hospital, Lanzhou, China
| | - Zhou Junlin
- Department of Radiology, Lanzhou University Second Hospital, Lanzhou, China.,Second Clinical School, Lanzhou University, Lanzhou, China.,Key Laboratory of Medical Imaging, Lanzhou, China
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Ahmed SI, Javed G, Laghari AA, Bareeqa SB, Aziz K, Khan M, Samar SS, Humera RA, Khan AR, Farooqui MO, Shahbaz A. Third Ventricular Tumors: A Comprehensive Literature Review. Cureus 2018; 10:e3417. [PMID: 30542631 PMCID: PMC6284874 DOI: 10.7759/cureus.3417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Third ventricle tumors are uncommon and account for 0.6 - 0.9% of all the brain tumors. Tumors of the third ventricle are classified into primary tumors, such as colloid cysts, choroid plexus papillomas, and ependymomas, or secondary tumors, such as craniopharyngiomas, optic nerve gliomas, pineal tumors, and meningiomas. Third ventricular tumors are uncommon, and their treatment involves significant morbidity and mortality. The colloid cyst has a better surgical outcome and many approaches are available to achieve a complete cure. Choroid plexus papilloma is also a common tumor documented with its treatment majorly based on surgical resection. In addition to multiple treatment options for craniopharyngiomas, surgery is the most preferred treatment option. Ependymomas also have few treatment options, with surgical resection adopted as the first line of treatment.
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Affiliation(s)
- Syed Ijlal Ahmed
- Neurosurgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Gohar Javed
- Neurosurgery, The Aga Khan University, Karachi, PAK
| | | | | | - Kashif Aziz
- Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, New York, USA
| | - Mehreen Khan
- Internal Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Syeda Sana Samar
- Internal Medicine, Jinnah Sindh Medical University, Karachi , PAK
| | | | - Alizay Rashid Khan
- Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, PAK
| | | | - Amir Shahbaz
- Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, New York, USA
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Abstract
Gliomas are the most common primary brain tumor, the diagnosis of which is challenging. In this respect, the use of immunohistochemical proliferation markers may aid diagnosis; survivin, also known as Baculoviral IAP Repeat Containing 5, is one such marker. Survivin is a unique member of the inhibitors of apoptosis protein gene family, and is known for its dual function as an apoptosis inhibitor and mitosis regulator. Furthermore, survivin has been demonstrated to be overexpressed in a number of malignancies. The purpose of the present literature review was to gain an overview of studies published on the diagnostic and/or prognostic use of survivin in gliomas. Using PubMed, 19 studies matching the inclusion criteria were ultimately included in the present review. The majority of the studies identified revealed that survivin was significantly associated with other proliferation markers, histological malignancy grade, and inversely associated with prognosis. However, there were a number of inconsistencies between studies, which suggests a requirement for standardization of immunohistochemical procedures.
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Affiliation(s)
- Rosilin Kotakkathu Varughese
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway
| | - Sverre Helge Torp
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), 7030 Trondheim, Norway
- Department of Pathology and Medical Genetics, St. Olavs Hospital, 7006 Trondheim, Norway
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Abstract
Intramedullary tumors of the spinal cord account for 35-40% of intraspinal tumors in children. The biological behavior of these tumors is of slow progression, and hence aggressive surgery has been advocated. Surgical adjuncts include use of intraoperative neurophysiological monitoring, preoperative ultrasound, microsurgical techniques and ultrasonic suction devices. Osteoplastic laminoplasty approaches avoid post-laminectomy deformities in younger children. Postoperative radiotherapy and more recently chemotherapy regimes have been proposed for incompletely resected tumors.
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Affiliation(s)
- Sandip Chatterjee
- Department of Neurosurgery and Pathology, Park Clinic, Kolkata, India
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Forbes JA, Reig AS, Smith JG, Jermakowicz W, Tomycz L, Shay SD, Sun DA, Wushensky CA, Pearson MM. Findings on preoperative brain MRI predict histopathology in children with cerebellar neoplasms. Pediatr Neurosurg 2011; 47:51-9. [PMID: 21921669 PMCID: PMC3219443 DOI: 10.1159/000329627] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 05/23/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS The majority of pediatric patients with cerebellar neoplasms harbor pilocytic astrocytomas (PAs), medulloblastomas, or ependymomas. Knowledge of a preoperative likelihood of histopathology in this group of patients has the potential to influence many aspects of care. Previous studies have demonstrated hyperintensity on diffusion-weighted imaging to correlate with medulloblastomas. Recently, measurement of T(2)-weighted signal intensity (T2SI) was shown to be useful in identification of low-grade cerebellar neoplasms. The goal of this study was to assess whether objective findings on these MRI sequences reliably correlated with the underlying histopathology. METHODS We reviewed the radiologic findings of 50 pediatric patients who underwent resection of a cerebellar neoplasm since 2003 at our institution. Region of interest placement was used to calculate the relative diffusion-weighted signal intensity (rDWSI) and relative T2SI (rT2SI) of each neoplasm. RESULTS Tukey's multiple comparison test demonstrated medulloblastomas to have significantly higher rDWSIs than PAs/ependymomas, and PAs to have significantly higher rT2SIs than medulloblastomas/ependymomas. A simple method consisting of sequential measurement of rDWSI and rT2SI to predict histopathology was then constructed. Using this method, 39 of 50 (78%) tumors were accurately predicted. CONCLUSION Measurement of rDWSI and rT2SI using standard MRI of the brain can be used to predict histopathology with favorable accuracy in pediatric patients with cerebellar tumors.
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Affiliation(s)
- Jonathan A Forbes
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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Arnautovic K, Arnautovic A. Extramedullary intradural spinal tumors: a review of modern diagnostic and treatment options and a report of a series. Bosn J Basic Med Sci 2009; 9 Suppl 1:S40-S45. [PMID: 19912118 PMCID: PMC5655171 DOI: 10.17305/bjbms.2009.2755] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Extramedullary intradural spinal tumors are rare. Less than 15% of all central nervous system (CNS) tumors are spinal. Ninety percent of these patients are older than 20 years. Most of spinal tumors are extradural (50-55%) whereas 40-45% are intradural. Furthermore, 5% are intramedullary and 40% are extramedullary. Most common are Schwannomas (29%), followed by meningiomas (25%) and gliomas (22%). These tumors produce pain syndromes, a variety of neurological symptoms- motor, sensory, sphincter or a combination of thereof. All spinal levels may be involved. The diagnostics includes magnetic resonance imaging (MRI) including contrast enhancement, computerizing tomography (CT) scanning (bone windows with reconstruction) and possibly CT myelograms. Preferred treatment is the microsurgical radical resection. Perioperative mortality is very low as is serious morbidity.We herein discuss various aspects of presenting symptomatology, diagnostics, preoperative planning and tactics, surgical treatment and complications. In addition, we include our own retrospective experience with 14 patients treated over the 5.5 years time interval.
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Affiliation(s)
- Kenan Arnautovic
- Semmes-Murphey Clinic and Department of Neurosurgery, University of Tennesse, Memphis, TN, USA, Corresponding author
| | - Aska Arnautovic
- Semmes-Murphey Clinic and Department of Neurosurgery, University of Tennesse, Memphis, TN, USA
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