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2.
Ann Clin Lab Sci ; 50(3): 299-307, 2020 May.
Article in English | MEDLINE | ID: covidwho-614688

ABSTRACT

OBJECTIVE: An outbreak of pneumonia named COVID-19 caused by a novel coronavirus in Wuhan is rapidly spreading worldwide. The objective of the present study was to clarify further the clinical characteristics and blood parameters in COVID-19 patients. MATERIALS AND METHODS: Twenty-three suspected patients and 64 patients with laboratory-confirmed SARS-Cov-2 infection were admitted to a designated hospital. Epidemiological, clinical, laboratory, and treatment data were collected and analyzed. RESULTS: Of the 64 patients studied, 47 (73.4%) had been exposed to a confirmed source of COVID-19 transmission. On admission, the most common symptoms were fever (75%) and cough (76.6%). Twenty-eight (43.8%) COVID-19 patients showed leukopenia, 10 (15.6%) showed lymphopenia, 47 (73.4%) and 41 (64.1%) had elevated high-sensitivity C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR), respectively, and 30 (46.9%) had increased fibrinogen concentration. After the treatment, the counts of white blood cells and platelets, and the level of prealbumin increased significantly, while aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and hsCRP decreased. COVID-19 patients with the hospital stay longer than 12 days had higher body mass index (BMI) and increased levels of AST, LDH, fibrinogen, hsCRP, and ESR. CONCLUSIONS: Results of blood tests have potential clinical value in COVID-19 patients.


Subject(s)
Betacoronavirus/isolation & purification , Biomarkers/blood , Coronavirus Infections/complications , Cough/diagnosis , Fever/diagnosis , Leukopenia/diagnosis , Lymphopenia/diagnosis , Pneumonia, Viral/complications , Adult , Coronavirus Infections/virology , Cough/blood , Cough/etiology , Female , Fever/blood , Fever/etiology , Humans , Leukopenia/blood , Leukopenia/etiology , Lymphopenia/blood , Lymphopenia/etiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/virology , Prognosis
3.
J Investig Med High Impact Case Rep ; 8: 2324709620931239, 2020.
Article in English | MEDLINE | ID: covidwho-564936

ABSTRACT

On December 31, 2019, the World Health Organization was informed of a cluster of cases of pneumonia of unknown cause detected in Wuhan City, Hubei Province, China. The pneumonia was caused by a virus called SARS-Cov-2 (severe acute respiratory syndrome coronavirus 2), which was later named coronavirus infectious disease 2019 (COVID-19). The symptoms most commonly reported by patients affected by COVID-19 include fever, dry cough, and shortness of breath. In this report, we present a case of a 57-year-old woman who presented to the clinic's infectious department with swelling, pain, warmth, and redness in the left leg who was treated with therapeutic heparin. There were no typical and distinguished symptoms of COVID-19, and she had no risk factor for deep vein thrombosis. Then chest X-ray revealed bilateral patchy ground-glass opacity, and computed tomography angiography was performed to rule out pulmonary thromboembolism, which showed no evidence of thrombosis. Left lower limb venous color Doppler ultrasound revealed dilatation and thrombosis in the external iliac and left iliac veins up to the level of the bifurcation of the common iliac veins, as well as thrombosis to the superficial and small saphenous veins. Because of ground-glass opacity and lymphopenia, nasal swabs were used for sampling, and SARS-CoV-2 nucleic acid was detected by reverse transcription polymerase chain reaction (RT-PCR). This case aims to arouse the medical staff's awareness of deep vein thrombosis as a clinical symptom of COVID-19 even if the patient has no typical symptoms of COVID-19.


Subject(s)
Coronavirus Infections/complications , Lymphopenia/etiology , Pneumonia, Viral/complications , Venous Thrombosis/etiology , Anticoagulants/therapeutic use , Antimalarials/therapeutic use , Antiviral Agents/therapeutic use , Betacoronavirus , Chloroquine/therapeutic use , Clinical Laboratory Techniques , Computed Tomography Angiography , Coronavirus Infections/diagnosis , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/drug therapy , Drug Combinations , Female , Heparin/therapeutic use , Humans , Iliac Vein/diagnostic imaging , Lopinavir/therapeutic use , Lung/diagnostic imaging , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/drug therapy , Pulmonary Embolism/diagnosis , Radiography, Thoracic , Reverse Transcriptase Polymerase Chain Reaction , Ritonavir/therapeutic use , Saphenous Vein/diagnostic imaging , Tomography, X-Ray Computed , Ultrasonography, Doppler, Color , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapy
4.
J Investig Med High Impact Case Rep ; 8: 2324709620933438, 2020.
Article in English | MEDLINE | ID: covidwho-535847

ABSTRACT

In this article, we present a case of a young female patient with previously diagnosed lupus pneumonitis, now with a flare and new superimposed COVID-19 infection that was treated with intravenous steroids. On computed tomography scans, she had extensive interstitial lung fibrosis in addition to a positive COVID-19 polymerase chain reaction test requiring 6 L of oxygen via nasal cannula on admission. After administration of methylprednisolone, the patient improved and was weaned off her oxygen requirements and was discharged home.


Subject(s)
Coronavirus Infections/complications , Lupus Erythematosus, Systemic/complications , Pneumonia, Viral/complications , Pneumonia/complications , Antibodies, Antinuclear/immunology , Antirheumatic Agents/therapeutic use , Betacoronavirus , Cardiac Tamponade , Complement C3/immunology , Complement C4/immunology , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/drug therapy , Coronavirus Infections/therapy , DNA , Disease Progression , Enzyme Inhibitors/therapeutic use , Female , Fibrin Fibrinogen Degradation Products , Glucocorticoids/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Lung/diagnostic imaging , Lupus Erythematosus, Systemic/diagnostic imaging , Lupus Erythematosus, Systemic/drug therapy , Lupus Erythematosus, Systemic/immunology , Lupus Nephritis , Lymphopenia/etiology , Methylprednisolone/therapeutic use , Mycophenolic Acid/therapeutic use , Oxygen Inhalation Therapy , Pandemics , Pneumonia/diagnostic imaging , Pneumonia/immunology , Pneumonia/therapy , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/therapy , Tomography, X-Ray Computed , Young Adult
5.
FASEB J ; 34(6): 7247-7252, 2020 06.
Article in English | MEDLINE | ID: covidwho-306321

ABSTRACT

The medical, public health, and scientific communities are grappling with monumental imperatives to contain COVID-19, develop effective vaccines, identify efficacious treatments for the infection and its complications, and find biomarkers that detect patients at risk of severe disease. The focus of this communication is on a potential biomarker, short telomere length (TL), that might serve to identify patients more likely to die from the SARS-CoV-2 infection, regardless of age. The common thread linking these patients is lymphopenia, which largely reflects a decline in the numbers of CD4/CD8 T cells but not B cells. These findings are consistent with data that lymphocyte TL dynamics impose a limit on T-cell proliferation. They suggest that T-cell lymphopoiesis might stall in individuals with short TL who are infected with SARS-CoV-2.


Subject(s)
Betacoronavirus , Coronavirus Infections/pathology , Lymphopenia/etiology , Models, Biological , Pneumonia, Viral/pathology , T-Lymphocyte Subsets/ultrastructure , Telomere Shortening , Telomere/ultrastructure , Biomarkers , Bone Marrow/pathology , Cell Division , Coronavirus Infections/genetics , Coronavirus Infections/immunology , Coronavirus Infections/mortality , Disease Progression , Hematopoietic Stem Cells/pathology , Humans , Lymphocyte Activation , Lymphocyte Count , Lymphopenia/pathology , Lymphopoiesis , Pandemics , Pneumonia, Viral/genetics , Pneumonia, Viral/immunology , Pneumonia, Viral/mortality , Prognosis , Risk
6.
EMBO Mol Med ; 12(7): e12421, 2020 07 07.
Article in English | MEDLINE | ID: covidwho-306055

ABSTRACT

Progression to severe disease is a difficult problem in treating coronavirus disease 2019 (COVID-19). The purpose of this study is to explore changes in markers of severe disease in COVID-19 patients. Sixty-nine severe COVID-19 patients were included. Patients with severe disease showed significant lymphocytopenia. Elevated level of lactate dehydrogenase (LDH), C-reactive protein (CRP), ferritin, and D-dimer was found in most severe cases. Baseline interleukin-6 (IL-6) was found to be associated with COVID-19 severity. Indeed, the significant increase of baseline IL-6 was positively correlated with the maximal body temperature during hospitalization and with the increased baseline of CRP, LDH, ferritin, and D-dimer. High baseline IL-6 was also associated with more progressed chest computed tomography (CT) findings. Significant decrease in IL-6 and improved CT assessment was found in patients during recovery, while IL-6 was further increased in exacerbated patients. Collectively, our results suggest that the dynamic change in IL-6 can be used as a marker for disease monitoring in patients with severe COVID-19.


Subject(s)
Coronavirus Infections/pathology , Interleukin-6/analysis , Pneumonia, Viral/pathology , Adult , Aged , Aged, 80 and over , Antiviral Agents/therapeutic use , Betacoronavirus/isolation & purification , Biomarkers/analysis , C-Reactive Protein/analysis , Coronavirus Infections/drug therapy , Coronavirus Infections/virology , Female , Humans , Lymphopenia/etiology , Male , Middle Aged , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/virology , Severity of Illness Index , Tomography, X-Ray Computed
8.
Int J Infect Dis ; 96: 131-135, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-165300

ABSTRACT

OBJECTIVES: Coronavirus Disease 2019 (COVID-19) is a new respiratory and systemic disease which needs quick identification of potential critical patients. This meta-analysis aimed to explore the relationship between lymphocyte count and the severity of COVID-19. METHODS: A comprehensive systematic literature search was carried out to find studies published from December 2019 to 22 March 2020 from five databases. The language of literatures included English and Chinese. Mean difference (MD) of lymphocyte count in COVID-19 patients with or without severe disease and odds ratio (OR) of lymphopenia for severe form of COVID-19 was evaluated with this meta-analysis. RESULTS: Overall 13 case-series with a total of 2282 cases were included in the study. The pooled analysis showed that lymphocyte count was significantly lower in severe COVID-19 patients (MD -0.31×109/L; 95%CI: -0.42 to -0.19×109/L). The presence of lymphopenia was associated with nearly threefold increased risk of severe COVID-19 (Random effects model, OR=2.99, 95% CI: 1.31-6.82). CONCLUSIONS: Lymphopenia is a prominent part of severe COVID-19 and a lymphocyte count of less than 1.5×109/L may be useful in predicting the severity clinical outcomes.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Lymphopenia/etiology , Pneumonia, Viral/complications , Humans , Lymphocyte Count , Pandemics
11.
EBioMedicine ; 55: 102763, 2020 May.
Article in English | MEDLINE | ID: covidwho-72300

ABSTRACT

BACKGROUND: The dynamic changes of lymphocyte subsets and cytokines profiles of patients with novel coronavirus disease (COVID-19) and their correlation with the disease severity remain unclear. METHODS: Peripheral blood samples were longitudinally collected from 40 confirmed COVID-19 patients and examined for lymphocyte subsets by flow cytometry and cytokine profiles by specific immunoassays. FINDINGS: Of the 40 COVID-19 patients enrolled, 13 severe cases showed significant and sustained decreases in lymphocyte counts [0·6 (0·6-0·8)] but increases in neutrophil counts [4·7 (3·6-5·8)] than 27 mild cases [1.1 (0·8-1·4); 2·0 (1·5-2·9)]. Further analysis demonstrated significant decreases in the counts of T cells, especially CD8+ T cells, as well as increases in IL-6, IL-10, IL-2 and IFN-γ levels in the peripheral blood in the severe cases compared to those in the mild cases. T cell counts and cytokine levels in severe COVID-19 patients who survived the disease gradually recovered at later time points to levels that were comparable to those of the mild cases. Moreover, the neutrophil-to-lymphocyte ratio (NLR) (AUC=0·93) and neutrophil-to-CD8+ T cell ratio (N8R) (AUC =0·94) were identified as powerful prognostic factors affecting the prognosis for severe COVID-19. INTERPRETATION: The degree of lymphopenia and a proinflammatory cytokine storm is higher in severe COVID-19 patients than in mild cases, and is associated with the disease severity. N8R and NLR may serve as a useful prognostic factor for early identification of severe COVID-19 cases. FUNDING: The National Natural Science Foundation of China, the National Science and Technology Major Project, the Health Commission of Hubei Province, Huazhong University of Science and Technology, and the Medical Faculty of the University of Duisburg-Essen and Stiftung Universitaetsmedizin, Hospital Essen, Germany.


Subject(s)
Betacoronavirus/immunology , Coronavirus Infections/immunology , Cytokines/blood , Leukocyte Count , Lymphocyte Subsets/immunology , Pneumonia, Viral/immunology , Adult , Aged , CD8-Positive T-Lymphocytes/immunology , China/epidemiology , Comorbidity , Coronavirus Infections/blood , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Cytokine Release Syndrome/etiology , Cytokine Release Syndrome/immunology , Female , Flow Cytometry , Humans , Lymphocyte Count , Lymphopenia/etiology , Male , Middle Aged , Neutrophils/immunology , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Prognosis , Time Factors
12.
Circulation ; 142(1): 68-78, 2020 07 07.
Article in English | MEDLINE | ID: covidwho-66429

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has affected health and economy worldwide on an unprecedented scale. Patients have diverse clinical outcomes, but those with preexisting cardiovascular disease, hypertension, and related conditions incur disproportionately worse outcome. The high infectivity of severe acute respiratory syndrome coronavirus 2 is in part related to new mutations in the receptor binding domain, and acquisition of a furin cleavage site in the S-spike protein. The continued viral shedding in the asymptomatic and presymptomatic individuals enhances its community transmission. The virus uses the angiotensin converting enzyme 2 receptor for internalization, aided by transmembrane protease serine 2 protease. The tissue localization of the receptors correlates with COVID-19 presenting symptoms and organ dysfunction. Virus-induced angiotensin converting enzyme 2 downregulation may attenuate its function, diminish its anti-inflammatory role, and heighten angiotensin II effects in the predisposed patients. Lymphopenia occurs early and is prognostic, potentially associated with reduction of the CD4+ and some CD8+ T cells. This leads to imbalance of the innate/acquired immune response, delayed viral clearance, and hyperstimulated macrophages and neutrophils. Appropriate type I interferon pathway activation is critical for virus attenuation and balanced immune response. Persistent immune activation in predisposed patients, such as elderly adults and those with cardiovascular risk, can lead to hemophagocytosis-like syndrome, with uncontrolled amplification of cytokine production, leading to multiorgan failure and death. In addition to the airways and lungs, the cardiovascular system is often involved in COVID-19 early, reflected in the release of highly sensitive troponin and natriuretic peptides, which are all extremely prognostic, in particular, in those showing continued rise, along with cytokines such as interleukin-6. Inflammation in the vascular system can result in diffuse microangiopathy with thrombosis. Inflammation in the myocardium can result in myocarditis, heart failure, cardiac arrhythmias, acute coronary syndrome, rapid deterioration, and sudden death. Aggressive support based on early prognostic indicators with expectant management can potentially improve recovery. Appropriate treatment for heart failure, arrhythmias, acute coronary syndrome, and thrombosis remain important. Specific evidence-based treatment strategies for COVID-19 will emerge with ongoing global collaboration on multiple approaches being evaluated. To protect the wider population, antibody testing and effective vaccine will be needed to make COVID-19 history.


Subject(s)
Cardiovascular System/metabolism , Coronavirus Infections/pathology , Pneumonia, Viral/pathology , Betacoronavirus/isolation & purification , Betacoronavirus/physiology , Blood Coagulation , CD4-Positive T-Lymphocytes/cytology , CD4-Positive T-Lymphocytes/immunology , CD4-Positive T-Lymphocytes/metabolism , CD8-Positive T-Lymphocytes/cytology , CD8-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/metabolism , Cardiovascular Diseases/complications , Cardiovascular Diseases/mortality , Cardiovascular Diseases/pathology , Coronavirus Infections/immunology , Coronavirus Infections/virology , Female , Humans , Immunity, Innate , Interleukin-6/metabolism , Lymphopenia/etiology , Male , Pandemics , Peptidyl-Dipeptidase A/metabolism , Phenotype , Pneumonia, Viral/immunology , Pneumonia, Viral/virology , Prognosis , Serine Endopeptidases/metabolism , Survival Rate
13.
Am J Hematol ; 95(7): 834-847, 2020 07.
Article in English | MEDLINE | ID: covidwho-46110

ABSTRACT

COVID-19 is a systemic infection with a significant impact on the hematopoietic system and hemostasis. Lymphopenia may be considered as a cardinal laboratory finding, with prognostic potential. Neutrophil/lymphocyte ratio and peak platelet/lymphocyte ratio may also have prognostic value in determining severe cases. During the disease course, longitudinal evaluation of lymphocyte count dynamics and inflammatory indices, including LDH, CRP and IL-6 may help to identify cases with dismal prognosis and prompt intervention in order to improve outcomes. Biomarkers, such high serum procalcitonin and ferritin have also emerged as poor prognostic factors. Furthermore, blood hypercoagulability is common among hospitalized COVID-19 patients. Elevated D-Dimer levels are consistently reported, whereas their gradual increase during disease course is particularly associated with disease worsening. Other coagulation abnormalities such as PT and aPTT prolongation, fibrin degradation products increase, with severe thrombocytopenia lead to life-threatening disseminated intravascular coagulation (DIC), which necessitates continuous vigilance and prompt intervention. So, COVID-19 infected patients, whether hospitalized or ambulatory, are at high risk for venous thromboembolism, and an early and prolonged pharmacological thromboprophylaxis with low molecular weight heparin is highly recommended. Last but not least, the need for assuring blood donations during the pandemic is also highlighted.


Subject(s)
Betacoronavirus , Coronavirus Infections/blood , Lymphopenia/etiology , Pneumonia, Viral/blood , Thrombophilia/etiology , Anticoagulants/therapeutic use , Biomarkers , Blood Coagulation Tests , Blood Donors/supply & distribution , C-Reactive Protein/analysis , Clinical Laboratory Techniques , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Cytokine Release Syndrome/blood , Cytokine Release Syndrome/etiology , Cytokines/blood , Disseminated Intravascular Coagulation/blood , Disseminated Intravascular Coagulation/etiology , Early Diagnosis , Ferritins/blood , Fibrin Fibrinogen Degradation Products/analysis , Humans , Meta-Analysis as Topic , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Risk , Thrombophilia/blood , Thrombophilia/drug therapy , Venous Thromboembolism/blood , Venous Thromboembolism/etiology , Venous Thromboembolism/prevention & control
14.
J Korean Med Sci ; 35(13): e142, 2020 Apr 06.
Article in English | MEDLINE | ID: covidwho-31389

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected pneumonia emerged in Wuhan, China in December 2019. In this retrospective multicenter study, we investigated the clinical course and outcomes of novel coronavirus disease 2019 (COVID-19) from early cases in Republic of Korea. METHODS: All of the cases confirmed by real time polymerase chain reaction were enrolled from the 1st to the 28th patient nationwide. Clinical data were collected and analyzed for changes in clinical severity including laboratory, radiological, and virologic dynamics during the progression of illness. RESULTS: The median age was 40 years (range, 20-73 years) and 15 (53.6%) patients were male. The most common symptoms were cough (28.6%) and sore throat (28.6%), followed by fever (25.0%). Diarrhea was not common (10.7%). Two patients had no symptoms. Initial chest X-ray (CXR) showed infiltration in 46.4% of the patients, but computed tomography scan confirmed pneumonia in 88.9% (16/18) of the patients. Six patients (21.4%) required supplemental oxygen therapy, but no one needed mechanical ventilation. Lymphopenia was more common in severe cases. Higher level of C-reactive protein and worsening of chest radiographic score was observed during the 5-7 day period after symptom onset. Viral shedding was high from day 1 of illness, especially from the upper respiratory tract (URT). CONCLUSION: The prodromal symptoms of COVID-19 were mild and most patients did not have limitations of daily activity. Viral shedding from URT was high from the prodromal phase. Radiological pneumonia was common from the early days of illness, but it was frequently not evident in simple CXR. These findings could be plausible explanations for the easy and rapid spread of SARS-CoV-2 in the community.


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , Adult , Aged , Asymptomatic Diseases , C-Reactive Protein/analysis , Cohort Studies , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Cough/etiology , Diarrhea/etiology , Fever/etiology , Humans , Lymphopenia/etiology , Male , Middle Aged , Oxygen Inhalation Therapy , Pharyngitis/etiology , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Prodromal Symptoms , Radiography, Thoracic , Real-Time Polymerase Chain Reaction , Republic of Korea , Retrospective Studies , Time Factors , Tomography, X-Ray Computed , Young Adult
15.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(2): 131-138, 2020 Mar.
Article in Chinese | MEDLINE | ID: covidwho-18396

ABSTRACT

This review summarizes the ongoing researches regarding etiology, epidemiology, transmission dynamics, treatment, and prevention and control strategies of the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with comparison to severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV) and pandemic H1N1 virus. SARS-CoV-2 may be originated from bats, and the patients and asymptomatic carriers are the source of epidemic infection. The virus can be transmitted human-to-human through droplets and close contact, and people at all ages are susceptible to this virus. The main clinical symptoms of the patients are fever and cough, accompanied with leukocytopenia and lymphocytopenia. Effective drugs have been not yet available thus far. In terms of the prevention and control strategies, vaccine development as the primary prevention should be accelerated. Regarding the secondary prevention, ongoing efforts of the infected patients and close contacts quarantine, mask wearing promotion, regular disinfection in public places should be continued. Meanwhile, rapid detection kit for serological monitoring of the virus in general population is expected so as to achieve early detection, early diagnosis, early isolation and early treatment. In addition, public health education on this disease and prevention should be enhanced so as to mitigate panic and mobilize the public to jointly combat the epidemic.


Subject(s)
Betacoronavirus , Coronavirus Infections , Pandemics , Pneumonia, Viral , Asymptomatic Diseases , Betacoronavirus/pathogenicity , Clinical Laboratory Techniques , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Cough/etiology , Early Diagnosis , Fever/etiology , Humans , Influenza A Virus, H1N1 Subtype , Leukopenia/etiology , Lymphopenia/etiology , Middle East Respiratory Syndrome Coronavirus , Pandemics/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , SARS Virus , Secondary Prevention , Viral Vaccines
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