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1.
G Ital Cardiol (Rome) ; 25(7): 499-508, 2024 Jul.
Article in Italian | MEDLINE | ID: mdl-38916465

ABSTRACT

Arterial blood gas (ABG) analysis is a simple and quick test that can provide multiple respiratory and metabolic parameters. The interpretation of ABG analysis and acid-base disorders represents one of the most complex chapters of clinical medicine. In this brief review, the authors propose a rational approach that sequentially analyzes the information offered by the ABG to allow a rapid classification of the respiratory, metabolic or mixed disorder. The patient's history and clinical-instrumental assessment are the framework in which to insert the information derived from the ABG analysis in order to characterize the critical heart patient.


Subject(s)
Blood Gas Analysis , Coronary Care Units , Humans , Blood Gas Analysis/methods , Heart Diseases/blood , Heart Diseases/diagnosis , Acid-Base Imbalance/blood , Acid-Base Imbalance/diagnosis , Acid-Base Imbalance/therapy
2.
G Ital Cardiol (Rome) ; 24(10): 800-809, 2023 Oct.
Article in Italian | MEDLINE | ID: mdl-37767832

ABSTRACT

The management of the patient with fever in the intensive cardiac care unit begins with a thorough evaluation of the patient, particularly symptoms, clinical history and physical examination, to provide information regarding the origin of the fever. The global evaluation of the patient should be integrated with blood and microbiological tests, in particular blood culture and swab. The laboratory, microbiologic or radiologic tests could be more or less detailed and targeted depending on the type of suspected infection and clinical conditions of the patient. When therapy is necessary, it is crucial to switch, as soon as possible, from broad spectrum antibiotic therapy to antibiotic therapy based on the results of the microbiological exams. Antibiotic therapy could be associated with antipyretic and specific organ support therapy when necessary.


Subject(s)
Fever , Intensive Care Units , Humans , Fever/etiology , Fever/therapy , Anti-Bacterial Agents/therapeutic use
3.
G Ital Cardiol (Rome) ; 24(8): 604-611, 2023 08.
Article in Italian | MEDLINE | ID: mdl-37492867

ABSTRACT

Arrhythmias are a common complication in the adult population with congenital heart disease (ACHD). Arrhythmias often lead to hemodynamic instability and, on the other hand, may be a marker of hemodynamic impairment in ACHD patients, both in natural history and after cardiac surgery. Treatment requires knowledge of basic anatomy and any previous cardiac surgery; the availability of patient's health records, if possible, is therefore crucial for therapeutic choices. In the emergency setting, the first target is represented by the patient's hemodynamic stabilization; mainly in moderate or high complexity ACHD, the connection with the referral center is recommended, to which patients should be entrusted for follow-up. A regional epidemiological observatory, aiming to assess the number, type and outcomes of emergency admissions of ACHD patients could be a useful tool for analyzing the effectiveness of the collaboration network between the different structures involved and for implementing organizational pathways.


Subject(s)
Cardiac Surgical Procedures , Heart Defects, Congenital , Adult , Humans , Heart Defects, Congenital/complications , Heart Defects, Congenital/epidemiology , Critical Pathways , Arrhythmias, Cardiac/therapy , Arrhythmias, Cardiac/complications , Cardiac Surgical Procedures/adverse effects , Emergency Service, Hospital
4.
ESC Heart Fail ; 10(5): 2853-2864, 2023 10.
Article in English | MEDLINE | ID: mdl-37415291

ABSTRACT

AIMS: The presence of anti-human leucocyte antigen (HLA) antibodies has been implicated in a higher incidence of complications as well as mortality rate in heart transplantation. The aim of the study was to identify through non-invasive parameters early signs of myocardial dysfunction in the presence of anti-HLA antibodies but without evidence of antibody-mediated rejection (AMR) and its possible prognostic impact. METHODS AND RESULTS: A total of 113 heart-transplanted patients without acute cellular rejection (ACR) and AMR or cardiac allograft vasculopathy (CAV) were prospectively enrolled and divided into two groups ['HLA+' (50 patients) and 'HLA-' (63 patients)], based on the presence of anti-HLA antibodies. Each patient was followed for 2 years after the enrolment, recording episodes of AMR, ACR, CAV, and mortality. Clinical characteristics were similar between the two groups. Among laboratory data, N-terminal pro-B-type natriuretic peptide and high-sensitivity cardiac troponin values were significantly higher in the presence of anti-HLA antibodies (P < 0.001 and P = 0.003, respectively). The echocardiographic parameters that showed a statistically significant difference between the two groups were deceleration time of E wave (DecT E, P < 0.001), left ventricular global longitudinal strain (P < 0.001), tricuspid annular plane systolic excursion (P = 0.011), tricuspid S' wave (P = 0.002), and free wall right ventricular longitudinal strain (fwRVLS, P = 0.027), whereas left atrial strain did not differ significantly (P = 0.408). Univariate analysis showed that anti-HLA antibodies were associated with the development of CAV at both 1 and 2 year follow-up [odds ratio (OR) 11.90, 95% confidence interval (CI) 1.43-90.79, P = 0.022 and OR 3.37, 95% CI 1.78-9.67, P = 0.024, respectively]. Bivariate analysis demonstrated that both fwRVLS and DecT E were predictors of CAV development independently from HLA status. CONCLUSIONS: The presence of circulating anti-HLA antibodies is correlated with a mild cardiac dysfunction, even in the absence of AMR, and CAV development. Interestingly, reduced values of DecT E and fwRVLS were predictors of future development of CAV, independently from anti-HLA antibody.


Subject(s)
Heart Transplantation , Humans , Heart Transplantation/adverse effects , Heart Transplantation/methods , Antibodies , Prognosis , Graft Rejection/diagnosis , Echocardiography
5.
G Ital Cardiol (Rome) ; 24(7): 538-546, 2023 Jul.
Article in Italian | MEDLINE | ID: mdl-37392119

ABSTRACT

Acute respiratory failure is a frequent complication of patients admitted to the intensive cardiac care unit and it is associated with a poor short- and long-term outcome. Acute respiratory failure can be managed with traditional oxygen therapy, with high-flow nasal cannula, continuous positive airway pressure, non-invasive ventilation or invasive ventilation according to clinical and blood gas condition. The use of advanced respiratory therapies is associated with both respiratory and hemodynamic effects, therefore the intensivist cardiologist should know deeply these respiratory devices. The intensivist cardiologist should perform an early diagnosis of acute respiratory failure, an appropriate selection of the respiratory device, and accurate monitoring and management to obtain clinical improvement and to avoid mechanical invasive ventilation.


Subject(s)
Cannula , Respiratory Insufficiency , Humans , Hypoxia/etiology , Hypoxia/therapy , Oxygen , Intubation, Intratracheal , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy
6.
G Ital Cardiol (Rome) ; 24(3): 178-187, 2023 Mar.
Article in Italian | MEDLINE | ID: mdl-36853154

ABSTRACT

Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure >20 mmHg at rest during right heart catheterization. PH prevalence is about 1% of the global population. The PH clinical classification includes five groups: pulmonary arterial hypertension, PH associated with left heart disease, PH associated with lung disease, PH associated with pulmonary artery obstructions, PH with unclear and/or multifactorial mechanisms. In case of clinical suspicion, echocardiography is the first-line tool to start the diagnostic process. Right heart catheterization is the gold standard for diagnosis of PH, requires great experience and should be performed in expert centers. The classification of the PH patient in a specific subgroup requires multidisciplinary clinical and instrumental skills that only a reference center can provide. This document proposes a clinical pathway for the management of PH patients in the Tuscany region in order to standardize access to specialized care.


Subject(s)
Heart Diseases , Hypertension, Pulmonary , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Hypertension, Pulmonary/therapy , Critical Pathways , Cardiac Catheterization , Echocardiography
7.
G Ital Cardiol (Rome) ; 24(2): 110-121, 2023 Feb.
Article in Italian | MEDLINE | ID: mdl-36735309

ABSTRACT

Circulatory shock is a clinical condition characterized by hypotension and organ hypoperfusion, potentially fatal if the underlying cause is not promptly identified and corrected. Circulatory shock outcome is certainly conditioned from early diagnosis and early and adequate therapy. The aim of this review is to provide a tool for a rapid differential diagnosis among the various phenotypes of circulatory shock, based on the clinical, hemodynamic and biochemical profile. We also prompt to emphasize the role of multiparametric monitoring from the early phases of the management and the need to implement the time-dependent network to improve the outcome of these critical patients.


Subject(s)
Hypotension , Shock , Vascular Diseases , Humans , Shock/diagnosis , Shock/etiology , Shock/therapy , Hemodynamics , Early Diagnosis , Vascular Diseases/complications , Shock, Cardiogenic/therapy
9.
G Ital Cardiol (Rome) ; 23(9): 686-702, 2022 Sep.
Article in Italian | MEDLINE | ID: mdl-36039719

ABSTRACT

The number of elderly patients admitted to cardiac intensive care units (CICU) is significantly increasing. Nowadays, novel diagnostic and therapeutic tools allow to treat the vast majority of cardiac acute diseases, nonetheless care of elderly patients requires a careful clinical evaluation. A favorable proportion of cost-effectiveness is warranted, aimed at avoiding futile procedures or treatments. On the other hand, the availability of minimally invasive procedures carries forward old limits to treatments in elderly patients in CICU. It appears evident that age cannot per se represent a limit in the care of elderly people. The present review gives insights in the management of the most common cardiovascular disease settings in elderly patients in the CICUs, thus providing important tools in complex decision-making.


Subject(s)
Cardiovascular Diseases , Heart Diseases , Aged , Cardiovascular Diseases/therapy , Heart Diseases/therapy , Hospital Mortality , Hospitalization , Humans , Intensive Care Units , Medical Futility , Retrospective Studies
10.
G Ital Cardiol (Rome) ; 23(6): 437-443, 2022 Jun.
Article in Italian | MEDLINE | ID: mdl-35674034

ABSTRACT

Cardio-oncology is now part of the standard clinical approach for patients with cancer and cannot be overlooked anymore. While its scientific background is solid and its clinical relevance is well known, its application in daily practice varies greatly among hospitals. To provide the best cardio-oncology care to cancer patients and to make cardio-oncology's clinical use uniform, we developed a shared multidisciplinary proposal for a dedicated clinical pathway. Our proposition presents the minimum requirements needed to which this path caters for, identifies patient categories to be entered into the path, highlights the role of a specific inter-hospital clinical and imaging network and indicates follow-up strategies during and after oncological treatments. The proposed pathway is based on some key elements and is easily adaptable to different hospitals with minimal changes.


Subject(s)
Cardiology , Neoplasms , Critical Pathways , Humans , Medical Oncology , Neoplasms/therapy , Outpatients
11.
Eur Heart J Suppl ; 23(Suppl C): C204-C220, 2021 Aug.
Article in English | MEDLINE | ID: mdl-34456647

ABSTRACT

The treatment of patients with advanced acute heart failure is still challenging. Intra-aortic balloon pump (IABP) has widely been used in the management of patients with cardiogenic shock. However, according to international guidelines, its routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian Association of Hospital Cardiologists, reviews the available data derived from clinical studies. It also provides practical recommendations for the optimal use of IABP in the treatment of cardiogenic shock and advanced acute heart failure.

12.
G Ital Cardiol (Rome) ; 22(8): 621-634, 2021 Aug.
Article in Italian | MEDLINE | ID: mdl-34310565

ABSTRACT

The diagnosis of cardiac amyloidosis (CA) is challenging because of its phenotypic heterogeneity, multi-organ involvement often requiring the interaction among experts in different specialties and subspecialties, the lack of a single non-invasive diagnostic tool, and limited awareness in the medical community. Recent studies have challenged the dogma of CA as a rare, incurable disease, and have redefined the epidemiology and therapeutic options for this condition. Missing or delaying the diagnosis may have a profound impact on patient outcome, as potentially life-saving treatments may be omitted or delayed, particularly chemotherapy in the case of amyloid light-chain amyloidosis. For a timely identification, clinical cardiologists should be able to recognize the "red flags" prompting a dedicated diagnostic work-up. Cardiologists could also face the challenge of making decisions about drug and device therapies for patients with known CA. The present consensus document aims to provide a practical guide and an organizational framework for professionals belonging to the Tuscan network of hospital cardiologists.


Subject(s)
Amyloidosis , Cardiologists , Cardiology , Amyloidosis/diagnosis , Amyloidosis/therapy , Consensus , Hospitals , Humans , Italy
13.
G Ital Cardiol (Rome) ; 22(5): 404-423, 2021 May.
Article in Italian | MEDLINE | ID: mdl-33960985

ABSTRACT

The treatment of patients with advanced acute heart failure is still challenging. Intra-aortic balloon pump (IABP) has widely been used in the management of patients with cardiogenic shock. However, according to international guidelines, its routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian Association of Hospital Cardiologists (ANMCO), reviews the available data derived from clinical studies. It also provides practical recommendations for the optimal use of IABP in the treatment of cardiogenic shock and advanced acute heart failure. Data deriving from a national survey in Italian hospitals about IABP use are also provided.


Subject(s)
Heart Failure , Myocardial Infarction , Heart Failure/therapy , Humans , Intra-Aortic Balloon Pumping , Shock, Cardiogenic/therapy , Treatment Outcome
14.
G Ital Cardiol (Rome) ; 22(2): 122-136, 2021 Feb.
Article in Italian | MEDLINE | ID: mdl-33470228

ABSTRACT

Cardiogenic shock is a clinical syndrome characterized by hypotension and hypoperfusion due to the inability of the heart to provide adequate cardiac output. It is an infrequent clinical condition still burdened by high mortality rates. In patients with cardiogenic shock rapid diagnosis, multiparameter monitoring and timely therapeutic strategies with pharmacological agents or mechanical circulatory support are necessary to provide adequate peripheral tissue perfusion and to improve outcome. Recent investigations reported lower mortality rates to be associated with clinical pathways based on a well-organized network, and on admission in high-volume specialized hospitals (Shock Center) with a dedicated multidisciplinary team (Shock Team). The aim of this clinical pathway for cardiogenic shock is to describe the best organization to ensure to Tuscan citizens an equal access to care independently of the site where they suffer from cardiogenic shock.


Subject(s)
Hypotension , Shock, Cardiogenic , Critical Pathways , Humans , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/therapy
15.
Intern Emerg Med ; 16(2): 463-470, 2021 Mar.
Article in English | MEDLINE | ID: mdl-32772282

ABSTRACT

Refractory cardiogenic shock (RCS) or refractory cardiac arrest (RCA) complicating acute coronary syndrome (ACS) is associated with extremely high mortality rate. Veno-arterial extracorporeal life support (VA-ECLS) represents a valuable therapeutic option to stabilize patients' condition before or at the time of emergency revascularization. We analyzed 29 consecutive patients with RCS or RCA complicating ACS, and implanted with VA-ECLS in two centers who have adopted a similar, structured approach to ECLS implantation. Data were collected from January 2010 to December 2015 and ECLS had to be percutaneously implanted either before (within 48 h) or at the time of attempted percutaneous coronary revascularization (PCI). We investigated in-hospital outcome and factors associated with survival. Twenty-one (72%) were implanted for RCA, whereas 8 (28%) were implanted on ECLS for RCS. All RCA were witnessed and no-flow time was shorter than 5 min in all cases but one. All patients underwent attempted emergency PCI, using radial access in ten cases (34.5%), whereas in three patients a subsequent CABG was performed. Overall, ten patients (34.5%) survived, nine of them with a good neurological outcome. Life threatening complications, including stroke (4 pts), leg ischemia (4 pts), intestinal ischemia (5 pts), and deep vein thrombosis 2 pts), occurred frequently, but were not associated with in-hospital death. Main cause of death was multi-organ failure. PCI variables did not predict survival. Survivors were younger, with shorter low-flow time, and with ECLS mainly implanted for RCS. At multivariate analysis, levels of lactate at ECLS implantation (OR 4.32, 95%CI 1.01-18.51, p = 0.049) emerged as the only variable that independently predicted survival. In patients with RCA or RCS complicating ACS who are percutaneously implanted with ECLS before or at the time of coronary revascularization, in hospital survival rate is higher than 30%. Level of lactate at ECLS implantation appears to be the most important factor to predict survival.


Subject(s)
Acute Coronary Syndrome/mortality , Acute Coronary Syndrome/therapy , Extracorporeal Membrane Oxygenation , Heart Arrest/mortality , Heart Arrest/therapy , Lactates/blood , Shock, Cardiogenic/mortality , Shock, Cardiogenic/therapy , Acute Coronary Syndrome/complications , Biomarkers/blood , Female , Heart Arrest/complications , Hospital Mortality , Humans , Italy , Male , Middle Aged , Postoperative Complications/mortality , Predictive Value of Tests , Registries , Risk Factors , Shock, Cardiogenic/complications , Survival Rate
16.
J Cardiovasc Med (Hagerstown) ; 21(8): 540-546, 2020 Aug.
Article in English | MEDLINE | ID: mdl-32618760

ABSTRACT

: The article reviews the rate of embolic risk in permanent and paroxysmal atrial fibrillation reported in the current literature. The data analyzed suggest that the embolic risk in the two forms of atrial fibrillation is different and therefore careful clinical judgment is needed to offer patients tailored anticoagulation treatments.


Subject(s)
Atrial Fibrillation/complications , Stroke/etiology , Thromboembolism/etiology , Administration, Oral , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Atrial Fibrillation/diagnosis , Atrial Fibrillation/drug therapy , Clinical Decision-Making , Hemorrhage/chemically induced , Humans , Risk Assessment , Risk Factors , Stroke/diagnosis , Stroke/prevention & control , Thromboembolism/diagnosis , Thromboembolism/prevention & control , Treatment Outcome
17.
Cardiovasc Revasc Med ; 21(9): 1099-1105, 2020 09.
Article in English | MEDLINE | ID: mdl-32471713

ABSTRACT

BACKGROUND: Calcified coronary lesions still represent a challenge for coronary angioplasty, with sub-optimal acute PCI results causing more frequent late stent failure. PURPOSE: The study aimed at the evaluation of the immediate procedural outcome in a real-world consecutive population of a selective use of lithotripsy based on the intravascular imaging assessment with IVUS or OCT. METHODS AND RESULTS: Thirty-one calcified stenoses (28 patients) out of a total of 455 lesions (370 patients) treated between November 2018 and May 2019 received IVL under intravascular imaging guidance. The majority of the IVL lesions had angiographically severe calcifications and were selected after intravascular imaging. A smaller group was identified by poor expansion after high-pressure balloon dilatation, in one case despite preliminary small burr Rotablation. After IVL, when OCT was performed calcium fractures were observed in 71% of cases. After OCT/IVUS guided stent optimization a satisfactory lumen enlargement (minimal stent area 7.09 ±â€¯2.77 mm2) was observed with good stent expansion (residual area stenosis<20% in 29 lesions, 93.5%) Peri-procedural complications were limited to one dissection at the distal edge requiring an additional stent and 3 peri-procedural myocardial infarctions. There were no periprocedural coronary perforations or pericardial effusions, and no in-hospital or 30 days stent thrombosis. When patients were divided into two subgroups according to a calcium arc ≤180° (Group A: 10 lesions, calcium arc 140 ±â€¯24°; Group B: 21 lesions, calcium arc 289 ±â€¯53°), at OCT Group B presented also a higher number of calcium fractures post IVL than group A (group A: 38% vs group B: 92%, p = 0.03). The in-stent minimum lumen diameter (MSD), the in stent minimal lumen area (MSA) and the acute gain, however, were similar between the two groups (acute gain group A: 1.22 ±â€¯0.29 mm; group B: 1.31 ±â€¯0.52 mm, p = 0.63). CONCLUSIONS: A standardized algorithm applying intravascular imaging guidance of IVL facilitated second generation DES expansion delivers excellent immediate lumen expansion and patient outcome, both in concentric and eccentric calcifications.


Subject(s)
Lithotripsy , Coronary Angiography , Coronary Artery Disease/therapy , Humans , Percutaneous Coronary Intervention , Stents , Treatment Outcome , Ultrasonography, Interventional
18.
Interv Cardiol ; 14(3): 154-163, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31867062

ABSTRACT

Percutaneous treatment of heavily calcified coronary lesions still represents a challenge for interventional cardiology, with higher risk of immediate complications, late failure due to stent underexpansion and malapposition, and consequently poor clinical outcome. Good characterisation of calcium distribution with multimodal imaging is important to improve the successful treatment of these lesions. The use of traditional or new dedicated devices for the treatment of calcified lesions allows better lesion preparation; therefore, it is important that we know the different mechanisms and technical features of these devices.

19.
G Ital Cardiol (Rome) ; 19(6 Suppl 1): 14S-22S, 2018 06.
Article in Italian | MEDLINE | ID: mdl-29989607

ABSTRACT

In patients with severe cardiac dysfunction refractory to conventional therapies, extracorporeal membrane oxygenation used in veno-arterious modality can provide temporary circulatory assistance (extracorporeal life support, ECLS). Since it is an invasive and complex technique, its use is potentially burdened by severe complications, thus requiring careful nursing and medical care during intensive cardiac care unit stay. The use of ECLS requires specific skills such as knowledge of protective mechanical invasive ventilation, specific echocardiographic evaluation, accurate monitoring of hemodynamics and laboratory tests. A patient on ECLS is at high risk of thrombotic and hemorrhagic complications that could be fatal, hence specific pro- and anti-hemostatic therapy is needed. Moreover, the knowledge of some peculiar aspects of ECLS system and management can help doctors to avoid several complications such as limb ischemia, left ventricular overload and regional perfusion discrepancy. In conclusion, careful management by adequately trained personnel is required.


Subject(s)
Extracorporeal Membrane Oxygenation/methods , Heart Diseases/therapy , Intensive Care Units , Clinical Competence , Critical Care/methods , Echocardiography/adverse effects , Heart Diseases/physiopathology , Hemodynamics , Humans
20.
Catheter Cardiovasc Interv ; 92(6): 1201-1204, 2018 11 15.
Article in English | MEDLINE | ID: mdl-29508515

ABSTRACT

The Cardioband system is a transcatheter direct annuloplasty device that is implanted in patients with severe symptomatic functional mitral regurgitation (MR) due to annulus dilatation and high surgical risk. This device covers the posterior two-thirds of the annulus, from the anterolateral to the posteromedial commissure, implanted in close proximity of the left circumflex artery, atrioventricular (AV) conduction system, and coronary sinus. We present the case of an 80-year-old-gentleman with prohibitive surgical risk, treated with Cardioband implantation for functional MR with an evident P1-P2 cleft and P2-P3 indentation, a relative contraindication to MitraClip implantation. We achieved procedural success with significative mitral annulus reduction (30% anteroposterior reduction from 37 to 26 mm) and MR reduction (from grade 4 to grade 1-2). A late onset Mobitz 2 AV block developed after 26 hr and evolved to complete AV block in the following day, requiring definitive biventricular pacemaker (PM). Less than 200 Cardioband implantations have been performed but, to our knowledge, this is the first reported AV block, possibly facilitated by the pre-existing bifascicular block, suggesting the opportunity of prolonged ECG monitoring after Cardioband like any other mechanical transcatheter structural intervention possibly affecting the AV conduction system.


Subject(s)
Atrioventricular Block/etiology , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis , Mitral Valve Annuloplasty/adverse effects , Mitral Valve Annuloplasty/instrumentation , Mitral Valve Insufficiency/surgery , Aged, 80 and over , Atrioventricular Block/diagnosis , Atrioventricular Block/physiopathology , Atrioventricular Block/therapy , Cardiac Resynchronization Therapy , Humans , Male , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/physiopathology , Prosthesis Design , Treatment Outcome
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