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Development and Validation of a Prognostic Nomogram Based on Clinical and CT Features for Adverse Outcome Prediction in Patients with COVID-19

  • Yingyan Zheng;Anling Xiao;Xiangrong Yu;Yajing Zhao;Yiping Lu;Xuanxuan Li;Nan Mei;Dejun She;Dongdong Wang;Daoying Geng;Bo Yin
    • Korean Journal of Radiology
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    • v.21 no.8
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    • pp.1007-1017
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    • 2020
  • Objective: The purpose of our study was to investigate the predictive abilities of clinical and computed tomography (CT) features for outcome prediction in patients with coronavirus disease (COVID-19). Materials and Methods: The clinical and CT data of 238 patients with laboratory-confirmed COVID-19 in our two hospitals were retrospectively analyzed. One hundred sixty-six patients (103 males; age 43.8 ± 12.3 years) were allocated in the training cohort and 72 patients (38 males; age 45.1 ± 15.8 years) from another independent hospital were assigned in the validation cohort. The primary composite endpoint was admission to an intensive care unit, use of mechanical ventilation, or death. Univariate and multivariate Cox proportional hazard analyses were performed to identify independent predictors. A nomogram was constructed based on the combination of clinical and CT features, and its prognostic performance was externally tested in the validation group. The predictive value of the combined model was compared with models built on the clinical and radiological attributes alone. Results: Overall, 35 infected patients (21.1%) in the training cohort and 10 patients (13.9%) in the validation cohort experienced adverse outcomes. Underlying comorbidity (hazard ratio [HR], 3.35; 95% confidence interval [CI], 1.67-6.71; p < 0.001), lymphocyte count (HR, 0.12; 95% CI, 0.04-0.38; p < 0.001) and crazy-paving sign (HR, 2.15; 95% CI, 1.03-4.48; p = 0.042) were the independent factors. The nomogram displayed a concordance index (C-index) of 0.82 (95% CI, 0.76-0.88), and its prognostic value was confirmed in the validation cohort with a C-index of 0.89 (95% CI, 0.82-0.96). The combined model provided the best performance over the clinical or radiological model (p < 0.050). Conclusion: Underlying comorbidity, lymphocyte count and crazy-paving sign were independent predictors of adverse outcomes. The prognostic nomogram based on the combination of clinical and CT features could be a useful tool for predicting adverse outcomes of patients with COVID-19.

CT Quantitative Analysis and Its Relationship with Clinical Features for Assessing the Severity of Patients with COVID-19

  • Dong Sun;Xiang Li;Dajing Guo;Lan Wu;Ting Chen;Zheng Fang;Linli Chen;Wenbing Zeng;Ran Yang
    • Korean Journal of Radiology
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    • v.21 no.7
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    • pp.859-868
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    • 2020
  • Objective: To investigate the value of initial CT quantitative analysis of ground-glass opacity (GGO), consolidation, and total lesion volume and its relationship with clinical features for assessing the severity of coronavirus disease 2019 (COVID-19). Materials and Methods: A total of 84 patients with COVID-19 were retrospectively reviewed from January 23, 2020 to February 19, 2020. Patients were divided into two groups: severe group (n = 23) and non-severe group (n = 61). Clinical symptoms, laboratory data, and CT findings on admission were analyzed. CT quantitative parameters, including GGO, consolidation, total lesion score, percentage GGO, and percentage consolidation (both relative to total lesion volume) were calculated. Relationships between the CT findings and laboratory data were estimated. Finally, a discrimination model was established to assess the severity of COVID-19. Results: Patients in the severe group had higher baseline neutrophil percentage, increased high-sensitivity C-reactive protein (hs-CRP) and procalcitonin levels, and lower baseline lymphocyte count and lymphocyte percentage (p < 0.001). The severe group also had higher GGO score (p < 0.001), consolidation score (p < 0.001), total lesion score (p < 0.001), and percentage consolidation (p = 0.002), but had a lower percentage GGO (p = 0.008). These CT quantitative parameters were significantly correlated with laboratory inflammatory marker levels, including neutrophil percentage, lymphocyte count, lymphocyte percentage, hs-CRP level, and procalcitonin level (p < 0.05). The total lesion score demonstrated the best performance when the data cut-off was 8.2%. Furthermore, the area under the curve, sensitivity, and specificity were 93.8% (confidence interval [CI]: 86.8-100%), 91.3% (CI: 69.6-100%), and 91.8% (CI: 23.0-98.4%), respectively. Conclusion: CT quantitative parameters showed strong correlations with laboratory inflammatory markers, suggesting that CT quantitative analysis might be an effective and important method for assessing the severity of COVID-19, and may provide additional guidance for planning clinical treatment strategies.

Association between Initial Chest CT or Clinical Features and Clinical Course in Patients with Coronavirus Disease 2019 Pneumonia

  • Zhe Liu;Chao Jin;Carol C. Wu;Ting Liang;Huifang Zhao;Yan Wang;Zekun Wang;Fen Li;Jie Zhou;Shubo Cai;Lingxia Zeng;Jian Yang
    • Korean Journal of Radiology
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    • v.21 no.6
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    • pp.736-745
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    • 2020
  • Objective: To identify the initial chest computed tomography (CT) findings and clinical characteristics associated with the course of coronavirus disease 2019 (COVID-19) pneumonia. Materials and Methods: Baseline CT scans and clinical and laboratory data of 72 patients admitted with COVID-19 pneumonia (39 men, 46.2 ± 15.9 years) were retrospectively analyzed. Baseline CT findings including lobar distribution, presence of ground glass opacities, consolidation, linear opacities, and lung severity score were evaluated. The outcome event was recovery with hospital discharge. The time from symptom onset to discharge or the end of follow-up (for those remained hospitalized) was recorded. Data were censored in events such as death or discharge without recovery. Multivariable Cox proportional hazard regression was used to explore the association between initial CT, clinical or laboratory findings, and discharge with recovery, whereby hazard ratio (HR) values < 1 indicated a lower rate of discharge at four weeks and longer time until discharge. Results: Thirty-two patients recovered and were discharged during the study period with a median length of admission of 16 days (range, 9 to 25 days), while the rest remained hospitalized at the end of this study (median, 17.5 days; range, 4 to 27 days). None died during the study period. After controlling for age, onset time, lesion characteristics, number of lung lobes affected, and bilateral involvement, the lung severity score on baseline CT (> 4 vs. ≤ 4 [reference]: adjusted HR = 0.41 [95% confidence interval, CI = 0.18-0.92], p = 0.031) and initial lymphocyte count (reduced vs. normal or elevated [reference]: adjusted HR = 0.14 [95% CI = 0.03-0.60], p = 0.008) were two significant independent factors that influenced recovery and discharge. Conclusion: Lung severity score > 4 and reduced lymphocyte count at initial evaluation were independently associated with a significantly lower rate of recovery and discharge and extended hospitalization in patients admitted for COVID-19 pneumonia.

CT-Based Radiomics Signature for Preoperative Prediction of Coagulative Necrosis in Clear Cell Renal Cell Carcinoma

  • Kai Xu;Lin Liu;Wenhui Li;Xiaoqing Sun;Tongxu Shen;Feng Pan;Yuqing Jiang;Yan Guo;Lei Ding;Mengchao Zhang
    • Korean Journal of Radiology
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    • v.21 no.6
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    • pp.670-683
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    • 2020
  • Objective: The presence of coagulative necrosis (CN) in clear cell renal cell carcinoma (ccRCC) indicates a poor prognosis, while the absence of CN indicates a good prognosis. The purpose of this study was to build and validate a radiomics signature based on preoperative CT imaging data to estimate CN status in ccRCC. Materials and Methods: Altogether, 105 patients with pathologically confirmed ccRCC were retrospectively enrolled in this study and then divided into training (n = 72) and validation (n = 33) sets. Thereafter, 385 radiomics features were extracted from the three-dimensional volumes of interest of each tumor, and 10 traditional features were assessed by two experienced radiologists using triple-phase CT-enhanced images. A multivariate logistic regression algorithm was used to build the radiomics score and traditional predictors in the training set, and their performance was assessed and then tested in the validation set. The radiomics signature to distinguish CN status was then developed by incorporating the radiomics score and the selected traditional predictors. The receiver operating characteristic (ROC) curve was plotted to evaluate the predictive performance. Results: The area under the ROC curve (AUC) of the radiomics score, which consisted of 7 radiomics features, was 0.855 in the training set and 0.885 in the validation set. The AUC of the traditional predictor, which consisted of 2 traditional features, was 0.843 in the training set and 0.858 in the validation set. The radiomics signature showed the best performance with an AUC of 0.942 in the training set, which was then confirmed with an AUC of 0.969 in the validation set. Conclusion: The CT-based radiomics signature that incorporated radiomics and traditional features has the potential to be used as a non-invasive tool for preoperative prediction of CN in ccRCC.

The protective effects of BMSA1 and BMSA5-1-1 proteins against Babesia microti infection

  • Yu Chun Cai;Chun Li Yang;Peng Song;Muxin Chen;Jia Xu Chen
    • Parasites, Hosts and Diseases
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    • v.62 no.1
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    • pp.53-63
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    • 2024
  • The intracellular parasite Babesia microti is among the most significant species causing human babesiosis and is an emerging threat to human health worldwide. Unravelling the pathogenic molecular mechanisms of babesiosis is crucial in developing new diagnostic and preventive methods. This study assessed how priming with B. microti surface antigen 1 (BHSA 1) and seroreactive antigen 5-1-1 (BHSA 5-1-1) mediate protection against B. microti infection. The results showed that 500 ㎍/ml rBMSA1 and rBMSA5-1-1 partially inhibited the invasion of B. microti in vitro by 42.0±3.0%, and 48.0±2.1%, respectively. Blood smears revealed that peak infection at 7 days post-infection (dpi) was 19.6%, 24.7%, and 46.7% in the rBMSA1, rBmSA5-1-1, compared to the control groups (healthy mice infected with B. microti only), respectively. Routine blood tests showed higher white blood cell, red blood cell counts, and haemoglobin levels in the 2 groups (BMSA1 and BMSA5 5-1-1) than in the infection control group at 0-28 dpi. Moreover, the 2 groups had higher serum interferon-γ, tumor necrosis factor-α and Interleukin-17A levels, and lower IL-10 levels than the infection control group throughout the study. These 2 potential vaccine candidate proteins partially inhibit in vitro and in vivo B. microti infection and enhance host immunological response against B. microti infection.

Multivariate statistical study on naturally occurring radioactive materials and radiation hazards in lakes around a Chinese petroleum industrial area

  • Yan Shi;Junfeng Zhao;Baiyao Ding;Yue Zhang;Zhigang Li;Mohsen M.M.Ali;Tuya Siqin;Hongtao Zhao;Yongjun Liu;Weiguo Jiang;Peng Wu
    • Nuclear Engineering and Technology
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    • v.56 no.6
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    • pp.2182-2189
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    • 2024
  • The high-purity germanium gamma-ray spectrometer was used to measure the radioisotope in surface water of lakes in a Chinee petroleum industrial area. 92 samples were collected from surface water of three lakes. Activity concentrations of 232Th, 226Ra and 40K in three lakes were measured, distributed in the range of 101.8-209.4, 192.1-224.9 and 335.0-548.9 mBq/L, respectively. Results were all within the limits of WHO and China. Potential environmental and health risks were assessed by calculating some radiation hazard indicators, radium equivalent index, annual effective dose, excess lifetime cancer risk, absorbed dose rate, external hazard index, internal hazard index, annual gonadal dose equivalent, activity utilization index and representative gamma index, which ranged 0.38-0.54 Bq/L, 0.06-0.08 mSv/y, 0.23 × 10-3-0.31 × 10-3, 0.17-0.24 nGy/h, 1.01 × 10-3-1.46 × 10-3, 1.55 × 10-3-2.02 × 10-3, 1.16-1.66 μSv/y, 3.13 × 10-3-4.45 × 10-3 and 2.60 × 10-3-3.77 × 10-3. The results were all at acceptable levels, meaning no impact on human health. The relationship between the electrical conductivity of surface water and the activity concentration of 232Th, 226Ra and 40K was evaluated. The electrical conductivity value was 0.241-0.369 mS/cm, showing a significant correlation coefficient between 226Ra and 40K and electrical conductivity. Multivariate statistical methods were used to determine the relationship between the activity concentrations of 232Th, 226Ra, and 40K, radiation hazard indicators and electrical conductivity.

Permanent Brachytherapy of Localized Prostate Cancer: Preliminary Results (국소 전립선암의 영구적 근접치료: 조기 결과)

  • Park, Hye-Li;Chang, Sei-Kyung;Kim, Ja-Young;Lee, Bo-Mi;Ko, Seong-Young;Kim, Sung-Joon;Shin, Hyun-Soo
    • Radiation Oncology Journal
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    • v.29 no.2
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    • pp.71-82
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    • 2011
  • Purpose: To evaluate the biochemical control rate and the rate of side effects after performing permanent brachytherapy of localized prostate cancer. Materials and Methods: 67 patients with localized prostate cancer were treated with brachytherapy between April 2007 and December 2008. Of these, 43 patients who were followed up and did not receive external radiotherapy were evaluated for the change in prostate specific antigen (PSA) level and the occurrence of side effects. In total, 18 patients were classified as low risk, 19 patients as intermediate risk, and 6 patients as high risk. The prescription dose was 145 Gy. Results: A PSA increase greater than 2 ng/mL occurred in 2 patients (4.7%). Radiation Therapy Oncology Group (RTOG) grade 1 and 2 acute urologic complications (UC) occurred in 40 and 3 patients, respectively. Further, 5 patients had RTOG grade 1 acute rectal complication (RC). The numbers of RTOG grade 1, 2, and 3 chronic UC were 1, 4, and 1, respectively. The numbers of RTOG grade 1, 2, and 4 chronic RC were 5, 10, and 3, respectively. The statistically significant risk factors (RF) of acute RC were the minimal dose in the most irradiated 0.1 cc volume ($D_{0.1cc}$, p=0.041) and absolute volume receiving 150% of the prescribed dose ($V_{150cc}$, p=0.038) in the entire rectum (ER). The percentage ($V_{100%}$, p=0.019) and absolute volume ($V_{100cc}$, p=0.047) in the involved rectum (IR) were also statistically significant. The RF of chronic RC were $V_{100%}$ (p=0.011) in the ER and the $D_{0.1cc}$ (p=0.049), $V_{100cc}$ (p=0.023) in the IR. The number of used seeds were related with acute UC (p=0.028). Conclusion: Permanent brachytherpy of localized prostate cancer showed a favorable short term biochemical control rate. As such, selective intermediate and high risk patients can be managed with permanent brachytherapy. The effort to reduce rectal complication is also necessary.

Intramuscular Administration of Zinc Metallothionein to Preslaughter Stressed Pigs Improves Anti-oxidative Status and Pork Quality

  • Li, L.L.;Hou, Z.P.;Yin, Y.L.;Liu, Y.H.;Hou, D.X.;Zhang, B.;Wu, G.Y.;Kim, S.W.;Fan, M.Z.;Yang, C.B.;Kong, X.F.;Tang, Z.R.;Peng, H.Z.;Deng, D.;Deng, Z.Y.;Xie, M.Y.;Xiong, H.;Kang, P.;Wang, S.X.
    • Asian-Australasian Journal of Animal Sciences
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    • v.20 no.5
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    • pp.761-767
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    • 2007
  • This study was conducted to determine the effects of exogenous zinc-metallothionein (Zn-MT) on anti-oxidative function and pork quality. After feeding a corn-soybean meal-based diet for two weeks, 48 pigs ($Duroc{\times}Landrace{\times}Chinese\;Black Pig$) were assigned randomly to four groups. Pigs in Group 1 were maintained under non-stress conditions, whereas pigs in Groups 2, 3 and 4 were aggressively handled for 25 min to produce stress. Pigs in Groups 1, 2, 3, and 4 received intramuscular administration of saline (control group; CON), 0 (negative control group; NCON), 0.8 (low dose group; LOW), and 1.6 (high dose group; HIGH) mg rabbit liver Zn-MT per kg body weight, respectively. Pigs were slaughtered at 3 and 6 h post-injection. Zn-MT treatment increased (p<0.05) the activities of superoxide dismutase (SOD) and glutathione-peroxidase (GSH-PX) while decreasing the concentration of malondialdehyde (MDA) in liver. These responses were greater (p<0.05) at 6 h than at 3 h post Zn-MT injection. Zn-MT treatment increased (p<0.05) hepatic SOD mRNA levels in a time and dose-dependent manner and decreased (p<0.05) serum glutamate-pyruvate transaminase and lactate dehydrogenase activities (indicators of tissue integrity). Zn-MT administration decreased (p<0.05) lactate concentration and increased (p<0.05) pH and water-holding capacity in the longissimus thorasis meat. Collectively, our results indicate that intramuscular administration of Zn-MT to pre-slaughter stressed pigs improved tissue anti-oxidative ability and meat quality.

True Digestibility of Phosphorus in Different Resources of Feed Ingredients in Growing Pigs

  • Wu, X.;Ruan, Z.;Zhang, Y.G.;Hou, Y.Q.;Yin, Y.L.;Li, T.J.;Huang, R.L.;Chu, W.Y.;Kong, X.F.;Gao, B.;Chen, L.X.
    • Asian-Australasian Journal of Animal Sciences
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    • v.21 no.1
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    • pp.107-119
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    • 2008
  • To determine the true digestible phosphorus (TDP) requirement of growing pigs, two experiments were designed with the experimental diets containing five true digestible P levels (0.16%, 0.20%, 0.23%, 0.26% and 0.39%) and the ratio of total calcium to true digestible P (TDP) kept at 2:1. In Experiment 1, five barrows (Duroc${\times}$Landrace${\times}$Yorkshire) with an average initial body weight of 27.9 kg were used in a $5{\times}5$ Latin-square design to evaluate the effect of different dietary P levels on the digestibility and output of P and nitrogen. In Experiment 2, sixty healthy growing pigs (Duroc${\times}$Landrace${\times}$Yorkshire) with an average body weight (BW) of 21.4 kg were assigned randomly to one of the five dietary treatments (12 pigs/diet), and were used to determine the true digestible phosphorus (TDP) requirement of growing pigs on the basis of growth performance and serum biochemical indices. The results indicated that the true digestibility of P increased (p<0.05) linearly with increasing dietary TDP level below 0.26%. The true P digestibility was highest (56.6%) when dietary TDP was 0.34%. Expressed as g/kg dry matter intake (DMI), fecal P output increased (p<0.05) linearly with increasing P input. On the basis of g/kg fecal dry matter (DM), fecal P output was lowest for Diet 4 and highest (p<0.05) for Diet 5. The apparent digestibility of crude protein (CP) did not differ (p>0.05) among the five diets, with the average nitrogen output of 12.14 g/d and nitrogen retention of 66% to 74% (p>0.05), which suggested that there was no interaction between dietary P and CP protein levels. During the 28-d experimental period of Experiment 2, the average daily gain (ADG) of pigs was affected by dietary TDP levels as described by Eq. (1): $y=-809,532x^4+788,079x^3-276,250x^2+42,114x-1,759$; ($R^2=0.99$; p<0.01; y = ADG, g/d; x = dietary TDP, %), F/G for pigs by Eq. (2): $y=3,651.1x^4-3,480.4x^3+1,183.8x^2-172.5x+10.9$ ($R^2=0.99$; p<0.01; y = F/G; x = dietary TDP, %), and Total P concentrations in serum by Eq. (3): $y=-3,311.7x^4+3,342.7x^3-1,224.6x^2+195.6x-8.7$ (R2 = 0.99; p<0.01; y = total serum P concentration and x = dietary TDP, %). The highest ADG (782 g/d), the lowest F/G (1.07) and the highest total serum P concentration (3.1 mmol/L) were obtained when dietary TDP level was 0.34%. Collectively, these results indicate that the optimal TDP requirement of growing pigs is 0.34% of the diet at a total Ca to TDP ratio of 2:1.

Seroepidemiology of helminthic diseases in Yanbian of the People's Republic of China (중국 연변지역 주요 기생충질환에 대한 혈청역학적 조사)

  • Joo, Kyoung-Hwan;Quan, Fu Shi;Kwon, Hye-Soo;Cho, Sung-Weon;Li, Shun Yu
    • Journal of agricultural medicine and community health
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    • v.23 no.2
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    • pp.275-285
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    • 1998
  • Antibody responses(IgG) to Paragonimus westermani. Clonorchis sinensis, Cysticercus cellulosae, Sparganum Anisakis simplex, Toxocara canis and Trichinella spiralis were studied. The ELISA technique was performed to determine the prevalence of above helminthic diseases. 975 cases obtained from Yanbian of China during October, 1995 to July, 1997 were examined with a positive antibody titer of 5.74% in clonorchiasis, 4.92% in paragonimiasis, 1.54% in cysticercosis. 8.51% in sparganosis, 1.85% in anisakiosis, 12.51% in toxocariasis, and 7.08% in trichinosis respectively. And 23.87% in showed positive antibody titer at least one of the seven helminths. The differences of the age and sex in the positive sera were analysed by the Chi-squared test and the level of significance accepted was p<0.05. The significant differences in positive antibody production were P.W.(p<0.01). C.S.(p<0.01), A.S.(p<0.05). T.C.(p<0.001), and T.S.(p<0.01) respectively in age groups. sparganosis(p<0.05) in sex groups. Other parasites showed that there were no significant differences among age groups and sex groups(males and females). Higher positive antibody rate of C.S. and P.W. occured in the 50-59 years old and those of T.C. and T.S. happened in the 20-29 years old. Patients of internal disease showed more positive antibody titer, that is to say, there was significant difference between positive rate of internal diseases and that of control (p<0.01. p<0.05) in 6 helminths except cysticercosis. The result showed that some cross reactions existed among nematodes, and the developed techniques(EITB) should be done for a correct diagnosis. Also the prevalence of some important helminths may be evaluated from the result and it would be a basic data for controlling parasitic diseases in Yanbian.

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