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Hörnsten, Rolf
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Publications (10 of 24) Show all publications
Wiklund, U., Kadkhodaee, A., Andersson, K., Suhr, O. B. & Hörnsten, R. (2018). Normal scores of deep breathing tests: beware of dysrhythmia in transthyretin amyloidosis. Amyloid: Journal of Protein Folding Disorders, 25(1), 54-61
Open this publication in new window or tab >>Normal scores of deep breathing tests: beware of dysrhythmia in transthyretin amyloidosis
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2018 (English)In: Amyloid: Journal of Protein Folding Disorders, ISSN 1350-6129, E-ISSN 1744-2818, Vol. 25, no 1, p. 54-61Article in journal (Refereed) Published
Abstract [en]

Background: The heart rate (HR) response to paced deep breathing (DB) is a common test of cardiac autonomic function, where high heart rate variability (HRV) is considered to reflect normal autonomic function. We evaluated the DB test in patients with hereditary transthyretin amyloid (ATTRm) amyloidosis, where autonomic dysregulation and atrial arrhythmias are common.Methods: Paced DB was performed during one minute (six breaths/min) in 165 recordings in adult ATTRm amyloidosis patients with the TTR Val30Met mutation, 42 hypertrophic cardiomyopathy (HCM) patients and 211 healthy subjects. HRV was scored by traditional DB indices and by a novel regularity index, estimating the fraction of the HRV that was coherent with the breathing pattern.Results: Twenty per cent of ATTRm amyloidosis patients presented with age-adjusted HRV scores within normal limits but poor regularity due to subtle atrial arrhythmias and cardiac conduction disturbances. Forty-seven per cent of ATTRm amyloidosis patients presented with HRV scores below normal limits, whereas HCM patients presented with higher HRV than ATTRm amyloidosis patients.Conclusions: Reduced HRV is common in ATTRm amyloidosis patients during DB, however, autonomic function cannot be evaluated in patients presenting with the combination of normal scores and low regularity, since their HR responses often reflects dysrhythmias.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2018
Keywords
HRV, heart rate variability, amyloidosis hereditary, transthyretin, autonomic function
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-146594 (URN)10.1080/13506129.2018.1434140 (DOI)000428570300008 ()29394116 (PubMedID)
Available from: 2018-05-08 Created: 2018-05-08 Last updated: 2019-05-22Bibliographically approved
Henein, M. Y., Suhr, O. B., Arvidsson, S., Pilebro, B., Westermark, P., Hörnsten, R. & Lindqvist, P. (2018). Reduced left atrial myocardial deformation irrespective of cavity size: a potential cause for atrial arrhythmia in hereditary transthyretin amyloidosis. Amyloid: Journal of Protein Folding Disorders, 25(1), 46-53
Open this publication in new window or tab >>Reduced left atrial myocardial deformation irrespective of cavity size: a potential cause for atrial arrhythmia in hereditary transthyretin amyloidosis
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2018 (English)In: Amyloid: Journal of Protein Folding Disorders, ISSN 1350-6129, E-ISSN 1744-2818, Vol. 25, no 1, p. 46-53Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cardiac amyloidosis (CA) is a myocardial disease and commonly under-diagnosed condition. In CA patients, atrial fibrillation might occur in the absence of left atrial (LA) enlargement.

OBJECTIVES: The aim of this study is to assess LA size and function, and its relationship with atrial arrhythmia in patients with hereditary transthyretin amyloidosis (ATTR).

METHODS: Forty-six patients with confirmed ATTR amyloidosis on abdominal biopsy were studied. Assessment with 2D echocardiography and 2D strain showed 31 patients had increased LV wall thickness (LVWT) (septal thickness >12 mm), and 15 had normal LVWT. In addition to conventional measurements, LV and LA global longitudinal strain (GLS%) and strain rate (SR) were obtained. Western blot analysis was done to assess fibril type. ATTR patients with increased LVWT were compared with 23 patients with hypertrophic cardiomyopathy (HCM) and 31 healthy controls. ATTR amyloidosis patients also underwent 24 hour Holter monitoring to determine the presence of atrial arrhythmia.

RESULTS: Atrial deformation during atrial systole was reduced in ATTR amyloidosis patients with increased LVWT independent of LA size and in contrast to HCM. Twenty of the ATTR amyloidosis patients (54%) had ECG evidence of significant atrial arrhythmic events. LA strain rate, during atrial systole, was the only independent predictor of atrial arrhythmia (β = 3.28, p = .012).

CONCLUSION: In ATTR cardiomyopathy with increased LVWT, LA myocardial function is abnormal, irrespective of atrial cavity size. Reduced LA myocardial SR during atrial systole, irrespective of cavity volume, E/e' and LV deformation, is also a strong predictor for atrial arrhythmic events.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Arrhythmia, Holter ECG, deformation echocardiography, left atrial function
National Category
Other Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-145431 (URN)10.1080/13506129.2018.1430027 (DOI)000428570300007 ()29369708 (PubMedID)
Available from: 2018-03-05 Created: 2018-03-05 Last updated: 2019-05-17Bibliographically approved
Hendrikx, T., Sundqvist, M., Sandström, H., Sahlin, C., Rohani, M., Al-Khalili, F., . . . Franklin, K. A. (2017). Atrial fibrillation among patients under investigation for suspected obstructive sleep apnea. PLoS ONE, 12(2), Article ID e0171575.
Open this publication in new window or tab >>Atrial fibrillation among patients under investigation for suspected obstructive sleep apnea
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2017 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 2, article id e0171575Article in journal (Refereed) Published
Abstract [en]

STUDY OBJECTIVES: Obstructive sleep apnea is common among patients with atrial fibrillation, but the prevalence and risk factors for atrial fibrillation among patients who are being investigated on suspicion of sleep apnea are not well known. The aim of the study was to estimate the prevalence of atrial fibrillation among patients investigated for suspected obstructive sleep apnea and to identify risk factors for atrial fibrillation among them.

METHODS: The prevalence of atrial fibrillation was investigated among 201 patients referred for suspected obstructive sleep apnea. Patients without known atrial fibrillation were investigated with a standard 12-lead ECG at hospital and short intermittent handheld ECG recordings at home, during 14 days.

RESULTS: Atrial fibrillation occurred in 13 of 201 subjects (6.5%), and in 12 of 61 men aged 60 years and older (20%). The prevalence of atrial fibrillation increased with sleep apnea severity (p = 0.038). All patients with atrial fibrillation were men and all had sleep apnea. Age 60 or older, the occurrence of central sleep apnea and diabetes mellitus were independent risk factors for atrial fibrillation after adjustments for body mass index, gender, sleep apnea and cardiovascular disease.

CONCLUSIONS: Atrial fibrillation is common among subjects referred for sleep apnea investigation and the prevalence of atrial fibrillation increases with sleep apnea severity. Independent risk factors for atrial fibrillation among patients investigated for suspected obstructive sleep apnea include the occurrence of coexisting central sleep apnea, age 60 years or older and diabetes mellitus.

National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-131353 (URN)10.1371/journal.pone.0171575 (DOI)000393712500051 ()28178304 (PubMedID)
Available from: 2017-02-13 Created: 2017-02-13 Last updated: 2018-06-09Bibliographically approved
Hendrikx, T., Rosenqvist, M., Sandström, H., Persson, M. & Hörnsten, R. (2015). Identifiering av paroxysmala, kortvariga arytmier: intermittent registrering mer effektiv än 24-timmars Holter-EKG. Läkartidningen, 112(1-2), Article ID C6SE.
Open this publication in new window or tab >>Identifiering av paroxysmala, kortvariga arytmier: intermittent registrering mer effektiv än 24-timmars Holter-EKG
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2015 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 1-2, article id C6SEArticle in journal (Refereed) Published
Abstract [en]

Many patients suffer from palpitations or dizziness/presyncope. These patients are often referred for Holter ECG (24 hour), although the sensitivity for detecting arrhythmias is low. A new method, short intermittent regular and symptomatic ECG registrations at home, might be a convenient and more sensitive alternative also suitable for primary health care. In this case report we present a patient who had contacted health care several times during a seven year period for paroxysmal palpitations. Routine examination with 24 hour Holter ECG and event recorder did not result in a diagnosis. Using intermittent handheld ECG registration at home, a paroxysmal supraventricular arrhythmia was diagnosed. Further investigation revealed that the patient had a concealed Wolff-Parkinson-White (WPW) syndrome.

Place, publisher, year, edition, pages
Stockholm: Sveriges läkarförbund, 2015
National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-118044 (URN)25584602 (PubMedID)
Available from: 2016-03-10 Created: 2016-03-10 Last updated: 2018-06-07Bibliographically approved
Alenius Dahlqvist, J., Karlsson, M., Wiklund, U., Hörnsten, R. & Rydberg, A. (2014). Handheld ECG in analysis of arrhythmia and heart rate variability in children with Fontan circulation. Journal of Electrocardiology, 47(3), 374-382
Open this publication in new window or tab >>Handheld ECG in analysis of arrhythmia and heart rate variability in children with Fontan circulation
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2014 (English)In: Journal of Electrocardiology, ISSN 0022-0736, E-ISSN 1532-8430, Vol. 47, no 3, p. 374-382Article in journal (Refereed) Published
Abstract [en]

Background: Our aim was to evaluate the intermittent use of a handheld ECG system for detecting silent arrhythmias and cardiac autonomic dysfunction in children with univentricular hearts. Methods: Twenty-seven patients performed intermittent ECG recordings with handheld devices during a 14-day period. A manual arrhythmia analysis was performed. We analyzed heart rate variability (HRV) using scatter plots of all interbeat intervals (Poincare plots) from the total observation period. Reference values of HRV indices were determined from Holter-ECGs in 41 healthy children. Results: One asymptomatic patient had frequent ventricular extra systoles. Another patient had episodes with supraventricular tachycardia (with concomitant palpitations). Seven patients showed reduced HRV. Conclusions: Asymptomatic arrhythmia was detected in one patient. The proposed method for pooling of intermittent recordings from handheld or similar devices may be used for detection of arrhythmias as well as for cardiac autonomic dysfunction.

Keywords
Handheld ECG, Arrhythmia, Heart rate variability, Fontan circulation
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-90080 (URN)10.1016/j.jelectrocard.2014.02.006 (DOI)000335712700018 ()
Available from: 2014-06-23 Created: 2014-06-17 Last updated: 2019-02-25Bibliographically approved
Hendrikx, T., Rosenqvist, M., Wester, P., Sandström, H. & Hörnsten, R. (2014). Intermittent short ECG recording is more effective than 24-hour Holter ECG in detection of arrhythmias. BMC Cardiovascular Disorders, 14, 41
Open this publication in new window or tab >>Intermittent short ECG recording is more effective than 24-hour Holter ECG in detection of arrhythmias
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2014 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 14, p. 41-Article in journal (Refereed) Published
Abstract [en]

Background: Many patients report symptoms of palpitations or dizziness/presyncope. These patients are often referred for 24-hour Holter ECG, although the sensitivity for detecting relevant arrhythmias is comparatively low. Intermittent short ECG recording over a longer time period might be a convenient and more sensitive alternative. The objective of this study is to compare the efficacy of 24-hour Holter ECG with intermittent short ECG recording over four weeks to detect relevant arrhythmias in patients with palpitations or dizziness/presyncope.

Methods:

Design: prospective, observational, cross-sectional study. Setting: Clinical Physiology, University Hospital. Patients: 108 consecutive patients referred for ambiguous palpitations or dizziness/presyncope.

Interventions: All individuals underwent a 24-hour Holter ECG and additionally registered 30-second handheld ECG (Zenicor EKG ((R)) thumb) recordings at home, twice daily and when having cardiac symptoms, during 28 days.

Main outcome measures: Significant arrhythmias: atrial fibrillation (AF), paroxysmal supraventricular tachycardia (PSVT), atrioventricular (AV) block II-III, sinus arrest (SA), wide complex tachycardia (WCT).

Results: 95 patients, 42 men and 53 women with a mean age of 54.1 years, completed registrations. Analysis of Holter registrations showed atrial fibrillation (AF) in two patients and atrioventricular (AV) block II in one patient (= 3.2% relevant arrhythmias [95% CI 1.1-8.9]). Intermittent handheld ECG detected nine patients with AF, three with paroxysmal supraventricular tachycardia (PSVT) and one with AV-block-II (= 13.7% relevant arrhythmias [95% CI 8.2-22.0]). There was a significant difference between the two methods in favour of intermittent ECG with regard to the ability to detect relevant arrhythmias (P = 0.0094). With Holter ECG, no symptoms were registered during any of the detected arrhythmias. With intermittent ECG, symptoms were registered during half of the arrhythmia episodes.

Conclusions: Intermittent short ECG recording during four weeks is more effective in detecting AF and PSVT in patients with ambiguous symptoms arousing suspicions of arrhythmia than 24-hour Holter ECG.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keywords
Arrhythmias, Atrial fibrillation, Electrocardiography, Holter ECG, Intermittent ECG
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-88955 (URN)10.1186/1471-2261-14-41 (DOI)000334546200001 ()
Available from: 2014-05-23 Created: 2014-05-19 Last updated: 2018-06-07Bibliographically approved
Hendrikx, T., Hörnsten, R., Rosenqvist, M. & Sandström, H. (2013). Screening for atrial fibrillation with baseline and intermittent ECG recording in an out-of-hospital population. BMC Cardiovascular Disorders, 13, 41, Article ID 41.
Open this publication in new window or tab >>Screening for atrial fibrillation with baseline and intermittent ECG recording in an out-of-hospital population
2013 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 13, p. 41-, article id 41Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: the objective of this study is to investigate the detection rate of undiagnosed atrial fibrillation (AF) with short intermittent ECG recordings during four weeks among out-of-hospital patients, having at least one additional risk factor (CHADS2) for stroke.

METHOD: Design: Cross-sectional study. Setting: Eight family practice centres and two hospital-based out-patient clinics in Sweden. Subjects: 989 out-of-hospital patients, without known AF, having one or more risk factors associated with stroke (CHADS2). Interventions: All individuals were asked to perform 10-second handheld ECG recordings during 28 days, twice daily and when having palpitations. Main outcome measures: Episodes of AF on handheld ECG recordings were defined as irregular supraventricular extrasystoles in series with a duration of 10 seconds.

RESULTS: 928 patients completed registration. AF was found in 35 of 928 patients; 3.8% (95% confidence interval [CI] 2.7--5.2). These 35 patients had a mean age of 70.7 years (SD +/- 7.7; range 53--85) and a median CHADS2 of 2 (range 1--4).

CONCLUSIONS: Intermittent handheld ECG recording over a four week period had a detection rate of 3.8% newly diagnosed AF, in a population of 928 out-of-hospital patients having at least one additional risk factor for stroke. Intermittent handheld ECG registration is a feasible method to detect AF in patients with an increased risk of stroke in whom oral anticoagulation (OAC) treatment is indicated.

Place, publisher, year, edition, pages
London: BioMed Central, 2013
Keywords
Arrhythmia, Atrial fibrillation, Handheld ECG, Stroke prevention, Screening
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-73635 (URN)10.1186/1471-2261-13-41 (DOI)000320401000001 ()
Available from: 2013-06-25 Created: 2013-06-25 Last updated: 2018-06-08Bibliographically approved
Hörnsten, R., Suhr, O. B., Olofsson, B.-O. & Wiklund, U. (2012). Arrhythmia - a pitfall in tests of cardiac autonomic function after liver transplantation for familial amyloidotic polyneuropathy: a long-term follow-up of Swedish patients. Amyloid: Journal of Protein Folding Disorders, 19(2), 81-86
Open this publication in new window or tab >>Arrhythmia - a pitfall in tests of cardiac autonomic function after liver transplantation for familial amyloidotic polyneuropathy: a long-term follow-up of Swedish patients
2012 (English)In: Amyloid: Journal of Protein Folding Disorders, ISSN 1350-6129, E-ISSN 1744-2818, Vol. 19, no 2, p. 81-86Article in journal (Refereed) Published
Abstract [en]

Liver transplantation (LT) is a potentially curative treatment for hereditary transthyretin amyloidosis, of which familial amyloid polyneuropathy (FAP) is the most common form in Sweden. This study investigated the long-term development in heart rate variability (HRV) after LT in Swedish FAP patients. HRV was analyzed before LT, and during a first (<40 months) and a second (>40 months) follow-up recording after transplantation, respectively. Power spectrum analysis was performed on 2-min sequences in the supine position and after passive tilt, after careful identification of patients with arrhythmia. Data were obtained from 33 patients, but 18 patients had developed cardiac arrhythmia or were pacemaker-treated (4 before LT and 14 after LT) and three patients had not performed the first follow-up recording. In the remaining 12 patients, HRV decreased between the pretransplant evaluation and the first follow-up, thereafter no significant changes were found. In conclusion, our study showed that the progressive development of cardiac arrhythmias after LT is a major pitfall when assessing cardiac autonomic function in FAP patients, especially in patients older than 40 years. In the minority of patients with sinus rhythm in all recordings, cardiac autonomic modulation remained stable after transplantation and no improvement was noted.

Place, publisher, year, edition, pages
London: Informa Healthcare, 2012
Keywords
Amyloid, amyloidosis, FAP, heart rate variability, HRV, transthyretin
National Category
Cell and Molecular Biology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-56685 (URN)10.3109/13506129.2012.674073 (DOI)000304521800004 ()
Available from: 2012-06-26 Created: 2012-06-25 Last updated: 2018-06-08Bibliographically approved
Karlsson, M., Hörnsten, R., Rydberg, A. & Wiklund, U. (2012). Automatic filtering of outliers in RR intervals before analysis of heart rate variability in Holter recordings: a comparison with carefully edited data.. Biomedical engineering online, 11(2), 12
Open this publication in new window or tab >>Automatic filtering of outliers in RR intervals before analysis of heart rate variability in Holter recordings: a comparison with carefully edited data.
2012 (English)In: Biomedical engineering online, ISSN 1475-925X, E-ISSN 1475-925X, Vol. 11, no 2, p. 12-Article in journal (Refereed) Published
Abstract [en]

Background: Undetected arrhythmic beats seriously affect the power spectrum of the heart rate variability (HRV). Therefore, the series of RR intervals are normally carefully edited before HRV is analysed, but this is a time consuming procedure when 24-hours recordings are analysed. Alternatively, different methods can be used for automatic removal of arrhythmic beats and artefacts. This study compared common frequency domain indices of HRV when determined from manually edited and automatically filtered RR intervals.

Methods and Results: Twenty-four hours Holter recordings were available from 140 healthy subjects of age 1-75 years. An experienced technician carefully edited all recordings. Automatic filtering was performed using a recursive procedure where RR intervals were removed if they differed from the mean of the surrounding RR intervals with more than a predetermined limit (ranging from 10% to 50%). The filtering algorithm was evaluated by replacing 1% of the beats with synthesised ectopic beats. Power spectral analysis was performed before and after filtering of both the original edited data and the noisy data set. The results from the analysis using the noisy data were used to define an age-based filtering threshold. The age-based filtration was evaluated with completely unedited data, generated by removing all annotations from the series of RR intervals, and then comparing the resulting HRV indices with those obtained using edited data. The results showed equivalent results after age-based filtration of both the edited and unedited data sets, where the differences in HRV indices obtained by different preprocessing methods were small compared to the mean values within each age group.

Conclusions: The study showed that it might not be necessary to perform the time-consuming careful editing of all detected heartbeats before HRV is analysed in Holter recordings.

In most subjects, it is sufficient to perform the regular editing needed for valid arrhythmia analyses, and then remove undetected ectopic beats and artefacts by age-based filtration of the series of RR intervals, particularly in subjects older than 30 years.

National Category
Biomedical Laboratory Science/Technology
Identifiers
urn:nbn:se:umu:diva-51790 (URN)10.1186/1475-925X-11-2 (DOI)22236441 (PubMedID)
Available from: 2012-02-02 Created: 2012-02-02 Last updated: 2018-06-08Bibliographically approved
Wixner, J., Karling, P., Rydh, A., Hornsten, R., Wiklund, U., Anan, I. & Suhr, O. B. (2012). Gastric emptying in hereditary transthyretin amyloidosis: the impact of autonomic neuropathy. Neurogastroenterology and Motility, 24(12), 1111-e568
Open this publication in new window or tab >>Gastric emptying in hereditary transthyretin amyloidosis: the impact of autonomic neuropathy
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2012 (English)In: Neurogastroenterology and Motility, ISSN 1350-1925, E-ISSN 1365-2982, Vol. 24, no 12, p. 1111-e568Article in journal (Refereed) Published
Abstract [en]

Background: Gastrointestinal (GI) complications are common in hereditary transthyretin amyloidosis and an autonomic dysfunction has been considered to explain these symptoms. The aim of this study was to investigate the impact of autonomic neuropathy on gastric emptying in hereditary transthyretin amyloidosis and to relate these findings to nutritional status, GI symptoms, gender, and age at disease onset.

Methods: Gastric emptying was evaluated with gastric emptying scintigraphy. Spectral analysis of the heart rate variability and cardiovascular responses after tilt test were used to assess the autonomic function. The nutritional status was evaluated with the modified body mass index (s-albumine x BMI).

Key Results: Gastric retention was found in about one-third of the patients. A weak correlation was found between the scintigraphic gastric emptying rate and both the sympathetic (rs = -0.397, P < 0.001) and parasympathetic function (rs = -0.282, P = 0.002). The gastric emptying rate was slower in those with lower or both upper and lower GI symptoms compared with those without symptoms (median T50 123 vs 113 min, P = 0.042 and 192 vs 113 min, P = 0.003, respectively). Multiple logistic regression analysis showed that age of onset (OR 0.10, CI 0.020.52) and sympathetic dysfunction (OR 0.23, CI 0.100.51), but not gender (OR 0.76, CI 0.311.84) and parasympathetic dysfunction (OR 1.81, CI 0.724.56), contributed to gastric retention.

Conclusions and Inferences: Gastric retention is common in hereditary transthyretin amyloidosis early after onset. Autonomic neuropathy only weakly correlates with gastric retention and therefore additional factors must be involved.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2012
Keywords
amyloidosis, autonomic nervous system disorders, gastric emptying, hereditary, nutrition status, transthyretin
National Category
Gastroenterology and Hepatology Neurosciences
Identifiers
urn:nbn:se:umu:diva-63020 (URN)10.1111/j.1365-2982.2012.01991.x (DOI)000311565300014 ()
Available from: 2012-12-28 Created: 2012-12-27 Last updated: 2018-06-08Bibliographically approved
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