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Lundberg, Owe
Publications (10 of 11) Show all publications
Rosenmuller, M. H., Ornberg, M. T., Myrnäs, T., Lundberg, O., Nilsson, E. & Haapamäki, M. M. (2013). Expertise-based randomized clinical trial of laparoscopic versus small-incision open cholecystectomy. British Journal of Surgery, 100(7), 886-894
Open this publication in new window or tab >>Expertise-based randomized clinical trial of laparoscopic versus small-incision open cholecystectomy
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2013 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 100, no 7, p. 886-894Article in journal (Refereed) Published
Abstract [en]

Background: Several randomized clinical trials have compared laparoscopic cholecystectomy (LC) and small-incision open cholecystectomy (SIOC). Most have had wide exclusion criteria and none was expertise-based. The aim of this expertise-based randomized trial was to compare healthcare costs, quality of life (QoL), pain and clinical outcomes after LC and SIOC. Methods: Patients scheduled for cholecystectomy were randomized to treatment by one of two teams of surgeons with a preference for either LC or SIOC. Each team performed their specific method (SIOC or LC) as a first-choice operation, but converted to open cholecystectomy and common bile duct exploration when necessary. Intraoperative cholangiography was carried out routinely. The intention was to include all patients undergoing cholecystectomy, including emergency operations and procedures involving surgical training for residents. Results: Some 74.9 per cent of all patients undergoing cholecystectomy were included. Of 355 patients randomized, 333 were analysed. Self-estimated QoL scores in 258 patients, analysed by the area under the curve method, were significantly lower in the SIOC group at 1 month after surgery: median 2326 (95 per cent confidence interval 2187 to 2391) compared with 2411 (2334 to 2502) for the LC group (P = 0.030). The mean(s.d.) duration of operation was shorter for SIOC: 97(41) versus 120(48) min (P < 0.001). There were no significant differences between the groups in conversion rate, pain, complications, length of hospital stay or readmissions. Conclusion: SIOC had comparable surgical results but slightly worse short-term QoL compared with LC. Registration number: NCT00370344 (http://www.clinicaltrials.gov).

National Category
Surgery
Identifiers
urn:nbn:se:umu:diva-72693 (URN)10.1002/bjs.9133 (DOI)000318373000006 ()
Available from: 2013-06-11 Created: 2013-06-10 Last updated: 2018-06-08Bibliographically approved
Haapamäki, M. M., Pihlgren, V., Lundberg, O., Sandzén, B. & Rutegård, J. (2011). Physical performance and quality of life after extended abdominoperineal excision of rectum and reconstruction of the pelvic floor with gluteus maximus flap. Diseases of the Colon & Rectum, 54(1), 101-106
Open this publication in new window or tab >>Physical performance and quality of life after extended abdominoperineal excision of rectum and reconstruction of the pelvic floor with gluteus maximus flap
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2011 (English)In: Diseases of the Colon & Rectum, ISSN 0012-3706, E-ISSN 1530-0358, Vol. 54, no 1, p. 101-106Article in journal (Refereed) Published
Abstract [en]

The oncological outcome of the operation was acceptable, but functional drawbacks must be considered preoperatively in counseling the patient. More research is needed to find ways to preserve better function and well-being.

Keywords
Colorectal surgery; Reconstructive surgery; Physical fitness; Rectal cancer; Anal cancer
National Category
Gastroenterology and Hepatology Surgery
Identifiers
urn:nbn:se:umu:diva-41183 (URN)10.1007/DCR.0b013e3181fce26e (DOI)21160320 (PubMedID)
Available from: 2011-03-18 Created: 2011-03-18 Last updated: 2018-06-08Bibliographically approved
Buunen, M., Veldkamp, R., Hop, W. C., Kuhry, E., Jeekel, J., Haglind, E., . . . Lundberg, O. (2009). Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial.. The Lancet Oncology, 10(1), 44-52
Open this publication in new window or tab >>Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial.
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2009 (English)In: The Lancet Oncology, ISSN 1470-2045, E-ISSN 1474-5488, Vol. 10, no 1, p. 44-52Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Laparoscopic surgery for colon cancer has been proven safe, but debate continues over whether the available long-term survival data justify implementation of laparoscopic techniques in surgery for colon cancer. The aim of the COlon cancer Laparoscopic or Open Resection (COLOR) trial was to compare 3-year disease-free survival and overall survival after laparoscopic and open resection of solitary colon cancer. METHODS: Between March 7, 1997, and March 6, 2003, patients recruited from 29 European hospitals with a solitary cancer of the right or left colon and a body-mass index up to 30 kg/m(2) were randomly assigned to either laparoscopic or open surgery as curative treatment in this non-inferiority randomised trial. Disease-free survival at 3 years after surgery was the primary outcome, with a prespecified non-inferiority boundary at 7% difference between groups. Secondary outcomes were short-term morbidity and mortality, number of positive resection margins, local recurrence, port-site or wound-site recurrence, and blood loss during surgery. Neither patients nor health-care providers were blinded to patient groupings. Analysis was by intention-to-treat. This trial is registered with ClinicalTrials.gov, number NCT00387842. FINDINGS: During the recruitment period, 1248 patients were randomly assigned to either open surgery (n=621) or laparoscopic surgery (n=627). 172 were excluded after randomisation, mainly because of the presence of distant metastases or benign disease, leaving 1076 patients eligible for analysis (542 assigned open surgery and 534 assigned laparoscopic surgery). Median follow-up was 53 months (range 0.03-60). Positive resection margins, number of lymph nodes removed, and morbidity and mortality were similar in both groups. The combined 3-year disease-free survival for all stages was 74.2% (95% CI 70.4-78.0) in the laparoscopic group and 76.2% (72.6-79.8) in the open-surgery group (p=0.70 by log-rank test); the difference in disease-free survival after 3 years was 2.0% (95% CI -3.2 to 7.2). The hazard ratio (HR) for disease-free survival (open vs laparoscopic surgery) was 0.92 (95% CI 0.74-1.15). The combined 3-year overall survival for all stages was 81.8% (78.4-85.1) in the laparoscopic group and 84.2% (81.1-87.3) in the open-surgery group (p=0.45 by log-rank test); the difference in overall survival after 3 years was 2.4% (95% CI -2.1 to 7.0; HR 0.95 [0.74-1.22]). INTERPRETATION: Our trial could not rule out a difference in disease-free survival at 3 years in favour of open colectomy because the upper limit of the 95% CI for the difference just exceeded the predetermined non-inferiority boundary of 7%. However, the difference in disease-free survival between groups was small and, we believe, clinically acceptable, justifying the implementation of laparoscopic surgery into daily practice. Further studies should address whether laparoscopic surgery is superior to open surgery in this setting.

National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-23264 (URN)10.1016/S1470-2045(08)70310-3 (DOI)19071061 (PubMedID)
Available from: 2009-06-08 Created: 2009-06-08 Last updated: 2018-06-08Bibliographically approved
Lundberg, O. & Kristoffersson, A. (2005). Reduction of abdominal wall blood flow by clamping or carbon dioxide insufflation increases tumor growth in the abdominal wall: an experimental study in rats.. Surgical Endoscopy, 19(5), 720-723
Open this publication in new window or tab >>Reduction of abdominal wall blood flow by clamping or carbon dioxide insufflation increases tumor growth in the abdominal wall: an experimental study in rats.
2005 (English)In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 19, no 5, p. 720-723Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: We have previously demonstrated that there is a reduction of blood flow in the abdominal wall in rats insufflated with air concomitant with an increase in tumor growth. The present study was designed to examine whether a reduction of blood flow achieved by clamping or insufflation with carbon dioxide (CO(2)) would increase tumor growth in the abdominal wall. METHODS: In the first part of the experiments, laser Doppler blood flow of both rectus muscles was measured in 16 Wistar Fu rats. The left rectus muscle was clamped to reduce blood flow, and 5 x 10(4) adenocarcinoma cells were injected into both rectus muscles. Clamping was maintained for 45 min. In the second part, 22 rats had 5 x 10(4) adenocarcinoma cells injected into the rectus muscle and blood flow was measured. The experimental group (n = 11) was insufflated with CO(2) at 10 mmHg for 45 min; the control group (n = 11) was not insufflated. After 9 days, tumor weight and volume were analyzed. RESULTS: Clamping caused a 69% reduction of blood flow (p < 0.001), whereas no reduction was registered on the nonclamped side. Tumor weight (p = 0.028) and volume (p = 0.030) were increased on the clamped side. The insufflation of CO(2) caused a 71% reduction of blood flow, whereas no reduction was registered in the control group. Tumor weight (p = 0.006) and volume (p = 0.006) were increased in the insufflated group. CONCLUSION: Clamping, as well as CO(2) insufflation, causes a significant reduction of blood flow in the abdominal wall, which seems to increase tumor growth at the same site.

Keywords
Abdominal Neoplasms/*pathology, Abdominal Wall/*blood supply, Adenocarcinoma/*pathology, Animals, Carbon Dioxide/administration & dosage/*adverse effects, Constriction, Disease Progression, Injections; Intramuscular, Insufflation/adverse effects, Ischemia/*etiology, Laser-Doppler Flowmetry, Neoplasm Transplantation, Pneumoperitoneum; Artificial/*adverse effects, Pressure, Random Allocation, Rats, Rats; Inbred WF, Rectus Abdominis/*blood supply, Single-Blind Method, Tumor Burden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-6039 (URN)10.1007/s00464-004-9061-0 (DOI)15798898 (PubMedID)
Available from: 2007-12-05 Created: 2007-12-05 Last updated: 2018-06-09Bibliographically approved
Lundberg, O. (2004). Laparoscopy and tumour growth: a clinical and experimental study. (Doctoral dissertation).
Open this publication in new window or tab >>Laparoscopy and tumour growth: a clinical and experimental study
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims: Laparoscopic technique was quickly adopted in general surgery because of less pain, quicker recovery and shorter hospital stay. In the 1990´s several reports on port site metastases restrained the enthusiasm to use laparoscopic surgery in malignant diseases. The numerous reports on port site metastases initiated a debate whether laparoscopic surgery would increase the risk of tumour spread and growth. Personal experience of two patients who devloped port site metastases from an incidental gall bladder cancer (GBC) after laparoscopic cholecystectomy (LC), encouraged us to study the incidence of wound metastases from GBC after laparoscopic and open cholecystectomy (OC). Experimentally we examined whether pneumoperitoneum would increase the risk of tumour development. Several studies had demonstrated that minimally invasive procedures exert a less negative influence on the immune system and may have beneficial effects for cancer patients. We wanted to compare the long term survival after OC and LC and if the occurence of port site metastases had any impact on survival.

Material and methods: A questionnaire was sent out to all major hospitals in Sweden requesting information obout the number of port site metastases encountered 1991-94. Data on all pateints with verfied GBC were obtained from the Swedish Oncological Centres. Data on all patients with GBC registered with surgical codes for cholecystectomy were collected from the National Board of Health and Welfare (EpC). The patient files were scrutinized and long term survival data was achieved (EpC). In the first experiment on Wistar Fu rats, adenocarcinoma cells were injected intraperitoneally in animals insufflated with air, CO2 and not insufflated controls. In the following studies, rats were similarly insufflated with air,CO2 and compared to not insufflated controls. Laser Doppler blood flow in the abdominal wall was concomitantly measured. To study the effect of reduced blood flow, one rectus muscle was clamped and the other not and laser Doppler Blood flow was measured in both rectus muscles. Adenocarcinoma cells were injected into the rectus muscles in all animals at the induction of pneumoperitoneum/clamping.

Results: 14 of 55 patients developed wound metastases from GBC after LC and 12 of 187 after OC. Gallbladder perforation was overrepresented in patients with wound metastases. Improved survival was noted after LC in patients with T3 tumours. Experimentally, air and CO2 equally increased intraperitoneal tumour development, Insufflation with air,CO2 and clamping decreased blood flow in the abdominal wall and increased tumour growth at the same site.

Conclusion: Despite a high rate of wound metastases, LC does not seem to worsen the prognosis of GBC and may even have a positive effect on survival. Perforation of the malignant gallbladder seems to be associated with an increased risk of metastatic formation. In the experimental setting, pneumoperitoneum seems to increase tumour development. Other features of laparoscopic surgery such as decreased blood flow in the abdominal wall may contribute to increased risk of tumour progress.

Publisher
p. 138
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 889
Keywords
Surgery, laparoscopy, tumour growth, metastases, gallbladder cancer, pneumoperitoneum, blood flow, Kirurgi
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:umu:diva-227 (URN)91-7305-613-8 (ISBN)
Public defence
2004-05-14, sal B, 9 tr, Tandläkarhögskolan, Umeå Universitetssjukhus, Umeå, 13:00
Opponent
Supervisors
Available from: 2004-04-08 Created: 2004-04-08 Last updated: 2018-06-09Bibliographically approved
Lundberg, O. & Kristoffersson, A. (2004). Pneumoperitoneum impairs blood flow and augments tumor growth in the abdominal wall.. Surgical Endoscopy, 18(2), 293-296
Open this publication in new window or tab >>Pneumoperitoneum impairs blood flow and augments tumor growth in the abdominal wall.
2004 (English)In: Surgical Endoscopy, ISSN 0930-2794, E-ISSN 1432-2218, Vol. 18, no 2, p. 293-296Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Despite several clinical and experimental studies, the mechanisms behind the development of port site metastases in laparoscopic surgery have remained largely unknown. The current study was designed to investigate the effect of pneumoperitoneum on blood flow in the abdominal wall and its possible effects on tumor growth at this site. METHODS: A total of 40 Wistar Fu rats had a laser Doppler probe placed on their left rectus muscle and a suspension of 50,000 adenocarcinoma cells was injected into their right rectus muscle. The experimental group (n = 20) was insufflated with air at 10 mmHg for 45 min while abdominal blood flow was registered before and during insufflation and after exsufflation. The control group (n = 20) was not insufflated but the blood flow was recorded in the same manner. After 9 days, all animals were killed and the occurrence of tumor was observed. The tumors were analyzed with respect to weight and volume. RESULTS: The insufflation caused an 82% reduction in blood flow in the experimental group (p < 0.001). No reduction in blood flow was registered in the control group. Tumor nodules developed significantly more often in the insufflated group (20/20) compared to the controls (14/20) (p = 0.016). Tumor weight (p = 0.003) and volume (p < 0.001) were significantly increased in the insufflated group. CONCLUSIONS: Pneumoperitoneum seems to enhance tumor growth. It also causes a significant reduction in blood flow in the abdominal wall, which may contribute to the increased susceptibility of tumor take.

Keywords
Adenocarcinoma/*secondary, Air, Animals, Cell Line; Tumor, Humans, Injections; Intramuscular, Intraoperative Complications/*etiology, Ischemia/*etiology, Laser-Doppler Flowmetry, Neoplasm Seeding, Neoplasm Transplantation, Pneumoperitoneum; Artificial/*adverse effects, Rats, Rats; Inbred WF, Rectus Abdominis/*blood supply/pathology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-6004 (URN)10.1007/s00464-003-9035-7 (DOI)14691694 (PubMedID)
Available from: 2007-12-04 Created: 2007-12-04 Last updated: 2018-06-09Bibliographically approved
Lundberg, O. & Kristoffersson, A. (2000). Wound recurrences from gallbladder cancer after open cholecystectomy. Surgery, 127(3), 296-300
Open this publication in new window or tab >>Wound recurrences from gallbladder cancer after open cholecystectomy
2000 (English)In: Surgery, ISSN 0039-6060, E-ISSN 1532-7361, Vol. 127, no 3, p. 296-300Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Reports of port site recurrences from gallbladder cancer after laparoscopic cholecystectomy have raised considerable concern as to whether the laparoscopic technique implies an increased risk of metastatic disease. In a previous study of gallbladder cancer and laparoscopic cholecystectomy, we reported a frequency of 16% port site metastases. The purpose of the present study was to determine the frequency of wound metastases from gallbladder cancer after open cholecystectomy. METHODS: The registers from the Swedish Oncological Centers and the National Board of Health and Welfare were checked for reported cases of gallbladder cancer and surgical classification codes for open cholecystectomy from 1991 to 1994. The study included all 8 university and 24 county hospitals in Sweden. The files from all patients with gallbladder cancer who had an open cholecystectomy were retrospectively reviewed. RESULTS: The study included 270 patients who had a cholecystectomy, of which 215 were classified as open and 55 as laparoscopic. Of the 215 patients, 11 patients were excluded because of an incorrect or deficient histopathologic or surgical classification. In 186 patients (91%), sufficient data were obtained for follow-up. Twelve patients (6.5%) had wound metastases from their gallbladder cancer. All patients with wound metastases died with a median survival of 10 months (range, 3 to 65 months). CONCLUSIONS: Wound metastases from gallbladder cancer after open cholecystectomy may be more common than previously assumed.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-3854 (URN)10.1067/msy.2000.104487 (DOI)10715985 (PubMedID)
Available from: 2004-04-08 Created: 2004-04-08 Last updated: 2018-06-09Bibliographically approved
Lundberg, O. & Kristoffersson, A. (1999). Port site metastases from gallbladder cancer after laparoscopic cholecystectomy.: Results of a Swedish survey and review of published reports.. European Journal of Surgery, 165(3), 215-222
Open this publication in new window or tab >>Port site metastases from gallbladder cancer after laparoscopic cholecystectomy.: Results of a Swedish survey and review of published reports.
1999 (English)In: European Journal of Surgery, ISSN 1102-4151, E-ISSN 1741-9271, Vol. 165, no 3, p. 215-222Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate the incidence of port site metastases from unsuspected gallbladder cancer after laparoscopic cholecystectomy. DESIGN: Retrospective national multicentre study, 1991-94. SETTING: All 8 university and 24 central hospital, Sweden. SUBJECTS AND INTERVENTIONS: All 32 hospitals were interviewed by means of a written questionnaire. The registers of all Swedish Oncological Centres and the registers of the National Board of Health and Welfare were checked for reported cases of gallbladder cancer and surgical classification codes for cholecystectomy. To detect laparoscopic interventions incorrectly registered as open operations, all cholecystectomies registered as open were matched against the Swedish Registry of Laparoscopic Cholecystectomy for the years 1991-93 and all patients records for 1994 were scrutinised. RESULTS: Replies were obtained from 30/32 clinics (94%) and 11976 laparoscopic cholecystectomies were done. Of 447 patients with verified gallbladder carcinoma 270 had their gallbladders removed, 55 (20%) laparoscopically. 9 of these (16%) developed port site metastases and 6 died from their disease at a median of 18 months (range 5-22). Two patients are alive, 54 and 45 months after cholecystectomy. One patient has been lost to follow-up. CONCLUSIONS: Port site metastases from gallbladder cancer may be more common than previously thought. A laparoscopic procedure should not be done if cancer of the gallbladder is suspected.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-3853 (URN)10.1080/110241599750007072 (DOI)10231654 (PubMedID)
Available from: 2004-04-08 Created: 2004-04-08 Last updated: 2018-06-09Bibliographically approved
Lundberg, O. & Kristoffersson, A. (1998). Effect of pneumoperitoneum induced by carbon dioxide and air on tumor load in a rat model.. World Journal of Surgery, 22(5), 470-472
Open this publication in new window or tab >>Effect of pneumoperitoneum induced by carbon dioxide and air on tumor load in a rat model.
1998 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 22, no 5, p. 470-472Article in journal (Refereed) Published
Abstract [en]

Laparoscopic surgery for malignant disease is highly controversial mainly due to the large number of abdominal wall metastases being reported. Previous experimental studies have particularly studied CO2 pneumoperitoneum and its effect on tumor development. The purpose of this study was to compare CO2- and air-induced pneumoperitoneum with regard to intraperitoneal tumor growth. Altogether 39 rats were injected intraperitoneally with 10(5) colonic tumor cells and randomly allocated into three groups: 13 rats had a pneumoperitoneum created with CO2, 13 with air, and 13 served as controls. Tumor development was determined semiquantitatively by a peritoneal cancer index scale after 12 days. CO2 and air pneumoperitoneum equally increased intraperitoneal tumor growth compared to controls. Pneumoperitoneum induced by CO2 and air seems to increase tumor load, but the mechanisms are not established. This finding supports the hypothesis that insufflation not only by causing tumor cell movements but in fact pneumoperitoneum per se and the used gas are involved in the development of abdominal wall metastases after laparoscopic surgery.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-3856 (URN)10.1007/s002689900418 (DOI)9564290 (PubMedID)
Available from: 2004-04-08 Created: 2004-04-08 Last updated: 2018-06-09Bibliographically approved
Brorsson, C., Dahlqvist, P., Lundberg, O., Naredi, P. & Naredi, S. Liver resection is not associated with decreased cortisol levels..
Open this publication in new window or tab >>Liver resection is not associated with decreased cortisol levels.
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(English)Article in journal (Refereed) Submitted
Abstract [en]

Background: Adrenal hormones are synthesized from cholesterol, produced and stored in the liver. Liver failure has been reported to be associated with adrenal insufficiency. A possible mechanism could be a limited supply of substrate for cortisol synthesis. The aims of this study was to evaluate the occurrence of total serum cortisol <200 nmol/L after major liver resection (≥ 30%) and other major surgery (hemicolectomy) and to assess associations between cholesterol and corti­sol levels after liver resection.

Methods: Prospective, observational study. 40 patients were included (major liver resection n=15, hemicolectomy n=25). Serum and salivary cortisol were followed from morning before surgery up to five days postoperatively. Sulphated dehy­droepiandrosterone (DHEAS) and lipids (cholesterol, low density lipoproteins, high density lipoproteins and triglycerides) were obtained in liver resection patients.

Results: 8/25 (32%, hemicolectomy patients), and 3/15 (20%, liver resection patients) had serum cortisol <200 nmol/L. Neither hemicolectomy nor liver resec­tion was significantly associated with serum cortisol <200 nmol/L, p=0.49. Serum cortisol <200 nmol/L was not significantly associated with lipids below normal limits, (cholesterol; p=1.0 day 1, p=0.46 day 4, LDL; p=0.56 day 1, p=1.0 day 4, and HDL; p=0.27 day 1, p=1.0 day 4). Serum and salivary cortisol correlated sig­nificantly (rs=0.83, p<0.0001, hemicolectomy, rs=0.80, p<0.0001, liver resection).

Conclusion: Serum cortisol levels <200 nmol/L was found in 32% (hemicolec­tomy) and 20% (liver resection) postoperatively. Compared to after hemicolec­tomy, serum cortisol <200 nmol/L was not significantly more common after liver resection. Lipids below normal limits were not associated with serum cortisol <200 nmol/L after liver resection.

Key words: gastrointestinal surgical procedures, adrenal insufficiency, hydrocortisone

National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:umu:diva-92170 (URN)
Available from: 2014-08-22 Created: 2014-08-22 Last updated: 2018-06-07
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