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Nilsson, C., Sperker, W., Schien, C., Isaksson, M. & Stegmayr, B. (2019). A surgical girdle postoperatively may prevent pain and tunnel infections of peritoneal dialysis patients. International Journal of Artificial Organs
Open this publication in new window or tab >>A surgical girdle postoperatively may prevent pain and tunnel infections of peritoneal dialysis patients
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2019 (English)In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040Article in journal (Refereed) Epub ahead of print
Abstract [en]

Aim: When performing acute onset dialysis after insertion of catheters for peritoneal dialysis, pain exists and tunnel infections may develop. This study investigated whether patients benefit from the use of a surgical girdle and specific dressing postoperatively to prevent pain and tunnel infections.

Materials and Methods: In 85 consecutive patients, the development of tunnel infections was followed. The patients used a surgical girdle when they were in supine position from day 1 to day 3. The peritoneal dialysis catheter was fixed in a curvature avoiding stretch in the exit. A total of 53 patients participated in a retrospective questionnaire to evaluate abdominal pain within the first 3 days after surgery either with or without girdle. A visual analogue scale from 0 to 10 was used.

Results: In 23 patients, data on pain both with and without the girdle could be recorded. Pain was relieved more when using the girdle versus no girdle (median day 1 3.0 vs 4.0, p < 0.001, n = 30, Wilcoxon paired). The development of tunnel infections during the latest 7-year period (exposure period 1487 months) showed a total of three episodes (one every 495 months) of which one caused a subsequent peritonitis, while the other two resolved after antibiotic therapy. Peritonitis episodes appeared at a mean of 37-month interval.

Conclusion: The use a surgical girdle for 3 days postoperatively and a fixation of the peritoneal dialysis catheter in a curved loop relieves the pain and results in few tunnel infections and subsequent episodes of peritonitis.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Peritoneal dialysis, insertion technique, wound healing, leakage
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-165106 (URN)10.1177/0391398819882439 (DOI)000492623700001 ()31648577 (PubMedID)
Available from: 2019-11-13 Created: 2019-11-13 Last updated: 2019-11-13
Forsberg, U., Jonsson, P. & Stegmayr, B. (2019). Air contamination during medical treatment results in deposits of microemboli in the lungs: an autopsy study. International Journal of Artificial Organs, 42(9), 477-481
Open this publication in new window or tab >>Air contamination during medical treatment results in deposits of microemboli in the lungs: an autopsy study
2019 (English)In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040, Vol. 42, no 9, p. 477-481Article in journal (Refereed) Published
Abstract [en]

Introduction: Microbubbles of air may enter into patients during conventional hemodialysis, infusions of fluids, or by injections. The aim of this study was to investigate whether the air that enters the patient during hemodialysis can be detected in the lungs after death, and if so, whether this may be related to tissue damage. Methods: The material consisted of lung tissue from five chronic hemodialysis patients who died either during (two) or after hemodialysis (range 10 min from start until 3333 min after the last hemodialysis session); as reference group tissue was taken from seven patients who died due to amyotrophic lateral sclerosis. The lung tissue was investigated by microscopy after autopsy using a fluorescein-marked polyclonal antibody against fibrinogen as a marker for clots preformed before death. Results: All five hemodialysis patients had microbubbles of air in the lung tissue, whereas two of seven amyotrophic lateral sclerosis patients had such findings (Fisher's test p = 0.0278, relative risk = 3.5, confidence interval: 1.08-11.3). There were more microbubbles of air/10 randomly investigated microscopic fields of tissue in the hemodialysis patients than the amyotrophic lateral sclerosis patients (Student's test, p < 0.05). All hemodialysis patients had a medium graded extent of pulmonary fibrosis that was not found in any of the ALS patients. The microbubbles of air were surrounded by fibrin as a sign of development of clots around the air bubbles while the patients were still alive. Conclusion: Exposure to microbubbles of air during various treatments such as hemodialysis may result in microemboli. Future studies should clarify whether microbubbles of air contribute to tissue scarring. We suggest preventive measures against the exposure to microbubbles of air during especially repeated exposures such as hemodialysis.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Microbubbles, microemboli, hemodialysis, pulmonary fibrosis, air bubbles
National Category
Biomedical Laboratory Science/Technology Other Clinical Medicine
Identifiers
urn:nbn:se:umu:diva-162833 (URN)10.1177/0391398819840363 (DOI)000480759400001 ()30973284 (PubMedID)
Available from: 2019-09-13 Created: 2019-09-13 Last updated: 2019-09-13Bibliographically approved
Vollmer, T., Ljungberg, B., Jankowski, V., Jankowski, J., Glorieux, G. & Stegmayr, B. (2019). An in-vitro assay using human spermatozoa to detect toxicity of biologically active substances. Scientific Reports, 9, Article ID 14525.
Open this publication in new window or tab >>An in-vitro assay using human spermatozoa to detect toxicity of biologically active substances
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2019 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 14525Article in journal (Refereed) Published
Abstract [en]

Identifying the key toxic players within an in-vivo toxic syndrome is crucial to develop targeted therapies. Here, we established a novel method that characterizes the effect of single substances by means of an ex-vivo incubation set-up. We found that primary human spermatozoa elicit a distinct motile response on a (uremic) toxic milieu. Specifically, this approach describes the influence of a bulk toxic environment (uremia) as well as single substances (uremic toxins) by real-time analyzing motile cellular behavior. We established the human spermatozoa-based toxicity testing (HSTT) for detecting single substance-induced toxicity to be used as a screening tool to identify in-vivo toxins. Further, we propose an application of the HSTT as a method of clinical use to evaluate toxin-removing interventions (hemodialysis).

National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-165676 (URN)10.1038/s41598-019-50929-z (DOI)000489555200037 ()31601841 (PubMedID)
Available from: 2019-12-06 Created: 2019-12-06 Last updated: 2019-12-06Bibliographically approved
Hadimeri, U., Wärme, A., Nasic, S., Fransson, S.-G., Wigelius, A. & Stegmayr, B. (2019). Angiography and phlebography in a hemodialysis population: A retrospective analysis of interventional results. International Journal of Artificial Organs
Open this publication in new window or tab >>Angiography and phlebography in a hemodialysis population: A retrospective analysis of interventional results
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2019 (English)In: International Journal of Artificial Organs, ISSN 0391-3988, E-ISSN 1724-6040Article in journal (Refereed) Epub ahead of print
Abstract [en]

Objective: To clarify the reasons and beneficial effects and duration of arteriovenous fistula patency after radiological interventions in arteriovenous fistula. The patients investigated were referred due to arteriovenous fistula access flow problems.

Material and methods: In 174 patients, 522 radiological investigations and endovascular treatments such as percutaneous transluminal angioplasty were analyzed, retrospectively. All investigations were performed due to clinical suspicion of impaired arteriovenous fistula function.

Results: Arterial stenosis was significantly more frequent among patients with diabetic nephropathy (p < 0.001) and interstitial nephritis (p < 0.001). According to the venous stenosis, the diagnosis did not affect the frequency (p = 0.22) or the degree (p = 0.39) of stenosis. The degree of stenosis prior to percutaneous transluminal angioplasty correlated significantly with the degree of remaining stenosis after intervention (p < 0.001). Of the 174 patients, 123 (71%) performed a total of 318 investigations including percutaneous transluminal angioplasty. Repeated percutaneous transluminal angioplasty was performed significantly more often in patients with diabetic nephropathy. The median times to the first percutaneous transluminal angioplasty and to the subsequent percutaneous transluminal angioplasties were 9.5 and 5 months, respectively. Arteriovenous fistula in patients with diabetic nephropathy performed similar to most other diagnoses, although performing more percutaneous transluminal angioplasty/patient than most other diagnoses.

Conclusion: Many patients could maintain long-term patency of arteriovenous fistula, including those with diabetic nephropathy, with repeated interventions; this motivates a closer follow-up for these patients. Clinically significant stenosis should be dilated as meticulously and as soon as possible. Occlusions of the arteriovenous fistula in most instances can be successfully thrombolyzed or dilated upon early diagnosis.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Arteriovenous fistula, angiography, hemodialysis, percutaneous transluminal angioplasty, fistulography, phlebography
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-161902 (URN)10.1177/0391398819863429 (DOI)000476206500001 ()31303134 (PubMedID)2-s2.0-85069887785 (Scopus ID)
Available from: 2019-08-08 Created: 2019-08-08 Last updated: 2019-08-08
Wärme, A., Hadimeri, U., Hadimeri, H., Nasic, S. & Stegmayr, B. (2019). High doses of erythropoietin stimulating agents may be a risk factor for AV-fistula stenosis. Clinical hemorheology and microcirculation, 71(1), 53-57
Open this publication in new window or tab >>High doses of erythropoietin stimulating agents may be a risk factor for AV-fistula stenosis
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2019 (English)In: Clinical hemorheology and microcirculation, ISSN 1386-0291, E-ISSN 1875-8622, Vol. 71, no 1, p. 53-57Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A native AV-fistula (AVF) for access in hemodialysis (HD) is preferable. Stenosis, a major hurdle, is associated with older age and diabetes mellitus. PURPOSE: This case-control study aimed to clarify if any medical and/or laboratory factors, that can be altered, could be associated to AVF stenosis.

METHODS: 33 patients with a patent AVF without need of intervention during a two year period (Controls) were matched by diagnosis and age with 33 patients (Cases), that had at least one radiological invasive examination/intervention due to suspected AVF malfunction (case-control mode 2:1).

RESULTS: Cases had higher weekly doses of Erythropoietin-Stimulating Agent (ESA) than Controls both before intervention (mean 8312 +/- 7119 U/w versus 4348 +/- 3790, p = 0.005) and after the intervention (7656 +/- 6795, versus 4477 +/- 3895, p = 0.018). Before intervention serum phosphate was higher in Cases while there was no significant difference in blood hemoglobin, weekly standard Kt/V, parathyroid hormone, calcium, albumin, C-reactive protein, smoking habits, BMI or other medication.

CONCLUSION: Higher doses of ESA were administered in patients with AVF stenosis. Since ESA may cause local hypertrophic effects on the vascular endothelium, we should prescribe lower doses of ESA in patients at risk. Further studies should clarify such connection.

Place, publisher, year, edition, pages
IOS Press, 2019
Keywords
Arterio-venous fistula, hemodialysis, erythropoietin, stenosis, uremia
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-158771 (URN)10.3233/CH-180381 (DOI)000463644100007 ()29914013 (PubMedID)
Available from: 2019-05-08 Created: 2019-05-08 Last updated: 2019-05-08Bibliographically approved
Ramsauer, B., Graaff, R., Sikole, A., Trajceska, L., Lundström, S., Arsov, S., . . . Stegmayr, B. (2019). Skin Autofluorescence, a Measure of Cumulative Metabolic Stress and Advanced Glycation End Products, Decreases During the Summer in Dialysis Patients. Artificial Organs, 43(2), 173-180
Open this publication in new window or tab >>Skin Autofluorescence, a Measure of Cumulative Metabolic Stress and Advanced Glycation End Products, Decreases During the Summer in Dialysis Patients
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2019 (English)In: Artificial Organs, ISSN 0160-564X, E-ISSN 1525-1594, Vol. 43, no 2, p. 173-180Article in journal (Refereed) Published
Abstract [en]

Tissue advanced glycation end products (AGEs) are a measure of cumulative metabolic and oxidative stress and cytokine-driven inflammatory reactions. AGEs are thought to contribute to the cardiovascular complications of hemodialysis (HD) patients. Skin autofluorescence (SAF) is related to the tissue accumulation of AGEs and rises with age. SAF is one of the strongest prognostic markers of mortality in these patients. The content of AGEs is high in barbecue food. Due to the location in northern Sweden, there is a short intense barbecue season between June and August. The aim of this study was to investigate if seasonal variations in SAF exist in HD patients, especially during the barbecue season. SAF was measured noninvasively with an AGE Reader in 34 HD-patients (15 of those with diabetes mellitus, DM). Each time the median of three measures were used. Skin-AF was measured before and after each one HD at the end of February and May in 31 patients (22 men/9 women); the end of May and August in 28 (20 m/8 w); the end of August and March in 25 (19 m/6 w). Paired statistical analyses were performed during all four periods (n = 23, 17 m/6 w); as was HbA1c of those with DM. There was at a median 5.6% increase in skin-AF during the winter period (February-May, P = 0.004) and a 10.6% decrease in the skin-AF during the summer (May-August, P < 0.001). HbA1c in the DM rose during the summer (P = 0.013). In conclusion, skin-AF decreased significantly during the summer. Future studies should look for favorable factors that prevent skin-AF and subsequently cardiovascular diseases.

Place, publisher, year, edition, pages
Wiley Periodicals, Inc., 2019
Keywords
Skin autofluorescence, Hemodialysis, Seasonal variations, Advanced glycation end products
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-157223 (URN)10.1111/aor.13320 (DOI)000459167900010 ()30229953 (PubMedID)
Available from: 2019-03-22 Created: 2019-03-22 Last updated: 2019-03-22Bibliographically approved
Skagerlind, M. & Stegmayr, B. (2018). An evaluation of four modes of low-dose anticoagulation during intermittent haemodialysis. European Journal of Clinical Pharmacology, 74(3), 267-274
Open this publication in new window or tab >>An evaluation of four modes of low-dose anticoagulation during intermittent haemodialysis
2018 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 74, no 3, p. 267-274Article in journal (Refereed) Published
Abstract [en]

Intensive care participants that need dialysis frequently suffer from increased risk of bleeding. Standard intermittent haemodialysis (SHD) includes anticoagulation to avoid clotting of the dialysis system. The aim of this study was to clarify which of four different low-dose anticoagulant modes was preferable in reducing the exposure to i.v. unfractionated heparin (heparin) and maintaining patency of the dialysis circuit. Twenty-three patients on SHD were included to perform haemodialysis with four modes of low-dose anticoagulation. For comparative analyses, patients served as their own control. Haemodialysis with a single bolus of tinzaparin at the start was compared to haemodialysis initiated without i.v. heparin but priming with (1) heparin in saline (H), (2) heparin and albumin in saline (HA), (3) heparin and albumin in combination with a citrate-containing dialysate (HAC), (4) saline and usinga heparin-coated filters (EvodialA (R)). The priming fluid was discarded before dialysis started. Blood samples were collected at 0, 30 and 180 min during haemodialysis. Smaller bolus doses of heparin (500 Units/dose) were allowed during the modes to avoid interruption by clotting. The mean activated partial thromboplastin (APTT) time as well as the doses of anticoagulation administered was highest with SHD and least with HAC and EvodialA (R). Mode H versus SHD had the highest rate of prematurely interrupted dialyses (33%, p = 0.008). The urea reduction rate was less with EvodialA (R) vs. SHD (p < 0.01). One hypersensitivity reaction occurred with EvodialA (R). Changes in blood cell concentrations and triglycerides differed between the modes. If intermittent haemodialysis is necessary in patients at risk of bleeding, anticoagulation using HAC and EvodialA (R) appeared most preferable with least administration of heparin, lowest APTT increase and lowest risk for prematurely clotted dialyzers in contrast to the least plausible H mode.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Haemodialysis, Haemorrhage, Priming, Anticoagulation
National Category
Hematology Pharmacology and Toxicology Nursing
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-132227 (URN)10.1007/s00228-017-2389-x (DOI)000424708300002 ()29198062 (PubMedID)
Note

Originally included in thesis in manuscript form with title "An evaluation of four modes of low-dose anticoagulation during haemodialysis".

Available from: 2017-03-07 Created: 2017-03-07 Last updated: 2019-08-15Bibliographically approved
Duranton, F., Palma, A., Stegmayr, B., Wauthier, M., Torres, A. & Argilés, A. (2018). Blood Pressure Seasonality in Hemodialysis Patients from Five European Cities of Different Latitudes. Kidney and Blood Pressure Research, 43(5), 1529-1538
Open this publication in new window or tab >>Blood Pressure Seasonality in Hemodialysis Patients from Five European Cities of Different Latitudes
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2018 (English)In: Kidney and Blood Pressure Research, ISSN 1420-4096, E-ISSN 1423-0143, Vol. 43, no 5, p. 1529-1538Article in journal (Refereed) Published
Abstract [en]

Background/Aims: Climate influences the regulation of blood pressure (BP). Our objective was to precisely estimate BP seasonality in hemodialysis (HD) patients from five European cities with marked climate differences. Methods: Stable prevalent HD patients from 5 European facilities (Santa Cruz de Tenerife (Spain), Seville (Spain), Montpellier (France), Ottignies (Belgium), Umea (Sweden)) present over the years 1995-1999 were included in this historical longitudinal observational study. Individual monthly averages of pre-dialysis BP level were computed from all facility BP measurements (>90 000 observations). The association between BP level and location, seasons and meteorological measurements was analyzed by mixed models. Results: 261 patients were included and followed-up for a median duration of 2 years (6903 monthly observations). Pre-dialysis SBP and DBP were minimal in summer (July) and maximal in winter (November and December), and mean changes were respectively 4.2 [3.0;5.4] and 2.0 [1.3;2.7] mmHg. Seasonality was confirmed in 4 locations (P-season <= 0.0010.001 for SBP and DBP), but not in Umea (both P-season >0.05). Seasonal changes in DBP were larger in southern locations (P-interaction =0.02). BP level was associated with climate parameters: in a positive manner with humidity or rainfall, and inversely with sunshine duration or temperature. The effects of temperature and rainfall on DBP varied with latitude (P-interaction <0.02) and were greater in southern locations. Conclusion: BP varies with seasons and climate in different European areas and seasonality can be more important in southern locations. These changes in BP deserve attention as they may be responsible for a significant increase in cardiovascular risk which may be preventable.

Place, publisher, year, edition, pages
S. Karger, 2018
Keywords
Chronic renal failure, Blood pressure, Weather, Geography, Chronic hemodialysis
National Category
Urology and Nephrology Physiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-156349 (URN)10.1159/000494019 (DOI)000456656400011 ()30286451 (PubMedID)
Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-02-12Bibliographically approved
Peters, B., Hadimeri, H., Mölne, J., Nasic, S., Jensen, G. & Stegmayr, B. (2018). Desmopressin (Octostim®) before a native kidney biopsy can reduce the risk for biopsy complications in patients with impaired renal function: a pilot study. Nephrology (Carlton. Print), 23(4), 366-370
Open this publication in new window or tab >>Desmopressin (Octostim®) before a native kidney biopsy can reduce the risk for biopsy complications in patients with impaired renal function: a pilot study
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2018 (English)In: Nephrology (Carlton. Print), ISSN 1320-5358, E-ISSN 1440-1797, Vol. 23, no 4, p. 366-370Article in journal (Refereed) Published
Abstract [en]

AIM: To evaluate if the administration of desmopressin alters the risk for renal biopsy complications.

METHODS: A multicenter registry containing 576 native kidney biopsies (NKb) with a serum creatinine above 150 µmol/L in 527 patients (372 men and 155 women, median age 61 years) was used. Most of the data were prospective. At one of the hospitals all biopsies with creatinine above 150 µmol/L received desmopressin before biopsies (NKb 204). These were compared to outcome of biopsy complications against other centres where desmopressin was not given (NKb 372). Fisher's exact test, χ2 analyses, univariate and multiple binary logistic regression were used. Data were given as Odds Ratio (OR) and Confidence Interval (CI). A two sided p-value of <0.05 was considered significant.

RESULTS: In NKb with creatinine >150 µmol/L, those with desmopressin had less overall (3.4% versus 8.4%, OR 0.39, CI 0.17-0.90) whereas major or minor complications were not different. While desmopressin did not exhibit difference in complications in men, women received less major (0% versus 8.6%, p = 0.03) and overall complications (0% versus 12.1%, p = 0.006). A multiple logistic regression revealed that, after adjusting for BMI, age and sex, prophylaxis with desmopressin showed less major (OR 0.38, CI 0.15-0.96) and overall complications (OR 0.36, CI 0.15-0.85).

CONCLUSION: Desmopressin given before a native kidney biopsy in patients with impaired renal function can reduce the risk for complications.

Keywords
desmopressin, kidney biopsy, renal biopsy, biopsy complications
National Category
Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-131383 (URN)10.1111/nep.13004 (DOI)000427015500010 ()28107603 (PubMedID)
Available from: 2017-02-13 Created: 2017-02-13 Last updated: 2019-05-21Bibliographically approved
Toss, F., Edgren, G., Berlin, G., Stegmayr, B. & Witt, V. (2018). Does prophylactic calcium in apheresis cause more harm than good?: Centre heterogeneity within the World Apheresis Association Register prevents firm conclusions. Vox Sanguinis, 113(7), 632-638
Open this publication in new window or tab >>Does prophylactic calcium in apheresis cause more harm than good?: Centre heterogeneity within the World Apheresis Association Register prevents firm conclusions
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2018 (English)In: Vox Sanguinis, ISSN 0042-9007, E-ISSN 1423-0410, Vol. 113, no 7, p. 632-638Article in journal (Refereed) Published
Abstract [en]

Background and objectives: Symptomatic hypocalcaemia is common during apheresis procedures based on citrate‐based anticoagulants. As a consequence, patients often receive prophylactic calcium treatment. However, a recent publication based on the World Apheresis Association (WAA) register suggested harmful effects of such prophylactic calcium use. Recognizing possible limitations in the previous WAA register analyses, we critically re‐evaluate the data, to test whether a change in prophylactic calcium usage may be warranted.

Materials and methods: Using the WAA register, we reanalysed previous data by means of centre and treatment type stratification, to explore the role of prophylactic calcium as a risk factor for adverse events.

Results: There was large variability in adverse event rates dependent on the centre performing the apheresis procedure and dependent on the type of procedure. When this variability was accounted for, there was no clear effect of calcium administration on risk of adverse effects.

Conclusion: Shortcomings in the previous WAA register analyses may have failed to account for important confounding factors resulting in a substantial overestimation of the risk attributable to calcium usage. Overall our findings do not support a negative effect of prophylactic calcium administration in the apheresis setting.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
blood component removal, plasmapheresis, plasma exchange, cytapheresis, adverse events, calcium
National Category
Hematology
Identifiers
urn:nbn:se:umu:diva-153132 (URN)10.1111/vox.12698 (DOI)000447492200003 ()30079964 (PubMedID)
Available from: 2018-11-09 Created: 2018-11-09 Last updated: 2018-11-09Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-2694-7035

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