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Sörelius, Karl
Publications (10 of 14) Show all publications
Sörelius, K., Wanhainen, A., Wahlgren, C.-M., Langenskiöld, M., Roos, H., Resch, T., . . . Mani, K. (2019). Nationwide Study on Treatment of Mycotic Thoracic Aortic Aneurysms. European Journal of Vascular and Endovascular Surgery, 57(2), 239-246
Open this publication in new window or tab >>Nationwide Study on Treatment of Mycotic Thoracic Aortic Aneurysms
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2019 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 2, p. 239-246Article in journal (Refereed) Published
Abstract [en]

Objective: Mycotic aortic aneurysms are rare, life threatening, and complex. This nationwide study aimed to assess outcome after repair of mycotic thoracic aortic aneurysms (MTAAs).

Methods: Patients treated in Sweden for MTAAs between 2000 and 2016 were identified in the Swedish vascular registry (2010-16) and local patient registries (2000-09). Primary outcome was survival, and secondary outcomes included surgical strategy, rate of infection related complications (IRC), and re-operations.

Results: Fifty-two patients (median age 71 +/- 8.1 years; 28 [54%] men, 13 [25%] ruptured) were identified (3.6% of all thoracic aortic aneurysm repairs in Sweden). Aneurysm location was aortic arch (n = 6; 11%), descending aorta (n = 42; 81%), and multiple locations (n = 4; 8%). Twenty-nine (56%) patients had positive cultures; the most prevalent agent was Staphylococcus aureus (n = 16; 31%). Operative techniques included thoracic endovascular aortic repair (TEVAR; n = 35 [67%]), fenestrated/branched TEVAR (n = 8; 15%), hybrid repair (n = 7; 14%), and open patch repair (n = 2; 4%). Survival was 92% (95% confidence interval [CI] 88-96) at 30 days, 88% (95% CI 84-93) at three months, 78% (73-84) at one year, and 71% (64-77) at five years. The mean follow up among survivors (> 90 days) was 45 months (range 4-216 months). Antibiotics were administered for a median of 15 weeks (range 0-220 weeks). IRCs occurred in nine patients (17%): sepsis (n = 3), graft infection (n = 3), recurrent mycotic aneurysm (n = 1), aorto-oesophageal/bronchial fistula (n = 2). Six (67%) IRCs were fatal; 80% occurred within the first year. Re-operations were performed in nine patients (17%).

Conclusions: TEVAR was often used as treatment for MTAAs, with acceptable short- and long-term survival when compared with open cohorts in the literature. IRCs are of concern and warrant follow up and long-term antibiotic treatment.

Place, publisher, year, edition, pages
W B SAUNDERS CO LTD, 2019
Keywords
Aneurysm, Aorta, Infected, Mycotic, Thoracic, Treatment
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-379269 (URN)10.1016/j.ejvs.2018.08.052 (DOI)000459894800012 ()30340857 (PubMedID)
Available from: 2019-03-18 Created: 2019-03-18 Last updated: 2019-03-18Bibliographically approved
Sörelius, K., Schiraldi, L., Giordano, S., Oranges, C. M., Raffoul, W. & Di Summa, P. G. (2019). Reconstructive Surgery of Inguinal Defects: A Systematic Literature Review of Surgical Etiology and Reconstructive Technique. In Vivo, 33(1), 1-9
Open this publication in new window or tab >>Reconstructive Surgery of Inguinal Defects: A Systematic Literature Review of Surgical Etiology and Reconstructive Technique
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2019 (English)In: In Vivo, ISSN 0258-851X, E-ISSN 1791-7549, Vol. 33, no 1, p. 1-9Article, review/survey (Refereed) Published
Abstract [en]

Background/Aim: This study aimed to evaluate the literature regarding surgical etiology demanding inguinal reconstructive surgery, associated reconstructive techniques and outcomes.

Materials and Methods: A systematic literature search was performed according to the PRISMA statement between 1996-2016.

Results: A total of 64 articles were included, comprising 816 patients. Two main subgroups of patients were identified: Oncological resections (n = 255, 31%), and vascular surgery (n = 538, 66%). Oncological resection inguinal defects were treated with pedicled myocutaneous flaps (n = 166, 65%), fasciocutaneous flaps (77, 31%), muscle flaps (7, 3%) and direct closure (3, 1%). Vascular surgery complications were treated with muscle flaps (n = 513, 95%). Complications for the respective subgroup (oncological resections, vascular surgery) were: infection (24%, 14%), seroma (34%, 7.5%), flap dehiscence/delayed healing (20.6%, 40.8%,). The total reintervention rate was 20%.

Conclusion: Reconstruction of inguinal defects should be addressed on a case-by-case basis. Myocutaneous flaps were favoured after oncological resections, while muscle flaps were preferred after vascular surgery.

Keywords
Oncological surgery, vascular surgery, inguinal defect, reconstructive surgery, complications, review
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-373910 (URN)10.21873/invivo.11431 (DOI)000454333900001 ()30587595 (PubMedID)
Note

Karl Sörelius and Luigi Schiraldi contributed equally to this study.

Available from: 2019-01-17 Created: 2019-01-17 Last updated: 2019-01-17Bibliographically approved
Sörelius, K. & di Summa, P. G. (2018). On the Diagnosis of Mycotic Aortic Aneurysms. Clinical Medicine Insights: Cardiology, 12
Open this publication in new window or tab >>On the Diagnosis of Mycotic Aortic Aneurysms
2018 (English)In: Clinical Medicine Insights: Cardiology, ISSN 1179-5468, E-ISSN 1179-5468, Vol. 12Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: There is striking paucity in consensus on the terminology, definition, and diagnostic criteria of mycotic aortic aneurysms. This literature study aims to elucidate this scientific omission, discuss its consequences, and present a proposition for reporting items on this disease.

METHODS: A systematic literature review on PubMed and Medline using mycotic and infected aortic aneurysms between 1850 and 2017 was performed. Articles were assessed according to a protocol regarding terminology, definition, and diagnostic criteria. Case series with less than 5 patients were excluded.

RESULTS: A total of 49 articles were included. The most prevalent term was mycotic aortic aneurysm but there was no widely accepted definition. Most modern publications used a diagnostic workup based on a combination on clinical presentation, laboratory results, imaging findings, and intraoperative findings. How these protean variables should be balanced was unclear. A proposition of reporting items was framed and consisted of definition of disease used, basis of diagnostic workup, exclusion criteria, patient characteristics, laboratory and imaging findings, aneurysm anatomy, details on treatment, pre/postoperative antibiotic treatment, and details on follow-up.

CONCLUSIONS: This article emphasizes the need to standardize definition, terminology, and diagnostic criteria for mycotic aortic aneurysms and proposes reporting items enhancing comparability between studies.

Place, publisher, year, edition, pages
SAGE PUBLICATIONS LTD, 2018
Keywords
Mycotic, aneurysm, infected, aorta, diagnosis, revised, terminology, criteria, reporting standards
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-349351 (URN)10.1177/1179546818759678 (DOI)000425618500001 ()29497343 (PubMedID)
Available from: 2018-04-27 Created: 2018-04-27 Last updated: 2018-04-27Bibliographically approved
Heinola, I., Sörelius, K., Wyss, T. R., Eldrup, N., Settembre, N., Setacci, C., . . . Venermo, M. (2018). Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 7(12), Article ID e008104.
Open this publication in new window or tab >>Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study
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2018 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 12, article id e008104Article in journal (Refereed) Published
Abstract [en]

Background-The treatment of mycotic abdominal aortic aneurysm requires surgery and antimicrobial therapy. Since prosthetic reconstructions carry a considerable risk of reinfection, biological grafts are noteworthy alternatives. The current study evaluated the durability, infection resistance, and midterm outcome of biological grafts in treatment of mycotic abdominal aortic aneurysm. Methods and Results-All patients treated with biological graft in 6 countries between 2006 and 2016 were included. Primary outcome measures were 30- and 90-day survival, treatment-related mortality, and reinfection rate. Secondary outcome measures were overall mortality and graft patency. Fifty-six patients (46 males) with median age of 69 years (range 35-85) were included. Sixteen patients were immunocompromised (29%), 24 (43%) had concomitant infection, and 12 (21%) presented with rupture. Bacterial culture was isolated from 43 (77%). In-situ aortic reconstruction was performed using autologous femoral veins in 30 patients (54%), xenopericardial tube-grafts in 12 (21%), cryopreserved arterial/venous allografts in 9 (16%), and fresh arterial allografts in 5 (9%) patients. During a median follow-up of 26 months (range 3 weeks-172 months) there were no reinfections and only 3 patients (5%) required assistance with graft patency. Thirty-day survival was 95% (n=53) and 90-day survival was 91% (n=51). Treatment-related mortality was 9% (n=5). Kaplan-Meier estimation of survival at 1 year was 83% (95% confidence interval, 73%-94%) and at 5 years was 71% (52%-89%). Conclusions-Mycotic abdominal aortic aneurysm repair with biological grafts is a durable option for patients fit for surgery presenting an excellent infection resistance and good overall survival.

Place, publisher, year, edition, pages
WILEY, 2018
Keywords
allograft, aneurysm, aorta, autologous vein, femoral vein, graft, in situ reconstruction, infection, vein
National Category
Cardiac and Cardiovascular Systems Surgery
Identifiers
urn:nbn:se:uu:diva-372905 (URN)10.1161/JAHA.117.008104 (DOI)000452696000008 ()29886419 (PubMedID)
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-01-11Bibliographically approved
Sörelius, K. (2018). Re: "Management of Atherosclerotic Carotid and Vertebral Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)" [Letter to the editor]. European Journal of Vascular and Endovascular Surgery, 55(1), 142-142
Open this publication in new window or tab >>Re: "Management of Atherosclerotic Carotid and Vertebral Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)"
2018 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 55, no 1, p. 142-142Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Saunders Elsevier, 2018
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-350663 (URN)10.1016/j.ejvs.2017.10.015 (DOI)000424147800012 ()29208349 (PubMedID)
Available from: 2018-05-15 Created: 2018-05-15 Last updated: 2018-05-15Bibliographically approved
Sörelius, K., Mani, K., Björck, M. & Wanhainen, A. (2017). Endovascular treatment of mycotic aortic aneurysms: a paradigm shift. Journal of Cardiovascular Surgery, 58(6), 870-874
Open this publication in new window or tab >>Endovascular treatment of mycotic aortic aneurysms: a paradigm shift
2017 (English)In: Journal of Cardiovascular Surgery, ISSN 0021-9509, E-ISSN 1827-191X, Vol. 58, no 6, p. 870-874Article, review/survey (Refereed) Published
Abstract [en]

Treatment of mycotic aortic aneurysms (MAAs) composes a particularly difficult challenge. Open repair has been considered the gold standard, despite lack of evidence supporting its superiority compared with the emerging alternative endovascular aortic repair (EVAR). This review discusses the pros and cons of EVAR for MAAs by dissecting the three largest publications on MAAs, and concludes that there has been a paradigm shift in treatment of MAAs for the benefit of EVAR.

National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-335156 (URN)10.23736/S0021-9509.17.10069-8 (DOI)000413016100009 ()28627863 (PubMedID)
Available from: 2017-12-01 Created: 2017-12-01 Last updated: 2018-03-29Bibliographically approved
Acosta, S., Seternes, A., Venermo, M., Vikatmaa, L., Sörelius, K., Wanhainen, A., . . . Björck, M. (2017). Open Abdomen Therapy with Vacuum and Mesh Mediated Fascial Traction After Aortic Repair: an International Multicentre Study. European Journal of Vascular and Endovascular Surgery, 54(6), 697-705
Open this publication in new window or tab >>Open Abdomen Therapy with Vacuum and Mesh Mediated Fascial Traction After Aortic Repair: an International Multicentre Study
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2017 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 54, no 6, p. 697-705Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:

Open abdomen therapy may be necessary to prevent or treat abdominal compartment syndrome (ACS). The aim of the study was to analyse the primary delayed fascial closure (PDFC) rate and complications after open abdomen therapy with vacuum and mesh mediated fascial traction (VACM) after aortic repair and to compare outcomes between those treated with open abdomen after primary versus secondary operation.

METHODS:

This was a retrospective cohort, multicentre study in Sweden, Finland, and Norway, including consecutive patients treated with open abdomen and VACM after aortic repair at six vascular centres in 2006-2015. The primary endpoint was PDFC rate.

RESULTS:

Among 191 patients, 155 were men. The median age was 71 years (IQR 66-76). Ruptured abdominal aortic aneurysm (RAAA) occurred in 69.1%. Endovascular/hybrid and open repairs were performed in 49 and 142 patients, respectively. The indications for open abdomen were inability to close the abdomen (62%) at primary operation and ACS (80%) at secondary operation. Duration of open abdomen was 11 days (IQR 7-16) in 157 patients alive at open abdomen termination. The PDFC rate was 91.8%. Open abdomen initiated at primary (N=103), compared with secondary operation (N=88), was associated with less severe initial open abdomen status (p=.006), less intestinal ischaemia (p=.002), shorter duration of open abdomen (p=.007), and less renal replacement therapy (RRT, p<.001). In hospital mortality was 39.3%, and after entero-atmospheric fistula (N=9) was 88.9%. Seven developed graft infection within 6 months, 1 year mortality was 28.6%. Intestinal ischaemia (OR 3.71, 95% CI 1.55-8.91), RRT (OR 3.62, 95% CI 1.72-7.65), and age (OR 1.12, 95% CI 1.06-1.12), were independent factors associated with in hospital mortality, but not open abdomen initiated at primary versus secondary operation.

CONCLUSIONS:

VACM was associated with a high PDFC rate after prolonged open abdomen therapy following aortic repair. Patient outcomes seemed better when open abdomen was initiated at primary, compared with secondary operation but a selection effect is possible.

Keywords
Aortic repair, Endovascular repair, Mesh mediated fascial traction, Open abdomen, Open repair, Vacuum assisted closure
National Category
Surgery
Identifiers
urn:nbn:se:uu:diva-335152 (URN)10.1016/j.ejvs.2017.09.002 (DOI)000419053800005 ()29033336 (PubMedID)
Available from: 2017-12-01 Created: 2017-12-01 Last updated: 2019-01-25Bibliographically approved
Sörelius, K. (2016). Aortic infections: The Nadir of Vascular Surgery. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
Open this publication in new window or tab >>Aortic infections: The Nadir of Vascular Surgery
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aortic infections are rare, life-threatening and constitute a major challenge in surgical management. This thesis aims to evaluate short – and long-term outcome of endovascular aortic repair (EVAR) for mycotic aortic aneurysms (MAA) and the subsequent risk of recurrent infections, changes in surgical practice over time for abdominal MAAs in Sweden and outcome for different treatment modalities, as well as the risk of secondary vascular infection after treatment with Open abdomen after aortic surgery.

Paper I, a retrospective single centre study of patients with MAA treated with EVAR, demonstrated a good short-term outcome, 91% survival at 30-days, and acceptable mid-term survival, 73% at 1-year.

Paper II, a retrospective international multicentre study of patients treated with EVAR for MAA, confirmed the results in paper I, and showed that EVAR is feasible and for most MAA patients a durable treatment option, 5-year survival was 55% and 10-year 41%. A total of 19% died from an infection-related complication, mostly during the first postoperative year. Non-Salmonella-positive culture was a predictor for late infection–related death.

Paper III, a population-based cohort study on all abdominal MAAs operated on between 1994-2014 in Sweden. Overall survival was 86% at 3-months, 79% at 1-year and 59% at 5-years. The survival was significantly better after endovascular compared to open repair up to 1-year without increasing recurrence of infection or reoperation, thereafter there was no difference. After 2001 EVAR constituted 60 % of all repairs, thus indicating a paradigm shift in treatment for abdominal MAAs in Sweden.

Paper IV, a prospective multicentre study of patients treated with open abdomen after aortic surgery. Infectious complications, such as graft infections, occurred after intestinal ischaemia and prolonged OA-treatment, and were often fatal.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2016. p. 77
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1249
Keywords
Mycotic, aortic, aneurysm, surgery, infection, endovascular repair, open abdomen
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-300954 (URN)978-91-554-9663-0 (ISBN)
Public defence
2016-10-22, Auditorium minus, Gustavianum, Akademigatan 3, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2016-09-23 Created: 2016-08-16 Last updated: 2016-10-11
Sörelius, K., Wanhainen, A., Furebring, M., Björck, M., Gillgren, P. & Mani, K. (2016). Nationwide Study of the Treatment of Mycotic Abdominal Aortic Aneurysms Comparing Open and Endovascular Repair. Circulation, 134(23), 1822-1832
Open this publication in new window or tab >>Nationwide Study of the Treatment of Mycotic Abdominal Aortic Aneurysms Comparing Open and Endovascular Repair
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2016 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 134, no 23, p. 1822-1832Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: -No reliable comparative data exist between open repair (OR) and endovascular repair (EVAR) for mycotic abdominal aortic aneurysms (MAAAs). This nationwide study assessed outcomes after OR and EVAR for MAAA in a population-based cohort.

METHODS: -All patients treated for MAAAs in Sweden between1994-2014 were identified in the Swedish vascular registry. The primary aim was to assess survival after MAAA with OR and EVAR. Secondary aims were analyses of the rate of recurrent infections and reoperations, and time-trends in surgical treatment. Survival was analyzed using Kaplan-Meier and log-rank test. A propensity score weighted correction for risk factor differences in the two groups was performed, including the operation year to account for differences in treatment and outcomes over time.

RESULTS: -132 patients were identified, (0.6% of all operated AAA in Sweden). Mean age was 70 years (SD 9.2), and 50 presented with rupture. Survival at 3-months was 86% (95% CI 80-92%), 1-year 79% (72-86%), and 5-years 59% (50-68%). The preferred operative technique shifted from OR to EVAR after 2001 (proportion EVAR 1994-2000 0%, 2001-2007 58%, 2008-2014 60%). Open repair was performed in 62 patients (47%); aortic resection and extra-anatomical bypass (n=7), in-situ reconstruction (n=50), patch plasty (n=3), and 2 patients died intraoperatively. EVAR was performed in 70 patients (53%); standard EVAR (n=55), fenestrated/branched EVAR (n=8), and visceral deviation with stent grafting (n=7); no deaths occurred intraoperatively. Survival at 3-months was lower for OR compared with EVAR (74% vs 96%, p<0.001), with a similar trend present at 1-year (73% vs 84%, p=0.054). A propensity score weighted risk-adjusted analysis confirmed the early better survival associated with EVAR. During median follow-up of 36 and 41 months for OR and EVAR, respectively, there was no difference in long-term survival (5-years 60 vs 58%, p=0.771), infection-related complications (18 vs 24%, p=0.439), or reoperation (21% vs 24%, p=0.650).

CONCLUSIONS: -This study demonstrates a paradigm shift in treatment of MAAA in Sweden, with EVAR being the preferred treatment modality. EVAR was associated with improved short-term survival compared with OR, without higher associated incidence of serious infection-related complications or reoperations.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-308345 (URN)10.1161/CIRCULATIONAHA.116.024021 (DOI)000390418100012 ()27799273 (PubMedID)
Available from: 2016-11-24 Created: 2016-11-24 Last updated: 2017-08-08Bibliographically approved
Sörelius, K., Mani, K., Björck, M., Sedivy, P., Wahlgren, C.-M., Taylor, P., . . . Wanhainen, A. (2014). Endovascular Treatment of Mycotic Aortic Aneurysms A European Multicenter Study. Circulation, 130(24), 2136-2142
Open this publication in new window or tab >>Endovascular Treatment of Mycotic Aortic Aneurysms A European Multicenter Study
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2014 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 130, no 24, p. 2136-2142Article in journal (Refereed) Published
Abstract [en]

Background-Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infection-related complications and long-term survival. Methods and Results-All EVAR treated MAAs, between 1999 and 2013 at 16 European centers, were retrospectively reviewed. One hundred twenty-three patients with 130 MAAs were identified. Mean age was 69 years (range 39-86), 87 (71%) were men, 58 (47%) had immunodeficiency, and 47 (38%) presented with rupture. Anatomic locations were ascending/arch (n=4), descending (n=34), paravisceral (n=15), infrarenal aorta (n=63), and multiple (n=7). Treatments were thoracic EVAR (n=43), fenestrated/branched EVAR (n=9), and infrarenal EVAR (n=71). Antibiotic was administered for mean 30 weeks. Mean follow-up was 35 months (range 1 week to 149 months). Six patients (5%) were converted to open repair during follow-up. Survival was 91% (95% confidence interval, 86% to 96%), 75% (67% to 83%), 55% (44% to 66%), and 41% (28% to 54%) after 1, 12, 60, and 120 months, respectively. Infection-related death occurred in 23 patients (19%), 9 after discontinuation of antibiotic treatment. A Cox regression analysis demonstrated non-Salmonella-positive culture as predictors for late infection-related death. Conclusions-Endovascular treatment of MAA is feasible and for most patients a durable treatment option. Late infections do occur, are often lethal, and warrant long-term antibiotic treatment and follow-up. Patients with non-Salmonellapositive blood cultures were more likely to die from late infection.

Keywords
aneurysm, aorta, infection, surgery
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-241408 (URN)10.1161/CIRCULATIONAHA.114.009481 (DOI)000346141900011 ()25378548 (PubMedID)
Available from: 2015-01-19 Created: 2015-01-12 Last updated: 2017-12-05Bibliographically approved
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