Pub Date : 2024-06-14DOI: 10.1177/26324636241254621
K. Jadhav, Bhulaxmi Pullikanti, Harish Kancharla, Pankaj V. Jariwala
Carcinoma of lung (CoL) is the fourth most common cancer in India. It is classified as either small-cell or non-small-cell lung cancer, with adenocarcinoma being the most common variant. CoL can present either as paraneoplastic or non-paraneoplastic manifestation. We discuss a case of a patient who had an abrupt onset of sustained ventricular tachycardia and was subsequently diagnosed with metastatic non-small cell lung cancer with no cardiac infiltrates.
{"title":"An Unusual Primary Paraneoplastic Manifestation of Adenocarcinoma of Lung","authors":"K. Jadhav, Bhulaxmi Pullikanti, Harish Kancharla, Pankaj V. Jariwala","doi":"10.1177/26324636241254621","DOIUrl":"https://doi.org/10.1177/26324636241254621","url":null,"abstract":"Carcinoma of lung (CoL) is the fourth most common cancer in India. It is classified as either small-cell or non-small-cell lung cancer, with adenocarcinoma being the most common variant. CoL can present either as paraneoplastic or non-paraneoplastic manifestation. We discuss a case of a patient who had an abrupt onset of sustained ventricular tachycardia and was subsequently diagnosed with metastatic non-small cell lung cancer with no cardiac infiltrates.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"29 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141344476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-12DOI: 10.1177/26324636241259526
Sudipta Mondal, Jyothi Vijay, N. Namboodiri
A man in his 60s presented with occasional giddiness to the emergency department. Clinical examination and echocardiogram were within normal limits. His electrocardiogram was reported as having sinus arrhythmia with alternate PR interval prolongation. Does he require pacemaker? The discussion guides the reader with the explanation.
{"title":"A Fascinating Electrocardiogram with an Apparent Alternating PR Interval","authors":"Sudipta Mondal, Jyothi Vijay, N. Namboodiri","doi":"10.1177/26324636241259526","DOIUrl":"https://doi.org/10.1177/26324636241259526","url":null,"abstract":"A man in his 60s presented with occasional giddiness to the emergency department. Clinical examination and echocardiogram were within normal limits. His electrocardiogram was reported as having sinus arrhythmia with alternate PR interval prolongation. Does he require pacemaker? The discussion guides the reader with the explanation.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"26 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141354639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-12DOI: 10.1177/26324636241258265
Suyog Mokashi, Martin Keane
Artificial intelligence (AI) has attracted great interest in the world of cardiology and cardiovascular surgery. For simplicity, AI has 3 distinct sectors: machine learning (ML), deep learning, and generative AI. In the case of ML, when calculating cardiovascular risk scores, ML algorithms analyze large, complex datasets (data mining) to predict the risk of morbidity and mortality.
{"title":"The Utility of Machine Learning for Cardiology and Cardiac Surgery Risk Assessment Scores","authors":"Suyog Mokashi, Martin Keane","doi":"10.1177/26324636241258265","DOIUrl":"https://doi.org/10.1177/26324636241258265","url":null,"abstract":"Artificial intelligence (AI) has attracted great interest in the world of cardiology and cardiovascular surgery. For simplicity, AI has 3 distinct sectors: machine learning (ML), deep learning, and generative AI. In the case of ML, when calculating cardiovascular risk scores, ML algorithms analyze large, complex datasets (data mining) to predict the risk of morbidity and mortality.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"134 42","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141351458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-08DOI: 10.1177/26324636241254611
D. Kahali, Shashank Desai, Kranthi Kiran Pebbili
Dual-antiplatelet therapy (DAPT) is a cornerstone treatment for patients diagnosed with acute coronary syndrome (ACS) and coronary artery disease (CAD). Although DAPT effectively reduces the occurrence of thrombotic events, it also substantially increases the likelihood of gastrointestinal (GI) bleeding. Proton pump inhibitors (PPIs) are essential for mitigating the GI bleeding risk, yet concerns persist regarding their prolonged use and potential adverse effects. Apart from rabeprazole, PPIs share the hepatic metabolism pathway with clopidogrel, resulting in unfavorable cardiovascular outcomes. The pairing of rabeprazole with clopidogrel emerges as a prudent recommendation, displaying superior efficacy in mitigating major adverse cardiovascular events (MACE) when juxtaposed with other PPIs. This narrative review underscores the complexity of managing PPIs in cardiac patients and emphasizes the importance of tailored approaches based on emerging evidence while providing valuable insights to clinicians navigating this challenging therapeutic landscape.
{"title":"Role of Proton Pump Inhibitors in Cardiac Patients: Guideline Recommendations Versus Practical Approach","authors":"D. Kahali, Shashank Desai, Kranthi Kiran Pebbili","doi":"10.1177/26324636241254611","DOIUrl":"https://doi.org/10.1177/26324636241254611","url":null,"abstract":"Dual-antiplatelet therapy (DAPT) is a cornerstone treatment for patients diagnosed with acute coronary syndrome (ACS) and coronary artery disease (CAD). Although DAPT effectively reduces the occurrence of thrombotic events, it also substantially increases the likelihood of gastrointestinal (GI) bleeding. Proton pump inhibitors (PPIs) are essential for mitigating the GI bleeding risk, yet concerns persist regarding their prolonged use and potential adverse effects. Apart from rabeprazole, PPIs share the hepatic metabolism pathway with clopidogrel, resulting in unfavorable cardiovascular outcomes. The pairing of rabeprazole with clopidogrel emerges as a prudent recommendation, displaying superior efficacy in mitigating major adverse cardiovascular events (MACE) when juxtaposed with other PPIs. This narrative review underscores the complexity of managing PPIs in cardiac patients and emphasizes the importance of tailored approaches based on emerging evidence while providing valuable insights to clinicians navigating this challenging therapeutic landscape.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":" 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141369698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-23DOI: 10.1177/26324636241230148
Sudipta Mondal, Dipanjan Bandyopadhyay
We present a case of bigeminal rhythm where a critical evaluation of underlying rhythm abnormality is important to differentiate escape-capture bigeminy from escape-echo bigeminy, and to decide further management plans.
{"title":"An Interesting Case of Bigeminy with Presyncope","authors":"Sudipta Mondal, Dipanjan Bandyopadhyay","doi":"10.1177/26324636241230148","DOIUrl":"https://doi.org/10.1177/26324636241230148","url":null,"abstract":"We present a case of bigeminal rhythm where a critical evaluation of underlying rhythm abnormality is important to differentiate escape-capture bigeminy from escape-echo bigeminy, and to decide further management plans.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"16 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139957409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lutembacher’s syndrome is a rare condition and is most often treated surgically. Due to the advances in percutaneous procedures, this form of management is desired which has the advantage of decreased morbidity and is aesthetically superior. In this case report of percutaneous treatment for a Lutembacher’s patient the percutaneous transvenous mitral commissurotomy and atrial septal defect device closure was done with minimal technical difficulties and with excellent post-procedure results.
{"title":"Percutaneous Transcatheter Therapy in a Case of Lutembacher’s Syndrome","authors":"Pranav Nadkarni, Michelle Viegas Parab, Guruprasad Naik","doi":"10.1177/26324636241230725","DOIUrl":"https://doi.org/10.1177/26324636241230725","url":null,"abstract":"Lutembacher’s syndrome is a rare condition and is most often treated surgically. Due to the advances in percutaneous procedures, this form of management is desired which has the advantage of decreased morbidity and is aesthetically superior. In this case report of percutaneous treatment for a Lutembacher’s patient the percutaneous transvenous mitral commissurotomy and atrial septal defect device closure was done with minimal technical difficulties and with excellent post-procedure results.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"57 41","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139960812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-12DOI: 10.1177/26324636231224598
Vikas Reddy Maddali, Sudheer Koganti
Optical coherence tomography (OCT) is an optical analog of intravascular ultrasound (IVUS) used to examine the coronary arteries with a higher resolution. Based on polarization properties, OCT can differentiate tissue characteristics (fibrous, calcified, or lipid-rich plaque) and identify vulnerable plaque. Because of the strong attenuation of light by blood, OCT requires a field of view that is free of blood. OCT can provide detailed information on coronary intervention such as dissection, tissue prolapse, thrombus stent malapposition, and under expansion. Despite the diagnostic utility of OCT, facilitated by its high resolution, the impact of intracoronary OCT on clinical practice has thus far been limited for various reasons. Herein, we provide a comprehensive up-to-date overview on the utility of OCT in coronary artery disease, specifically acute coronary syndromes along with a summary of the evidence, work in progress, and future directions.
光学相干断层扫描（OCT）是血管内超声（IVUS）的光学类似物，用于以更高分辨率检查冠状动脉。根据偏振特性，OCT 可以区分组织特征（纤维斑块、钙化斑块或富脂斑块）并识别易损斑块。由于血液对光有很强的衰减作用，OCT 需要一个没有血液的视野。OCT 可以提供冠状动脉介入治疗的详细信息，如剥离、组织脱垂、血栓支架错位和扩张不足等。尽管 OCT 因其高分辨率而具有诊断作用，但由于各种原因，冠状动脉内 OCT 对临床实践的影响迄今仍然有限。在此，我们将对 OCT 在冠状动脉疾病（尤其是急性冠状动脉综合征）中的应用进行全面的最新概述，并对证据、进展中的工作和未来方向进行总结。
{"title":"Role of Optical Coherence Tomography in Coronary Interventions","authors":"Vikas Reddy Maddali, Sudheer Koganti","doi":"10.1177/26324636231224598","DOIUrl":"https://doi.org/10.1177/26324636231224598","url":null,"abstract":"Optical coherence tomography (OCT) is an optical analog of intravascular ultrasound (IVUS) used to examine the coronary arteries with a higher resolution. Based on polarization properties, OCT can differentiate tissue characteristics (fibrous, calcified, or lipid-rich plaque) and identify vulnerable plaque. Because of the strong attenuation of light by blood, OCT requires a field of view that is free of blood. OCT can provide detailed information on coronary intervention such as dissection, tissue prolapse, thrombus stent malapposition, and under expansion. Despite the diagnostic utility of OCT, facilitated by its high resolution, the impact of intracoronary OCT on clinical practice has thus far been limited for various reasons. Herein, we provide a comprehensive up-to-date overview on the utility of OCT in coronary artery disease, specifically acute coronary syndromes along with a summary of the evidence, work in progress, and future directions.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"9 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139783230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-12DOI: 10.1177/26324636231224598
Vikas Reddy Maddali, Sudheer Koganti
Optical coherence tomography (OCT) is an optical analog of intravascular ultrasound (IVUS) used to examine the coronary arteries with a higher resolution. Based on polarization properties, OCT can differentiate tissue characteristics (fibrous, calcified, or lipid-rich plaque) and identify vulnerable plaque. Because of the strong attenuation of light by blood, OCT requires a field of view that is free of blood. OCT can provide detailed information on coronary intervention such as dissection, tissue prolapse, thrombus stent malapposition, and under expansion. Despite the diagnostic utility of OCT, facilitated by its high resolution, the impact of intracoronary OCT on clinical practice has thus far been limited for various reasons. Herein, we provide a comprehensive up-to-date overview on the utility of OCT in coronary artery disease, specifically acute coronary syndromes along with a summary of the evidence, work in progress, and future directions.
光学相干断层扫描（OCT）是血管内超声（IVUS）的光学类似物，用于以更高分辨率检查冠状动脉。根据偏振特性，OCT 可以区分组织特征（纤维斑块、钙化斑块或富脂斑块）并识别易损斑块。由于血液对光有很强的衰减作用，OCT 需要一个没有血液的视野。OCT 可以提供冠状动脉介入治疗的详细信息，如剥离、组织脱垂、血栓支架错位和扩张不足等。尽管 OCT 因其高分辨率而具有诊断作用，但由于各种原因，冠状动脉内 OCT 对临床实践的影响迄今仍然有限。在此，我们对 OCT 在冠状动脉疾病（尤其是急性冠状动脉综合征）中的应用进行了全面的最新概述，并对证据、进展中的工作和未来方向进行了总结。
{"title":"Role of Optical Coherence Tomography in Coronary Interventions","authors":"Vikas Reddy Maddali, Sudheer Koganti","doi":"10.1177/26324636231224598","DOIUrl":"https://doi.org/10.1177/26324636231224598","url":null,"abstract":"Optical coherence tomography (OCT) is an optical analog of intravascular ultrasound (IVUS) used to examine the coronary arteries with a higher resolution. Based on polarization properties, OCT can differentiate tissue characteristics (fibrous, calcified, or lipid-rich plaque) and identify vulnerable plaque. Because of the strong attenuation of light by blood, OCT requires a field of view that is free of blood. OCT can provide detailed information on coronary intervention such as dissection, tissue prolapse, thrombus stent malapposition, and under expansion. Despite the diagnostic utility of OCT, facilitated by its high resolution, the impact of intracoronary OCT on clinical practice has thus far been limited for various reasons. Herein, we provide a comprehensive up-to-date overview on the utility of OCT in coronary artery disease, specifically acute coronary syndromes along with a summary of the evidence, work in progress, and future directions.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"121 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139842888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-08DOI: 10.1177/26324636241228428
Qureshi Naeem, Abhishek Kumar, Rajesh G.
A 22-year-old male having cardiomegaly with prominent right atrium (RA) enlargement in his chest X-ray underwent echocardiography which revealed an anterior mediastinal cystic lesion. Contrast-enhanced computed tomography of the thorax showed saccular contrast filling outpouching from ostia of the right coronary artery (RCA) of size 5.9 × 6.4 cm in anterior atrioventricular groove compressing RA and right ventricle along the RCA course. The left main coronary artery also appeared to be dilated with a diameter of 1.1 cm proximally. The patient denied any prior angina, palpitation, and dyspnea on exertion. This case is reported for its rarity and the dilemma involving its appropriate medical and surgical management.
一名 22 岁的男性患有心脏肥大，胸部 X 光片显示右心房（RA）明显增大，接受了超声心动图检查，结果显示前纵隔囊性病变。胸部对比增强计算机断层扫描显示，右冠状动脉（RCA）造口处有一个 5.9 × 6.4 厘米大小的囊状造影剂充盈袋，位于房室前沟，沿 RCA 走向压迫 RA 和右心室。左冠状动脉主干也出现扩张，近端直径为 1.1 厘米。患者否认之前有任何心绞痛、心悸和劳力性呼吸困难。本病例因其罕见性和涉及适当的内科和外科治疗的难题而被报道。
{"title":"Globe in the Heart: A Rare Case Report of Giant Coronary Artery Aneurysm","authors":"Qureshi Naeem, Abhishek Kumar, Rajesh G.","doi":"10.1177/26324636241228428","DOIUrl":"https://doi.org/10.1177/26324636241228428","url":null,"abstract":"A 22-year-old male having cardiomegaly with prominent right atrium (RA) enlargement in his chest X-ray underwent echocardiography which revealed an anterior mediastinal cystic lesion. Contrast-enhanced computed tomography of the thorax showed saccular contrast filling outpouching from ostia of the right coronary artery (RCA) of size 5.9 × 6.4 cm in anterior atrioventricular groove compressing RA and right ventricle along the RCA course. The left main coronary artery also appeared to be dilated with a diameter of 1.1 cm proximally. The patient denied any prior angina, palpitation, and dyspnea on exertion. This case is reported for its rarity and the dilemma involving its appropriate medical and surgical management.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":"120 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139852951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-02-08DOI: 10.1177/26324636241228428
Qureshi Naeem, Abhishek Kumar, Rajesh G.
A 22-year-old male having cardiomegaly with prominent right atrium (RA) enlargement in his chest X-ray underwent echocardiography which revealed an anterior mediastinal cystic lesion. Contrast-enhanced computed tomography of the thorax showed saccular contrast filling outpouching from ostia of the right coronary artery (RCA) of size 5.9 × 6.4 cm in anterior atrioventricular groove compressing RA and right ventricle along the RCA course. The left main coronary artery also appeared to be dilated with a diameter of 1.1 cm proximally. The patient denied any prior angina, palpitation, and dyspnea on exertion. This case is reported for its rarity and the dilemma involving its appropriate medical and surgical management.
一名 22 岁的男性患有心脏肥大，胸部 X 光片显示右心房（RA）明显增大，接受了超声心动图检查，结果显示前纵隔囊性病变。胸部对比增强计算机断层扫描显示，右冠状动脉（RCA）造口处有一个 5.9 × 6.4 厘米大小的囊状造影剂充盈袋，位于房室前沟，沿 RCA 走向压迫 RA 和右心室。左冠状动脉主干也出现扩张，近端直径为 1.1 厘米。患者否认之前有任何心绞痛、心悸和劳力性呼吸困难。本病例因其罕见性和涉及适当的内科和外科治疗的难题而被报道。
{"title":"Globe in the Heart: A Rare Case Report of Giant Coronary Artery Aneurysm","authors":"Qureshi Naeem, Abhishek Kumar, Rajesh G.","doi":"10.1177/26324636241228428","DOIUrl":"https://doi.org/10.1177/26324636241228428","url":null,"abstract":"A 22-year-old male having cardiomegaly with prominent right atrium (RA) enlargement in his chest X-ray underwent echocardiography which revealed an anterior mediastinal cystic lesion. Contrast-enhanced computed tomography of the thorax showed saccular contrast filling outpouching from ostia of the right coronary artery (RCA) of size 5.9 × 6.4 cm in anterior atrioventricular groove compressing RA and right ventricle along the RCA course. The left main coronary artery also appeared to be dilated with a diameter of 1.1 cm proximally. The patient denied any prior angina, palpitation, and dyspnea on exertion. This case is reported for its rarity and the dilemma involving its appropriate medical and surgical management.","PeriodicalId":429933,"journal":{"name":"Indian Journal of Clinical Cardiology","volume":" 97","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139792858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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