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Identifying coronary artery bypass grafting patients at high risk for adverse long-term prognosis using serial health-related quality of life assessments

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中华医学杂志(英文版) 2024年第9期137卷 1069-1077页

作者： Wang Juncheng Liu Hanning Yue Chao Yang Limeng Yang Kai Zhao Yan Ren Huan Zhang Ying Zheng Zhe National Clinical Research Center for cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China Department of cardiovascular Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China Department of Vascular Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China Department of Cardiac Surgery Wuhan Asia Heart Hospital Wuhan Hubei China

Background: Patients who undergo coronary artery bypass grafting (CABG) are known to be at a significant risk of experiencing long-term adverse events, emphasizing the importance of regular assessments. Evaluating health-related quality of life (HRQoL) serves as a direct method to gauge prognosis. Our objective is to ascertain the prognostic significance of consecutive HRQoL assessments using the Physical Component Summary (PCS) and Mental Component Summary (MCS) derived from the Short-Form 36 (SF-36) health survey in CABG patients.Methods: The study population consisted of 433 patients who underwent isolated elective CABG at Fuwai Hospital between 2012 and 2013. SF-36 assessments were conducted during both the hospitalization period and follow-up. The primary endpoint of the study was all-cause mortality, while the secondary outcome was a composite measure including death, myocardial infarction, stroke, and repeat revascularization. We assessed the relationships between the PCS and MCS at baseline, as well as their changes during the first 6 months after the surgery (referred to as ΔPCS and ΔMCS, respectively), and the observed outcomes.Results: The patients were followed for an average of 6.28 years, during which 35 individuals (35/433, 8.1%) died. After adjusting for clinical variables, it was observed that baseline MCS scores (hazard ratio [HR] for a 1-standard deviation [SD] decrease, 1.57; 95% confidence interval [CI], 1.07–2.30) and ΔMCS (HR for a 1-SD decrease, 1.67; 95% CI, 1.09–2.56) were associated with all-cause mortality. However, baseline PCS scores and ΔPCS did not exhibit a significant relationship with all-cause mortality. Notably, there was a dose-response relationship observed between ΔMCS and the likelihood of all-cause mortality (HRs for the 2nd, 3rd and 4th quartiles compared to the 1st quartile, 0.33, 0.45 and 0.11, respectively).Conclusions: Baseline MCS and changes in MCS were independent predictors for long-term mortality of CABG. Better mental health status and recovery indicated better

关键词： Coronary artery bypass grafting Coronary artery disease Prognosis Quality of life Short-Form 36 Risk factor Serial measurements

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Evaluation of mitral chordae tendineae length using four-dimensional computed

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World Journal of Cardiology 2024年第5期16卷 274-281页

作者： Takuya Mori Satoshi Matsushita Terumasa Morita Abulaiti Abudurezake Junji Mochizuki Atsushi Amano Department of cardiovascular Surgery Juntendo University Faculty of MedicineTokyo 113-8421Japan Department of cardiovascular Surgery JACCT Japan Animal Cardiovascular Care TeamOsaka 533-0033Japan Department of Radiology Minamino Cardiovascular HospitalTokyo 192-0918Japan

BACKGROUND Mitral valvuloplasty using artificial chordae tendineae represents an effective surgical approach for treating mitral regurgitation.Achieving precise measurements of artificial chordae tendineae length(CL)is an important factor in the procedure;however,no objective index currently exists to facilitate this measurement.Therefore,preoperative assessment of CL is critical for surgical planning and support.Four-dimensional x-ray micro-computed tomography(4D-CT)may be useful for accurate CL measurement considering that it allows for dynamic three-dimensional(3D)evaluation compared to that with transthoracic echocardiography,a conventional inspection method.AIM To investigate the behavior and length of mitral chordae tendineae during systole using 4D-CT.METHODS Eleven adults aged>70 years without mitral valve disease were evaluated.A 64-slice CT scanner was used to capture 20 phases in the cardiac cycle in electrocardiographic synchronization.The length of the primary chordae tendineae was measured from early systole to early diastole using the 3D image.The primary chordae tendineae originating from the anterior papillary muscle and attached to the A1-2 region and those from the posterior papillary muscle and attached to the A2-3 region were designated as cA and cP,respectively.The behavior and maximum lengths[cA(ma),cP(max)]were compared,and the correlation with body surface area(BSA)was evaluated.RESULTS In all cases,the mitral anterior leaflet chordae tendineae could be measured.In most cases,the cA and cP chordae tendineae could be measured visually.The mean cA(max)and cP(max)were 20.2 mm±1.95 mm and 23.5 mm±4.06 mm,respectively.cP(max)was significantly longer.The correlation coefficients(r)with BSA were 0.60 and 0.78 for cA(max)and cP(max),respectively.Both cA and cP exhibited constant variation in CL during systole,with a maximum 1.16-fold increase in cA and a 1.23-fold increase in cP from early to mid-systole.For cP,CL reached a plateau at 15%and remained elongated until end-systole,whereas for cA,aft

关键词： Mitral valve Chordae tendineae Computed tomography Four-dimensional Cardiac cycle

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Modeling drug-induced mitochondrial toxicity with human primary cardiomyocytes

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Science China(Life Sciences) 2024年第2期67卷 301-319页

作者： Xiaoli Tang Hong Liu Rongjia Rao Yafei Huang Mengqi Dong Miaomiao Xu Shanshan Feng Xun Shi Li Wang Zengwu Wang Bingying Zhou State Key Laboratory of cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100037China Department of Epidemiology Cardiovascular Institute and Fuwai HospitalChinese Academy of Medical Science&Peking Union Medical CollegeBeijing 100037China Shenzhen Key Laboratory of cardiovascular Disease Fuwai Hospital Chinese Academy of Medical SciencesShenzhenShenzhen 518020China

Mitochondrial toxicity induced by therapeutic drugs is a major contributor for cardiotoxicity,posing a serious threat to pharmaceutical industries and patients’lives.However,mitochondrial toxicity testing is not incorporated into routine cardiac safety screening procedures.To accurately model native human cardiomyocytes,we comprehensively evaluated mitochondrial responses of adult human primary cardiomyocytes(h PCMs)to a nucleoside analog,remdesivir(RDV).Comparison of their response to human pluripotent stem cell-derived cardiomyocytes revealed that the latter utilized a mitophagy-based mitochondrial recovery response that was absent in h PCMs.Accordingly,action potential duration was elongated in h PCMs,reflecting clinical incidences of RDV-induced QT prolongation.In a screen for mitochondrial protectants,we identified mitochondrial ROS as a primary mediator of RDV-induced cardiotoxicity.Our study demonstrates the utility of h PCMs in the detection of clinically relevant cardiac toxicities,and offers a framework for h PCM-based high-throughput screening of cardioprotective agents.

关键词： remdesivir mitochondrial toxicity cardiotoxicity human primary cardiomyocytes high-throughput screening

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Clinical application and management of temporary mechanical circulatory support: A clinical consensus

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中华医学杂志(英文版) 2024年第10期137卷 2023 Dec 26页

作者： Dong Nianguo Chen Liangwan Chen Xin Wang Huishan Xiao Yingbin Wang Xianqiang Huang Jinsong Yan Yang Bonde Pramod Sodha Neel Atluri Pavan Maureira Juan Pablo Vincentelli André Yanase Masanobu Wang Yixuan Zhang Haitao Hou Xiaotong Takami Yoshijuki Leprince Pascal Folliguet Thierry Sellke Frank W Chinese Society for Thoracic and cardiovascular Surgery Chinese Association of cardiovascular Surgeons Cardiac Critical Care Professional Committee of Chinese Medical Association Chinese Society of Extracorporeal Life Support European Society of cardiovascular and Endovascular Surgery French Society of Thoracic and cardiovascular Surgery Japanese Society for cardiovascular Surgery Japanese Society of Artificial Organs Department of Cardiothoracic Surgery Alpert Medical School Brown University Rhode Island Hospital Providence RI USA Department of cardiovascular Surgery Department of Surgery University of Pennsylvania Philadelphia PA USA Department of cardiovascular Surgery and Transplantation University Hospital of Nancy University of Lorraine Vandoeuvre-lès-Nancy France Department of cardiovascular Surgery University Hospital of Lille University of Lille Lille France Department of Cardiology Fujita Health University School of Medicine Toyoake Aichi-1192 Japan Department of Adult Surgical Intensive Care unit Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China Department of Cardiac Intensive Care Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing Anzhen Hospital Capital Medical University Beijing China Department of cardiovascular Surgery Fujita Health University School of Medicine Toyoake Aichi-1192 Japan Department of cardiovascular Surgery Groupe Hospitalier Pitié-Salpêtrière University Pierre et Marie Curie APHP Paris France Department of Cardiac Surgery APHP H?pitaux Universitaires Henri Mondor Créteil F-94010 France Department of cardiovascular Surgery Union Hospital of Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei China Department of cardiovascular Surgery Fujian Medical University Union Hospital Fuzhou Fujian China Department of Thoracic and cardiovascular Surgery Nanjing First Hospital Nanjing Medical University Nanjing Jiangsu China Department of cardiovascular Surgery General Hospital of Northern Theater Command Shenyang Liaoning China Department of cardiovascular Surgery Xinqiao Hospital Third Military Medical University Chongqing China Department of cardiovascular Surgery Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing Chi

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A case report of chylous ascites after cardiac surgery

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Emergency and Critical Care Medicine 2024年第1期4卷 42-45页

作者： Shuaishuai Yuan Pailing Xie Xiantao Liu Peijun Li The University of Hong Kong-Shenzhen Hospital cardiovascular Medicine Center Cardiac Intensive Care unit ShenzhenGuangdongChina.

Background:Chylous ascites(CA),an emulsion rich in triglycerides,is a rare type of ascites,especially after cardiac surgery.Also,there are few reports of the occurrence of CA after mitral valve replacement,aortic valve replacement,tricuspid valvuloplasty,and coronary artery bypass grafting.Case presentation:We report the case of a 53-year-old man who underwent surgery for a diagnosis of mitral incompetence,aortic incompetence,tricuspid incompetence,and coronary atherosclerotic heart disease.Fifteen days after surgery,3000 mL of milky-yellow ascites appeared in the abdominal cavity,diagnosed as CA by laboratory examination.The ascites gradually disappeared after being drained,and the patients improved.The curative was objective,but the exact cause is not clear.Conclusion:Although CA is rare,it may occur during the surgical intervention in cardiac surgery.

关键词： Cardiac intensive care unit Cardiac valve replacement Case report Chylous ascites Coronary artery bypass graft Department of cardiac surgery

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Top Five Stories of the Cellular Landscape and Therapies of Atherosclerosis:Current Knowledge and Future Perspectives

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Current Medical Science 2024年第1期44卷 1-27页

作者： Qi PAN Cheng CHEN Yue-jin YANG State Key Laboratory of cardiovascular Disease Department of CardiologyFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100037China

Atherosclerosis(AS)is characterized by impairment and apoptosis of endothelial cells,continuous systemic and focal inflammation and dysfunction of vascular smooth muscle cells,which is documented as the traditional cellular paradigm.However,the mechanisms appear much more complicated than we thought since a bulk of studies on efferocytosis,transdifferentiation and novel cell death forms such as ferroptosis,pyroptosis,and extracellular trap were reported.Discovery of novel pathological cellular landscapes provides a large number of therapeutic targets.On the other side,the unsatisfactory therapeutic effects of current treatment with lipid-lowering drugs as the cornerstone also restricts the efforts to reduce global AS burden.Stem cell-or nanoparticle-based strategies spurred a lot of attention due to the attractive therapeutic effects and minimized adverse effects.Given the complexity of pathological changes of AS,attempts to develop an almighty medicine based on single mechanisms could be theoretically challenging.In this review,the top stories in the cellular landscapes during the initiation and progression of AS and the therapies were summarized in an integrated perspective to facilitate efforts to develop a multi-targets strategy and fill the gap between mechanism research and clinical translation.The future challenges and improvements were also discussed.

关键词： atherosclerosis transdifferentiation extracellular traps efferocytosis stem cell nanoparticles

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The prognostic value of collateral circulation in coronary chronic total occlusion underwent percutaneous coronary intervention

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Journal of Geriatric Cardiology 2024年第2期21卷 232-241页

作者： Xiao-Ying HU Wei-Xian YANG Chang-Dong GUAN Li-Hua XIE Ke-Fei DOU Yong-Jian WU Jin-Qing YUAN Jie QIAN Yue-Jin YANG Shu-Bin QIAO Lei SONG Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina National Clinical Research Center for cardiovascular Diseases BeijingChina Catheterization Laboratories Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina

BACKGROUND The prognostic value of coronary collateral circulation(CC)in patients undergoing chronic total occlusion(CTO)percutaneous coronary intervention(PCI)is underdetermined.The purpose of the study was to assess the prognostic value of current two CC grading systems and their association with long-term outcomes in patients with CTO underwent PCI.METHODS We consecutively enrolled patients with single-vessel CTO underwent PCI between January 2010 and December2013.All patients were categorized into well-developed or poor-developed collaterals group according to angiographic Werner's CC(grade 2 vs.grade 0–1)or Rentrop(grade 3 vs.grade 0–2)grading system.The primary endpoint was 5-year cardiac death.RESULTS Of 2452 enrolled patients,the overall technical success rate was 74.1%.Well-developed collaterals were present in686 patients(28.0%)defined by Werner's CC grade 2,and in 1145 patients(46.7%)by Rentrop grade 3.According to Werner's CC grading system,patients with well-developed collaterals had a lower rate of 5-year cardiac death compared with those with poordeveloped collaterals(1.6%vs.3.3%,P=0.02),those with suboptimal recanalization was associated with higher rate of 5-year cardiac death compared with optimal recanalization(4.7%vs.0.8%,P=0.01)and failure patients(4.7%vs.1.6%,P=0.12).However,the similar effect was not shown in Rentrop grading system.CONCLUSIONS In patients with the single-vessel CTO underwent PCI,well-developed collaterals by Werner's CC definition were associated with lower rate of 5-year cardiac death.Werner's CC grading system had a greater prognostic value than Rentrop grading system in patients with CTO underwent PCI.

关键词： coronary collateral occlusion

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Genetically predicted waist circumference and risk of atrial fibrillation

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Chinese Medical Journal 2024年第1期137卷 82-86页

作者： Wenting Wang Jiang-shan Tan Jingyang Wang Wei Xu Liting Bai Yu Jin Peng Gao Peiyao Zhang Yixuan Li Yanmin Yang Jinping Liu Department of Cardiopulmonary Bypass State Key Laboratory of Cardiovascular DiseaseFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China Department of Anaesthesiology Second Affiliated HospitalHainan Medical CollegeHaikouHainan 570311China State Key Laboratory of cardiovascular Disease Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100037China

Introduction:Observational studies have revealed an association between waist circumference(WC)and atrial fibrillation(AF).However,it is difficult to infer a causal relationship from observational studies because the observed associations could be confounded by unknown risk factors.Therefore,the causal role of WC in AF is unclear.This study was designed to investigate the causal association between WC and AF using a two-sample Mendelian randomization(MR)analysis.Methods:In our two-sample MR analysis,the genetic variation used as an instrumental variable for MR was acquired from a genome-wide association study(GWAS)of WC(42 single nucleotide polymorphisms with a genetic significance of P<5×10^(-8)).The data of WC(from the Genetic Investigation of ANthropometric Traits consortium,containing 232,101 participants)and the data of AF(from the European Bioinformatics Institute database,containing 55,114 AF cases and 482,295 controls)were used to assess the causal role of WC on AF.Three different approaches(inverse variance weighted[IVW],MR-Egger,and weighted median regression)were used to ensure that our results more reliable.Results:All three MR analyses provided evidence of a positive causal association between high WC and AF.High WC was suggested to increase the risk of AF based on the IVW method(odds ratio[OR]=1.43,95%confidence interval[CI],1.30-1.58,P=2.51×10^(-13)).The results of MR-Egger and weighted median regression exhibited similar trends(MR-Egger OR=1.40[95%CI,1.08-1.81],P=1.61×10^(-2);weighted median OR=1.39[95%CI,1.21-1.61],P=1.62×10^(-6)).MR-Egger intercepts and funnel plots showed no directional pleiotropic effects between high WC and AF.Conclusions:Our findings suggest that greater WC is associated with an increased risk of AF.Taking measures to reduce WC may help prevent the occurrence of AF.

关键词： Genetically predicted Waist circumference Atrial fibrillation Mendelian randomization

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Metabolomics signature of blood pressure salt sensitivity and its link to cardiovascular disease:A dietary salt-intervention trial

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Science China Life Sciences 2024年第8期 1666-1675页

作者： Zhennan Lin Jianxin Li Fangchao Liu Jie Cao Shufeng Chen Jichun Chen Keyong Huang Yaqin Wang Hongfan Li Yan Wang Jianfeng Huang Dongfeng Gu Xiangfeng Lu Key Laboratory of cardiovascular Epidemiology Department of EpidemiologyFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical College/National Center for Cardiovascular Diseases Medical School Southern University of Science and Technology

Individuals with a high degree of salt sensitivity(SS) have a greater risk of cardiovascular disease(CVD),but whether SS fosters CVD by influencing metabolomics homeostasis remains unclear.This study aimed to reveal the role of the SS-related metabolomics signature in the development of CVDs,based on the Meta Salt study,which was a dietary salt-intervention trial conducted at four centers in China in 2019.A total of 528 participants were recruited and underwent 3 days of baseline observations,a 10-day low-salt intervention,and a 10-day highsalt intervention.Plasma untargeted metabolomics,lipidomics,and BP measurements were scheduled at each stage.Participants were grouped into extreme SS,moderate SS,and salt-resistant(SR) individuals according to their BP responses to salt.Linear mixed models were used to identify SS-related metabolites and determine the relationship between the SS-related metabolomics signature and arterial stiffness.Mendelian randomization(MR) analyses were applied to establish the causal pathways among the SS-related metabolites,BP,and CVDs.Among the 713 metabolites,467 were significantly changed after the high-salt intervention.Among them,the changes in 30 metabolites from the low-salt to the high-salt intervention differed among the SS groups.Of the remaining nonsalt-related metabolites,the baseline levels of 11 metabolites were related to SS.These 41 metabolites explained 23% of the variance in SS.Moreover,SS and its metabolomics signature were positively correlated with arterial stiffness.MR analyses demonstrated that the SS-related metabolites may affect CVD risk by altering BP,indicating that the increase in BP was the consequence of the changes in SS-related metabolites rather than the cause.Our study revealed that the metabolomics signature of SS individuals differs from that of SR individuals and that the changes in SS-related metabolites may increase arterial stiffness and foster CVDs.This study provides insight into understanding the biology and targets of SS and its role in CVDs.

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Integrin β5 subunit regulates hyperglycemia-induced vascular endothelial cell apoptosis through FoxO1-mediated macroautophagy

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Chinese Medical Journal 2024年第5期137卷 565-576页

作者： Xuze Lin Sizhuang Huang Side Gao Jinxing Liu Jiong Tang Mengyue Yu Department of Cardiology Fuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100037China Department of Cardiology Fuwai Yunnan Cardiovascular HospitalKunmingYunnan 650000China

Background:Hyperglycemia frequently induces apoptosis in endothelial cells and ultimately contributes to microvascular dysfunction in patients with diabetes mellitus(DM).Previous research reported that the expression of integrins as well as their ligands was elevated in the diseased vessels of DM patients.However,the association between integrins and hyperglycemia-induced cell death is still unclear.This research was designed to investigate the role played by integrin subunit β5(ITGB5)in hyperglycemia-induced endothelial cell apoptosis.Methods:We used leptin receptor knockout(Lepr-KO)(db/db)mice as spontaneous diabetes animal model.Selective deletion of ITGB5 in endothelial cell was achieved by injecting vascular targeted adeno-associated virus via tail vein.Besides,we also applied small interfering RNA in vitro to study the mechanism of ITGB5 in regulating high glucose-induced cell apoptosis.Results:ITGB5 and its ligand,fibronectin,were both upregulated after exposure to high glucose in vivo and in vitro.ITGB5 knockdown alleviated hyperglycemia-induced vascular endothelial cell apoptosis and microvascular rarefaction in vivo.In vitro analysis revealed that knockdown of either ITGB5 or fibronectin ameliorated high glucose-induced apoptosis in human umbilical vascular endothelial cells(HUVECs).In addition,knockdown of ITGB5 inhibited fibronectin-induced HUVEC apoptosis,which indicated that the fibronectin-ITGB5 interaction participated in high glucose-induced endothelial cell apoptosis.By using RNA-sequencing technology and bioinformatic analysis,we identified Forkhead Box Protein O1(FoxO1)as an important downstream target regulated by ITGB5.Moreover,we demonstrated that the excessive macroautophagy induced by high glucose can contribute to HUVEC apoptosis,which was regulated by the ITGB5-FoxO1 axis.Conclusion:The study revealed that high glucose-induced endothelial cell apoptosis was positively regulated by ITGB5,which suggested that ITGB5 could potentially be used to predict and treat DM-related vascular complic

关键词： Endothelial cell apoptosis Integrin Autophagy Diabetes

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