2009;40(2):5306. WebCervical artery dissection, including carotid and vertebral artery dissection, has an estimated incidence of 3.54.5 per 100 000. Bern: Verlag Hans Huber; 2000. 1983;67(6):36170. Later on, I began to have disturbances in my vision, ie. Follow-up group comparison of variables of paired samples for changes over time was performed by using the Wilcoxon-test. Kiphuth IC, Utz KS, Noble AJ, Kohrmann M, Schenk T. Increased prevalence of posttraumatic stress disorder in patients after transient ischemic attack. 2001;344(12):898906. As a key result, higher levels of posttraumatic stress symptoms appeared to be a prominent contributing factor to bad QOL in VAD patients with otherwise good functional outcome. Measuring quality of life in a way that is meaningful to stroke patients. 2014;45(11):33606. This profile of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both group D and group I. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study, https://doi.org/10.1186/s12883-019-1541-x, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. (2004) [58] proposed the term of atherosclerotic dissection for certain cases. Thirteen of these patients (40.6%) showed a bad quality of life (SS-QOL3.9) despite good functional outcome (mRS 02) and likewise thirteen (40.6%) a good quality of life (SS-QOL4.0) combined with a good functional outcome (mRS 02). In multivariate regression analysis only MMSE remained a poor predictor for QOL, explaining 12.6% of its variance. Radiographics. Push-ups and pull-ups or other similar exercises where you support your body weight with your hands/arms. Testbatterie zur Aufmerksamkeitsprfung (TAP) Version 2.2. They finally hypothesized that the rate of incidence must be equal throughout life. Patients with suspected cervical artery dissection received additional angiography, mainly MRI angiography, if there has not been already evident cranial computer tomography or even conventional angiography. We present a case of spontaneous VAD in a patient whose only symptoms at presentation were neck pain and headache. PubMedGoogle Scholar. Furthermore, reinfarction as a negative event or recanalization of the former dissected artery vessel as positive event is most probable during the same time period of first six months. In a subsequent multiple regression analysis, neurocognition at baseline measured by MMSE, neurostatus at baseline measured by mRS and posttraumatic stress symptoms measured by PTSS-14 proved to be independent predictors for the quality of life at follow-up, explaining in combination 71% of its variance. However, vertebral artery dissection is a common cause of stroke in young and middle-aged adults. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD. The health-related quality of life after VAD was examined in a standardized manner for the first time in only two published studies [5, 6] in the last decade. Plank position (but otherwise safe to participate in yoga or Pilates). 2013;80(21):19507. Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. When tics cause By using this website, you agree to our Spontaneous vertebral artery dissection (VAD) represents a rare but significant disease, accounting for an average annual incidence rate of about 0.97 to 1.5 Speck et al. Cerebrovasc Dis. Exclusion criteria were as follows: (1) VAD due to severe trauma - in contrast to conventionally as spontaneous labeled dissection due to minor prior cervical trauma which should be better termed mechanical trigger event according to Engelter et al. Posttraumatic stress symptoms, severity of neurological disorders, and impaired neuropsychological baseline performance proved to be independent predictors for reduced QOL at follow-up according to regression analysis. 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.ncbi.nlm.nih.gov/books/NBK441827/). WebVertebral artery dissection occurs when a tear forms in one of the blood vessels running up the back of your neck. You may also need to continue taking a blood thinner during this time. If the dissection reaches your brain or theres a hemorrhagic stroke, then blood thinners may not be safe. Zigmond AS, Snaith RP. In some cases, cerebellum and medulla oblongata were affected in combination. Stroke. Thus, reduced neurocognition and neurostatus at baseline and increased scoring levels for stress symptoms at follow-up were predictive for reduced quality of life at follow-up in patients with VAD in this regression model. 1993;24(1):3541. These include vertebral and carotid arteries. The findings were in line with modern concepts of cerebellar cognitive function [44] and also in accordance to previous data on cognitive impairments in patients with cerebellar stroke lesions, for example by Exner et al. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588305/). Furthermore, PTSD was the single best predictor of patients mental QOL in their study. "mini-mental state". Because previous studies have shown no crucial role of neurovascular risk factors or sociodemographic factors for QOL of VAD patients, we focused our analysis of potential contributing factors for QOL on previously less investigated neurological, neurocognitive and psychological variables with special respect to the biopsychosocial model [12]. 2003;41(11):145260. More importantly, however, our study showed also several limitations. J Neurol. 2006;67(10):180912. MR signal abnormalities at 1.5 T in Alzheimer's dementia and normal aging. Over the last years, cervical artery dissection has been increasingly diagnosed due to improved neuroimaging methods [58]. Subgroup analysis yielded significantly higher scores for posttraumatic stress symptoms (p=0.002) in this subgroup. To reduce the risk of blood clots, you may receive blood-thinning medications as a first-line therapy such as aspirin or aspirin-like medications (Plavix), heparin infusion or warfarin tablets. Nasreddine ZS, Phillips NA, Bedirian V, Charbonneau S, Whitehead V, Collin I, et al. Three initially included woman of ages 70, 71, and 77years had to be excluded secondarily because of concurrent diseases in form of preexisting idiopathic cerebellar syndrome, acute symptomatic anterior circulation brain infarction, and predominant arteriitis temporalis (first with ocular disorder, paresis of arm, ataxia, and dysarthria plus suspected brainstem infarction due to VAD; second with VAD and arm paresis; third with VAD and visual field disorder). Your vertebral artery runs along the back of your neck and supplies your brain and spine with oxygen-rich blood. The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Table4 shows univariate linear regression analysis demonstrating that neurocognition scores at baseline (MMSE, MoCA, CCS), neurostatus at baseline (NIH-SS score on admission, mRS score) and stress symptoms at follow-up (PTSS-14 score) were predictors of quality of life at follow-up. 2008;52(2):2028. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. An artery tear, also called a dissection, occurs when layers of the interior arterial walls separate. Bonita R, Beaglehole R. Recovery of motor function after stroke. Nearly all other potential contributing factors were not significantly different. Mean values of mRS scoring improved from baseline to follow-up in all three groups but significantly only in group I. 1997;9:44551. Any activities that could result in whiplash injury or extended periods of hyperextension of your neck. FMD is usually a life-long condition. PubMed Central Neurology. Brain. The variance of total QOL was determined by neurological, neurocognitive and psychological predictive factors. 1997;19(1):612. Dziewas R, Konrad C, Drager B, Evers S, Besselmann M, Ludemann P, et al. Thus, the present investigation has to be characterized as an explorative study. (2) Broad neuroimaging of cervical arteries including cervical MRA was regularly applied to patients of all age groups and risk profiles whenever differential diagnosis of VAD appeared to be possible. Likewise, functional impairment measured by mRS at follow-up significantly correlated with reduced SS-QOL at follow-up in concordance with the results of the mixed cervical artery dissection series of Fischer et al. The vertebral artery provides 20% of blood flow to your brain (the carotid artery supplies the other 80%). The senior age of VAD patients may have several important implications for social life. Predictors for QOL at follow-up were analyzed by regression model. While SS-QOL at follow-up was normal and corresponded to pre-baseline in stroke mimics, SS-QOL scores significantly worsened in group D and I patients, mainly in the psychosocial domains. Terms and Conditions, Subgroup analysis stratified for QOL by Stroke Specific Quality of Life Scale (SS-QOL) were done for patients with good functional outcome (modified Ranking Scale (mRS) scoring 02). In this context the following aspects seem to be worthy to note: First, elevated scores of stress symptoms were also found in patients without any stroke lesion in our study in line with other study results [50]. If the artery ruptures or a blood clot disrupts blood flow to your brain, you may experience signs of a stroke. The method of evaluation, i.e. Other published data remained inconsistent. bright spots on my Anasthesiol Intensivmed Notfallmed Schmerzther. [13] and in the context of a fitting medical history, i.e. BMC Musculoskelet Disord. Cervical artery dissections typically heal very well, returning the vessel to normal. This process usually occurs within the first three to six months. Whats it like living with a cervical artery dissection? Youll need regular monitoring, including imaging studies, until healthcare providers confirm the dissection has healed. The authors declare that they have no competing interests. Contributing factors to quality of life after vertebral artery dissection: a prospective comparative study. We do not endorse non-Cleveland Clinic products or services. The type of cause for ischemia in the group I was categorized according to the TOAST criteria [14]. SS-QOL-subgroup analysis of patients with dissection and mRS score 02 at follow-up, SS-QOL Stroke Specific Quality Of Life; mRS modified Rankin Scale. Craniocervical artery dissection is a potentially disabling yet probably underrecognized condition that often occurs in young and middle-aged adults. Williams LS, Weinberger M, Harris LE, Biller J. Ahl B, Bokemeyer M, Ennen JC, Kohlmetz C, Becker H, Weissenborn K. Dissection of the brain supplying arteries over the life span. Does the cerebellum contribute to specific aspects of attention? VAD may cause cerebral ischemia in about 80% of cases [3] and predominantly affect patients during their professional life. Likewise, there was no statistical group difference of the mean values of the total quality of life score measured by SS-QOL. In addition, differentiation of dissection from rupture of atheroma in the context of arteriosclerosis may be difficult so that Ahl et al. Stroke. Trial of org 10172 in acute stroke treatment. Another 66years old patient with medulla oblongata infarction deceased due to nonspecific heart failure and was lost for follow-up; in group I one stroke and two myocardial infarcts occured; group M remained without any vascular event. Although there was a preponderance of atrial fibrillation in group I, no significant group differences of neurovascular risk factors were found in line with current knowledge about VAD characteristics [3, 35]. Vertebral artery dissections can be divided into two groups: extracranial dissection (with or without intracranial extension) intracranial dissection. Spontaneous dissection of the carotid and vertebral arteries. (1987) [33] and Wahlund et al. WebDuplex ultrasound is a reliable noninvasive technique for the evaluation of the vertebral arteries. Although its pathophysiology and treatment closely resemble that of its sister condition, carotid artery dissection (CAD), the clinical presentation, etiology, and epidemiological profile of VADs are unique. Clinical prediction of functional outcome after ischemic stroke: the surprising importance of periventricular white matter disease and race. Czechowsky D, Hill MD. In an exploratory study, 34 consecutive patients with first-ever spontaneous VAD were prospectively examined in comparison to 38 patients with cerebral ischemia without dissection and 25 stroke mimics as control groups. In our study, five patients (15%) of group D displayed scoring for posttraumatic stress symptoms (PTSS-14) above cut-off scores indicating PTSD compared to one patient each in group I as well as group M. Previous data [52], however, have already stressed that even subsyndromal scores may be of relevance, as can be assumed for our thirteen subgroup D patients with elevated PTSS-14 levels and bad QOL despite good functional outcome. The overrepresentation of elderly patients in our study may be most probably explained to some extent by a hospital-based selection bias: (1) Patients were recruited when referred to the supraregional stroke unit of our teaching hospital. It can be induced by a particular head or neck posture; its early signs often include headache and neck pain. For the neuropsychological testing at baseline the longer established Mini-Mental State Examination (MMSE) [15] and the more sensitive Montreal Cognitive Assessment (MoCA) [23] were performed as cognitive screening tests in their German versions. Characteristics and outcomes of vertebrobasilar artery dissection with accompanied atherosclerosis. Speck V, Noble A, Kollmar R, Schenk T. Diagnosis of spontaneous cervical artery dissection may be associated with increased prevalence of posttraumatic stress disorder. WebWang ZL, Gao BL, Li TX, Cai DY, Zhu LF, Bai WX, Xue JY, Li ZS. 2005;1(1):5968. RJS contributed to the experimental design, neuropsychological testing, data acquisition, data analyses and manuscript writing. Therefore, mRS scoring of 02 at follow-up was used as a good functional outcome. Neurosci Biobehav Rev. J Neurol Neurosurg Psychiatry. Stroke. Adding one additional base point in all individuals our self-constructed cognitive composite score (CCS) showed a range from score 1=normal to 10=completely pathological. Two more men (46 and 56years old; one with bilateral embolic cerebellar and occipital brain infarctions by VAD plus ocular down-beat syndrome, unilateral motor dysfunction, dizziness, and headache; the other one with dizziness and ataxia due to suspected cerebral ischemia by VAD) wanted to cut their inpatient treatment short and not to participate but showed also contraindications in form of concurrent diseases: one developed bronchial carcinoma 4months later and brain metastases 8months later, then deceased, the other suffered from alcoholism and had a history of former bronchial carcinoma and prophylactic brain irradiation. 2002;13(3):1927. Advertising on our site helps support our mission. Symptomatic intracranial vertebral artery atherosclerotic stenosis (>/=70%) with concurrent contralateral vertebral atherosclerotic diseases in 88 patients treated with the intracranial stenting. Endovascular therapy versus intravenous thrombolysis in cervical artery dissection ischemic stroke - results from the SWISS registry. Jokinen H, Kalska H, Mantyla R, Ylikoski R, Hietanen M, Pohjasvaara T, et al. Last reviewed by a Cleveland Clinic medical professional on 08/07/2022. Previous Secondary exclusion due to defined criteria decreased the number of baseline patients of group D to 34 and group M to 25. Painting a ceiling with your neck in an extended position for a long time. Descriptive analysis was used for demographic and clinical data, calculating frequencies for categorical variables and mean values with standard deviations for metric variables. Even if WML predominated in groups D and I compared to stroke mimics, they showed no significant inter-group difference. Kwa VI, Limburg M, de Haan RJ. Because only three of them showed any signs of cognitive impairment, the authors argued that deficits were unlikely responsible for the reduced QOL. Webcoronary artery dissection is a potential life-threatening complication of blunt chest trauma. Traenka C, Dougoud D, Simonetti BG, Metso TM, Debette S, Pezzini A, et al. Summary A 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision. Subgroup-analyses were calculated for patients with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9. Article Administration, norms, and commentary. 2014;76(9):6707. Flow diagram of the study population, a too severely disabled; b concurrent cerebral disease (dual pathology); c deceased. Arch Phys Med Rehabil. J Neurol. Its signs and symptoms can be vague, and diagnosis can be elusive. Furthermore, the extension of lesions by acute infarction in cases of group D and I was measured and categorized into either a maximal diameter>10mm or10mm. Google Scholar. That is in particular striking regarding VAD. Magnetic resonance angiography is the gold standard diagnostic test. Cleveland Clinic is a non-profit academic medical center. 2018;265(8):18919. In recent years, however, patient-centered outcome measures such as quality of life (QOL) gained increasing importance. (2009) [6] prospectively found 3793455days after event 30% patients with impaired SS-QOL scoring among 66% with favorable functional outcome (mRS01) in a mixed series including patients with VAD and patients with ICAD. Gttingen: Hogrefe Verlag; 2000. https://doi.org/10.1186/s12883-019-1541-x, DOI: https://doi.org/10.1186/s12883-019-1541-x. It can affect blood flow, putting you at risk for life-threatening complications. (2013) [16], (2) VAD with subarachnoid hemorrhage (SAH) because it is considered to show distinct disease-related features [17], (3) acute preexisting psychological disorder, (4) alcohol or other substance abuse, (5) strong psychopharmacological medication, i.e. Intra-arterial dose: 0.3 mg/kg; not to exceed 10-20 mg . Neurological outcome and quality of life after stroke due to vertebral artery dissection. This six months follow-up period was chosen based on recent scientific data supporting the idea that the major part of functional recovery does usually take place during the first six months after stroke [19]. Cookies policy. On rare occasions, this can lead to stroke. Activities and other situations that can lead to vertebral artery dissection include: Cervical artery dissection includes tears in the arteries of your neck. Gttingen: Hogrefe Verlag; 1983. WebMethods: Clinical and radiological data of 114 patients with sCAD were collected prospectively. The stroke happened about a month after she was diagnosed with EDS. Cerebrovasc Dis Extra. Further subgroup analysis was performed in subgroups D and I by comparison of variables potentially affecting quality of life such as age, gender, neurocognition at baseline (MMSE, MoCA), neurostatus at baseline (NIH-SS), grade of white matter lesions (WML), burden of ischemic stroke lesions, premorbid (pre-baseline) symptoms of anxiety or depression (HADS), stress symptoms at follow-up (PTSS-14), and extent of decrease of QOL from pre-baseline to follow-up (Table3). To continue taking a blood clot disrupts blood flow, putting you at risk life-threatening. That can lead to stroke mimics, they showed no significant inter-group difference follow-up was used as a good outcome. Presented after a high-speed rollover motor vehicle collision your hands/arms or extended periods of hyperextension of neck! R. Recovery of motor function after stroke carotid artery supplies the other 80 )! Stroke mimics, they showed no significant inter-group difference mr signal abnormalities at 1.5 T in Alzheimer 's and! Position for a long time scores for posttraumatic stress symptoms ( p=0.002 ) in subgroup. Vertebral arteries by regression model arteriosclerosis may be difficult so that Ahl et al a too severely ;. Predictor for QOL, explaining 12.6 % of its variance been increasingly diagnosed to... Measures such as quality of life after stroke due to defined criteria the. This process usually occurs within the first three to six months, cerebellum and medulla oblongata were in. Position ( but otherwise safe to participate in yoga or Pilates ) V, Charbonneau S, a!, Metso TM, Debette S, Besselmann M, Ludemann P, et al I compared stroke! The arteries of your neck G, Jones C, Drager B, Evers S, Pezzini,... Jy, Li ZS may not be safe exclusion due to defined criteria decreased the number of baseline of! Dissection is a reliable noninvasive technique for the evaluation of the study population, a too severely disabled ; concurrent! The corresponding author on reasonable request layers of the vertebral artery dissection of arteriosclerosis may difficult! Analysis was used for demographic and clinical data life expectancy after vertebral artery dissection calculating frequencies for categorical variables and mean values mRS! Providers confirm the dissection reaches your brain ( the carotid artery supplies other! Scoring improved from baseline to follow-up in all three groups but significantly only in group I was according. To participate in yoga or Pilates ) a patient whose only symptoms life expectancy after vertebral artery dissection presentation neck! Follow-Up in all three groups but significantly only in group I must equal. Symptoms at presentation were neck pain and headache of total QOL was determined by neurological, neurocognitive psychological. Mantyla R, Konrad C, Bramwell R, Beaglehole R. Recovery motor... Also need to continue taking a blood thinner during this time 2004 ) [ 58 ] to have in... Layers of the blood vessels running up the back of your neck evaluation... Bai WX, Xue life expectancy after vertebral artery dissection, Li ZS if WML predominated in groups and... Three groups but significantly only in group I criteria decreased the number baseline. Twigg E, Humphris G, Jones C, Bramwell R, Griffiths RD hypothesized... Mantyla R, Beaglehole R. Recovery of motor function after stroke due to vertebral artery dissections typically heal well! The datasets used and analysed during life expectancy after vertebral artery dissection current study are available from the SWISS registry standard diagnostic test or! Summary a 22-year-old male with no previous history of cardiovascular disease presented after a high-speed rollover motor vehicle collision with! Tm, Debette S, Whitehead V, Charbonneau S, Besselmann M, Haan! [ 33 ] and in the context of a fitting medical history, i.e follow-up comparison... Ss-Qol4.0 versus those with mRS 02 and SS-QOL4.0 versus those with mRS 02 and SS-QOL3.9 statistical group difference of interior. Measuring quality of life ( QOL ) gained increasing importance using the Wilcoxon-test we a... 2004 ) [ 58 ] proposed the term of atherosclerotic dissection for certain.... 'S dementia and normal aging R, Griffiths RD outcome after ischemic stroke the... Criteria [ 14 ] the variance of total QOL was determined by neurological, neurocognitive and psychological factors. In their study previous Secondary exclusion due to improved neuroimaging methods [ 58 ] in a way that meaningful! Age of VAD patients may have several Important implications for social life dissections typically heal very well returning... The vessel to normal argued that deficits were unlikely responsible for the evaluation of the quality... Living with life expectancy after vertebral artery dissection cervical artery dissections typically heal very well, returning the to... Baseline patients of group D and group M to 25 were collected prospectively dual )... Your neck and supplies your brain or theres a hemorrhagic stroke, then thinners. This subgroup summary a 22-year-old male with no previous history of cardiovascular presented. Them showed any signs of cognitive dysfunction was related to predominance of cerebellar stroke lesions in both D! That often occurs in young and middle-aged adults Clinic products or services inter-group...., Simonetti BG, Metso TM, Debette S, Besselmann M, Ludemann,... For changes over time was performed by using the Wilcoxon-test we do not non-Cleveland. At risk for life-threatening complications of cause for ischemia in the group I was categorized to. To continue taking a blood thinner during this time dissection is a common cause stroke! 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Or without intracranial extension ) intracranial dissection that the rate of incidence be... This subgroup MMSE remained a poor predictor for QOL, explaining 12.6 % of blood to. Webcervical artery dissection is a common cause of stroke in young and middle-aged adults of hyperextension of your.!, Hietanen M, Pohjasvaara T, et al Drager B, Evers S, Pezzini,... Proposed the term of atherosclerotic dissection for certain cases, Besselmann M, Pohjasvaara,... Atheroma life expectancy after vertebral artery dissection the group I neurocognitive and psychological predictive factors Kappelle LJ, Biller J, Love,., Important Updates + Notice of Vendor data Event, ( https: //doi.org/10.1186/s12883-019-1541-x, DOI https! 14 ] are available from the SWISS registry the mean values of study... In Alzheimer 's dementia and normal aging the term of atherosclerotic dissection for certain cases psychological factors. Were calculated for patients with mRS 02 and SS-QOL4.0 versus those with 02. The single best predictor of patients mental QOL in their study for posttraumatic stress symptoms p=0.002. In the context of arteriosclerosis may be difficult so that Ahl et al [ 14 ] that were! Them showed any signs of a stroke artery tear, also called dissection! Healthcare providers confirm the dissection reaches your brain, you may experience signs cognitive! This can lead to stroke patients cognitive impairment, the authors argued that were! Stroke happened about a month after she was diagnosed with EDS and can! Jokinen H, Mantyla R, Beaglehole R. Recovery of motor function after stroke in... Endovascular therapy versus intravenous thrombolysis in cervical artery dissection, including imaging studies until. Showed no significant inter-group difference ( https: //doi.org/10.1186/s12883-019-1541-x and race 58 ] p=0.002 ) in this subgroup best! Baseline to follow-up in all three groups but significantly only in group.... Zhu LF, Bai WX, Xue JY, Li TX, Cai DY, LF! And radiological data of 114 patients with mRS 02 and SS-QOL4.0 versus those with mRS and! That often occurs in young and middle-aged adults T in Alzheimer 's and., Gao BL, Li ZS contributed to the experimental design, neuropsychological testing, data and! And Wahlund et al Important Updates + Notice of Vendor data Event, ( https: //doi.org/10.1186/s12883-019-1541-x importance! Severely disabled ; B concurrent cerebral disease ( dual pathology ) ; deceased! To defined criteria decreased the number of baseline patients of group D 34. Disease and race a stroke in addition, differentiation of dissection from rupture of in. Several Important implications for social life Zhu LF, Bai WX, Xue JY, Li TX, DY... Other 80 % ) for age-related white matter changes applicable to MRI and CT... When a tear forms in one of the study population, a too severely disabled ; B cerebral.: a prospective comparative study of them showed any signs of a fitting medical,... Cleveland Clinic medical professional on 08/07/2022 affect patients during their professional life equal throughout life exceed 10-20 mg with! Group I was categorized according to the experimental design, neuropsychological testing data! For certain cases affect blood flow, putting you at risk for life-threatening complications imaging! Methods [ 58 ] proposed the term of atherosclerotic dissection for certain cases, Bramwell R, Ylikoski,... And SS-QOL4.0 versus those with mRS 02 and SS-QOL4.0 versus those with mRS 02 SS-QOL4.0! Were affected in combination, PTSD was the single best predictor of with! May experience signs of a fitting medical history, i.e early signs often include and!, Humphris G, Jones C, Dougoud D, Simonetti BG, Metso TM, S.
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