Rafael Bonfante-Cabarcas *

Autor invitado por SIIC

El trabajo contribuye al diagnóstico temprano de la Miocardiopatía Chagásica Aguda, realizado en el contexto de un brote epidémico de enfermedad de Chagas debido a transmisión oral, realizado por instituciones prestigiosas y expertas en el tema

LOS TRASTORNOS DE LA REPOLARIZACIÓN VENTRICULAR SON SIGNOS CARACTERÍSTICOS DE LA MIOCARDIOPATÍA CHAGÁSICA AGUDA

Los trastornos de repolarización en un adecuado y bien documentado contexto epidemiológico y clínico son signos que aumentan la sensibilidad para el diagnostico de Miocardiopatía Chagásica Aguda.

*Rafael Bonfante-Cabarcas
describe para SIIC los aspectos relevantes de su trabajo
ELECTROCARDIOGRAPHY REPOLARIZATION ABNORMALITIES ARE CHARACTERISTIC SIGNS OF ACUTE CHAGASIC CARDIOMYOPATHY
Institución principal de la investigación
*Universidad Centro-occidental "lisandro Alvarado", Barquisimeto, Venezuela
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Otros artículos escogidos

Referencias bibliográficas
1. Armaganijan L, Morillo CA. Chagas disease: 101 years of solitude! Time for action. Stroke 2010; 41: 2453-2454.
2. WHO. Chagas disease (American trypanosomiasis) fact sheet (revised in June 2010). Wkly Epidemiol Rec 2010; 85:334-36.
3. WHO. Chagas disease: control and elimination. Report of the Secretariat. EXECUTIVE BOARD 124th Session 27 November 2008 Document EB124/17. http://apps.who .int/gb/ebwha/pdf_files/EB124/B124_17-en.pdf (accessed on 21/May/2011).
4. OPS. Estimación cuantitativa de la enfermedad de Chagas en las Américas. Montevideo, Uruguay: Organización Panamericana de la Salud; 2006. OP5/HDM/CD/425-0G. http://www.bvsops.org.uy/pdf/chagas19.pdf (accessed on 21/May/2011).
5. Rojas ME, Várquez P, Villarreal MF, Velandia C, Vergara L, Morán-Borges YH, Ontiveros J, Yelitza Calderón M, Chiurillo-Siervo MA, Rodríguez-Bonfante C del C, Aldana E, Concepción JL, Bonfante-Cabarcas RA. An entomological and seroepidemiological study of Chagas' disease in an area in central-western Venezuela infested with Triatoma maculata (Erichson 1848). Cad Saude Publica 2008, 24:2323-2333.
6. Bonfante-Cabarcas R, Rodríguez-Bonfante C, Vielma BO, García D, Saldivia AM, Aldana E, Curvelo JL. Seroprevalence for Trypanosoma cruzi infection and associated factors in an endemic area of Venezuela. Cad Saude Publica 2011; 27:1917-1929.
7. Bastos CJ, Aras R, Mota G, Reis F, Dias JP, de Jesus RS, Freire MS, de Araújo EG, Prazeres J, Grassi MF. Clinical outcomes of thirteen patients with acute chagas disease acquired through oral transmission from two urban outbreaks in northeastern Brazil. PLoS Negl Trop Dis 2010; 4(6):e711.
8. Toso M A, Vial UF, Galanti N. Oral transmission of Chagas' disease. Rev Med Chil 2011; 139:258-266
9. Alarcón de Noya B, Martínez J. Transmisión oral de la enfermedad de Chagas en Venezuela: un segundo brote escolar. Salus on line 2009; 13: 9-10.
10. Alarcón de Noya B, Díaz-Bello Z, Colmenares C, Ruiz-Guevara R, Mauriello L, Zavala-Jaspe R, Suarez JA, Abate T, Naranjo L, Paiva M, Rivas L, Castro J, Márques J, Mendoza I, Acquatella H, Torres J, Noya O. Large urban outbreak of orally acquired acute Chagas disease at a school in Caracas, Venezuela. J Infect Dis 2010; 201:1308-1315.
11. Pinto AY, Valente SA, Valente Vda C, Ferreira Junior AG, Coura JR. Acute phase of Chagas disease in the Brazilian Amazon region: study of 233 cases from Pará, Amapá and Maranhão observed between 1988 and 2005. Rev Soc Bras Med Trop 2008; 41:602-614.
12. Laranja FS, Dias E, Nobrega G, Miranda A. Chagas' disease; a clinical, epidemiologic, and pathologic study. Circulation 1956; 14:1035-1060.
13. Pinto-Dias JC. Revisão geral e evolução imediata de casos agudos de doença de Chagas estudados no Posto Avançado Emmanuel Dias (Bambuí, MG, Brasil) entre 1940 e 1969. Rev Med Minas Gerais 2009; 19: 325-335.
14. Regueiro A, García-Álvarez A, Sitges M, Ortiz-Pérez JT, De Caralt MT, Pinazo MJ, Posada E, Heras M, Gascón J, Sanz G. Myocardial involvement in Chagas disease: Insights from cardiac magnetic resonance. Int J Cardiol. 2011, In press.
15. Rossi MA, Tanowitz HB, Malvestio LM, Celes MR, Campos EC, Blefari V, Prado CM. Coronary microvascular disease in chronic Chagas cardiomyopathy including an overview on history, pathology, and other proposed pathogenic mechanisms. PLoS Negl Trop Dis 2010, 4(8): e674.
16. Carvalho CM, Andrade MC, Xavier SS, Mangia RH, Britto CC, Jansen AM, Fernandes O, Lannes-Vieira J, Bonecini-Almeida MG. Chronic Chagas' disease in rhesus monkeys (Macaca mulatta): evaluation of parasitemia, serology, electrocardiography, echocardiography, and radiology. Am J Trop Med Hyg 2003; 6:683-691.
17. Schachterle GR, Pollack RL.A simplified method for the quantitative assay of small amounts of protein in biologic material. Anal. Biochem 1973; 351:654–655.
18. Laemmli UK. Cleavage of structural proteins during the assembly of the head of bacteriophage T4. Nature 1970; 227:680–685.
19. Sambrook J, Fritsch EF, Maniatis T. Molecular Cloning: A Laboratory Manual, second ed. Cold Spring Harbor Laboratory Press, Cold Spring Harbor, New York. 1989.
20. Miles MA. Culturing and biological cloning of Trypanosoma cruzi. Methods Mol Biol 1993; 21:15-28
21. Carrasco HJ, Frame IA, Valente SA, Miles MA. Genetic exchange as a possible source of genomic diversity in sylvatic populations of Trypanosoma cruzi. Am J Trop Med Hyg 1996; 54: 418-424.
22. Das Neves Pinto AY, Gomes Ferreira Jr A, Da Costa Valente V, Saburo Harada G, Da Silva Valente SA. Urban outbreak of acute Chagas disease in Amazon region of Brazil: four-year follow-up after treatment with benznidazole. Rev Panam Salud Publica 2009; 25: 77–83.
23. Barbosa-Ferreira JM, Guerra JA, Santana Filho FS, Magalhães BM, Coelho LI, Barbosa MG. Cardiac involvement in Acute Chagas' Disease cases in the Amazon region. Arq Bras Cardiol 2010; 94:147-149.
24. Mendoza I, Marques J. Una nueva epidemia de arritmias. La enfermedad de Chagas aguda por transmisión oral. Avances Cardiol 2008; 28: 70-72
25. Ochoa O, Anselmi G, Machado I, Febres C, Villalobos L, Gontran E, Gomez JR. Acute Chagas myocarditis in children. Diagnosis and current treatment. Acta Pediatr Mex 1995; 16: 187-196
26. Parada H, Carrasco HA, Añez N, Fuenmayor C, Inglessis I. Cardiac involvement is a constant finding in acute Chagas´ disease: a clinical, parasitological and histopathological study. Int J Cardiol 1997, 60:49-54
27. De micheli A, Medrano GA: En torno al concepto electrofisiopatológico y las manifestaciones electrocardiográficas de isquemia, lesión y necrosis. Arch Inst Cardiol Mex 2009; 79:2-4.
28. Huszar RJ. Arritmias. 3ª edición, Ediciones Harcourt, S.A, Madrid, España, Capitulo 3 (p: 34-69), Capítulo 15 (p: 315-340), 2002.
29. Handjani AM. Significance of positive, tall and peaked electrocardiographic T waves in early diagnosis of ischemic heart disease. Chest 1972; 62:24-28.
30. Cowan JC, Hilton CJ, Griffiths CJ, Tansuphaswadikul S, Bourke JP, Murray A, Campbell RW. Sequence of epicardial repolarization and configuration of the T wave. Br Heart J 1988; 60:424-433.
31. Yan GX, Antzelevitch C. Cellular basis for the normal T wave and the electrocardiographic manifestations of the long-QT syndrome. Circulation 1998; 98:1928-1936.
32. Higuchi T, Nakaya Y. T wave polarity related to the repolarization process of epicardial and endocardial ventricular surfaces. Am Heart J 1984; 108:290-295.
33. Suarez J, de Suarez C, Alarcón de Noya B, Espinosa R, Chiurillo MA, Villaroel A, De Martin F, Paiva M, Díaz-Bello Z, Valderrama E, Estrada D, Vivas E. Enfermedad de Chagas sistémico en fase aguda por transmision oral: diagnostic integral de un caso autopsiado. Gac Med Caracas 2010; 118: 212-222
34. Sicouri S, Civetta M, Chiale P, Elizari M. El papel de la heterogeneidad electrica celular del miocardio ventricular en la génesis de las arritmias cardiácas. Rev Argent Cardiol 2003; 71: 372-379.
35. Simon MA. Right ventricular adaptation to pressure overload. Curr Opin Crit Care 2010; 16:237-43.
36. Salles GF, Cardoso CR, Xavier SS, Sousa AS, Hasslocher-Moreno A. Electrocardiographic ventricular repolarization parameters in chronic Chagas' disease as predictors of asymptomatic left ventricular systolic dysfunction. Pacing Clin Electrophysiol 2003; 26:1326-1335.
37. Salles G, Xavier S, Sousa A, Hasslocher-Moreno A, Cardoso C. Prognostic value of QT interval parameters for mortality risk stratification in Chagas' disease: results of a long-term follow-up study. Circulation 2003, 108:305-312
38. Ribeiro AL, Rocha MO, Terranova P, Cesarano M, Nunes MD, Lombardi F. T-wave amplitude variability and the risk of death in chagas disease. J Cardiovasc Electrophysiol 2011; 22:799-805
39. Medei E, Pedrosa RC, Benchimol Barbosa PR, Costa PC, Hernández CC, Chaves EA, Linhares V, Masuda MO, Nascimento JH, Campos de Carvalho AC. Human antibodies with muscarinic activity modulate ventricular repolarization: basis for electrical disturbance. Int J Cardiol 2007; 115:373-380.
1. Armaganijan L, Morillo CA. Chagas disease: 101 years of solitude! Time for action. Stroke 2010; 41: 2453-2454.
2. WHO. Chagas disease (American trypanosomiasis) fact sheet (revised in June 2010). Wkly Epidemiol Rec 2010; 85:334-36.
3. WHO. Chagas disease: control and elimination. Report of the Secretariat. EXECUTIVE BOARD 124th Session 27 November 2008 Document EB124/17. http://apps.who .int/gb/ebwha/pdf_files/EB124/B124_17-en.pdf (accessed on 21/May/2011).
4. OPS. Estimación cuantitativa de la enfermedad de Chagas en las Américas. Montevideo, Uruguay: Organización Panamericana de la Salud; 2006. OP5/HDM/CD/425-0G. http://www.bvsops.org.uy/pdf/chagas19.pdf (accessed on 21/May/2011).
5. Rojas ME, Várquez P, Villarreal MF, Velandia C, Vergara L, Morán-Borges YH, Ontiveros J, Yelitza Calderón M, Chiurillo-Siervo MA, Rodríguez-Bonfante C del C, Aldana E, Concepción JL, Bonfante-Cabarcas RA. An entomological and seroepidemiological study of Chagas' disease in an area in central-western Venezuela infested with Triatoma maculata (Erichson 1848). Cad Saude Publica 2008, 24:2323-2333.
6. Bonfante-Cabarcas R, Rodríguez-Bonfante C, Vielma BO, García D, Saldivia AM, Aldana E, Curvelo JL. Seroprevalence for Trypanosoma cruzi infection and associated factors in an endemic area of Venezuela. Cad Saude Publica 2011; 27:1917-1929.
7. Bastos CJ, Aras R, Mota G, Reis F, Dias JP, de Jesus RS, Freire MS, de Araújo EG, Prazeres J, Grassi MF. Clinical outcomes of thirteen patients with acute chagas disease acquired through oral transmission from two urban outbreaks in northeastern Brazil. PLoS Negl Trop Dis 2010; 4(6):e711.
8. Toso M A, Vial UF, Galanti N. Oral transmission of Chagas' disease. Rev Med Chil 2011; 139:258-266
9. Alarcón de Noya B, Martínez J. Transmisión oral de la enfermedad de Chagas en Venezuela: un segundo brote escolar. Salus on line 2009; 13: 9-10.
10. Alarcón de Noya B, Díaz-Bello Z, Colmenares C, Ruiz-Guevara R, Mauriello L, Zavala-Jaspe R, Suarez JA, Abate T, Naranjo L, Paiva M, Rivas L, Castro J, Márques J, Mendoza I, Acquatella H, Torres J, Noya O. Large urban outbreak of orally acquired acute Chagas disease at a school in Caracas, Venezuela. J Infect Dis 2010; 201:1308-1315.
11. Pinto AY, Valente SA, Valente Vda C, Ferreira Junior AG, Coura JR. Acute phase of Chagas disease in the Brazilian Amazon region: study of 233 cases from Pará, Amapá and Maranhão observed between 1988 and 2005. Rev Soc Bras Med Trop 2008; 41:602-614.
12. Laranja FS, Dias E, Nobrega G, Miranda A. Chagas' disease; a clinical, epidemiologic, and pathologic study. Circulation 1956; 14:1035-1060.
13. Pinto-Dias JC. Revisão geral e evolução imediata de casos agudos de doença de Chagas estudados no Posto Avançado Emmanuel Dias (Bambuí, MG, Brasil) entre 1940 e 1969. Rev Med Minas Gerais 2009; 19: 325-335.
14. Regueiro A, García-Álvarez A, Sitges M, Ortiz-Pérez JT, De Caralt MT, Pinazo MJ, Posada E, Heras M, Gascón J, Sanz G. Myocardial involvement in Chagas disease: Insights from cardiac magnetic resonance. Int J Cardiol. 2011, In press.
15. Rossi MA, Tanowitz HB, Malvestio LM, Celes MR, Campos EC, Blefari V, Prado CM. Coronary microvascular disease in chronic Chagas cardiomyopathy including an overview on history, pathology, and other proposed pathogenic mechanisms. PLoS Negl Trop Dis 2010, 4(8): e674.
16. Carvalho CM, Andrade MC, Xavier SS, Mangia RH, Britto CC, Jansen AM, Fernandes O, Lannes-Vieira J, Bonecini-Almeida MG. Chronic Chagas' disease in rhesus monkeys (Macaca mulatta): evaluation of parasitemia, serology, electrocardiography, echocardiography, and radiology. Am J Trop Med Hyg 2003; 6:683-691.
17. Schachterle GR, Pollack RL.A simplified method for the quantitative assay of small amounts of protein in biologic material. Anal. Biochem 1973; 351:654–655.
18. Laemmli UK. Cleavage of structural proteins during the assembly of the head of bacteriophage T4. Nature 1970; 227:680–685.
19. Sambrook J, Fritsch EF, Maniatis T. Molecular Cloning: A Laboratory Manual, second ed. Cold Spring Harbor Laboratory Press, Cold Spring Harbor, New York. 1989.
20. Miles MA. Culturing and biological cloning of Trypanosoma cruzi. Methods Mol Biol 1993; 21:15-28
21. Carrasco HJ, Frame IA, Valente SA, Miles MA. Genetic exchange as a possible source of genomic diversity in sylvatic populations of Trypanosoma cruzi. Am J Trop Med Hyg 1996; 54: 418-424.
22. Das Neves Pinto AY, Gomes Ferreira Jr A, Da Costa Valente V, Saburo Harada G, Da Silva Valente SA. Urban outbreak of acute Chagas disease in Amazon region of Brazil: four-year follow-up after treatment with benznidazole. Rev Panam Salud Publica 2009; 25: 77–83.
23. Barbosa-Ferreira JM, Guerra JA, Santana Filho FS, Magalhães BM, Coelho LI, Barbosa MG. Cardiac involvement in Acute Chagas' Disease cases in the Amazon region. Arq Bras Cardiol 2010; 94:147-149.
24. Mendoza I, Marques J. Una nueva epidemia de arritmias. La enfermedad de Chagas aguda por transmisión oral. Avances Cardiol 2008; 28: 70-72
25. Ochoa O, Anselmi G, Machado I, Febres C, Villalobos L, Gontran E, Gomez JR. Acute Chagas myocarditis in children. Diagnosis and current treatment. Acta Pediatr Mex 1995; 16: 187-196
26. Parada H, Carrasco HA, Añez N, Fuenmayor C, Inglessis I. Cardiac involvement is a constant finding in acute Chagas´ disease: a clinical, parasitological and histopathological study. Int J Cardiol 1997, 60:49-54
27. De micheli A, Medrano GA: En torno al concepto electrofisiopatológico y las manifestaciones electrocardiográficas de isquemia, lesión y necrosis. Arch Inst Cardiol Mex 2009; 79:2-4.
28. Huszar RJ. Arritmias. 3ª edición, Ediciones Harcourt, S.A, Madrid, España, Capitulo 3 (p: 34-69), Capítulo 15 (p: 315-340), 2002.
29. Handjani AM. Significance of positive, tall and peaked electrocardiographic T waves in early diagnosis of ischemic heart disease. Chest 1972; 62:24-28.
30. Cowan JC, Hilton CJ, Griffiths CJ, Tansuphaswadikul S, Bourke JP, Murray A, Campbell RW. Sequence of epicardial repolarization and configuration of the T wave. Br Heart J 1988; 60:424-433.
31. Yan GX, Antzelevitch C. Cellular basis for the normal T wave and the electrocardiographic manifestations of the long-QT syndrome. Circulation 1998; 98:1928-1936.
32. Higuchi T, Nakaya Y. T wave polarity related to the repolarization process of epicardial and endocardial ventricular surfaces. Am Heart J 1984; 108:290-295.
33. Suarez J, de Suarez C, Alarcón de Noya B, Espinosa R, Chiurillo MA, Villaroel A, De Martin F, Paiva M, Díaz-Bello Z, Valderrama E, Estrada D, Vivas E. Enfermedad de Chagas sistémico en fase aguda por transmision oral: diagnostic integral de un caso autopsiado. Gac Med Caracas 2010; 118: 212-222
34. Sicouri S, Civetta M, Chiale P, Elizari M. El papel de la heterogeneidad electrica celular del miocardio ventricular en la génesis de las arritmias cardiácas. Rev Argent Cardiol 2003; 71: 372-379.
35. Simon MA. Right ventricular adaptation to pressure overload. Curr Opin Crit Care 2010; 16:237-43.
36. Salles GF, Cardoso CR, Xavier SS, Sousa AS, Hasslocher-Moreno A. Electrocardiographic ventricular repolarization parameters in chronic Chagas' disease as predictors of asymptomatic left ventricular systolic dysfunction. Pacing Clin Electrophysiol 2003; 26:1326-1335.
37. Salles G, Xavier S, Sousa A, Hasslocher-Moreno A, Cardoso C. Prognostic value of QT interval parameters for mortality risk stratification in Chagas' disease: results of a long-term follow-up study. Circulation 2003, 108:305-312
38. Ribeiro AL, Rocha MO, Terranova P, Cesarano M, Nunes MD, Lombardi F. T-wave amplitude variability and the risk of death in chagas disease. J Cardiovasc Electrophysiol 2011; 22:799-805
39. Medei E, Pedrosa RC, Benchimol Barbosa PR, Costa PC, Hernández CC, Chaves EA, Linhares V, Masuda MO, Nascimento JH, Campos de Carvalho AC. Human antibodies with muscarinic activity modulate ventricular repolarization: basis for electrical disturbance. Int J Cardiol 2007; 115:373-380.

Otros artículos de Rafael Bonfante-Cabarcas

1) Segovia M, Carrasco HJ, Martínez CE, Messenger LA, Nessi A, Londoño JC, Espinosa R, Martínez C, Alfredo M, Bonfante-Cabarcas R, Lewis MD, de Noya BA, Miles MA, Llewellyn MS. Molecular epidemiologic source tracking of orally transmitted Chagas disease, Venezuela. Emerg Infect Dis. 2013 Jul;19(7):1098-101.
2) Bravo Tobar I, Parra F, Nello Pérez C, Rodríguez-Bonfante C, Useche F, Bonfante-Cabarcas R. Prevalence of Trypanosoma cruzi antibodies and inflammatory markers in uncompensated heart failure. Rev Soc Bras Med Trop. 2011
3) Bonfante-Cabarcas R, Rodríguez-Bonfante C, Vielma BO, García D, Saldivia AM, Aldana E, Curvelo JL. [Seroprevalence for Trypanosoma cruzi infection and associated factors in an endemic area of Venezuela]. Cad Saude Publica. 2011 Oct;27(10):1917-29.
4) Alvarado-Tapias E, Rivas-Coppola M, Alvarado A, Bello M, Briceño M, Rodríguez-Bonfante C, Bonfante-Cabarcas R. [Adenosine induces ventricular arrythmias in hearts with chronic chagas cardiomyopathy]. Rev Esp Cardiol. 2010 Apr;63(4):478-82.
5) Pascuzzo-Lima C, Mendible JC, Bonfante-Cabarcas RA. Angiotensin-converting enzyme insertion/deletion gene polymorphism and progression of Chagas' cardiomyopathy. Rev Esp Cardiol. 2009 Mar;62(3):320-2.
6) Rojas ME, Várquez P, Villarreal MF, Velandia C, Vergara L, Morán-Borges YH, Ontiveros J, Yelitza Calderón M, Chiurillo-Siervo MA, Rodríguez-Bonfante Cdel C, Aldana E, Concepción JL, Bonfante-Cabarcas RA. [An entomological and seroepidemiological study of Chagas' disease in an area in central-western Venezuela infested with Triatoma maculata (Erichson 1848)]. Cad Saude Publica. 2008 Oct;24(10):2323-33.
7) Labrador-Hernández M, Suárez-Graterol O, Romero-Contreras U, Rumenoff L, Rodríguez-Bonfante C, Bonfante-Cabarcas R. The cholinergic system in cyclophosphamide-induced Chagas dilated myocardiopathy in Trypanosoma-cruzi-infected rats: an electrocardiographic study. Invest Clin. 2008 Jun;49(2):207-24.
8) Rodríguez-Bonfante C, Amaro A, García M, Mejías Wohlert LE, Guillen P, Antonio García R, Alvarez N, Díaz M, Cárdenas E, Castillo S, Bonfante-Garrido R, Bonfante-Cabarcas R. [Epidemiology of Chagas disease in Andrés Eloy Blanco, Lara, Venezuela: triatomine infestation and human seroprevalence]. Cad Saude Publica. 2007 May;23(5):1133-40.
9) López L, Arai K, Giménez E, Jiménez M, Pascuzo C, Rodríguez-Bonfante C, Bonfante-Cabarcas R. [C-reactive protein and interleukin-6 serum levels increase as Chagas disease progresses towards cardiac failure]. Rev Esp Cardiol. 2006 Jan;59(1):50-6.
10) D'Angelo-Mendoza E, Rodríguez-Bonfante C, Camacho I, Martínez J, Perdomo T, Cabrera A, Bonfante-Cabarcas R. [Patients suffering dilated chagasic cardiopathy or non chagasic cardiopathy show an increased levels of tumor necrosis factor alpha]. Invest Clin. 2005 Sep;46(3):229-40.

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LOS TRASTORNOS DE LA REPOLARIZACIÓN VENTRICULAR SON SIGNOS CARACTERÍSTICOS DE LA MIOCARDIOPATÍA CHAGÁSICA AGUDA

Título original en castellano
LOS TRASTORNOS DE LA REPOLARIZACION VENTRICULAR SON SIGNOS CARACTERISTICOS DE LA CARDIOMIOPATIA CHAGASICA AGUDA

Autor
Rafael Bonfante-Cabarcas¹
1 Médico, Profesor Titular de Me, Universidad Centro-occidental "lisandro Alvarado", Barquisimeto, Venezuela, Profesor Titular

Acceso a la fuente original
Investigación Clínica
https://sites.google.com/site/revistainvestigacion

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